We report the results of using impacted cancellous allografts and cement for fixation of the femoral component when revision arthroplasty is required in the face of lost bone stock. In 56 hips reviewed after 18 to 49 months there were few complications and a majority of satisfactory results with evidence of incorporation of the graft. Further study and review are necessary, but the use of the method appears to be justified.

Smoking is a well-documented risk factor for periodontal disease, although the mechanisms of its negative influence are not well understood. In the present study, the influence of smoking on the gingival crevicular fluid (GCF) content of the pro-inflammatory cytokines IL-6 and TNF-alpha was investigated in patients with moderate to severe forms of the disease. The study base consisted of 108 patients including 45 current smokers, 28 former smokers and 35 non-smokers. The median GCF sample levels of IL-6 and TNF-alpha were 5.0 pg/ml and 61.0 pg/ml, respectively, for current smokers, 13.0 pg/ml and 51.0 pg/ml, respectively, for former smokers, and 10.0 pg/ml and 12.0 pg/ml, respectively, for non-smokers. The differences between smoking groups with regard to IL-6 were not significant suggesting that the IL-6 content was not influenced by smoking. In contrast, the TNF-alpha content was significantly increased in current smokers as compared to non-smokers confirming our previous observations. The present results in patients with moderate to severe periodontal disease may indicate different mediator functions of IL-6 and TNF-alpha in response to smoking.

Smoking exerts little, if any, influence on the subgingival occurrence of several of the bacteria most commonly associated with periodontal disease.

The aim of the present study was to monitor the clinical and microbiological effects of non-surgical therapy in smokers and non-smokers. The subject material included 32 patients (age range 32-61 years), 11 men and 21 women with moderate to severe periodontitis. 17 patients were smokers ( > or = 15 cigarettes/day) and 15 non-smokers. All patients were subjected to non-surgical periodontal therapy performed by a dental hygienist. Periodontal variables (plaque index, gingival index and probing depth) were registered and bacterial samples were collected before and 2 months after treatment. The treatment resulted in significant reductions towards very low plaque and gingival indices in smokers and non-smokers alike (p < 0.05). Although probing depth was reduced in both smokers and non-smokers, the probing pocket depth reduction was significantly smaller in smokers than non-smokers (p < 0.05). Microbiologically, the same therapeutical efficacy was attained in both smoking groups, indicating an almost total eradication of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Concerning Prevotella intermedia, out of 14 smokers and 10 non-smokers positive at baseline, 9 and 5, respectively, remained positive after treatment. The results suggest a less favourable clinical outcome of non-surgical therapy in smokers than non-smokers in spite of the fact that the therapy was equally effective with regard to reducing the alleged periopathogens A. actinomycetemcomitans, P. gingivalis and P. intermedia.

The 5-year outcome following periodontal surgery was evaluated in 57 patients that had received regular maintenance care throughout the follow-up period. The study population included 20 smokers, 20 former smokers and 17 non-smokers in the age range 37-77 years. The clinical characteristics evaluated were supragingival plaque, gingival bleeding and pocket probing depth. The region assigned for surgery was, in addition, radiographically evaluated in terms of periodontal bone height. Furthermore, the occurrence of the periopathogens Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) and the gingival crevicular fluid (GCF) levels of tumor necrosis factor alpha (TNF-alpha) were assessed at follow-up. Plaque index was 28.5% at baseline and 32.9% at follow-up, indicating a good standard of oral hygiene, and gingival bleeding 31.7% and 24.9%, respectively, suggesting a low to moderate level of gingival inflammation. In regions assigned for surgery, pocket probing depth decreased significantly from on average 5.6 mm to 4.3 mm (p<0.0001) and periodontal bone height increased significantly from on average 62.5% to 67.5% (p<0.0001). In terms of bone height, the outcome was less favorable among smokers compared with non-smokers. There was a predominance of smokers among patients exhibiting loss of bone height after the 5 years of maintenance. No significant associations were found between the therapeutical outcome and supragingival plaque or subgingival occurrence of periopathogens. The associations between GCF levels of TNF-alpha and probing depth and bone height were unclear, whereas the level of TNF-alpha was significantly elevated in smokers.