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Taylor A, Burns L. Deep margin elevation in restorative dentistry: A scoping review. J Dent 2024; 146:105066. [PMID: 38740249 DOI: 10.1016/j.jdent.2024.105066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web. DATA Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening. SOURCES This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information. STUDY SELECTION The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources. CONCLUSIONS DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to. CLINICAL SIGNIFICANCE With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.
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Affiliation(s)
- Anna Taylor
- The Treatment Centre, Tinner's Court, Back Quay, Truro, Cornwall TR1 2LL, UK
| | - Lorna Burns
- Peninsula Dental School, John Bull Building, Research Way, Plymouth, Devon PL6 8BU, UK.
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Sadeghnezhad P, Sarraf Shirazi A, Borouziniat A, Majidinia S, Soltaninezhad P, Nejat AH. Enhancing subgingival margin restoration: a comprehensive review and meta-analysis of deep margin elevation's impact on microleakage. Evid Based Dent 2024:10.1038/s41432-024-01028-0. [PMID: 38907025 DOI: 10.1038/s41432-024-01028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/03/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Restorative dentistry faces complex challenges with deep proximal surface destruction, requiring novel approaches like DME (Deep Margin Elevation). In order to achieve the best results while treating severe tooth damage, this study examines the advantages, disadvantages, and possible collaborations of different treatments. AIMS This systematic review investigates the efficacy of DME as an adjunctive procedure in restorative dentistry, specifically focusing on its impact on microleakage. METHODS The study adheres to PRISMA guidelines and employs the PICOS framework for eligibility criteria. 394 potentially qualifying studies were discovered and thorough literature search was carried out via databases. After applying inclusion criteria, 7 studies were included in the analysis. Articles were selected based on criteria that included indirect restoration and performing DME and were compared with indirect restorations without DME. Composite resin was used for DME. Other materials for DME performing, including GI and composite flow, were systematically reviewed. Data analysis was done by biostat software (α = 0.05). RESULTS The meta-analysis of selected studies reveals a statistically significant positive effect of DME on reduction of microleakage (p = 0.001). CONCLUSION The results of this study underscore the potential of DME in addressing subgingival margin challenges and provide valuable insights for restorative dentistry practices.
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Affiliation(s)
- Pegah Sadeghnezhad
- Dentist, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | | | - Alireza Borouziniat
- Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Majidinia
- Dental Materials Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Pouria Soltaninezhad
- Dentist, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Amir Hossein Nejat
- Department of Prosthodontics, School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, USA
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Montoya C, Baraniya D, Chen T, Al-Hebshi NN, Orrego S. The effect of dental material type and masticatory forces on periodontitis-derived subgingival microbiomes. Biofilm 2024; 7:100199. [PMID: 38800100 PMCID: PMC11127099 DOI: 10.1016/j.bioflm.2024.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/19/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024] Open
Abstract
Restorative dental materials can frequently extend below the gingival margin, serving as a potential haven for microbial colonization, and altering the local oral microbiome to ignite infection. However, the contribution of dental materials on driving changes of the composition of the subgingival microbiome is under-investigated. This study evaluated the microbiome-modulating properties of three biomaterials, namely resin dental composites (COM), antimicrobial piezoelectric composites (BTO), and hydroxyapatite (HA), using an optimized in vitro subgingival microbiome model derived from patients with periodontal disease. Dental materials were subjected to static or cyclic loading (mastication forces) during biofilm growth. Microbiome composition was assessed by 16S rRNA gene sequencing. Dysbiosis was measured in terms of subgingival microbial dysbiosis index (SMDI). Biomaterials subjected to cyclic masticatory loads were associated with enhanced biofilm viability except on the antibacterial composite. Biomaterials held static were associated with increased biofilm biomass, especially on HA surfaces. Overall, the microbiome richness (Chao index) was similar for all the biomaterials and loading conditions. However, the microbiome diversity (Shannon index) for the HA beams was significantly different than both composites. In addition, beta diversity analysis revealed significant differences between composites and HA biomaterials, and between both loading conditions (static and cyclic). Under static conditions, microbiomes formed over HA surfaces resulted in increased dysbiosis compared to composites through the enrichment of periopathogens, including Porphyromonas gingivalis, Porphyromonas endodontalis, and Fretibacterium spp., and depletion of commensals such as Granulicatella and Streptococcus spp. Interestingly, cyclic loading reversed the dysbiosis of microbiomes formed over HA (depletion of periopathogenes) but increased the dysbiosis of microbiomes formed over composites (enrichment of Porphyromonas gingivalis and Fusobacterim nucleatum). Comparison of species formed on both composites (control and antibacterial) showed some differences. Commercial composites enriched Selenomonas spp. and depleted Campylobacter concisus. Piezoelectric composites effectively controlled the microbiome viability without significantly impacting the species abundance. Findings of this work open new understandings of the effects of different biomaterials on the modulation of oral biofilms and the relationship with oral subgingival infections.
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Affiliation(s)
- Carolina Montoya
- Smart Biomaterials Laboratory, Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
| | - Divyashri Baraniya
- Oral Microbiome Research Laboratory, Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
| | - Tsute Chen
- Department of Microbiology, Forsyth Institute, Cambridge, MA, USA
| | - Nezar Noor Al-Hebshi
- Oral Microbiome Research Laboratory, Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
| | - Santiago Orrego
- Smart Biomaterials Laboratory, Department of Oral Health Sciences, Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
- Bioengineering Department, College of Engineering, Temple University, Philadelphia, PA, USA
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Alam MN, Ibraheem W, Ramalingam K, Sethuraman S, Basheer SN, Peeran SW. Identification, Evaluation, and Correction of Supracrestal Tissue Attachment (Previously Biologic Width) Violation: A Case Presentation With Literature Review. Cureus 2024; 16:e58128. [PMID: 38741844 PMCID: PMC11089581 DOI: 10.7759/cureus.58128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
The supracrestal tissue attachment (SCTA) is the new terminology for biologic width. SCTA is defined as the physiologic dimension of a solitary functional unit composed of junctional epithelium and connective tissue attachment. Its preservation is critical for the well-being of periodontal health. SCTA has been widely studied and scientific literature is indicative of its significance during the placement of restoration, including prosthetic crowns. This should be taken care of in cases of anterior teeth within the smile zone, where dental crowns are regularly placed subgingivally for aesthetic reasons. In addition, any violation of SCTA while restoring the dentition will present as gingival inflammation and pain, consequently, leading to failure of the clinical procedure.
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Affiliation(s)
| | - Wael Ibraheem
- Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, SAU
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sathya Sethuraman
- Physiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Syed Nahid Basheer
- Restorative Dentistry, College of Dentistry, Jazan University, Jazan, SAU
| | - Syed Wali Peeran
- Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, SAU
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Farouk AT, Hassanein OES, Fahmy OI, Elkady AM, ElNahass H. Biological evaluation of indirect restorations in endodontically treated posterior teeth with deeply located proximal margins following deep margin elevation versus surgical crown lengthening: a randomized controlled trial. Clin Oral Investig 2023; 28:24. [PMID: 38147139 DOI: 10.1007/s00784-023-05434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE The current clinical trial was conducted to evaluate the effect of proximal indirect restorations in endodontically treated posterior teeth with deeply located margins following deep margin elevation compared to surgical crown lengthening. MATERIAL AND METHODS Deep proximal cavities in endodontically treated posterior teeth were randomly assigned into two groups; deep margin elevation (DME) or crown lengthening (CL). The clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP), crestal bone level (CBL), and secondary caries were evaluated at the baseline, 1, 3, 6, 9, and 12 months. RESULTS A total of 20 proximal cavities were included in the study; there was no significant difference between the two groups regarding mean CAL values at the baseline and 1 month, while there was a significant difference between the two groups in all other periods. Regarding the PD, there was no statistical significance between the two groups except at 9 and 12 months, where CL showed higher mean PD values than DME. There was no statistically significant difference in BOP or CBL between the two groups. CONCLUSIONS DME and CL are considered clinically successful with favorable biologic responses. CLINICAL RELEVANCE The deep margin elevation approach could provide a more conservative solution when relocating deeply seated cervical margins in a more coronal position. DME reduced the number of visits and time needed for the restoration of endodontically treated teeth. Surgical crown lengthening remains a gold standard procedure in the re-establishment of the supracrestal tissue attachment, especially in cases where cervical margins are beyond the elevation capacity.
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Affiliation(s)
- Ahmed Tarek Farouk
- Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Operative Dentistry Department, Faculty of Dentistry, Misr International University, Cairo, Egypt
| | | | - Ola Ibrahim Fahmy
- Operative Dentistry Department, Faculty of Dentistry, Misr International University, Cairo, Egypt
| | - Ahmed M Elkady
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Hani ElNahass
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt.
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
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Pedrinaci I, Calatrava J, Flores J, Hamilton A, Gallucci GO, Sanz M. Multifunctional anatomical prototypes (MAPs): Treatment of excessive gingival display due to altered passive eruption. J ESTHET RESTOR DENT 2023; 35:1058-1067. [PMID: 37078683 DOI: 10.1111/jerd.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To describe a strategy using digital technologies for improving the diagnosis, treatment planning, and surgical execution of patients with excessive gingival display (EGD) due to altered passive eruption (APE). CLINICAL CONSIDERATIONS An important component for successful patient's management is to fulfill their esthetic expectations whilst delivering predictable and long-term therapeutic outcomes. To achieve this goal in patients with excessive gingival display due to altered passive eruption, it is essential to perform an accurate diagnosis and to communicate to the patient the expected customized results using digital technologies. Computer-aided designed and manufactured multifunctional anatomical prototypes (MAPs) may contribute to these purposes. Additionally, they can guide the surgical crown lengthening procedure or serve as a reference during the surgical guide fabrication providing information of the required anatomical landmarks. CONCLUSIONS This novel strategy protocol for diagnosis, communication, and treatment management of patients with excessive gingival display follows functional and biological principles within the frame of a digital workflow, which improves the diagnostic capabilities, enhances communication, and guides the surgical treatment as shown in the 12 months follow-up of the reported case. CLINICAL SIGNIFICANCE Developing a virtual patient by combining multiple digital data sets including cone-beam computed tomography (CBCT), intra-oral scans and digital photography, supports the clinician and the patient to achieve a comprehensive diagnosis and to better communicate the expected results to the patient. Furthermore, this digital treatment exercise based on anatomical and biological principles will facilitate the surgical precision and the achievement of successful outcomes, thus fulfilling the patient needs and expectations.
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Affiliation(s)
- Ignacio Pedrinaci
- Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Javier Calatrava
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Juan Flores
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Adam Hamilton
- Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Restorative and Rehabilitative Sciences, University of Western Australia, Perth, Australia
| | - German O Gallucci
- Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Mariano Sanz
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
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Bruhnke M, Naumann M, Böse MWH, Beuer F, Schwendicke F. Health economic evaluation of forced orthodontic extrusion of extensively damaged teeth: up to 6-year results from a clinical study. Clin Oral Investig 2023; 27:5587-5594. [PMID: 37498335 PMCID: PMC10492751 DOI: 10.1007/s00784-023-05178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Clinical data on retaining extensively damaged teeth using forced orthodontic extrusion followed by restorative rehabilitation are scarce, and economic evaluations are basically absent. A health economic evaluation of this method was performed based on a clinical study. MATERIALS AND METHODS In a convenience sample of individuals recruited from routine care, extensively damaged teeth were orthodontically extruded prior to restoration. Patients were followed up for up to 6 years. The health outcome was tooth retention time. Direct medical, non-medical, and indirect initial and follow-up costs were estimated using the private payer's perspective in German healthcare. Association of initial direct medical treatment costs and cofounding variables was analyzed using generalized linear models. Success and survival were secondary outcomes. RESULTS A total of 35 teeth in 30 patients were followed over a mean ± SD of 49 ± 19 months. Five patients (14%) dropped out during that period. Median initial costs were 1941€ (range: 1284-4392€), median costs for follow-up appointments were 215€ (range: 0-5812€), and median total costs were 2284€ (range: 1453 to 7109€). Endodontic re-treatment and placement of a post had a significant impact on total costs. Three teeth had to be extracted and in three patients orthodontic relapse was observed. The survival and success rates were 91% and 83%, respectively. CONCLUSIONS Within the limitations of this clinical study, total treatment costs for orthodontic extrusion and subsequent restoration of extensively damaged teeth were considerable. Costs were by large generated initially; endodontic and post-endodontic therapies were main drivers. Costs for retreatments due to complications were limited, as only few complications arose. CLINICAL RELEVANCE The restoration of extensively damaged teeth after forced orthodontic extrusion comes with considerable initial treatment costs, but low follow-up costs. Overall and over the observational period and within German healthcare, costs are below those for tooth replacement using implant-supported crowns. TRIAL REGISTRATION ClinicalTrials.gov Identifier: DRK S00026697).
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Affiliation(s)
- Maria Bruhnke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany.
| | - Michael Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Mats Wernfried Heinrich Böse
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
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Couso-Queiruga E, Barboza EP, Avila-Ortiz G, Gonzalez-Martin O, Chambrone L, Rodrigues DM. Relationship between supracrestal soft tissue dimensions and other periodontal phenotypic features: A cross-sectional study. J Periodontol 2023; 94:944-955. [PMID: 36797817 DOI: 10.1002/jper.22-0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The purpose of this study was to determine the association between periodontal supracrestal soft tissue dimensions (PSSTDs) and other phenotypic features in non-molar maxillary teeth. MATERIALS AND METHODS Adult subjects in need of comprehensive dental treatment were recruited. Periodontal phenotypic variables (i.e., facial and palatal gingival thickness [GT], alveolar bone thickness [BT], and PSSTDs, namely distance from the gingival margin to the bone crest defined as periodontal supracrestal tissue height [PSTH] and distance from the cementoenamel junction to the bone crest [CEJ-BC]) were recorded using cone-beam computed tomography scans. Standardized intraoral photographs were obtained to assess facial keratinized tissue width (KTW) and other anatomical parameters (i.e., tooth type, gingival architecture, and interproximal papilla height). RESULTS The study sample was constituted of 87 participants that contributed with a total of 522 maxillary anterior teeth. Differences in mean values of PSSTDs, KTW, GT, and BT were observed between tooth types and sex. Males exhibited a thicker GT and BT, and taller PSTH and KTW compared to females. Shorter CEJ-BC was associated with shorter PSTH, wider KTW, and thicker GT and BT. Shorter PSTH was associated with thicker facial BT. Notably, BT and GT were positively correlated at both facial and palatal sites, meaning that the thicker the gingival phenotype, the thicker the bone morphotype. Facial BT and facial GT were positively correlated with KTW. A flat gingival architecture was associated with the thick periodontal phenotype. Square teeth had shorter CEJ-BC, wider KTW, and thicker GT. CONCLUSIONS Periodontal phenotypic features vary across and within subjects, between facial and palatal sites at different apico-coronal levels, and as a function of sex and tooth type. The shorter the PSSTDs, the wider the KTW and the thicker the GT and BT. PSSTDs, particularly PSTH, should be considered an integral component of the periodontal phenotype.
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Affiliation(s)
- Emilio Couso-Queiruga
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Eliane Porto Barboza
- Department of Dental Clinic, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Gustavo Avila-Ortiz
- Private Practice, Atelier Dental Madrid, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Oscar Gonzalez-Martin
- Private Practice, Atelier Dental Madrid, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
- Department of Periodontology, Complutense University of Madrid, Madrid, Spain
| | - Leandro Chambrone
- Evidence-Based Hub, Interdisciplinary Research Center Egas Moniz (CiiEM), Egas Moniz-Cooperative of Higher Education, Caparica, Almada, Portugal
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Diogo Moreira Rodrigues
- Department of Periodontology, National Institute of Dental Sciences (INCO 25), Niterói, Rio de Janeiro, Brazil
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Falahchai M, Musapoor N, Mokhtari S, Babaee Hemmati Y, Neshandar Asli H. Fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: Cervical margin relocation and crown lengthening with complete and partial ferrule with three different post and core systems. J Prosthodont 2023. [PMID: 37505114 DOI: 10.1111/jopr.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To assess the fracture resistance and failure mode of endodontically treated premolars reconstructed by different preparation approaches: cervical margin relocation (CMR) and crown lengthening (CL) with complete ferrule (CLF) and partial ferrule (CLPF) with three different post and core systems. MATERIALS AND METHODS In this in vitro study, 100 maxillary premolars were assigned to the following 10 groups according to their preparation approach and type of post and core system (n = 10): (I) control (intact teeth), (II) prefabricated fiber post (PFP) and composite core with CMR (PFP-CMR), (III) polyethylene fiber-reinforced composite (PEFRC) with CMR (PEFRC-CMR), (IV) casting post (CP) and core with CMR (CP-CMR), (V) PFP-CLPF, (VI) PEFRC-CLPF, (VII) CP-CLPF, (VIII) PFP-CLF, (IX) PEFRC-CLF, and (X) CP-CLF. After thermomechanical loading, the fracture resistance and failure mode were assessed. Data were analyzed statistically (α = 0.05). RESULTS In all post and core systems, the CLPF approach had lower fracture resistance than CMR (p < 0.05); CLF showed higher fracture resistance than CLPF only in the PFP system (p = 0.038). In PEFRC and CP systems, the difference between CLF and CLPF was not significant (p > 0.05). No significant difference was found in fracture resistance of different post and core systems with the same preparation approach (p > 0.05). CLPF showed the highest frequency of favorable, and CLF showed the highest frequency of unfavorable fractures. CONCLUSION CLPF yielded lower fracture resistance than CMR. The difference in fracture resistance was not significant between CLF and CMR but the frequency of unfavorable fractures was higher in CLF than in other groups.
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Affiliation(s)
- Mehran Falahchai
- Department of Prosthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Naghmeh Musapoor
- Department of Prosthodontics, School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Soroosh Mokhtari
- Department of Prosthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Yasamin Babaee Hemmati
- Department of Orthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Neshandar Asli
- Department of Prosthodontics, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
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Mulla SA, Patil A, Mali S, Jain A, Sharma D, Jaiswal HC, Saoji HA, Jakhar A, Talekar S, Singh S. Exploring the Biological Width in Dentistry: A Comprehensive Narrative Review. Cureus 2023; 15:e42080. [PMID: 37602053 PMCID: PMC10434820 DOI: 10.7759/cureus.42080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Biological width (BW) is the distance established from the junctional epithelium and connective tissue attachment to the root surface of a tooth. It acts as a natural seal protecting the tooth from infections and diseases. The normal dimension of it is 2.04 mm on average. A periodontal probe is used to determine BW in routine clinical practice. Various methods are available for the determination of BW. A diagnosis of BW violation is asserted when the distance is found to be less than 2 mm at single or multiple locations. Gingival health is of utmost importance when considering the long-term health of the tooth as well as any restoration. A plethora of BW violations can lead to a myriad of complications, which are discussed briefly in this article. The article also aims to highlight BW in relation to restorative margins and implants and its clinical assessment as well as shed light on the procedure that can be employed to correct BW violations in dental practice.
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Affiliation(s)
- Sayem A Mulla
- Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Amit Patil
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Sheetal Mali
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Ashish Jain
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Deepak Sharma
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Himmat C Jaiswal
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Hrishikesh A Saoji
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Ashima Jakhar
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Shefali Talekar
- Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
| | - Shruti Singh
- Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
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Matuck B, Ferraz da Silva LF, Warner BM, Byrd KM. The need for integrated research autopsies in the era of precision oral medicine. J Am Dent Assoc 2023; 154:194-205. [PMID: 36710158 PMCID: PMC9974796 DOI: 10.1016/j.adaj.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Autopsy has benefited the practice of medicine for centuries; however, its use to advance the practice of oral health care is relatively limited. In the era of precision oral medicine, the research autopsy is poised to play an important role in understanding oral-systemic health, including infectious disease, autoimmunity, craniofacial genetics, and cancer. TYPES OF STUDIES REVIEWED The authors reviewed relevant articles that used medical and dental research autopsies to summarize the advantages of minimally invasive autopsies of dental, oral, and craniofacial tissues and to outline practices for supporting research autopsies of the oral and craniofacial complex. RESULTS The authors provide a historical summary of research autopsy in dentistry and provide a perspective on the value of autopsies for high-resolution multiomic studies to benefit precision oral medicine. As the promise of high-resolution multiomics is being realized, there is a need to integrate the oral and craniofacial complex into the practice of autopsy in medicine. Furthermore, the collaboration of autopsy centers with researchers will accelerate the understanding of dental, oral, and craniofacial tissues as part of the whole body. CONCLUSIONS Autopsies must integrate oral and craniofacial tissues as part of biobanking procedures. As new technologies allow for high-resolution, multimodal phenotyping of human samples, using optimized sampling procedures will allow for unprecedented understanding of common and rare dental, oral, and craniofacial diseases in the future. PRACTICAL IMPLICATIONS The COVID-19 pandemic highlighted the oral cavity as a site for viral infection and transmission potential; this was only discovered via clinical autopsies. The realization of the integrated autopsy's value in full body health initiatives will benefit patients across the globe.
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Affiliation(s)
- Bruno Matuck
- Department of Pathology, School of Medicine University of São Paulo, São Paulo, Brazil
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Blake M. Warner
- Salivary Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Kevin Matthew Byrd
- Salivary Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lab of Oral & Craniofacial Innovation (LOCI), Department of Innovation and Technology Research, ADA Science & Research Institute, Gaithersburg, MD, USA
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12
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Periodontal tissue changes after crown lengthening surgery: A systematic review and meta-analysis. Saudi Dent J 2023; 35:294-304. [DOI: 10.1016/j.sdentj.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
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13
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Bruhnke M, Beuer F, Böse MWH, Naumann M. Forced orthodontic extrusion to restore extensively damaged anterior and premolar teeth as abutments for single-crown restorations: Up to 5-year results from a pilot clinical study. J Prosthet Dent 2023; 129:61-68. [PMID: 36535882 DOI: 10.1016/j.prosdent.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 12/23/2022]
Abstract
STATEMENT OF PROBLEM Clinical data on orthodontic extrusion to restore teeth deemed unrestorable because of their defect size are scarce. It remains unclear for which defects forced orthodontic extrusion and tooth retention is preferred to extraction. PURPOSE The purpose of this pilot clinical study was to investigate the survival, frequency, and type of complications of extensively damaged teeth requiring single-crown restorations after forced orthodontic extrusion. MATERIAL AND METHODS Participants were recruited from consecutive patients in need of restorative treatment of extensively damaged teeth at a university clinic. The teeth were orthodontically extruded to reestablish the biologic width and to ensure a 2-mm ferrule preparation before restoration. The primary endpoint was restoration success and survival. At recall, survival was defined as the tooth being in situ and success as a symptom-free tooth with an intact, caries-free restoration and with physiological pocket probing depths, no signs of intrusion, ankylosis, root resorption, or periapical radiolucency. Recalls were performed every 6 months; the outcome was assessed by radiographic and clinical evaluation after up to 5 years of clinical service. Quantitative parameters were described with mean values and standard deviations. RESULTS Thirty-four participants were assessed for eligibility and enrolled (mean ±standard deviation age: 53.4 ±18.9 years). Four participants were premature dropouts. Data were analyzed for 35 teeth in 30 participants. The amount of extrusion varied between 2 and 6 mm (mean ±standard deviation 3.4 ±0.9 mm). The mean duration of extrusion was 18.9 ±12.6 days and the mean duration of retention was 126.94 ±88.1 days. The mean ±standard deviation crown-to-root ratio after treatment was 0.8 ±0.1 (range: 0.5 to 1.0). Three participants exhibited orthodontic relapse before restoration. Teeth were successfully restored after repeated extrusion. After a mean observation period of 3.3 years (range: 1 to 5.2 years), 29 of 31 teeth were still in situ. Two teeth were fractured, and 4 participants were not available for recall. Thus, the survival rate was 94%. No resorption or periapical translucencies were observed radiographically. Clinical examinations revealed physiological probing depths and absence of ankyloses. One tooth presented with marginal bone loss. The most frequent type of complication was orthodontic relapse at recall (n=3). A total of 84% of teeth were considered a success. CONCLUSIONS Forced orthodontic extrusion allowed for the restoration of anterior and premolar teeth deemed as nonrestorable because of their defect size. Tooth retention of extensively damaged teeth and their use as abutments for single-crown restorations can be recommended.
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Affiliation(s)
- Maria Bruhnke
- Assistant Professor, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Florian Beuer
- Professor, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mats Wernfried Heinrich Böse
- Assistant Professor, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Michael Naumann
- Professor, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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14
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Eggmann F, Ayub JM, Conejo J, Blatz MB. Deep margin elevation-Present status and future directions. J ESTHET RESTOR DENT 2023; 35:26-47. [PMID: 36602272 DOI: 10.1111/jerd.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Deep margin elevation (DME) is a treatment approach to relocate the cervical margin of teeth with subgingival defects to a supragingival position with a direct restoration to facilitate rubber dam isolation, impression taking, and bonding of indirect restorations. This article provides an overview of the current scientific evidence on DME and future directions for research. OVERVIEW The review included 38 studies on DME, most conducted in vitro. These studies indicate that DME has no detrimental effect on the fracture resistance of restored teeth. Evidence on the impact of DME on marginal quality is conflicting, but most in vitro studies observed no negative effect. Clinical studies, most comprising small patient cohorts, demonstrated favorable restorative outcomes and suggest that DME restorations made with scrupulous care are compatible with periodontal health. Bleeding on probing may occur more frequently at sites with DME, though evidence on this is not unequivocal. CONCLUSIONS Current evidence, based largely on laboratory studies and limited clinical data, supports DME as a viable approach to restore teeth with localized subgingival defects. However, further clinical studies with long-term follow-ups are required to provide corroborative evidence. CLINICAL SIGNIFICANCE Current evidence suggests that DME is a viable approach to restore teeth with localized subgingival defects as a possible alternative to surgical crown lengthening. Proper working field isolation, meticulous care in the bonding and buildup procedure, and biofilm removal through patient-performed oral hygiene and professional maintenance care are crucial. As scant clinical trial-based evidence is available today, further research is needed to evaluate the long-term performance of DME restorations and their impact on periodontal health.
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Affiliation(s)
- Florin Eggmann
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Jose M Ayub
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julián Conejo
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Buonavoglia A, Pellegrini F, Lanave G, Diakoudi G, Lucente MS, Zamparini F, Camero M, Gandolfi MG, Martella V, Prati C. Analysis of oral microbiota in non-vital teeth and clinically intact external surface from patients with severe periodontitis using Nanopore sequencing: a case study. J Oral Microbiol 2023; 15:2185341. [PMID: 36891191 PMCID: PMC9987744 DOI: 10.1080/20002297.2023.2185341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Periodontal diseases include a wide range of pathological conditions, damaging the supporting structures of the teeth. Origin and propagation of periodontal disease is believed to be caused by dysbiosis of the commensal oral microbiota. The aim of this study was to evaluate the presence of bacteria in the pulp cavity of teeth with severe periodontal disease with clinically intact external surface. Periodontal (P) and endodontic (E) tissue samples of root canals from six intact teeth of three patients were sampled for analysis of microbial population using Nanopore technology. Streptococcus was the predominant genus in E samples. Porphyromonas (33.4%, p = 0.047), Tannerella (41.7%, p = 0.042), and Treponema (50.0%, p = 0.0064) were significantly more present in P than in E samples. Some samples (E6 and E1) exhibited a remarkable difference in terms of microbial composition, whilst Streptococcus was a common signature in samples E2 to E5, all which were obtained from the same patient. In conclusion, bacteria were identified on both the root surface and the root canal system, thus demonstrating the possibility of bacteria to spread directly from the periodontal pocket to the root canal system even in the absence of crown's loss of integrity.
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Affiliation(s)
- Alessio Buonavoglia
- Department of Biomedical and Neuromotor Sciences, Dental School, University of Bologna, Bologna, Italy
| | | | - Gianvito Lanave
- Department of Veterinary Medicine, University of Bari, Valenzano, Bari, Italy
| | - Georgia Diakoudi
- Department of Veterinary Medicine, University of Bari, Valenzano, Bari, Italy
| | - Maria Stella Lucente
- Department of Biomedical and Neuromotor Sciences, Dental School, University of Bologna, Bologna, Italy
| | - Fausto Zamparini
- Department of Veterinary Medicine, University of Bari, Valenzano, Bari, Italy
| | - Michele Camero
- Department of Biomedical and Neuromotor Sciences, Dental School, University of Bologna, Bologna, Italy
| | | | - Vito Martella
- Department of Biomedical and Neuromotor Sciences, Dental School, University of Bologna, Bologna, Italy
| | - Carlo Prati
- Department of Biomedical and Neuromotor Sciences, Dental School, University of Bologna, Bologna, Italy
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16
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Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101482. [PMID: 36295642 PMCID: PMC9610387 DOI: 10.3390/medicina58101482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed.
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17
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Lee SJ, Kim EH, Lee DK, Song IS, Jun SH. The effect of loading time on marginal bone change of implants immediately placed after extraction: a retrospective study. Int J Implant Dent 2022; 8:44. [PMID: 36194298 PMCID: PMC9532494 DOI: 10.1186/s40729-022-00442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to compare and analyze the treatment outcomes between two groups which are both immediately placed implant cases, one is immediate loading, and the other is conventional loading group. METHODS Medical records of the patients who underwent implant treatment which were immediately placed after tooth extraction were analyzed. Demographic data were collected and by using periapical or panoramic radiographic image, marginal bone level and distant crestal bone level were measured. Marginal bone change over time was analyzed and compared between immediate loading group and conventional loading group. RESULTS A total of 71 patients, 112 immediately placed implants after tooth extraction were initially involved. Measuring was done with implants which had not failed (81). 10 implants were had failed and removed. The others were excluded because of follow-up loss, absence of radiographic image, etc. Demographic data were collected, and measured values were averaged at each follow-up and showed in linear graphs. CONCLUSIONS In case of immediate implantation of dental implant after extraction, loading time could affect marginal bone level or biological width of the implant. Immediate loading group showed 0.92 mm (mean value) more bone loss compared to conventional loading group at bone-implant contact points 24 months after implantation. At distant crestal points, there was no noticeable difference in bone change pattern between two groups.
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Affiliation(s)
- Sung-Jae Lee
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, Republic of Korea
| | - Euy-Hyun Kim
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, Republic of Korea
| | - Dong-Keon Lee
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, Republic of Korea
| | - In-Seok Song
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, Republic of Korea
| | - Sang-Ho Jun
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, Republic of Korea.
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18
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Moore CA, Law JK, Retout M, Pham CT, Chang KCJ, Chen C, Jokerst JV. High-resolution ultrasonography of gingival biomarkers for periodontal diagnosis in healthy and diseased subjects. Dentomaxillofac Radiol 2022; 51:20220044. [PMID: 35522698 PMCID: PMC10043620 DOI: 10.1259/dmfr.20220044] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the capacity of ultrasonographic image-based measurements of gingival height and alveolar bone level for monitoring periodontal health and disease. METHODS Sixteen subjects were recruited from patients scheduled to receive dental care and classified as periodontally healthy (n = 10) or diseased (n = 6) according to clinical guidelines. A 40-MHz ultrasound system was used to measure gingival recession, gingival height, alveolar bone level, and gingival thickness from 66 teeth for comparison to probing measurements of pocket depth and clinical attachment level. Interexaminer variability and comparison between ultrasound measurements and probing measurements was performed via Bland-Altman analysis. RESULTS Gingival recession and its risk in non-recessed patients could be determined via measurement of the supra- and subgingival cementoenamel junction relative to the gingival margin. Interexaminer bias for ultrasound image analysis was negligible (<0.10 mm) for imaged gingival height (iGH) and 0.45 mm for imaged alveolar bone level (iABL). Diseased subjects had significantly higher imaging measurements (iGH, iABL) and clinical measurements (probing pocket depth, clinical attachment level) than healthy subjects (p < 0.05). Subtraction of the average biologic width from iGH resulted in 83% agreement (≤1 mm difference) between iGH and probing pocket depth measurements. CONCLUSIONS Ultrasonography has an equivalent diagnostic capacity as gold-standard physical probing for periodontal metrics while offering more detailed anatomical information.
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Affiliation(s)
- Colman A Moore
- Department of NanoEngineering, University of California, San Diego, 9500 Gilman Drive. La Jolla, CA, USA
| | - Jane K Law
- Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA, USA
| | - Maurice Retout
- Department of NanoEngineering, University of California, San Diego, 9500 Gilman Drive. La Jolla, CA, USA
| | - Christopher T Pham
- Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA, USA
| | - Kai Chiao J Chang
- Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA, USA
| | - Casey Chen
- Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA, USA
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19
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Assessment of Negative Gingival Recession: A Critical Component of Periodontal Diagnosis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accurate measurement of negative gingival recession (GR) is essential to accurately determine the clinical attachment loss, which leads to an accurate diagnosis and optimal therapy of periodontal disease. However, the accuracy of measuring the negative GR has been shown to be low and highly variable between examiners. The position of the gingiva margin in relation to the cemento-enamel junction (CEJ) varies among different stages of passive eruption. The amount of negative GR is about 2 mm on average at the mid-facial sites and ranges from 2 to 3.5 mm at interproximal sites in periodontally healthy patients. Some other clinical conditions may change the gingival dimension coronal to the CEJ, such as altered passive eruption and gingival enlargement. In addition to the traditional approach using a periodontal probe to assess the negative GR, nowadays dental ultrasound imaging may be able to assist in accurately measuring the amount of negative GR. This narrative review will discuss the existing evidence of the dimension of dentogingival tissue and the clinical assessment of negative GR using different clinical tools.
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20
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Shahzad Dowlatshahi M, Anoosh G, Alania J, Latimer JM. Crown Lengthening Techniques and Modifications to Treat Excessive Gingival Display. Dent Clin North Am 2022; 66:361-372. [PMID: 35738732 DOI: 10.1016/j.cden.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Dental aesthetics are a fundamental treatment goal in dentistry, in which even minute deviations from the ideal may necessitate corrective treatment or constitute a suboptimal clinical outcome. A well-defined protocol that adheres to sound biological and surgical principles is necessary to harmoniously integrate the dental and periodontal components. This article reviews clinical and aesthetic guidelines based on these principles for clinical crown lengthening.
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Affiliation(s)
| | - Ghazal Anoosh
- Department of Periodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Jorge Alania
- Private Practice, Victor Maurtua Avenue 140, Office 407, San Isidro, Lima, Peru
| | - Jessica M Latimer
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
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21
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Deep Margin Elevation: A Literature Review. Dent J (Basel) 2022; 10:dj10030048. [PMID: 35323250 PMCID: PMC8947734 DOI: 10.3390/dj10030048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.
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22
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Chung HM, Park JY, Ko KA, Kim CS, Choi SH, Lee JS. Periodontal probing on digital images compared to clinical measurements in periodontitis patients. Sci Rep 2022; 12:1616. [PMID: 35102150 PMCID: PMC8803931 DOI: 10.1038/s41598-021-04695-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of the study was to compare the supra-alveolar gingival dimension (GD) and the clinical pocket probing depth (PD) by combining data from an intraoral scanner (IOS) and cone-beam computed tomography (CBCT) and identify the clinical features affecting the clinical PD. 1,071 sites from 11 patients were selected for whom CBCT, IOS images, and periodontal charts were recorded at the same visit. CBCT and IOS data were superimposed. GD was measured on cross-sectional images of the probed sites. The level of agreement and correlation between GD and PD were assessed for the entire population and within groups (treated vs untreated, bleeding on probing [BOP] vs no BOP, and PDs of 0–3 mm vs 4–5 mm vs ≥ 6 mm). The mean [± SD] difference between GD and PD was 0.82 [± 0.69] mm, and they were positively correlated (r = 0.790, p < 0.001). The correlations between GD and PD were stronger for untreated sites, sites with BOP, and sites with a larger PD. Within the limitations of this study, the similarity between GD and PD may suggest a possible tendency of overestimation when recording PD.
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23
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Lu JW, Shi X, Huang SH, Yan XZ, Hu CJ, Shi MY, Luo LJ. A novel cone-beam CT scanning technique for measuring periodontal soft tissues in the esthetic area. J Oral Sci 2022; 64:212-217. [DOI: 10.2334/josnusd.22-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jia-wei Lu
- Department of Periodontics, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration
| | - Xiong Shi
- Department of Radiology, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration
| | - Shi-hui Huang
- Department of Periodontics, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration
| | - Xiang-zhen Yan
- Department of Periodontics, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration
| | - Cong-jiao Hu
- Department of Periodontics, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration
| | - Ming-yan Shi
- Department of Periodontics, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration
| | - Li-jun Luo
- Department of Periodontics, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration
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Skośkiewicz-Malinowska K, Mysior M, Rusak A, Kuropka P, Kozakiewicz M, Jurczyszyn K. Application of Texture and Fractal Dimension Analysis to Evaluate Subgingival Cement Surfaces in Terms of Biocompatibility. MATERIALS 2021; 14:ma14195857. [PMID: 34640254 PMCID: PMC8510438 DOI: 10.3390/ma14195857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
Biocompatibility is defined as “the ability of a biomaterial, prosthesis, or medical device to perform with an appropriate host response in a specific application”. Biocompatibility is especially important for restorative dentists as they use materials that remain in close contact with living tissues for a long time. The research material involves six types of cement used frequently in the subgingival region: Ketac Fil Plus (3M ESPE, Germany), Riva Self Cure (SDI, Australia) (Glass Ionomer Cements), Breeze (Pentron Clinical, USA) (Resin-based Cement), Adhesor Carbofine (Pentron, Czech Republic), Harvard Polycarboxylat Cement (Harvard Dental, Great Britain) (Zinc polycarboxylate types of cement) and Agatos S (Chema-Elektromet, Poland) (Zinc Phosphate Cement). Texture and fractal dimension analysis was applied. An evaluation of cytotoxicity and cell adhesion was carried out. The fractal dimension of Breeze (Pentron Clinical, USA) differed in each of the tested types of cement. Adhesor Carbofine (Pentron, Czech Republic) cytotoxicity was rated 4 on a 0–4 scale. The Ketac Fil Plus (3M ESPE, Germany) and Riva Self Cure (SDI, Australia) cements showed the most favorable conditions for the adhesion of fibroblasts, despite statistically significant differences in the fractal dimension of their surfaces.
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Affiliation(s)
| | - Martyna Mysior
- SCTT Academic Dental Polyclinic, 50-425 Wroclaw, Poland
- Correspondence:
| | - Agnieszka Rusak
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Piotr Kuropka
- Division of Histology and Embryology, Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland;
| | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 90-647 Lodz, Poland;
| | - Kamil Jurczyszyn
- Department of Dental Surgery, Wroclaw Medical University, 50-425 Wroclaw, Poland;
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Pre-endodontic restoration of structurally compromised teeth: current concepts. Br Dent J 2021; 231:343-349. [PMID: 34561585 PMCID: PMC8463293 DOI: 10.1038/s41415-021-3467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
Teeth that require endodontic treatment are often structurally compromised and this considerably complicates endodontic procedures. Therefore, pre-endodontic restoration is a key approach that dentists should consider for such teeth. This article discusses current concepts of pre-endodontic restoration, with a focus on adhesive restorative methods and surgical/orthodontic techniques, and provides a relevant decision-making flowchart. Highlights the importance of pre-endodontic restoration for the predictability of endodontic treatment. Discusses restorability aspects for structurally compromised teeth. Reviews current restorative and surgical/orthodontic techniques for pre-endodontic restoration and provides a decision-making flowchart.
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Cordaro M, Staderini E, Torsello F, Grande NM, Turchi M, Cordaro M. Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9530. [PMID: 34574454 PMCID: PMC8469087 DOI: 10.3390/ijerph18189530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.
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Affiliation(s)
- Martina Cordaro
- IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Roma, Italy; (M.C.); (F.T.); (N.M.G.); (M.T.); (M.C.)
- Department of Orthodontics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Department of Endodontics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Edoardo Staderini
- IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Roma, Italy; (M.C.); (F.T.); (N.M.G.); (M.T.); (M.C.)
- Department of Orthodontics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ferruccio Torsello
- IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Roma, Italy; (M.C.); (F.T.); (N.M.G.); (M.T.); (M.C.)
- Department of Orthodontics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Nicola Maria Grande
- IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Roma, Italy; (M.C.); (F.T.); (N.M.G.); (M.T.); (M.C.)
- Department of Endodontics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Matteo Turchi
- IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Roma, Italy; (M.C.); (F.T.); (N.M.G.); (M.T.); (M.C.)
- Department of Orthodontics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Massimo Cordaro
- IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Roma, Italy; (M.C.); (F.T.); (N.M.G.); (M.T.); (M.C.)
- Department of Orthodontics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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Zhang H, Li H, Cong Q, Zhang Z, Du A, Wang Y. Effect of proximal box elevation on fracture resistance and microleakage of premolars restored with ceramic endocrowns. PLoS One 2021; 16:e0252269. [PMID: 34038489 PMCID: PMC8153463 DOI: 10.1371/journal.pone.0252269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background Restoration of endodontically treated premolar is in high risk for biomechanical failure, and often presents with subgingival margins. Proximal box elevation (PBE) has been used to relocate subgingival cavity outlines. Objective To evaluate the influence of PBE on fracture resistance and gingival microleakage of premolars with endodontic access cavities following ceramic endocrown. Methods Eighty sound maxillary premolars with standardized Class II cavities on mesial surfaces were randomly assigned to four groups (n = 20 in each group). Groups E1, E2 and E3, with proximal margins located in dentin/cementum, 2 mm below the cemento-enamel junction (CEJ), simulated subgingival location. Group E4 (supragingival group), with proximal margins located in enamel, 1 mm above the CEJ, was used as the positive control. For margin elevation of the proximal cavities, bulk-fill Smart Dentin Replacement (SDR), a visible light cured resin composite, was applied in group E1, and conventional resin composite (3M Z350 XT, a light-activated composite) was placed in group E2. Group E3 was only treated with a ceramic crown and served as the negative control. In all groups, computer-aided design (CAD) ceramic endocrowns were adhesively inserted, and fracture resistance, failure mode and microleakage were evaluated. Results A higher fracture resistance value was observed in PBE groups E1 and E2, regardless of the materials used (P = 0.038, and 0.010, respectively, vs E3), and fracture resistance in group E1 was higher than that in group E2. In teeth without PBE, the percentage of catastrophic failures reached 70%. Compared to group E3, a lower frequency distribution of microleakage was detected in supragingival group E4 (P = 0.031). No increased percentage of microleakage was observed in groups treated with PBE. Conclusion For endodontically treated maxillary premolars restored with ceramic endocrowns, PBE increases fracture resistance but not microleakage.
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Affiliation(s)
- Hong Zhang
- Hospital of Stomatology, Jilin University, Changchun, P.R China
| | - He Li
- Hospital of Stomatology, Jilin University, Changchun, P.R China
| | - Qian Cong
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, P.R China
| | - Zhimin Zhang
- Hospital of Stomatology, Jilin University, Changchun, P.R China
- * E-mail:
| | - Aobo Du
- Hospital of Stomatology, Jilin University, Changchun, P.R China
| | - Ying Wang
- Hospital of Stomatology, Jilin University, Changchun, P.R China
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Periodontal response to a tricalcium silicate material or resin composite placed in close contact to the supracrestal tissue attachment: a histomorphometric comparative study. Clin Oral Investig 2021; 25:5743-5753. [PMID: 33855658 DOI: 10.1007/s00784-021-03876-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Subgingival dental restorations and periodontal health have been studied for many years; however, there is a low histological evidence on the behavior of new materials in the supracrestal tissue attachment. The aim of this study is to analyze the periodontal response when a tricalcium silicate material (TSM) or composite margin restorations is placed to 0.5 mm and 1.5 mm from the bone crest with a histomorphometric analysis in dogs. METHODS Nine mongrel dogs were used in this study: four dogs (8 canine teeth) for TSM group, 4 dogs (8 canine teeth) for composite group, and 1 dog (2 canine teeth) with cavities without restorations. Cavity preparation of 2×2×1 mm was created on the buccal aspect of the canines at 0.5 and 1.5 mm of the crestal bone. Cavities were restored with composite and TSM or were left unrestored as control. After 12 weeks of healing, the dogs were euthanized and blocks containing the tooth and soft tissues were processed. RESULTS In all the specimens, the junction epithelium was stablished apical to the tooth preparations. A shorter distance to the bone (0.5 cavity) implies greater apical periodontal migration regardless of the material used. In the TSM groups, the connective tissue height and the distance between bone level and apical margin preparation were greater than those in the composite groups, while the epithelium height was less. However, there were no statistically significant differences comparing TSM and composite groups at either 0.5 mm or 1.5 mm (p > 0.05). CONCLUSION Histologic analysis did not show periodontal reattachment to TSM or composite. In both cases, bone crest migrates apically. For that reason, it is recommended to perform composite restorations at the subgingival level whenever the distance to the bone crest is at least 2 mm. CLINICAL RELEVANCE Both composite and TSM do not achieve reinsertion of the connective tissue in the biological width.
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Raigrodski AJ. Multipurpose application of custom, rigid, clear matrix for fabricating trial restorations, tooth preparation guides, and interim veneers. J Prosthet Dent 2021; 128:560-565. [PMID: 33745684 DOI: 10.1016/j.prosdent.2020.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
Interim veneers present an esthetic and functional challenge for restorative dentists. Moreover, inadequate fit or trauma to the soft tissue during their fabrication or subsequently may affect soft-tissue health and stability and lead to bleeding that will compromise the adhesive cementation of the definitive ceramic veneers. This article describes a technique for the atraumatic fabrication of interim veneers with a custom, rigid, clear matrix designed for multipurpose use during the patient's restorative care. Based on a diagnostic waxing, the clear matrix is made and first used for the fabrication of the trial restorations and as a tooth-preparation guide. Subsequently, it is used for the atraumatic fabrication of interim veneers with a photopolymerizing direct restorative material.
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Affiliation(s)
- Ariel J Raigrodski
- Private practice, Lynnwood, Wash; Affiliate Professor, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash.
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Ercoli C, Tarnow D, Poggio CE, Tsigarida A, Ferrari M, Caton JG, Chochlidakis K. The Relationships Between Tooth-Supported Fixed Dental Prostheses and Restorations and the Periodontium. J Prosthodont 2020; 30:305-317. [PMID: 33210761 DOI: 10.1111/jopr.13292] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses. MATERIALS AND METHODS PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design. RESULTS While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs. CONCLUSIONS Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.
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Affiliation(s)
- Carlo Ercoli
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Dennis Tarnow
- Department of Periodontics, Columbia University College of Dentistry, New York, NY
| | - Carlo E Poggio
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Alexandra Tsigarida
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Marco Ferrari
- Department of Medical Biotechnologies, Division of Fixed Prosthodontics, Dean, University of Siena, Siena, Italy
| | - Jack G Caton
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Konstantinos Chochlidakis
- Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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Vertolli TJ, Martinsen BD, Hanson CM, Howard RS, Kooistra S, Ye L. Effect of Deep Margin Elevation on CAD/CAM-Fabricated Ceramic Inlays. Oper Dent 2020; 45:608-617. [PMID: 32243253 DOI: 10.2341/18-315-l] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Using the deep margin elevation technique in preparations extending beyond the cemento-enamel junction appears to be beneficial in maintaining structural integrity of CAD/CAM-fabricated feldspathic ceramic inlays. SUMMARY Objective: To evaluate the effect of deep margin elevation on structural and marginal integrity of ceramic inlays.Methods and Materials: Forty extracted human third molars were collected and randomly separated into four groups (n=10/group). In group 1 (enamel margin group), the gingival margin was placed 1 mm supragingival to the cemento-enamel junction (CEJ). In group 2 (cementum margin group), the gingival margin was placed 2 mm below the CEJ. In group 3 (glass ionomer [GI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with GI to the CEJ. In group 4 (resin-modified glass ionomer [RMGI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with RMGI to the CEJ. Standardized ceramic class II inlays were fabricated with computer-aided design/computer-aided manufacturing and bonded to all teeth, and ceramic proximal box heights were measured. All teeth were subjected to 10,000 cycles of thermocycling (5°C/55°C) and then underwent 1,200,000 cycles of vertical chewing simulation at 50 N of force. Ceramic restorations and marginal integrity were assessed with a Hirox digital microscope. The Fisher exact test (two-tailed) with adjusted p-values (α=0.05) and logistic regression were used for statistical analysis.Results: The cementum margin group had a significantly higher ceramic fracture rate (90%) compared to other groups (10% in enamel margin and GI margin groups, p=0.007; 0% in RMGI group, p<0.001). Logistic regression showed that with increased ceramic proximal box heights, the probability of ceramic fracture increased dramatically.Conclusion: Deep marginal elevation resulted in decreased ceramic fracture when preparation margins were located below the CEJ. There was no difference found between margin elevation with GI or RMGI. Increased heights of ceramic proximal box may lead to an increased probability of ceramic fracture.
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The Complications of Biologic Width in Esthetic Anterior Restorations: A Case Report and Review. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2020. [DOI: 10.4028/www.scientific.net/jbbbe.48.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The biologic width is a specific concept that refers to the dimensional relationship between epithelial attachment, sulcus depth, connective tissue attachment, and alveolar crest. A harmony and precise relationship between periodontal tissue and the restoration of the teeth is fundamental to ensure function and esthetic. Biologic width includes both the connective tissue attachment and the junctional epithelium and has a mean dimension of approximately 2 mm. Violation of biologic width can result in localized crestal bone loss, gingival recession, localized gingival hyperplasia, or a combination of these three. Maintenance of gingival health is one of the keys to the longevity of both the teeth and restorations. A clinical crown lengthening procedure is needed to establish the biologic width, in a condition where a restored tooth developed a subgingival caries, fractured below the gingival attachment or failed crown restoration. This article presents a case reports and review that utilized gingivectomy procedures to corrected the complications because of the violation of biologic width.
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Walter C, Schmidt JC, Rinne CA, Mendes S, Dula K, Sculean A. Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: systematic review update. Clin Oral Investig 2020; 24:2943-2958. [DOI: 10.1007/s00784-020-03326-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
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Carvalho BAS, Duarte CAB, Silva JF, Batista WWDS, Douglas-de-Oliveira DW, de Oliveira ES, Soares LDG, Galvão EL, Rocha-Gomes G, Glória JCR, Gonçalves PF, Flecha OD. Clinical and radiographic evaluation of the Periodontium with biologic width invasion. BMC Oral Health 2020; 20:116. [PMID: 32299404 PMCID: PMC7164352 DOI: 10.1186/s12903-020-01101-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background The biologic width is defined as the coronal dimension to the alveolar bone that is occupied by healthy gingival tissue. The objective of the present study was to correlate radiographic findings of biologic width invasion with the periodontium status. Methods It were included 14 patients with restored teeth with biological width invasion, on the proximal sites, observed clinically and radiographically. 122 proximal sites were evaluated, 61 in the test group (biological width invasion) and 61 in the control group (adequate biological width). Smokers and patients presenting periodontal disease or restorations with contact in eccentric movements, horizontal over-contour or secondary caries were excluded from the sample. The invasion of the biologic width was diagnosed when the distance from the gingival margin of restoration to the bony crest was less than 3 mm. Intrabony defect and bone crest level, as well as, their vertical and horizontal components were radiographically evaluated when present. Plaque index, bleeding on probing, probing depth, gingival recession height, keratinized gingival height and thickness, and clinical attachment level were clinically evaluated. Data were subjected to Spearman’s Correlation and Wilcoxon’s test. Result The most prevalent tooth with biological width invasion was the first molar. There was a statistically significant correlation between the bone crest (p < 0.001), vertical (p < 0.001) and horizontal (p = 0.001) components. In the test group, there was a statistically significant correlation between bleeding on probing (p < 0.001; r = 0.618) and width of gingival recession (p = 0.030; r = − 0.602) with the intraosseous component; and between keratinized gingival height and bone level (p = 0.037; r = − 0.267). In the control group, there was a correlation between plaque index (p = 0.027; r = − 0.283) with bone level and correlation between keratinized gingival thickness and bone level (p = 0.034; r = − 0.273) and intrabony component (p = 0.042; r = 0.226). Conclusion A statistically significant relationship was found between bleeding on probing and gingival recession in patients who presented intrabony defects due to the invasion of biological width, which may be also related to the thickness of the keratinized gingiva.
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Affiliation(s)
- Bruna Almeida Silva Carvalho
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - César Augusto Barroso Duarte
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Jaciara Fagundes Silva
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Walter Winícius da Silva Batista
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Dhelfeson Willya Douglas-de-Oliveira
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil.
| | - Evandro Silveira de Oliveira
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Luana de Goés Soares
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Endi Lanza Galvão
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Gabriela Rocha-Gomes
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - José Cristiano Ramos Glória
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Patrícia Furtado Gonçalves
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
| | - Olga Dumont Flecha
- Department of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys, Rua da Glória, n° 187. Centro, Diamantina, MG, 39100-000, Brazil
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Stability of the gingival margin after an aesthetic crown lengthening procedure in the anterior region by means of a replaced flap and buccal osseous surgery: a prospective study. Clin Oral Investig 2020; 24:3633-3640. [PMID: 32124069 DOI: 10.1007/s00784-020-03239-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The main objective of this study was to assess changes in the position of the gingival margin (GM) after performing an aesthetic crown lengthening (ACLP) by means of submarginal incisions, buccal osseous surgery, and a replaced flap after a healing period of 6 months. METHODS Twenty-one patients who needed a surgical crown lengthening in the maxillary anterior teeth were included. An individual stent was fabricated to record changes in the position of the GM. Clinical measurements were recorded pre-surgically; immediately post-surgically (baseline); and at 42, 90, and 180 days. RESULTS After the ACLP, the GM displacement did not change significantly after 42, 90, and 180 days (4.32 ± 1.17 mm, 4.29 ± 1.14 mm, and 4.26 ± 1.11 mm, respectively). Tissue rebound seems to be related to the distance from the GM to the alveolar bone (AB) at the time of suturing (GM-AB(X)). When GM-AB(X) was ≤ 2 mm, 3 mm, and ≥ 4 mm, the GM rebound at 6 months was 0.94 ± 0.53 mm, 0.10 ± 0.28 mm, and - 0.26 ± 0.40 mm, respectively. These differences were statistically significant (P < 0.001). CONCLUSIONS An ACLP releasing the flap up to the mucogingival junction, with a ≥ 3-mm distance from the bone crest to the gingival margin can lead to a stable GM position at 42, 90, and 180 days. CLINICAL RELEVANCE This article focuses on variables affecting the stability of the GM, which is a critical factor that may compromise the biological and aesthetic long-term outcomes.
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Ercoli C, Caton JG. Dental prostheses and tooth-related factors. J Periodontol 2019; 89 Suppl 1:S223-S236. [PMID: 29926939 DOI: 10.1002/jper.16-0569] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This narrative review summarizes the current evidence about the role that the fabrication and presence of dental prostheses and tooth-related factors have on the initiation and progression of gingivitis and periodontitis. FINDINGS Placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession. The presence of fixed prostheses finish lines within the gingival sulcus or the wearing of partial, removable dental prostheses does not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. However, hypersensitivity reactions to the prosthesis dental material can be present. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of periodontal supporting tissues. Tooth anatomic factors, root abnormalities, and fractures can act as plaque-retentive factors and increase the likelihood of gingivitis and periodontitis. CONCLUSIONS Tooth anatomic factors, such as root abnormalities and fractures, and tooth relationships in the dental arch and with the opposing dentition can enhance plaque retention. Restoration margins located within the gingival sulcus do not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials have often been associated with plaque retention and loss of attachment. Hypersensitivity reactions can occur to dental materials. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. However, the evidence in several of the reviewed areas, especially related to the biologic mechanisms by which these factors affect the periodontium, is not conclusive. This highlights the need for additional well-controlled animal studies to elucidate biologic mechanisms, as well as longitudinal prospective human trials. Adequate periodontal assessment and treatment, appropriate instructions, and motivation in self-performed plaque control and compliance to maintenance protocols appear to be the most important factors to limit or avoid potential negative effects on the periodontium caused by fixed and removable prostheses.
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Affiliation(s)
- Carlo Ercoli
- Departments of Periodontics and Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Jack G Caton
- Department of Periodontics, Eastman Institute for Oral Health, University of Rochester
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Yang RQ, Guo SJ, Xiao SM, Ding Y. [Clinical application of laser in crown lengthening]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:551-555. [PMID: 31721507 DOI: 10.7518/hxkq.2019.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crown lengthening is one of the most common surgeries in clinical practice. Under the premise of ensuring the biologic width, the adequate crown is exposed by resecting the periodontal soft tissue and (or) hard tissue to meet the prosthodontic and (or) aesthetic requirements. Considering the various advantages of oral laser, such as safe, precise, minimally invasive and comfort, laser has become a promising technology which can be used to improve the traditional crown lengthening. In this review, the principles and characteristics of laser application in crown lengthening, especially in the minimally invasive or flapless crown lengthening will be reviewed. Its pros and cons will also be discussed.
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Affiliation(s)
- Ru-Qian Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shu-Juan Guo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shi-Meng Xiao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yi Ding
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Ercoli C, Caton JG. Dental prostheses and tooth-related factors. J Clin Periodontol 2019; 45 Suppl 20:S207-S218. [PMID: 29926482 DOI: 10.1111/jcpe.12950] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This narrative review summarizes the current evidence about the role that the fabrication and presence of dental prostheses and tooth-related factors have on the initiation and progression of gingivitis and periodontitis. FINDINGS Placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession. The presence of fixed prostheses finish lines within the gingival sulcus or the wearing of partial, removable dental prostheses does not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. However, hypersensitivity reactions to the prosthesis dental material can be present. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of periodontal supporting tissues. Tooth anatomic factors, root abnormalities, and fractures can act as plaque-retentive factors and increase the likelihood of gingivitis and periodontitis. CONCLUSIONS Tooth anatomic factors, such as root abnormalities and fractures, and tooth relationships in the dental arch and with the opposing dentition can enhance plaque retention. Restoration margins located within the gingival sulcus do not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials have often been associated with plaque retention and loss of attachment. Hypersensitivity reactions can occur to dental materials. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. However, the evidence in several of the reviewed areas, especially related to the biologic mechanisms by which these factors affect the periodontium, is not conclusive. This highlights the need for additional well-controlled animal studies to elucidate biologic mechanisms, as well as longitudinal prospective human trials. Adequate periodontal assessment and treatment, appropriate instructions, and motivation in self-performed plaque control and compliance to maintenance protocols appear to be the most important factors to limit or avoid potential negative effects on the periodontium caused by fixed and removable prostheses.
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Affiliation(s)
- Carlo Ercoli
- Departments of Periodontics and Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Jack G Caton
- Department of Periodontics, Eastman Institute for Oral Health, University of Rochester
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D'Silva E, Fraser D, Wang B, Barmak AB, Caton J, Tsigarida A. The association between gingival recession and buccal bone at maxillary anterior teeth. J Periodontol 2019; 91:484-492. [PMID: 31512742 DOI: 10.1002/jper.19-0375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/06/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gingival recession and a thin or absent buccal plate occur frequently at maxillary anterior teeth and necessitate careful treatment planning to prevent future complications. However, the association between these two conditions is unclear and the ability of gingival recession to predict underlying buccal bone deficiencies is unknown. Therefore, the aim of this study is to use clinical and radiographic data to test this association and determine the influence of demographic and clinical parameters on both conditions. METHODS This investigation comprised a single-center, retrospective study. Data were derived from periodontal examinations performed on 66 adult subjects. Corresponding cone-beam computed tomography images were used to measure the width of buccal bone at two points along the root surface and the distance between the bone crest and cemento-enamel junction (CEJ). Results were then analyzed to determine the association between the presence of gingival recession and the condition of radiographic buccal bone, as well as the relative contribution of demographic parameters and other clinical findings to gingival recession and buccal bone conditions. RESULTS Gingival recession was present at 32.9% of maxillary anterior teeth and was most common at canines, followed by lateral incisors and central incisors. Mean buccal bone widths were significantly less, and the distance between the CEJ and bone crest was significantly greater for teeth with recession. Accordingly, gingival recession was a significant predictor for buccal bone thickness <1 mm at the level of 4 mm apical to the CEJ (odds ratio 2.733, 95% confidence interval 1.644 to 4.543, P < 0.0001). Probing depths were related to the presence or absence of gingival recession, while patient sex, age, and the apico-coronal height of the gingiva were related to buccal bone thickness. CONCLUSION Within the limitations of this study, maxillary anterior teeth with pre-existing gingival recession were more likely to have thin (<1 mm) buccal bone.
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Affiliation(s)
- Eric D'Silva
- Department of Periodontology, Eastman Institute for Oral Healthy, University of Rochester, Rochester, NY
| | - David Fraser
- Department of Periodontology, Eastman Institute for Oral Healthy, University of Rochester, Rochester, NY
| | - Bokai Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Abdul Basir Barmak
- Department of Periodontology, Eastman Institute for Oral Healthy, University of Rochester, Rochester, NY
| | - Jack Caton
- Department of Periodontology, Eastman Institute for Oral Healthy, University of Rochester, Rochester, NY
| | - Alexandra Tsigarida
- Department of Periodontology, Eastman Institute for Oral Healthy, University of Rochester, Rochester, NY
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Bertoldi C, Monari E, Cortellini P, Generali L, Lucchi A, Spinato S, Zaffe D. Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations. Clin Oral Investig 2019; 24:1001-1011. [PMID: 31286261 DOI: 10.1007/s00784-019-02998-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the clinical and histological response of supracrestal periodontal tissues to subgingival composite restorations versus natural root surfaces MATERIAL AND METHODS: In 29 subjects with a single tooth requiring subgingival restorations, a deep margin elevation (DME) procedure with composite resin was applied. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and focal probing depth (PD) were measured at baseline, before DME, and after 3 months. The distance between the coronal marked (CM) point to the apical margin of the composite reconstruction (AMR), at baseline, and to the tip of the periodontal probe inserted to reach the bottom of the sulcus (APP), 3 months later, was measured. An all-around secondary flap, harvested to ensure the subsequent single-crown prosthetic rehabilitation was histologically processed. The histological inflammation degree was evaluated in areas of gingival tissues adjacent to the composite (group B) and adjacent to the natural surface of each single tooth (group A). RESULTS Significant FMPS, FMBS, and PD decreases were observed (p < 0.05). CM-AMR and CM-APP were significantly different (p < 0.05), suggesting an attachment gain after 3-months. The inflammation level of gingival tissue was similar in groups A and B (p > 0.05). CONCLUSIONS For the first time, this topic was clinically and histologically studied in humans. Subgingival restorations resulted compatible with gingival health, with levels similar to that of untreated root surfaces. CLINICAL RELEVANCE Deep margin elevation procedure produces favorable clinical and histological outcomes allowing a routine utilization in reconstructive dentistry.
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Affiliation(s)
- Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | - Emanuela Monari
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | | | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy.
| | - Andrea Lucchi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71,, 41124, Italy
| | | | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Bailey O, O’Connor C. Papilla management in sub-gingival, interproximal, direct composite restoration: a key step to success. Br Dent J 2019; 226:933-937. [DOI: 10.1038/s41415-019-0412-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Grubbs TD, Vargas M, Kolker J, Teixeira EC. Efficacy of Direct Restorative Materials in Proximal Box Elevation on the Margin Quality and Fracture Resistance of Molars Restored With CAD/CAM Onlays. Oper Dent 2019; 45:52-61. [PMID: 31084532 DOI: 10.2341/18-098-l] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effect of four direct restorative materials that can be used in the proximal box elevation (PBE) technique. METHODS AND MATERIALS Seventy-five molar teeth were randomly assigned to one of five groups (n=15): type II glass ionomer (GI), type II resin-modified glass ionomer (RMGI), resin-based composite (RBC), bulk-fill (BF) resin-based composite, and a control with no box elevation procedure. Specimens were prepared for a standard mesio-occlusal-distal, computer-aided design/computer-aided manufactured (CAD-CAM) resin, nanoceramic onlay with mesial cervical margins located 1 mm above the cementoenamel junction (CEJ) and distal cervical margins located 2 mm below the CEJ. PBE was used to elevate the distal margins to 1 mm above the CEJ in all groups except the control group. For the control group the onlay margin was placed directly on the prepared distal tooth structure without PBE. A Lava Ultimate CAD/CAM resin, nanoceramic onlay restorative was manufactured and bonded on all specimens with RelyX Ultimate adhesive resin cement. The quality of the tooth-PBE material and PBE material-onlay interface was evaluated with scanning electron microscopy using epoxy resin replicas before and after cyclic loading (100,000 cycles, 1.2 Hz at 65N and 37°C). In addition to margin quality, the fracture resistance of each group was measured using a universal testing machine. Fracture pattern was recorded by visual examination. The Levene test for homogeneity and the Welch analysis of variance were completed for fracture resistance and margin quality. A χ2 test was completed for break mode. RESULTS For dentin margins, a statistically significant difference was detected between the RMGI and control groups at baseline (p=0.0442). All other groups-GI, RBC, and BF-showed no difference from the control at baseline (p>0.05). No statistical significance was observed among groups for post-cyclic fatigue (p=0.8735). For onlay margins, no statistical significance was observed among groups for pre-cyclic fatigue, post-cyclic fatigue, or change (p=0.9713, p=0.528, p=0.4385, respectively). No significant difference was observed for the fracture resistance among groups or for the type of break by material used (p=0.1593, p=0.77, respectively). CONCLUSION Within the parameters of this study, after mechanical fatigue, the materials used for PBE: RMGI, RBC, and BF, did not influence results in terms of margin quality and fracture resistance. Therefore, collective findings suggest that these materials might be suitable for PBE procedures. Nevertheless, clinical caution is recommended with any PBE procedure and further testing of GI materials is needed.
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Chaves JDP, Figueredo TFM, Warnavin SVSC, Pannuti CM, Steffens JP. Sex hormone replacement therapy in periodontology-A systematic review. Oral Dis 2019; 26:270-284. [PMID: 30739380 DOI: 10.1111/odi.13059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/26/2018] [Accepted: 02/02/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To analyse whether sex hormone replacement therapy (HRT) improves periodontal parameters and dental implants osseointegration in humans. MATERIALS AND METHODS Electronic databases and hand searches were performed from June to August 2018 in SciELO, LILACS and PubMed/MEDLINE. Human observational and interventional studies that evaluated the following parameters were included: clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), radiographic bone loss (RBL) or osseointegration. RESULTS Initial search retrieved 1,282 non-duplicated articles. Fifteen studies were selected after inclusion criteria were applied. All studies were performed in postmenopausal women. Mean differences for PPD reduction ranged from 0.02 to 0.2 mm in HRT-positive patients; mean CAL gain -0.18 to 0.54 mm; mean RBL reduction -0.87 to 0.15 mm; and mean BOP reduction 9%-30.3%. Failure rate of dental implants increased -5.5% to 11.21% when HRT was used. CONCLUSIONS Very low but consistent evidence suggests a reduction in BOP and no impact on RBL in postmenopausal women receiving HRT. There are inconsistent reports that suggest that HRT in postmenopausal women: (a) improves or does not impact PPD reduction and CAL gain; and (b) does not impact or increase implant loss. In summary, there is no evidence to support HRT prescription for either men or women for periodontal/implant placement purposes.
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Affiliation(s)
| | | | | | | | - João Paulo Steffens
- Department of Stomatology, Federal University of Paraná (UFPR), Curitiba, Brazil
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Marzadori M, Stefanini M, Sangiorgi M, Mounssif I, Monaco C, Zucchelli G. Crown lengthening and restorative procedures in the esthetic zone. Periodontol 2000 2018; 77:84-92. [DOI: 10.1111/prd.12208] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Al-Harbi F, Ahmad I. A guide to minimally invasive crown lengthening and tooth preparation for rehabilitating pink and white aesthetics. Br Dent J 2018; 224:228-234. [PMID: 29472662 DOI: 10.1038/sj.bdj.2018.121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/09/2022]
Abstract
The rehabilitation of anterior dental aesthetics involves a multitude of disciplines, each with its own methodologies for achieving a predefined goal. The literature is awash with different techniques for a given predicament, based on both scientific credence, as well as empirical clinical judgements. An example is crown lengthening for correcting uneven gingival zeniths, increasing clinical crown lengths, and therefore, reducing the amount of maxillary gingival display that detracts from pleasing pink aesthetics. Many procedures have been advocated for rectifying gingival anomalies depending on prevailing clinical scenarios and aetiology. This paper presents a minimally invasive technique for crown lengthening for short clinical crowns concurrent with excessive maxillary gingival display, which is expedient, maintaining the inter-proximal papilla, mitigating morbidity, reducing post-operative inflammation, and increasing patient comfort. In addition, with a similar ethos, a minimally invasive tooth preparation approach is presented for achieving optimal white aesthetics.
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Affiliation(s)
- F Al-Harbi
- Imam Abdulrahman Bin Faisal University, Dammam, Dammam 31441, Saudi Arabia, Department of Substitutive Dental Sciences, College of Dentistry
| | - I Ahmad
- Imam Abdulrahman Bin Faisal University, Dammam, Dammam 31441, Saudi Arabia, Department of Substitutive Dental Sciences, College of Dentistry
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Kakizaki S, Aoki A, Tsubokawa M, Lin T, Mizutani K, Koshy G, Sadr A, Oda S, Sumi Y, Izumi Y. Observation and determination of periodontal tissue profile using optical coherence tomography. J Periodontal Res 2017; 53:188-199. [PMID: 29063599 DOI: 10.1111/jre.12506] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Diagnosis is a crucial step in periodontal treatment. The aim of this study was to evaluate the effectiveness of optical coherence tomography (OCT) for observation and determination of periodontal tissue profiles in vivo. MATERIAL AND METHODS In experiment 1, refractive indices of purified water, porcine gingiva and human gingiva at 1330 nm were determined for the analysis of OCT images of periodontal tissues. In experiment 2, OCT examination was performed in the midlabial apico-coronal plane of mandibular anteriors in 30 Asian volunteers with healthy gingiva. Sulcus depth was measured on intra-oral photographs taken during probing. In the OCT images, the gingival, epithelial and connective tissue thickness, and the position of alveolar bone crest were determined and finally, the biologic width was measured. RESULTS Refractive indices of purified water, porcine gingiva and human gingiva were 1.335, 1.393 and 1.397, respectively. Cross-sectional images of gingival epithelium, connective tissue and alveolar bone were depicted in real-time. The sulcular and junctional epithelium could be visualized occasionally. Laser penetration and reflection were limited to a certain depth with an approximate maximal imaging depth capability of 1.5 mm and OCT images of the periodontal structure were not clear in some cases. The average maximal thickness of gingiva and epithelium and biologic width at the mandibular anteriors were 1.06 ± 0.21, 0.49 ± 0.15 and 2.09 ± 0.60 mm, respectively. CONCLUSION OCT has promise for non-invasive observation of the periodontal tissue profile in detail and measurement of internal periodontal structures including biologic width in the anterior region.
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Affiliation(s)
- S Kakizaki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - A Aoki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - M Tsubokawa
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - T Lin
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - K Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - G Koshy
- Department of Periodontics, Sri Sankara Dental College, Varkala, Kerala, India
| | - A Sadr
- Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, WA, USA
| | - S Oda
- Oral Diagnosis and General Dentistry, University Hospital of Dentistry, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Y Sumi
- Center of Advanced Medicine for Dental and Oral Diseases National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Y Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Hamasni FM, El Hajj F. Comparison of the Clinical Biological Width with the Published Standard Histologic Mean Values. J Int Soc Prev Community Dent 2017; 7:264-271. [PMID: 29026699 PMCID: PMC5629855 DOI: 10.4103/jispcd.jispcd_261_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/08/2017] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES Biologic width (BW) as defined by Cohen is the part of the supracrestal gingival tissues that occupy the space between the base of the gingival crevice and the alveolar crest; it includes the junctional epithelium and the connective tissue element. Interactions between dental crowns and the marginal periodontal tissues analyzed in many review papers concluded that the recognition of the BW, in terms of crown margin placement, is beneficial for periodontal health. Therefore, knowledge of the dimensions of the sum of the junctional epithelium and connective tissue attachment as well as the sulcus depth (SD) is of clinical relevance. The aim of the study is to compare the average SD and BW clinically measured around teeth with the standard application of a mean value of 0.69 mm and 2.04 mm, respectively, found by Gargiulo et al.in a histological study on cadavers. MATERIALS AND METHODS Forty-two healthy patients with age ranging from 20 to 50 years presented to the Multidisciplinary Department at the Lebanese University. A total of 504 tooth sites of 126 teeth were selected and measured by two periodontists. All measurements were done on teeth requiring infiltration anesthesia for surgical, restorative, or endodontic procedures on neighboring tooth/teeth, which eliminate any ethical concerns. The SD and the distance from gingival margin to bone crest at four sites per tooth; mesial, midbuccal, distal, and midlingual/palatal were measured. Clinical, BW was calculated by subtracting SD from the distance between gingival margin to bone crest. STATISTICAL ANALYSIS Friedman's ANOVA test, independent samples t-tests, and one-sample t-tests were applied. The IBM® SPSS® statistics 20.0 statistical package was used to carry out all statistical analyses. RESULTS The BW is statistically significantly lower than the value stated by Gargiulo et al. (2.04 mm) with a mean value of 1.13 mm, whereas the SD is statistically significantly greater than the value stated by Gargiulo et al. (0.69 mm) with a mean value of 1.96 mm. CONCLUSION It can be concluded that there is a need to create a patient/site-specific distance from the proposed margin of the restoration to the bone crest when restoring subgingivally fractured or carious teeth. This leads to more stable and healthy tissues when performing crown lengthening procedures. Therefore, using the term clinical, BW is more reliable and it should be used to reestablish stability and integrity of periodontal tissues around restored teeth.
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Affiliation(s)
| | - Fady El Hajj
- Department of Periodontology, Faculty of Dentistry, Lebanese University, Hadat, Lebanon
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Agudio G, Chambrone L, Pini Prato G. Biologic Remodeling of Periodontal Dimensions of Areas Treated With Gingival Augmentation Procedure: A 25-Year Follow-Up Observation. J Periodontol 2017; 88:634-642. [DOI: 10.1902/jop.2017.170010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Leandro Chambrone
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, El Bosque University, Bogota, Colombia
- MSc Dentistry Program, School of Dentistry, Ibirapuera University, São Paulo, Brazil
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Rodriguez FR, Paganoni N, Eickholz P, Weiger R, Walter C. Presence of root canal treatment has no influence on periodontal bone loss. Clin Oral Investig 2017; 21:2741-2748. [PMID: 28213764 DOI: 10.1007/s00784-017-2076-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/07/2017] [Indexed: 01/24/2023]
Abstract
AIM The aim of this study was to compare the interproximal bone level at root canal-filled teeth and non-root canal-filled teeth. MATERIALS AND METHODS The records of patients from the department were consecutively screened from January 2009 to October 2011. The distance between the coronal reference point to the alveolar bone crest (AC) was assessed at the mesial and distal aspects of root canal-filled teeth (RCF+) and their contralateral non-root canal-filled teeth (RCF-) on periapical radiographs. Generalised linear mixed-effects models were applied. RESULTS The sample consisted of 128 pairs of teeth comprising data from 72 patients. The results for AC revealed a median distance of 3.2 mm for RCF+ and 3.4 mm for RCF- (p = 0.61). Using the maximal distance on either the distal or the mesial tooth surface, a median distance of 3.6 mm was detected for RCF+ and 3.8 mm for RCF-, respectively (p = 0.42). Even after taking several tooth- and subject-specific variables into account, the differences between AC on RCF+ and RCF- were statistically not significant (p > 0.05). CONCLUSION The interproximal bone loss did not differ statistically significant between root canal-filled teeth and non-root canal-filled teeth. CLINICAL RELEVANCE Existence of appropriately done root canal fillings in periodontitis patients has no effect on the prognosis of periodontal disease.
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Affiliation(s)
- Fabiola-Regina Rodriguez
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
| | - Nadine Paganoni
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
- Volkszahnklinik Basel, University Centre for Dental Medicine, Basel, Switzerland
| | - Peter Eickholz
- Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, 60596, Frankfurt, Germany
| | - Roland Weiger
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland
| | - Clemens Walter
- Department of Periodontology Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056, Basel, Switzerland.
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Pilalas I, Tsalikis L, Tatakis DN. Pre-restorative crown lengthening surgery outcomes: a systematic review. J Clin Periodontol 2016; 43:1094-1108. [DOI: 10.1111/jcpe.12617] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ioannis Pilalas
- Department of Preventive Dentistry, Periodontology and Implant Biology; School of Dentistry; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology; School of Dentistry; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Dimitris N. Tatakis
- Division of Periodontology; College of Dentistry; The Ohio State University; Columbus OH USA
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