Effectiveness of Emdogain in the periodontal treatment

OBJECTIVES

The study was designed to investigate how the periodontal disease treatment with Emdogain may influence the parameters of serum acute phase response and the total antioxidant status (TAS) of nonstimulated saliva.

MATERIAL AND METHODS

The wound healing process after periodontal treatment provided with EMD and regular open flap procedure was observed in 28 patients. TAS in saliva and acute phase proteins in blood was measured before and after treatment.

RESULTS

The PD varied from 3,91 mm before treatment to 1,27 after it in EMD group and from 3,83 mm and 1,33 in the control group. CAL varied from 3,2 - 2,4 mm in EMD group and from 2,70 - 2,2 in the control group (p<0,01 and p<0,001). On the basis and after treatment of acute phase proteins analysis existence of chronic inflammatory state with slight decreased total concentration of AGP, ACP. Low TAS level found in the saliva of the subjects in our study may suggest that the antioxidant defence of saliva in patients with chronic periodontitis is poor.

Platelet-rich plasma. A review

Platelet-rich plasma has been used in periodontal therapy because of its biologic characteristics in promoting wound healing and regeneration. Platelet-rich plasma, growth factors in platelet-rich plasma, their mechanism of action, probable role in wound healing, preparation of platelet-rich plasma and its activation are reviewed to provide insights into the role of this entity in wound healing and regeneration.

Rinsing with alcohol-free or alcohol-based chlorhexidine solutions after periodontal surgery. A double-blind, randomized, cross-over, pilot study

The aim of this randomized, double-blind, cross-over pilot study was to evaluate the effect on plaque formation and patient experience of rinsing after periodontal surgery using chlorhexidine solution with or without alcohol. Twenty patients refrained from tooth brushing after surgery and used two mouth rinses.Ten patients used alcohol-based (AB) 0.1% and another ten used alcohol-free (AF) 0.12% chlorhexidine (CHX). Sutures were removed after 2 weeks and teeth were cleaned; thereafter, the two groups shifted solution. Plaque at operated teeth was recorded at 2 and 4 weeks (Quigley-Hein Index). Patient experience was assessed with a visual analogue scale (0-10). Mean (SD) plaque indices at 2 and 4 weeks were 1.0 (0.8) and 1.1 (1.0) for AB CHX and 1.1 (0.7) and 0.8 (0.7) for AF CHX, respectively (no significant differences between solutions). At 2 weeks, between-group differences in taste experience of the solutions differed non-significantly: 6.1 (2.8) for AB and 6.0 (2.3) for AF. At 4 weeks, values were 4.6 (2.5) for AB and 6.9 (3.3) for AF-patients tended to prefer AF (p = 0.050). Taste change over the study period was equal for both groups: -37 (3.3) for AB and 3.4 (2.3) for AF at 2 weeks and slightly higher at 4 weeks 4.9 (2.8) and 4.5 (2.5) for AB and AF, respectively. Smarting was low in both groups: 2.2 (3.2) and 1.3 (2.2) for AB and 1.0 (1.5) and 1.9 (2.0) for AF at 2 and 4 weeks, respectively. To conclude, alcohol-free and alcohol-based chlorhexidine showed the same plaque inhibitory effect in periodontal patients after periodontal surgery. Both rinses were well tolerated by the patients.

Multivariate meta-analysis: a robust approach based on the theory of U-statistic

Meta-analysis is the methodology for combining findings from similar research studies asking the same question. When the question of interest involves multiple outcomes, multivariate meta-analysis is used to synthesize the outcomes simultaneously taking into account the correlation between the outcomes. Likelihood-based approaches, in particular restricted maximum likelihood (REML) method, are commonly utilized in this context. REML assumes a multivariate normal distribution for the random-effects model. This assumption is difficult to verify, especially for meta-analysis with small number of component studies. The use of REML also requires iterative estimation between parameters, needing moderately high computation time, especially when the dimension of outcomes is large. A multivariate method of moments (MMM) is available and is shown to perform equally well to REML. However, there is a lack of information on the performance of these two methods when the true data distribution is far from normality. In this paper, we propose a new nonparametric and non-iterative method for multivariate meta-analysis on the basis of the theory of U-statistic and compare the properties of these three procedures under both normal and skewed data through simulation studies. It is shown that the effect on estimates from REML because of non-normal data distribution is marginal and that the estimates from MMM and U-statistic-based approaches are very similar. Therefore, we conclude that for performing multivariate meta-analysis, the U-statistic estimation procedure is a viable alternative to REML and MMM. Easy implementation of all three methods are illustrated by their application to data from two published meta-analysis from the fields of hip fracture and periodontal disease. We discuss ideas for future research based on U-statistic for testing significance of between-study heterogeneity and for extending the work to meta-regression setting.

Frequency, causes and pattern of adult tooth extraction in a Nigerian rural health facility

OBJECTIVE

To determine the frequency, causes and pattern of tooth extraction in a Nigerian rural health facility.

MATERIALS AND METHOD

This descriptive cross sectional study was conducted in Eden dental clinic of Mount Gilead hospital; Uselu from January 2006 to December 2008. The information collected with questionnaire included demography of patients, indications for extraction, type of tooth extracted and other treatments performed. Results were presented as simple frequency tables and graph. Data analysis was done with SPSS statistical software version 13.0.

RESULTS

Tooth extractions represented one third (33.4%) of the total treatment procedure. Periodontal disease (45%) and caries (32.6%) were the main reasons for extraction. Other reasons in descending order are failed root canal treatment (1.5%), orthodontic reason (1.2%), tooth in fracture line (1.0%), trauma (0.6%), supernumeraries (0.4%) and prosthetic reasons (0.2%). There was higher extraction among females than males p > 0.05. Tooth extraction in 27-36 years age group was the highest and the main reason for extraction in this age group was impaction (47.8%). Higher number of extracted teeth was from lower right quadrant, lower arch and right side of mouth in this survey. Molars made up 95.3% of all extracted teeth with first molar predominating (40.1%). The proportion of extractions attributed to periodontal disease increased from 17-56 years, but declined thereafter.

CONCLUSION

Tooth extraction was a highly frequent treatment procedure in this survey. Molars were mostly extracted as a result of caries although periodontal disease was the dominant reason for extractions. This result is different from results from previous studies.

RECOMMENDATION

Findings in this study showed that tooth extraction constitute about one third of the total procedures done in this rural health facility during the study period. This is mainly due to late presentation and brings to the fore, the degree of ignorance on oral health issues among the Nigerian rural dwellers. It is the opinion of the authors that the attention of the dental professionals be drawn to the need to reach out, educate and encourage best oral healthcare practices.

Immediate implantation in infected tooth sockets

Although immediate implantation has not been previously recommended in infected sites, it is now becoming a procedure of choice in modern implant dentistry. We report a case of a 65-year-old male patient, who required multiple tooth extractions in the lower jaw and fabrication of a new overdenture in the lower jaw and a complete denture in the upper jaw. Immediate implantation in infected tooth sockets followed extraction. Two NobelReplace Tapered implants (Nobel BioCare, Zürich, Switzerland), one 13 mm long and 4.3 mm wide and the other 13 mm long and 5.0 mm wide, were placed in the position 33 and 43. The site was sutured and a temporary denture was fabricated by adjusting the old denture. After a period of three months the implant site was reopened and healing abutments were placed. Impressions were made using the Impregum Penta Soft (3M ESPE, St. Paul, Minn, USA) polyether material. Ball Abutment Titanium" was used as a patrix attachment and a matrix was inserted into the denture. Clinical examination and x-ray analysis after six months showed no significant changes of the implants. Bone resorption was within standard values. Although it is still a controversial subject, immediate implantation in infected sites can be a safe and predictable procedure if surgical protocols are followed. However, further research is needed to draw firm conclusions.

Reasons underlying the extraction of permanent teeth in patients attending Peoples Dental College and Hospital

Extraction of permanent teeth is common in Nepal. The study was undertaken to determine the causes and pattern of missing permanent teeth among patients attending Peoples Dental College and Hospital (PDCH) and to see if there is any association between variables like socio economic status, patient education level, dental visit and extraction of permanent teeth. A prospective cross sectional survey was carried out in patients attending the Department of Oral Surgery in PDCH between August 2006 and October 2006. The data was collected by trained clinician through clinical examination and using semi- structured questionnaires. Computer software SPSS 15 was used for statistical analysis. In age groups < or = 30 years, 90.0% it was reported that Dental caries was the most common reason for extraction of teeth. In age groups > 30 years, 55.6% periodontal disease was the most common reason for extraction of teeth. Distribution by type of teeth and dental disease was highly significant where. Dental caries was the reason for extraction of first permanent molar. Distribution by education level and visit to dentist was highly significant. About 93.1% of the people who were illiterate visited the dental surgeon while in pain and 76.0% of the university level graduates visited the dentist while in pain. Caries and its sequel remain the most important cause of tooth loss throughout adult life along with periodontal diseases at later stages.

Tooth loss among Nigerians treated in teaching hospitals: a national pilot study

AIM

The aim of this study was to identify the causes and patterns of tooth loss among Nigerian adults.

BACKGROUND

Tooth loss continues to be a major problem in clinical dentistry and has received significant attention in everyday dental practice. In Nigeria there is a discernible lack of current data that would explain the reasons and patterns of tooth loss from its different geopolitical zones.

METHODS AND MATERIALS

The reasons for tooth extractions during a period of 12 months were obtained from the hospital records of teaching and specialist hospitals in Nigeria's six geopolitical zones and the Federal Capital Territory (FCT). Data were analyzed using Statistical Package for the Social Sciences for Windows (SPSS) version 9.0.

RESULTS

A total of 4,204 teeth were extracted from 3,431 patients. Of these teeth 52.4 percent were lost due to dental caries while 30.2 percent were removed because of periodontal disease, 5.0 percent were missing as a result of trauma, and 3.9 percent were impacted and required extraction. The remaining 8.5 percent were extracted for a variety of reasons such as orthodontic treatment, overeruption, neoplasms, supernumerary teeth, attrition, a cystic lesion, and hypoplasia. Dental caries was the most common diagnosis given for tooth loss in the South-South (79 percent), South-East (68 percent), North-East (47 percent), North-West (69 percent), and North-Central (35 percent) zones followed by periodontal disease. In contrast, periodontal disease was the most common cause of tooth loss in the South-West zone (65 percent) and in the FCT (55 percent), followed by dental caries at 22 percent and 33 percent, respectively.

CONCLUSION

Although teeth were extracted based on a variety of diagnoses, dental caries was identified as the common reason cited for tooth loss in Nigeria and to a lesser extent periodontal disease. Also different reasons were given for tooth loss among the various geographical zones.

CLINICAL SIGNIFICANCE

Tooth loss among Nigerians was attributed largely to dental caries and secondarily to periodontal disease. Both conditions can be prevented if diagnosed early enough and treatment is instituted in a timely manner.

Compliance with periodontal maintenance at the University of Pittsburgh: Retrospective analysis of 315 cases

Maintenance care is the most important part of periodontal treatment because maintenance - adherence to the schedule of recall dental appointments after treatment - is believed to be the key in preventing the recurrence of periodontal disease. This article is a retrospective analysis of 315 cases from the Department of Periodontics and Preventive Dentistry at the University of Pittsburgh to determine compliance with periodontal maintenance schedules over a two-year period. Following the completion of periodontal surgical treatment, patients were placed on a regimen of maintenance care that included recalls every three months, professional prophylaxis by the hygiene faculty, and repeated instructions in home self-care. Medical records and patient charts of 315 subjects were selected randomly and reviewed in terms of the patient's attending the scheduled recall visit. It was hypothesized that female subjects would show better compliance with the maintenance care regimen than male subjects, as suggested in the literature. Among the 315 subjects, 112 (54 women and 58 men) followed the recommended recall schedule; 30% ultimately returned for the three-month prophylaxis recall visit after the initial periodontal surgical appointment, and thus were considered to have complied with the suggested maintenance program. The investigators failed to reject the stated hypothesis that women would display better compliance than men (p = 0.3).

[Functional state of mastication muscles and of separate factors of oral local immunity during non removable dentures use]

There were examined 100 people of the age from 18 to 31 years with intact dentitions and physiological byte (control group) and 65 patients of the age from 19 to 60 years with hard dental tissue defects, one- and two-sided included defects of dentitions requiring in installation of non removable dentures. Significantly different indicators in healthy persons and in persons with periodontal diseases and mastication muscles para-functions and also in patients before and after prosthetic treatment by non removable dentures were found.

Pre-clinical models for oral and periodontal reconstructive therapies

The development of new medical formulations (NMF) for reconstructive therapies has considerably improved the available treatment options for individuals requiring periodontal repair or oral implant rehabilitation. Progress in tissue engineering and regenerative medicine modalities strongly depends on validated pre-clinical research. Pre-clinical testing has contributed to the recent approval of NMF such as GEM 21S and INFUSE bone grafts for periodontal and oral regenerative therapies. However, the selection of a suitable pre-clinical model for evaluation of the safety and efficacy of a NMF remains a challenge. This review is designed to serve as a primer to choose the appropriate pre-clinical models for the evaluation of NMF in situations requiring periodontal or oral reconstruction. Here, we summarize commonly used pre-clinical models and provide examples of screening and functional studies of NMF that can be translated into clinical use.

[The bony modifications in the periodontal pockets]

The aim of this study was to demonstrate the bony structural changes in deep periodontal pockets.

MATERIAL AND METHODS

Bony fragments were taken from the alveolar wall of a group of 24 patients diagnosed with deep periodontal lesions which required the extraction of certain irrecuperable teeth. Fragments were fixed in glutaraldehyde, then decalcified in EDTA 5% and proccesed for electron microscopic examination and a semifinesse sections to microscop "Zeiss Axioscop".

RESULTS

Both optic and electron microscopy showed: decreaze of bone mineralization and alterations in cholagen structure; the presence of osteoclasts with intense activity and numerous macrofages; at the level of bone marrow, small, insignificant inflammatory reactions, contrasting with the important surrounding modifications; in certain cases though osteolytic reactions occured, the osteoclasts could not by evidenced, on the contrary, numerous macrophages with intense lysosomal enzymes activity were noticed; all the cases showed an alteration of the alveolar bone cholagen.

CONCLUSION

Thus, we can better understand the role of primary factors in this bony structures.

Causes and patterns of loss of permanent teeth among patients attending a dental teaching institution in south India

AIM

The aims of the present study are to determine the causes and pattern of loss of permanent teeth among patients attending a dental teaching institution in southern India.

METHODS AND MATERIALS

Data collected from patients attending the outpatient wing of the Sri Sankara Dental College, Kerala, during a three month period was used for the study. The cause for extraction was classified as follows: (1) caries and its sequelae, (2) periodontal disease, (3) orthodontic purposes, (4) impactions, (5) prosthodontic purposes, and (6) other reasons.

RESULTS

A total of 1791 permanent teeth were extracted of which 708 (39.5%) teeth were extracted due to caries and its sequelae, 508 (28.4%) due to periodontal disease, 347 (19.4%) for orthodontic purposes, 29 (1.6%) due to impactions, 155 (8.7%) for prosthodontic purposes, and 44 (2.5%) for other reasons.

CONCLUSION

The results of the present study suggest caries and periodontal disease are the major causes of tooth mortality in the study population.

CLINICAL SIGNIFICANCE

Data regarding the causes of tooth loss indirectly provides invaluable information on the pattern of oral health in a population which can be utilized for planning public health policies designed to address the burden of oral diseases.

[Bio-Oss collagen bone grafting in the treatment of endodontic-periodontic lesion]

OBJECTIVE

To study the effect of Bio-Oss collagen for bone grafting in the treatment of endodontic-periodontic lesion.

METHODS

Thirty patients (37 teeth) with endodontic-periodontic lesions received root canal therapy and periodontal treatment. Four weeks after the treatment, Bio-Oss collagen was grafted in these teeth. Clinical examinations were performed 1, 3, 6, 9, and 12 months after the surgery.

RESULTS

The mobility of these teeth improved 1 month after the surgery. At 3, 6, 9, and 12 months after the surgery, the pocket depth reduced obviously good attachment and further improvement of the tooth mobility.

CONCLUSION

Bio-Oss collagen for bone grafting can achieve good therapeutic effect for endodontic-periodontic lesions.