Effect of periodontal therapy on patients maintained for 15 years or longer. A retrospective study

A retrospective study of tooth loss in 211 patients who were treated for periodontal disease in private practice and maintained for 15 to 34 years on 3- to 6-month recall schedules is reported. The average age of the patients was 42 years, and the average length of time in maintenance was 22 years. On the basis of response to therapy, the patients were classified as Well-Maintained (62%), Downhill (28%) and Extreme Downhill (10%). Seven hundred and seventy-one (771) teeth were lost (13.4%) due to all causes. Molar teeth are the most prone to loss and the mandibular cuspid is the most resistant. The importance of maintenance therapy is emphasized.

Clinical and volumetric analysis of three-wall intrabony defects following open flap debridement

Fourteen defects were treated with flap debridement procedures using the Prichard principle of epithelial exclusion. Six defects were considered to be medium in width (3-4 mm), seven defects were wide (greater than 4 mm), and one defect was narrow (1-2 mm). The parameters studied were changes in gingival and plaque scores, attachment levels, and bone scores. All defects were reentered 9 to 16 months after surgery and changes between the pretreatment and posttreatment bone levels were recorded. The mean gain in probing attachment level was 2.76 mm. The mean amount of defect fill measured from models was 2.56 mm, while the mean defect fill from direct measurements was 3.26 mm. The percentage defect fill measured from study models was 61%. Crestal resorption was 9.7%. The average change in defect volume unadjusted for crestal resorption was 61.8 cu mm. Seven defects had a 50% or greater decrease in defect volume, while seven defects had less than a 50% change. Intrabony defects where calculus is present on the involved tooth surface prior to therapy will repair with substantial amounts of bone as a result of open debridement.

Histologic observations following the placement of tricalcium phosphate implants in human intrabony defects

Biopsies of soft tissue with visible ceramic particles were removed from the coronal part of grafted sites during reentry surgery. After 1 year there was evidence of osteoid forming alongside and within many of the ceramic particles. Viable fragments of mature bone were also observed separate from the ceramic material.

Human allografts of iliac bone and marrow in periodontal osseous defects

The purpose of this study was to statistically compare the bone regeneration and/or remodeling that occurred in human periodontal osseous defects treated with frozen allogenic, cancellous, iliac bone and marrow grafts, to defects treated by nongrafted flap curettage using a split-mouth protocol. Six patients were selected to participate in the study. These patients exhibited bilateral intrabony periodontal defects that had been refractory to nonsurgical periodontal therapy. Twenty-three intrabony defects were treated by osseous grafting using allogenic iliac bone and marrow and 32 intrabony defects were treated by open debridement procedures. The bony regeneration in each defect treated was evaluated by probing measurements taken from a fixed reference made at the initial surgery and at reentry 1 year after transplantation. The overall results of this study demonstrated that the percentage of osseous regeneration that occurred in intrabony defects treated by allogenic bone and marrow grafting was statistically greater than that which occurred in defects treated by nongrafted flap curettage procedures.

Hemisection and root amputation

The disciplines of endodontics and periodontics fuse when molars that have bifurcation or trifurcation involvements are treated with hemisection and root amputation. Attempts to save parts of teeth go back 100 years or more, but it is the increased predictability of success of endodontic therapy and the increased sophistication of periodontal treatment that have given us the means to save molars with furcation problems that, otherwise, would be lost. Even when less invasive modes of therapy have failed (scaling, root planing, occlusal adjustment, and flap surgery perhaps with osseous recontouring and synthetic or natural bone grafting material where indicated), it is no longer necessary to lose a molar with complete furcation problems. When restorative dentistry has already been finished, and the retention of part of the tooth will extend the life of a crown or fixed partial denture, the patient certainly deserves the option of hemisection or root amputation rather than extraction.