Although patients with refractory periodontitis have been widely reported, no clear biologic profile of these patients has been noted. The purpose of the present study was to evaluate host responsiveness of a well-defined group of refractory periodontitis patients by determining the effect of a lipopolysaccharide (LPS) challenge on monocyte surface receptor density and on the release of inflammatory mediators. Venous blood was obtained from 7 refractory periodontitis, 8 stable periodontal maintenance, and 8 gingivitis patients with no evidence of periodontitis. Mononuclear cells were cultured in either control media or media treated with Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), or Salmonella typhimurium (S. typh) LPS. At 0 and 24 hours supernatants were assayed for prostaglandin-E2 (PGE2) and interleukin-1 beta (Il-1 beta) release by ELISA. Using flow cytometry the density of specific monocyte surface receptors were assayed with Mo3e and LeuM3 monoclonal antibodies (mAb); T-cell CD4/CD8 ratios were assayed with OKT-3, OKT-4, and OKT-8 mAb. After 24 hours incubation with Pg or S. typh LPS, the upregulation of the Mo3e receptor was significantly decreased for refractory periodontitis patients (P < 0.05) when compared to gingivitis and to stable maintenance patients. In refractory periodontitis patients the T-cell CD4/CD8 ratio was decreased. Upon stimulation with Pg or S. typh LPS, monocytes from stable maintenance and refractory periodontitis patients released more Il-1 beta (P < 0.05) and PGE2 (P = 0.13 and 0.15) than monocytes from gingivitis subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective study was conducted of 620 patients in a periodontal practice over the years 1960 to 1982. Various periodontal therapies were assessed by using careful office protocols, meticulous record-keeping and well-defined outcome criteria. Four treatment outcome categories were used: two representing satisfactory outcomes (referred to as "STABLE"), and two unsatisfactory outcomes ("UNSTABLE"). The percentages of patients in the STABLE categories following different therapies were: (1) nonsurgical treatment, 63.6%; (2) closed curettage, 73.1%; (3) open curettage, 95.0%; (4) modified Widman flap, 91.6%; (5) full flap and osseous surgery, 71.1%. The major conclusions were that the modified Widman flap and open curettage were more effective than flap and osseous surgery, and much more effective than closed curettage when it was employed as an alternative treatment (54.8% STABLE) to the osseous surgery (71.1% STABLE). Thus, moderate surgical therapies appear to be at least as effective as ostectomy procedures in the treatment of periodontal disease, while nonsurgical and closed curettage therapies appear to be less effective.

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