A 19 year old black male was selected from a larger group for monitoring active destructive disease. Clinical measurements were taken, crevicular fluid obtained for volume measurement ( periotron ) and immunologic assay, a blood sample for immunologic monitoring and subgingival plaque samples taken. The immunologic analysis was don with ELISA as described by Ebersole 1980. The sera were screened against A.a., Actinomyces species, Bacteroides species, Campylobacter, Capnocytophaga sp., Eikenella corrodens, Haemophilus aphrophilus, Selenomonas, Streptococcus sp. and Wolinella recta. The crevicular fluid was examined in ELISA for reactivity against A. a. Microbiological analysis contained darkfield microscopy, culturing and ELISA for black-pigmented Bacteroides and asaccharolytic rods.
The TREATMENT rendered consisted of modified Widman flap surgery, tetracycline 250 mg q.i.d. 3 weeks.
The results of the 5 monitored sites showed that the 2 control sites showed no attachment changes as a result to treatment. The sites which exhibited significant attachment loss 4 month prior to therapy gained attachment 2-8 mm as a result of therapy. The improvement was maintained over 17 months to the end of the observation. The pocket depth changes were similar. Bleeding on probing was significantly reduced after therapy in all sites. Bone fill after therapy was seen on one tooth , but further bone loss occurred.
The humoral antibody response to B. intermedius and E. corrodens as well as the majority of the other isolates did not change. The antibody response to A.a. increased significantly during the first 100 days of the observation and remained at that level before treatment. It decreased significantly after treatment and remained low to the end of the treatment. There was an increase between the humoral antibody response to A.a. and C. sputigena and the number of sites showing a significant increase in attachment.
The local antibody response to A. a. revealed an elevated titer of IgG to A.a. in five of the six active sites as compared to serum level. After surgery and q› tetracycline the local titer returned to serum level and remained there for the rest of the observation period.
Only the non-motile rods differed significantly between control and active sites prior to treatment.
After treatment the microbiota shifted from moderate proportion of spirochetes to increased number of small motile rods at 5 months after treatment. The proportions of A.a. and S. sputigena were significantly elevated in active sites, whereas the proportions of Bacteroides intermedius were elevated in the control sites prior to therapy. At 5 months after treatment the proportions of gram-negative rods were significantly. decreased in the active sites; A.a., S. sputigena and E. corrodens decreased in the control sites. Before treatment there was great variability at the individual sites. Attachment level changes was predicted by the "loss-related" organisms S. sputigena and A.a. together with the "gain-related" organisms C. concisus and S. sanguis.
The author concludes that an increase in local antibodies against A.a. was seen 2 months before attachment loss. The sites contained 74% A.a.. A.a. is located at the most apical portion of the lesion. Shallow lesions provide plaque samples with higher proportions of A.a. than deeper ones. The elimination of A.a by surgery is desired.
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