Minimally invasive periodontal therapy for general practitioners

Recent Clinical Treatment and Basic Research on the Alveolar Bone

The periodontal ligament is located between the bone (alveolar bone) and the cementum of the tooth, and it is connected by tough fibers called Sharpey’s fibers. To maintain healthy teeth, the foundation supporting the teeth must be healthy. Periodontal diseases, also known as tooth loss, cause the alveolar bone to dissolve. The alveolar bone, similar to the bones in other body parts, is repeatedly resorbed by osteoclasts and renewed by osteogenic cells. This means that an old bone is constantly being resorbed and replaced by a new bone. In periodontal diseases, the alveolar bone around the teeth is absorbed, and as the disease progresses, the alveolar bone shrinks gradually. In most cases, the resorbed alveolar bone does not return to its original form even after periodontal disease is cured. Gum covers the tooth surface so that it matches the shape of the resorbed alveolar bone, exposing more of the tooth surface than before, making the teeth look longer, leaving gaps between the teeth, and in some cases causing teeth to sting. Previously, the only treatment for periodontal diseases was to stop the disease from progressing further before the teeth fell out, and restoration to the original condition was almost impossible. However, a treatment method that can help in the regeneration of the supporting tissues of the teeth destroyed by periodontal diseases and the restoration of the teeth to their original healthy state as much as possible is introduced. Recently, with improvements in implant material properties, implant therapy has become an indispensable treatment method in dentistry and an important prosthetic option. Treatment methods and techniques, which are mainly based on experience, have gradually accumulated scientific evidence, and the number of indications for treatment has increased. The development of bone augmentation methods has contributed remarkably to the expansion of indications, and this has been made possible by various advances in materials science. The induced pluripotent stem cell (iPS) cell technology for regenerating periodontal tissues, including alveolar bone, is expected to be applied in the treatment of diseases, such as tooth loss and periodontitis. This review focuses on the alveolar bone and describes clinical practice, techniques, and the latest basic research.

Wear Properties of Different Additive Restorative Materials Used for Onlay/Overlay Posterior Restorations

The purpose of this laboratory study was to compare the two-body wear resistance of different restorative materials commonly used for the indirect restoration of posterior teeth. The tested materials, based on ceramic (Imagine Press X, IPS e.max CAD, Milled Celtra Duo, Glaze-Fired Celtra Duo, Vita Mark II) and composite (Enamel Plus HRi, Enamel Plus HRi Bio-Function, Filtek Supreme XTE, Lava Ultimate), were compared with the wear properties of a type III gold alloy (Aurocast 8). Flat samples were prepared with a 6-mm thickness (n=10). Composite samples were tested after a heat polymerization cycle. All samples were exposed to a two-body wear test in a dual axis chewing simulator performing over 120,000 loading cycles. The opposing abrader cusps were fabricated from yttria-stabilized tetragonal zirconia polycrystal. The vertical substance loss (mm) and the volume loss (mm3) were recorded, as was the wear of the antagonist cusp (mm). Mean values were analyzed by one-way analysis of variance. Significant differences among materials were detected. The heat-cured resin-based composite material Enamel Plus Bio-Function and the type III gold alloy demonstrated similar mean values for wear depth and volumetric loss.

Knowledge, dentist confidence and management of periodontal patients among general dentists from Belarus, Lithuania, Macedonia, Moldova and Romania

BACKGROUND

Evidence concerning periodontal practice in Eastern European countries is scarce. The aim of the present study was to investigate periodontal risk knowledge, patient management and self-perceived confidence among General Dentists (GDs) from five Eastern European regarding their provision of periodontal care.

METHODS

GDs from Belarus, Lithuania, Macedonia, Moldova and Romania participated in a questionnaire survey. Power calculations were used to identify the sample size for each country. The structured questionnaire included several domains of inquiry. The socio-demographic domain inquired about dentist's age, gender and years of clinical experience. The dental practice domain inquired about practice location, practising or not practising in a group practice and having or not having a periodontist or a dental hygienist in the practice. The distributions of answers across-countries were compared employing one way ANOVA (comparison of means) or Chi square test (comparison of proportions). For each country, the predictors of the study outcomes: a summative knowledge score for periodontal risks and dentist's confidence level were identified employing either linear or logistic multiple regression models.

RESULTS

The sample comprised 390 Belarussian, 488 Lithuanian, 349 Macedonian, 316 Moldovan, and 401 Romanian GDs. The majority of GDs (~ 80%) practiced in urban areas. Age and gender distributions differed significantly among countries. Significant across-country differences were found regarding working/not working in a group practice, having/not having access to a periodontist/dental hygienist and in proportions of patients receiving periodontal treatments or being referred to specialists. None of Macedonian patients nor the majority of Moldovan patients (78%) were referred to periodontists. There were also significant across-country differences in diagnosis, patient management and periodontal knowledge. Only in the Lithuanian cohort were dentists' confidence levels associated significantly with their knowledge. In all countries, taking a medical history was a consistent and significant predictor of having higher periodontal knowledge score. Except in Belarus, periodontal risk assessment was a significantly consistent predictor of certainty levels associated with the provision of periodontal treatments.

CONCLUSIONS

There were substantial differences among GDs in the five countries regarding diagnosis, dentist's confidence and management of periodontal patients.

Antimicrobial photodynamic chemotherapy mediated by PapaMBlue on chronic periodontal disease: Study protocol for a randomized, blind, controlled trial

BACKGROUND

The elimination of the pathogenic microorganisms of the periodontal pocket is one of the main points for success in periodontal treatment. The objective of this study is to investigate the clinical and antimicrobial effect of papain-mediated photodynamic therapy in the clinical treatment of periodontal disease.

METHODS

Twenty patients with chronic periodontitis will be selected. Patients will be randomly divided into 2 groups (n = 10). Group 1 will receive conventional periodontal treatment and group 2 will receive conventional treatment and antimicrobial photodynamic therapy (PACT). Conventional treatment will consist of oral hygiene guidance, with brushing technique instructions and recommendation of daily flossing. The calculus deposits on the teeth will be removed with ultrasound equipment and curettes for scraping and root planning. The PACT will be performed at the end of each periodontal treatment session, at sites with bags ≥4 mm. PapaMblue photosensitizer will be deposited in the periodontal pockets with a syringe and a pre-irradiation time of 1 minute will be adopted. Then, the laser emitting wavelength of 660 nm, with power of 100 mW, for 2 minutes, radiant exposure of 30 J/cm and power density of 250 mW/cm will be applied. Patients will undergo clinical evaluations before treatment (day 1) at 30, 60, and 90 days after the end of treatment; and microbiological evaluations before and immediately after treatment. The distribution of the data within each group and the homogeneity of the variances will be verified. With this information, the most appropriate statistical test in each evaluation will be used. The sample calculation is based on the literature and the significance level of 5% will be adopted.

DISCUSSION

The combination of PACT with methylene blue in a papain gel and the conventional treatment may increase the reduction of bacteria in periodontal pockets.

Wear Evaluation of Prosthetic Materials Opposing Themselves

The purpose of the present in vitro study was to compare the two-body wear resistance of a type 3 gold alloy (Aurocast8), two lithium disilicate glass ceramics (IPS e.max CAD and IPS e.max Press), a heat-pressed feldspathic porcelain (Cerabien ZR Press), an yttria-stabilized tetragonal zirconia polycrystal ceramic (Katana Zirconia ML), and three heat-cured composite resins (Ceram.X Universal, Enamel Plus Function, and Enamel Plus HRi) opposing antagonistic cusps made out of the same restorative materials. Ten 6-mm-thick samples and 10 cusp-shaped abraders were manufactured with each test material (n=10) according to standard laboratory procedures. All sample/antagonist pairs made out of the same material were subjected to a two-body wear test in a dual-axis chewing simulator for up to 120,000 loading cycles. The total vertical wear (mm) and the total volumetric loss (mm3) for each sample/antagonist pair were calculated. Data were statistically analyzed using one-way analysis of variance tests. The total vertical wear for the gold alloy was not significantly different compared to Ceram.X Universal, Enamel Plus Function, IPS e.max CAD, and Cerabien ZR Press. Significantly increased wear values were observed for Enamel Plus HRi and IPS e.max Press. The lowest values for total vertical wear and volumetric loss were recorded on the monolithic zirconia.