16 patients with juvenile periodontitis and 12 patients with adult periodontitis were treated and clinically and microbiologically monitored over 2 years. The active treatment consisted of administration of 250 mg tetracycline q.i.d. and modified Widman flap surgery, a recall every 4 weeks in the first 3 post operative months and a further recall 6, 12, 18 and 24 months after surgery. Biopsies were taken during surgery and at 18 months. A reentry operation 18 months after surgery was done in two radiologically healed sites from JP patients and in three from AP patients.
All gingival units of the diseased sites bled on gentle probing. The INITIAL average probing depth was in the JP group 8.1 +/- 1.4 mm and in the AP group 6.4 +/- 1.7 mm. The attachment loss averaged 6.9 +/- 1.2 mm in the JP and 5.8 +/-1.9 mm in the AP group. The overall average depth of bony defect was 6.1 +/- 0.7 mm in the JP and 5.2 +/- 0.4 mm in the AP group.
AFTER treatment in both groups the frequency of bleeding sites decreased from 100% to 3-13 % on the various examinations. The pocket depth was reduced in both groups to 3-4.6 mm. The attachment gained was for the JP patients in the molar sites 4.7-5.1 mm and in incisors 2-2.6 mm. The was no difference in the attachment gain in two and three wall defects. At the termination of the observation the marginal bone crest in the JP patients was 0.3-0.6 mm apical than at the beginning of the study. The bony refill was assessed to range between 3.1-5.2 mm.
At INITIAL examination the JP patients harbored up to 70% coccoid cells and straight rods in the subgingival plaque and 20% filaments and fusiforms. The corresponding figures for the AP group were 25% cocci and straight rods, 13% filaments and fusiforms and 62% motile rods and spirochetes. JP patients showed minor changes of the composition of the plaque AFTER treatment. In the AP group however, marked alterations occurred. Cocci and straight rods made up 66-72%, whereas spirochetes and motile rods were absent.
The BIOPSIES revealed in both groups plasma cell infiltrates with plasma cells and blast cells making up ca. 70% ( JP ) and 35% ( AP ) of the volume of the lesion. The 18 month biopsies from healed and healthy sites contained small but definite areas of inflammatory cell infiltrate. Four JP patients had to be retreated due to recurrence of inflammation, increasing probing depth and bone loss.
The author concludes that attachment gain and bone fill occurs faster in young individuals than in older.
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