Dental care in patients with antiphospholipid syndrome: two case reports

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease that may be classified as primary or secondary. Treatment consists of oral anticoagulant, antiplatelet, and/or immunosuppressant drugs. This report describes the dental treatment of 2 women with APS and multiple dental concerns, including periodontal disease, caries, and missing teeth. The invasive dental procedures were performed in an outpatient setting with hematologic monitoring and use of local hemostatic measures. Neither interruption of anticoagulant medications nor administration of blood products was necessary. All of the procedures were performed without complications. To date, no recommendations for the dental care of patients with APS have been established, demonstrating a need to investigate the risks for bleeding and infection, among other concerns, during dental treatment of these patients.

Current status of the influence of osteoporosis on periodontology and implant dentistry

PURPOSE OF REVIEW

This review summarizes recent evidence on the impact of osteoporosis on periodontonlogy and implant dentistry, prevalence of diseases, pathophysiology and treatment outcomes.

RECENT FINDINGS

Patients with osteoporosis should be advised about the importance of returning for periodical periodontal maintenance as inadequate oral care may lead to a faster development of periodontitis. There is no definitive information on the development of bisphosphonate-related osteonecrosis of the jaw associated with dental implant therapy. Patients presenting severe periodontitis, undergoing intravenous bisphosphonate therapy (for long-term periods) and submitted to more invasive periodontal/peri-implant surgical procedures (that can promote superior dentoalveolar surgical trauma) might be advised about the possibility of developing bisphosphonate-related osteonecrosis of the jaw following dental therapy. Thus, individualized risk evaluation must be undertaken by both the medical and dental teams prior to any dental treatment.

SUMMARY

The most recent literature on the impact of osteoporosis on the periodontal and peri-implant tissues was reviewed to emphasize the importance of oral hygiene measures, and the combined medical/dental assessment of importance when osteoporotic patients are in need of dentoalveolar surgical procedures (e.g. tooth extraction and dental implant placement).

The effect of EDTA root conditioning on periodontal surgery outcome: A meta-analysis

OBJECTIVE

Chemical root conditioning is a procedure to remove the smear layer, which influences periodontal healing. The purpose of this study was to determine the effect of using ethylenediaminetetraacetic acid (EDTA) as a root conditioning agent on periodontal surgery outcomes.

METHOD AND MATERIALS

The databases searched from their earliest records to February 2015 included Pubmed, Embase, the Cochrane library, and ISI Web of Science. Quality assessment of the methodologies of all the included studies and data was performed with Review Manager software. Probing depth (PD) and clinical attachment level (CAL) were analyzed using inverse variance.

RESULTS

The evaluation of the three articles that met the inclusion criteria showed that the differences between the EDTA groups and the control groups were not statistically significant (6 months PD: mean difference [MD] = -0.15 mm, Z = 1.09, P = .27; CAL: MD = 0.15 mm, Z = 0.89, P = .37).

CONCLUSION

EDTA was not able to significantly improve the PD and CAL. A positive outcome of using EDTA as a root conditioning agent was not evident. Thus, future research should focus on EDTA in combination with other drugs or a better alternative drug to EDTA.

A systematic review and meta-analysis on the effects of crown lengthening on adjacent and non-adjacent sites

OBJECTIVES

The objective of the study was to assess the impact of periodontal crown lengthening surgery on clinical parameters at adjacent and non-adjacent sites compared to treated sites.

MATERIAL AND METHODS

An electronic search was carried out on MEDLINE-PubMed, The Cochrane Library, and ISI Web of Science databases between 1978 and 2015. Methodological quality assessment was based on Cochrane recommendations. Meta-analyses were assessed with RevMan 5.0 and heterogeneity between studies by the Higgin test (I ²). Clinical attachment level (CAL) and probing depth (PD) were the primary outcome variables. Four case series studies were included and three in the meta-analysis. All studies showed high risk of bias.

RESULTS

The surgery promoted significant changes in treated, adjacent, and non-adjacent sites. There were greater changes in PD (mean difference -0.14, 95 % CI -0.18 to -0.10, p < 0.00001) and CAL (mean difference 0.16, 95 % CI 0.13 to 0.20, p < 0.00001) in treated sites when compared to adjacent and non-adjacent sites for PD (mean difference -0.09, 95 % CI -0.12 to -0.05, p < 0.00001) and CAL (mean difference 0.91, 95 % CI 0.87 to 0.94, p < 0.00001).

CONCLUSION

Crown lengthening surgery results in changes of clinical parameters in treated, adjacent, and non-adjacent sites.

CLINICAL RELEVANCE

Clinical and esthetic alterations on the adjacent/non-adjacent teeth can lead to clinical and esthetic alterations, which must be considered in surgical planning.

Resective or Regenerative Periodontal Therapy: Considerations during Treatment Planning: A Case Report

Successful long-term management of molars having advanced periodontal disease with secondary endodontic involvement is a challenge to the periodontist. Several treatment options exist for the periodontist based upon various factors. A patient with a deep periodontal pocket on the right mandibular first molar reported for dental treatment. Periapical radiographs revealed bone loss extending to the apex of the mesial root. The treatment plan included scaling, root planing, endodontic therapy and periodontal surgery for the involved tooth. During periodontal surgery, resective and regenerative treatment options were evaluated and explained to the patient. Considering the prognosis of the case, risk-benefit ratio and the patient's choice, regenerative periodontal therapy was performed. The case has been followed for two years, with gain in clinical attachment and radibgraphic bone fill. The authors discuss factors to be considered when choosing regenerative periodontal therapy over resective periodontal therapy.

Management of Multiple Dental Infections in a Dog with Diabetes Mellitus

A dog with diabetes mellitus was treated for multiple dental fractures and refractory hyperglycemia. Five teeth were found to have endodontic infections. Three extractions and two root canal procedures were performed to resolve these infections, resulting in improved regulation of blood glucose levels. Treatment planning included special considerations in management of diabetes in the anesthetic and perioperative periods.

Bilateral Maxillary Periodontal Ligament Hamartoma in a Dog

A 12.5-year-old dog was presented for severe periodontal disease and bilateral maxillary enlargement. Radiographs of the maxilla showed generalized root resorption, ankylosis, and rarefaction of bone with focal radiodense areas. Surgical tooth extraction of multiple maxillary teeth and bilateral incisional biopsies of the periodontal tissue and maxilla in the legion of the maxillary fourth premolars were performed. Histopathologic examination showed features typical of fully differentiated periodontal ligament with abundant cementum/alveolar lining bone and sparce odontogenic epithelial cell rests. Histopathology in conjunction with radiographic and clinical signs suggested a diagnosis of bilateral periodontal ligament hamartoma. Examination 3-months postoperatively indicated uncomplicated healing of the extraction and biopsy sites with no resolution of the maxillary enlargement.

Inflammatory collateral cyst associated with a palatoradicular groove: report of a case and discussion of nomenclature

The aims of this article are to present a case demonstrating the connection between palatoradicular grooves and inflammatory collateral cysts and to discuss the related nomenclature. Radiographs in a 21-year-old man revealed a radiolucent, unilocular, well-defined area near the vital maxillary right lateral incisor and canine. Palatal swelling was present, and a 6-mm-deep periodontal pocket was found at the palatal surface of the right lateral incisor. The differential diagnoses were keratocystic odontogenic tumor, developmental lateral periodontal cyst, and inflammatory lateral periodontal cyst. The area was explored surgically, and the lesion was excised. Surgical exploration revealed a palatoradicular groove, which was scaled and planed with the aid of manual curettes with the intention of creating a flat surface to promote insertion of the periodontal fibers. Histopathologic analysis revealed that the lesion was an inflammatory cyst. The presence of a palatoradicular groove can put the periodontium at risk because a resulting lack of fiber insertion makes oral hygiene difficult. This established inflammatory process can initiate development of an inflammatory collateral cyst that may be misdiagnosed, hindering successful management. In this case, bone grafting and placement of a resorbable membrane were used to promote bone formation and subsequent sealing of the periodontal space.

Effect of angiotensin-converting enzyme inhibitors on vascular endothelial function in hypertensive patients after intensive periodontal treatment

There is a relation between vascular endothelial function, atherosclerotic disease, and inflammation. Deterioration of endothelial function has been observed twenty-four hours after intensive periodontal treatment. This effect may be counteracted by the action of angiotensin-converting enzyme inhibitors, which improve endothelial function. The aim of the present study was to evaluate vascular endothelial function after intensive periodontal treatment, in hypertensive patients treated with angiotensinconverting enzyme inhibitors. A prospective, longitudinal, comparative study involving repeated measurements was conducted. Fifty-two consecutive patients with severe periodontal disease were divided into two groups, one comprising hypertensive patients treated with converting enzyme inhibitors and the other comprising patients with no clinical signs of pathology and not receiving angiotensin-converting enzyme inhibitors. Endothelial function was assessed by measuring postischemic dilation of the humeral artery (baseline echocardiography Doppler), and intensive periodontal treatment was performed 24h later. Endothelial function was re-assessed 24h and 15 days after periodontal treatment.

STATISTICAL ANALYSIS

Results were analyzed using the SPSS 20 statistical software package. Student's t test and MANOVA were calculated and linear regression analysis with 95% confidence intervals and α<0.05 was performed. Arterial dilation at 24 hours was lower compared to baseline in both groups; values corresponding to the groups receiving angiotensin-converting enzyme inhibitors were 11.89 ± 4.87 vs. 7.30 ± 2.90% (p<0.01) and those corresponding to the group not receiving ACE inhibitors were 12.72 ± 4.62 vs. 3.56 ± 2.39 (p<0.001). The differences between groups were statistically significant (p<0.001).

CONCLUSION

The increase in endothelial dysfunction after intensive periodontal treatment was significantly lower in hypertensive patients treated with angiotensin-converting enzyme inhibitors. Endothelial function improved 15 days after periodontal treatment, reaching baseline values. These results support the protective effect of angiotensin converting enzyme inhibitors on the endothelial function after intensive periodontal treatment.

The use of resorbable cortical lamina and micronized collagenated bone in the regeneration of atrophic crestal ridges: a surgical technique. Case series

Some graft materials, such as micronized and collagenated bone, have an excellent capacity to be reabsorbed, allowing for the reformation of good-quality bone, but do not have the mechanical characteristics that would allow for stability in terms of shape and size. In this study, a technique is proposed which makes use of resorbable cortical lamina in order to create recipient sites that can be filled with micronized collagenated bone paste. The adequate vascularization of the graft combined with the integration of the lamina, which does not need to be removed, makes it possible to propose this technique as a potential alternative to those used to date.

Combined orthodontic-periodontal treatment in periodontal patients with anteriorly displaced incisors

INTRODUCTION

Flared and elongated incisors are associated with different types of periodontal bone defects, usually horizontal. Combined orthodontic-periodontal treatment is being used in periodontal patients with anterior displacement of the incisors. The purpose of this study was to investigate the changes in periodontal health and the shape of bone defects in the incisors after such combined treatment.

METHODS

Fourteen adults were included in the study. In total, 56 elongated maxillary incisors with horizontal bone defects received orthodontic-periodontal treatment with circumferential supracrestal fibrotomy. To improve bone morphology, periodontal regenerative surgery and guided tissue regeneration were performed on the anterior teeth with angular bone defects after orthodontic treatment. Cone-beam computed tomography scans were taken before treatment (T0), at the end of the orthodontic intrusion (T1), and 6 months after the guided tissue regeneration surgery (T2). Probing pocket depth and clinical attachment loss were examined at T0, T1, and T2. The data were analyzed using paired t tests.

RESULTS

From T0 to T1, clinical attachment loss decreased significantly by 0.29 mm (P <0.05). The distance from the cementoenamel junction to the marginal bone crest decreased by 0.66 mm (P <0.05). The labial side of alveolar bone thickness increased by 0.54 mm (P <0.05), and the lingual side of alveolar bone thickness decreased by 0.46 mm (P <0.05). The shape of the bone defect was changed from horizontal to vertical on some teeth. From T1 to T2, both probing pocket depth and clinical attachment loss improved significantly, and the radiographic examinations showed bone redepositions of 2.15 ± 0.68 mm (P <0.05) vertically and 1.44 ± 0.92 mm (P <0.05) horizontally. The distance from the most apical point of the bone defect to the cementoenamel junction after combined treatment decreased by 2.11 ± 1.30 mm (P <0.05).

CONCLUSIONS

Combined orthodontic-periodontal treatment improved the periodontal conditions of the defective bone sites. Bone morphology, altered by orthodontic intrusion with fibrotomy, can improve the results of subsequent guided tissue regeneration.

Database analysis of a French type 2 diabetic population shows a specific age pattern of tooth extractions and correlates health care utilization

AIMS

To assess the relationship between type 2 diabetes and tooth loss and the predictive value of health behavior and routine dental care in regard to both dental and medical follow-ups.

METHODS

Cross-sectional study from a national database of a French population of railways transport workers was conducted with a descriptive analysis between registered diabetic patients and non-diabetic subjects. The relationship between oral health and diabetes was measured by tooth extraction prevalence in regard to the frequency of scaling-prophylaxis sessions and the number of medical and dental appointments.

RESULTS

The prevalence of tooth extractions in the type 2 diabetic population is 1.88 higher than the non-diabetic population. Diabetic patients tend to undergo dental extractions earlier and more often than non-diabetic individuals. They also have more medical appointments and less dental check-ups and scaling sessions than the non-diabetic population.

CONCLUSION

Measured by tooth loss, type 2 diabetic patients have a significantly earlier detrimental oral status when compared to the non-diabetic population. They exhibit a different pattern in health care utilization of outpatient medical resources. Oral health surveillance is not correctly addressed by the medical and dental coverage of these diabetic patients. Emphasis should be directed on specific dental care programs aimed at preventing tooth loss.

Dental issues in Rett syndrome

The advancements in science and technology allowed saving the lives of children, who had no chance of survival before. Hence the problem of so called rare diseases, usually genetically determined. It is a new challenge for both the physicians and the health services. These children require a coordinated multi specialist oriented health care, which includes also dentists. This situation is reflected by the case of an 18 years old girl with Rett Syndrome, described by us. In this patient despite numerous visits to various dental practices, no decision of a radical surgical extraction of the tooth has been conducted. In our Department the extraction of teeth 22, 16 and 14 has been performed, as a part of 1 day surgery procedures, thus eliminating the dental infections and pain. Conclusion: Elaboration and introduction into praxis principles of dental care in children and young adults with rare diseases are needed.

Determinants of length of hospitalization due to acute odontogenic maxillofacial infections: a 2009-2013 retrospective analysis

OBJECTIVES

To investigate the determinants of the length of hospitalization (LOH) due to acute odontogenic maxillofacial infections (AOMIs) from 2009 to 2013.

MATERIALS AND METHODS

Dental records of adult patients with AOMIs and related data were retrieved from the Vilnius University's dental hospital. The LOH was related to several determinants in each of the following domains: outpatient primary care, severity of AOMIs, lifestyle and disease domains. Determinants were also associated with the LOH using multivariate analysis.

RESULTS

A total of 285 patients were hospitalized with AOMIs, of which 166 (58.2%) were males and 119 (41.8%) were females. The mean LOH was 8.3 ± 4.9 days. The bivariate analysis did not reveal any statistically significant differences in LOH between patients with AOMIs who received urgent outpatient primary care and those who did not receive such care prior to hospitalization. All AOMI severity-related determinants were associated with the LOH. The LOH was related to coexisting systemic conditions but not to the higher severity of dental or periodontal diseases. Both bivariate and multivariate analyses revealed similar trends, where the most significant determinants of a longer LOH were related to the severity of AOMIs.

CONCLUSION

The most important determinants regarding longer hospitalization were indicators of infection severity such as an extension of the odontogenic infection and the need for an extraoral incision to drain the infection.

Is there a place for lasers in periodontal therapy?

This article aims to provide an overview on the clinical applications of lasers in periodontics.

Treatment of amalgam tattoo with a subepithelial connective tissue graft and acellular dermal matrix

A 54-year-old female was referred for management of a large amalgam tattoo involving the alveolar mucosa between teeth #6 and #9. The lesion had been present for over 20 years following endodontic treatment of teeth #7 and #8. A two-stage surgical approach was used to remove the pigmentation, beginning with removal of amalgam fragments from the underlying bone and placement of a subepithelial connective tissue graft and acellular dermal matrix to increase soft tissue thickness subadjacent to the amalgam. Following 7 weeks of healing, gingivoplasty was performed to remove the overlying pigmented tissue. At the 21-month follow-up appointment, the patient exhibited naturally appearing soft tissue with no evidence of amalgam tattoo.

Regenerative periodontal therapy: 30 years of lessons learned and unlearned

In this review, we reflect upon advances and hindrances encountered over the last three decades in the development of strategies for periodontal regeneration. In this soul-searching pursuit we focus on revisiting lessons learned that should guide us in the quest for the reconstruction of the lost periodontium. We also examine beliefs and traditions that should be unlearned so that we can continue to advance the field. This learned/unlearned body of knowledge is consolidated into core principles to help us to develop new therapeutic approaches to benefit our patients and ultimately our society.

Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts

This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. Advances in technology have resulted in the introduction of a range of new methods for use in nonsurgical periodontal therapy, including machine-driven instruments, lasers, antimicrobial photodynamic therapy and local antimicrobial-delivery devices. However, these methods have not been shown to offer significant benefits over and above nonsurgical debridement using hand instruments. The method of debridement is therefore largely dependent on the preferences of the operator and the patient. Recent evidence indicates that specific systemic antimicrobials may be indicated for use as adjuncts to nonsurgical debridement in patients with advanced disease. Full-mouth disinfection protocols have been proven to be a relevant treatment option. We have learned that while nonsurgical and surgical methods result in similar long-term treatment outcomes, surgical therapy results in greater probing-depth reduction and clinical attachment gain in initially deep pockets. The surgical technique chosen seems to have limited influence upon changes in clinical attachment gain. What has not changed is the importance of thorough mechanical debridement and optimal plaque control for successful nonsurgical and surgical periodontal therapy.

Assessment of anxiety related to dental treatments among patients attending dental clinics and hospitals in Ranga Reddy District, Andhra Pradesh, India

PURPOSE

To assess the levels of dental anxiety among patients anticipating dental treatments in dental clinics/hospitals of Ranga Reddy district.

MATERIALS AND METHODS

A cross-sectional study was conducted among a representative sample of 1200 subjects (at least 18 years old) in dental clinics/hospitals which were selected from a list obtained through systematic random sampling. The data were collected using a pre-tested and calibrated questionnaire consisting of the Modified Corah Dental Anxiety Scale (MDAS) to assess anxiety levels.

RESULTS

The majority (52.4%) of subjects showed a low level of anxiety. Females (11.44 ± 4.41) were found to have higher mean MDAS scores than males, and the highest mean MDAS scores were found among 18- to 34-year-olds (11.28 ± 4.67) (P < 0.05). Significant differences were found among subjects anticipating different treatments, with higher MDAS scores for extraction (11.25 ± 5.4), followed by examination, root canal treatment, gum surgery, scaling, restoration and others, e.g. orthodontic treatment, restoration with crowns, bridges and dentures (7.79 ± 3.80). The highest mean MDAS scores were found among subjects who were apprehensive due to 'past difficult experience in dental treatments', followed by 'drill' and 'injection', with the lowest scores among subjects indicating 'other reasons' (7.82 ± 3.84).

CONCLUSION

The present data show that anxiety levels are higher in patients who have to undergo extractions than those who must be fitted with dentures. Thus, dental health care providers should pay more attention to patients' anxiety levels associated with different types of treatment.