[The use of subepithelial connective tissue as a biological barrier]

Bone regeneration may be enhanced when invasion of soft tissue into osseous defect is mechanically impeded by barrier membrane. Several studies have reported successful clinical outcomes for regenerative treatment of intrabony and furcation defects following use of free subepithelial connective tissue graft (SCTG) as biological barrier membrane. The current study introduces the use of SCTG as a barrier in following clinical situations: (1) Guided bone regeneration (GBR) of peri-implant bone lost due to early spontaneous exposure of submerged implants (2) Socket preservation combined with ridge augmentation (3) Guided tissue regeneration (GTR) of periodontal circumferential intrabony defect. Each of the above indication is presented to the reader by description in details of clinical cases in which SCTG was applied.

A Culturally-Specific Dietary Plan To Manage Weight Gain among African American Breast Cancer Survivors: A Feasibility Study

Background. African American (AA) women are less likely to survive for five years after a breast cancer diagnosis than Caucasian women. The higher prevalence of obesity in AA women may contribute to this disparity. Weight gain following breast cancer treatment is one of the few modifiable risk factors for breast cancer recurrence and mortality. AA breast cancer survivors face unique cultural and economic barriers to adopting diets which reduce the likelihood of weight gain.Objective. To determine the feasibility of adopting and maintaining a culturally-specific low-fat eating plan in a population of low to middle income AA breast cancer survivors.Participants. AA women recruited through urban medical centers who were between 30 to 75 years old, had a confirmed diagnosis of stage 0, I, II, III, or IIIA primary breast cancer, and had incomes < $50,000 per year.Methods. A culturally-specific dietary intervention was developed, based on the Women's Intervention Nutrition Study (WINS), to reduce consumption of dietary fat to 25% of total calories, while increasing fruits and vegetables.Eligible participants were enrolled in a one-year feasibility study. Participants received the Culturally-Specific WINS Low-Fat Eating Plan (WLEP) and 8 individual nutritional counseling sessions with a trained diet technician, to help reduce and maintain their fat intake to 25% of total calories. The intervention also included bi-monthly educational group meetings and follow-up telephone contacts with diet technicians.Study Measures. Dietary patterns were assessed with 3-day food records at baseline and follow-up. Compliance with the Culturally-Specific WLEP was defined as 1) dietary fat intake ≤ 25% of total calories; and 2) at least 6 to 7 servings of fruits and vegetables per day. Psychosocial factors and dietary biomarkers were also measured at baseline and follow-up to examine their association with study outcomes. Psychosocial factors included perceived susceptibility to recurrence, quality of life, and social support. Dietary biomarkers included weight, height, waist-hip circumference, blood pressure, lipids, serum fatty acid concentrations, insulin and insulin-like growth factors, glucose, and levels of sex hormone-binding globulins.Results. A total of 9 AA breast cancer survivors are enrolled and receiving the intervention. Baseline and six-month follow-up results for the psychosocial factors and dietary biomarkers associated with dietary compliance and weight maintenance will be reported in October 2009.Conclusions. A population of low to middle income AA breast cancer survivors with limited education and resources demonstrated compliance with the Culturally-Specific WLEP, thereby reducing their risk of cancer recurrence through diet. Procedures and data from this feasibility study will be used in a multi-center clinical trial of the Culturally-Specific WLEP.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1053.

Association between oral malodour and periodontal disease-related parameters in a population of 71 Israelis

The aim of the present study was to determine whether oral malodour and periodontal disease parameters are associated with one another in 71 Israeli subjects (mean age 36.2 +/- 18.4; ages ranging from 15 to 65). Parameters measured included whole mouth odour judge scoring, Halimeter, OK to Kiss test, gingival index, plaque index and probing depth. Odour judge scores were significantly associated with Halimeter (r = 0.55; P < 0.001), as well as the OK to Kiss test (r = 0.52; P < 0.001). However, neither gingival index, plaque index nor probing depth was significantly associated with odour judge scores or Halimeter scores. Logistic regression analysis showed that both Halimeter and OK to Kiss scores factored significantly (P = 0.005 and 0.018, respectively, odds ratios 14.9 and 2.7, respectively) in predicting the severity of oral malodour. Results suggest that in the population studied, periodontal health and oral malodour are not associated with one another.

[Differential diagnosis and treatment strategies for peri-implant diseases]

The aim of this article is to discuss the requirements to prevent, intercept and treat the peri-implant diseases at different stages. The ethiology and pathogenesis of peri-implant disease is presented, followed by definition and characteristics of the two main entites: peri-implant mucositis and peri-implantitis. Data and concepts regarding various evaluation parameters, such as pocket probing depth, bleeding on probing, gingival and plaque scores, radiographic and mobility which should be used to assess the clinical status of the peri-implant environment are discussed. The detection and treatment of early pathogenic changes during regular recall maintenance visits can prevent peri-implant soft tissue inflammation and progressive bone loss. The biologic rationale and guidelines for therapeutic procedures aimed to prevent and arrest the Peri-implant Disease according to a maintenance system termed Comulative Interceptive Supportive Therapy (CIST) is presented. The CIST protocol includes as a first sequence mechanical antiseptic and antibiotic treatment to control ongoing infection. Following this, peri-implant bony lesion may be corrected by regenerative or resective surgical techniques.

IN CONCLUSION

By continuing diagnosis during maintenance, developing peri-implant infections can be controlled successfully by providing mechanical, antiseptic, antibiotic and surgical supportive therapy, individually or combined.

Spontaneous early exposure of submerged endosseous implants resulting in crestal bone loss: a clinical evaluation between stage I and stage II surgery

Spontaneous early exposure of submerged implants during the osseointegration healing phase may be a harmful factor that results in early crestal bone loss around the implants. The objective of this study was to assess the effect of spontaneous early exposure on crestal bone loss around submerged implants, with special attention given to the relationship between the degree of exposure and the amount of peri-implant bone loss. Crestal bone level relative to the shoulder of the implant was measured at the time of placement and at the time of exposure 4 to 5 months later. During the period between stage I and stage II surgery, implant sites were observed, and each implant site in which spontaneous early exposure was detected was recorded. Perforations were classified according to the degree of implant exposure from Class 0 (no perforation) to Class IV (complete exposure). Measurements from 206 implants in 64 patients produced 85 groups valid for statistical comparison; each of these contained at least 2 lesions of different types. There was a statistically significant difference between bone loss associated with intact mucosa (Class 0) and Class I, Class II, and Class III lesions, and between Class I and II lesions. There were no significant differences between Class I and III and between Class II and III. In Class II and III lesions, there was more bone loss associated with the buccal aspect of the implants. Of the 115 perforated sites, 10 were associated with bone loss exceeding 2 mm, 2 presented 3 to 4 mm bone loss, 1 showed more than 4 mm, and 1 displayed more than 5 mm. In view of the clinical implications that spontaneous early exposure may have on the success of osseointegration, prematurely partially exposed implants should be exposed as soon as possible after the perforation is observed.

Effect of gender on acute pain prediction and memory in periodontal surgery

Pain is a complex experience that is affected by factors such as gender, stress, anxiety and cognitions. The purpose of this study was to investigate the inter-relationship between gender and acute pain prediction and memory under periodontal surgery treatment. The study was conducted on 15 male and 22 female dental patients (mean age 34 yr, mean education level 14.7 yr), who were scheduled for periodontal surgery. Patients were evaluated during four consecutive appointments: at initial check-up, immediately pre-operatively, 1 wk post-operatively, and at 4 wk post-operative follow-up. Patients were requested to complete questionnaires concerning their anxiety at each appointment and to indicate their subjective evaluations concerning pain (on a visual analogue scale). Evaluations concerning expectation to experience pain during the planned surgery (pain prediction) were made at the first two appointments and evaluations of the experienced pain as remembered from the surgery (pain memory) were made at the last two appointments. Gender had a significant effect on pain prediction and pain memory. Men expected to experience more pain pre-operatively than women but remembered less pain post-operatively. It was concluded that cognitive pain perception in clinical situations differs between genders.

Self-assessment of oral malodor 1 year following initial consultation

OBJECTIVE

In an initial study, subjects complaining of bad breath were generally unable to score the level of their own oral malodor in an objective fashion. Subjects were taught several techniques for self-measurement of bad breath. One year following the initial consultation, subjects were recalled to determine whether their ability to assess their own oral malodor had improved.

METHOD AND MATERIALS

In the study, subjects were blinded to their own scores 1 year earlier, to the odor-judge scores, and to the results of the clinical laboratory tests. Thirty-two of 43 subjects in the original study who presented with a complaint of oral malodor agreed to participate in the follow-up study. Odor-judge scores and self-assessments of oral malodor (whole-mouth odor, tongue odor, and saliva odor) were compared with one another as well as with clinical parameters.

RESULTS

Objective improvements were noted in both oral health parameters and malodor levels of subjects. Despite this, self-assessments generally remained unrelated to objective parameters (odor-judge scores, clinical indices, and laboratory tests). Self-assessments were all significantly correlated with one another, and also were significantly associated with corresponding self-estimates made 1 year earlier.

CONCLUSION

Subjects with a complaint of oral malodor remain largely unable to score their own bad breath in an objective fashion. In addition, they are not capable of sensing reductions in oral malodor 1 year following the original assessment, even though, from a clinical standpoint, improvements have taken place.

Castration prevents calcium channel blocker-induced gingival hyperplasia in beagle dogs

1. The purpose of this study was to investigate testosterone's role on the calcium channel antagonist oxodipine-inducing gingival hyperplasia in a dog model. 2. Two experiments were conducted using castrated and intact male dogs. Oxodipine was administered orally for 90 days, at a dose of 24 mg/kg/day. In the first experiment, the occurrence of gingival hyperplasia was evaluated. In the second, the gingival index (GI) and gingival hyperplasia index (GHI) were recorded and correlated with serum levels of testosterone. 3. A significant positive correlation between GI, GHI and plasma testosterone was noted. Castrated dogs were injected with testosterone, 4 months after the start of oxodipine treatment, while in the non-castrated dogs, administration of oxodipine was stopped. Castration correlated with lack of GH, while testosterone injection to the same dogs was associated with an increase of GI and GHI. 4. Since it is known that testosterone receptors are present in the gingiva, it is proposed that oxodipine-induced gingival hyperplasia could be mediated by the calcium channel blocker on plasma testosterone levels.

Efficacy of a 2-phase oil: water mouthrinse in controlling oral malodor, gingivitis, and plaque

The purpose of the study was to examine the anti-malodor, anti-gingivitis, and plaque reducing properties of a 2 phase oil:water mouthrinse compared with a control mouthrinse. Fifty subjects rinsed with one of the two rinses for 30 seconds twice a day over 6 weeks, while continuing their normal oral hygiene habits. Measurements were made at time zero (prior to beginning the rinsing regimen), and > or = 9 hours following rinsing, at intervals of 1, 3, and 6 weeks. Malodor of whole mouth, as well as tongue dorsum anterior and posterior, was assessed on a 0 to 5 semi-integer scale by two odor judges. Volatile sulphide compounds (VSC) were determined using a sulphide monitor. Gingival, plaque, and bleeding indices were recorded for Ramfjord teeth. Oral microbial levels were assessed using the oratest. Salivary levels of diamines (putrescine and cadaverine) were analyzed by HPLC. Results were analyzed by 2-tailed covariant ANOVA, with the time zero value as covariant. Dramatic improvements were observed in parameters associated with malodor, periodontal health, plaque accumulation, and microbial levels in both groups. As compared to time zero scores, whole mouth odor, tongue dorsum anterior and posterior odors decreased continuously over time, attaining 80%, 79% and 70%, reductions, respectively following 6 weeks, in the 2-phase mouthrinse group, versus 70%, 77% and 59% for the control group. For whole mouth and tongue dorsum posterior, the reductions observed in the 2-phase mouthrinse group were significantly greater than those obtained with the control mouthrinse (P = 0.026 and P = 0.025, respectively), suggesting that the 2-phase mouthrinse is superior to the control mouthrinse in long-term reduction of oral malodor. For bleeding index, gingival index, oral microbial levels, and VSC, differences between the groups were not significant. Diamine levels were not significantly reduced in either group. The control mouthrinse reduced plaque index more significantly than the 2-phase mouthrinse (P < 0.005). The results of this randomized clinical trial suggest that the 2-phase oil:water mouthrinse formulation is superior to the control mouthrinse in long-term reduction of oral malodor.

Clinical efficacy of a degradable film-forming product containing carbamide peroxide to reduce tooth discolouration

The methods used to lighten tooth discolouration while conserving the tooth structure have attracted much attention in a society which places a high value on esthetics. The purpose of this article is to present a home bleaching agent that uses a film-forming preparation containing carbamide peroxide (CP) which, while degrading, serves as a slow release delivery system of the bleaching agent. The efficacy of the preparation containing 3% CP and 10% CP on reduction of tooth discolouration is evaluated by a Chromameter in a double-blind placebo-controlled study. The effect of the tested bleaching agent on the gingival status, plaque accumulation and pulp sensitivity is also assessed.

The complaint of oral malodor: possible psychopathological aspects

Oral malodor (halitosis) is a common concern in Western society. As with other human perceptions, emotional as well as cognitive variables play a major role in one's sensation and complaint. To study factors potentially associated with the complaint of oral malodor, periodontal and psychological evaluations were carried out on 38 subjects (66% female, mean age 43 years) with a complaint of oral malodor. Subjects underwent evaluation of their periodontal status, odor evaluation by an odor judge, and psychopathological symptom survey by means of the SCL-90 questionnaire. The patient's self-rating of oral odor was significantly higher than the evaluation of an objective odor judge and was not associated with their periodontal status. The SCL-90 profile of subjects was relatively higher than that of an age- and gender-matched reference group of dental patients. The results suggest that the complaint of oral malodor may be related to psychopathological symptoms as recorded by the SCL-90 questionnaire.

Collagen gel and membrane in guided tissue regeneration in periodontal fenestration defects in dogs

The effect of a collagen gel matrix as a submembranous space-maintaining material was evaluated in guided tissue regeneration procedures. In 4 dogs, contralateral surgical circular fenestration defects, 5 mm in diameter, were produced at the midbuccal aspect of the alveolar bone in 8 maxillary canines. Removal of bone, PDL and cementum was complete. Experimental sites were filled with collagen gel and covered with collagen membranes; control sites were covered with collagen membranes and the underlying space was spontaneously filled with blood. Mucogingival flaps were repositioned. Histological and histomorphometric observations, 6 weeks post-surgery, indicated that defects covered by collagen membranes presented the most impressive regeneration with almost complete coverage of the denuded root by new cementum (98.4%) and new bone (63.2%). In the experimental defects, 83.5% coverage of new cementum with only 21.9% new bone regeneration was observed. These results suggest that collagen gel, interfered with healing by PDL and bone-derived cells in the submembranous space.

Self-estimation of oral malodor

Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such. The purpose of the present investigation was to determine whether objective self-measurement of oral malodors is possible. Each of 52 volunteers was asked to sample the odor from his/her mouth, tongue, and saliva. Results were compared with (i) self-assessments prior to (preconception) and following (post-measurement) self-measurements; (ii) odor judge scores; (iii) dental-measurements (plaque index, gingival index, and probing depth); (iv) volatile sulphide levels; (v) salivary cadaverine levels; and (vi) intra-oral trypsin-like activity. Among the self-measurements, only saliva self-scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-estimates, subsequent post-measurement self-assessments failed to correlate with objective parameters. The results suggest that (i) preconceived notions confound the ability to score one's own oral malodors in an objective fashion; and (ii) partial objectivity can be obtained in the case of saliva self-measurement, presumably because the stimulus is removed from the body proper.

Contiguous autogenous transplant--nineteen years' clinical and radiographic follow-up: a case report

Contiguous autogenous transplant, also known as the bone-swaging procedure, is a technique aimed at regenerating lost periodontium. Clinical healing of bony defects after bone swaging has been satisfactory, but the relationship and mode of attachment between the bone graft and the root surface have not been fully investigated. A 19-year clinical and radiographic follow-up of a bony defect treated with the bone-swaging technique is presented. A significant coronal increase in bone height and a gain in clinical probing depth were achieved postsurgery and remained unchanged during the first 6 years. The long-term clinical and radiographic findings, however, indicated that the attachment developed at the root-bone interface may not have been a true attachment and may have been more vulnerable to pathogenic local agents. These observations may help the clinician to interpret the clinical and radiographic changes that occur in the area of a bony defect following the use of a bone graft.

Cadaverine as a putative component of oral malodor

Whereas previous studies have shown correlations between volatile sulphur compounds (VSC) and bad breath levels, it is probable that other compounds found in the oral cavity may contribute to oral malodor. In the present investigation, the possibility that diamines (cadaverine and putrescine) are associated with oral malodor parameters was assessed. Saliva samples from 52 subjects were analyzed for cadaverine and putrescine by HPLC. Oral malodor of whole mouth, tongue, and saliva of the subjects was recorded by an experienced judge on a continuous 10-cm scale; peak and steady-state VSC intraoral levels were measured by the Interscan 1170 sulphide monitor. Log-transformed VSC and diamine levels were compared with odor judge measurements by Pearson analysis and stepwise forward multiple regression. Putrescine scores were not significantly associated with odor judge parameters or with VSC levels (p > 0.1). However, highly significant correlations (p < or = 0.003) were found between cadaverine levels and all three odor judge assessments. In contrast, associations between cadaverine and VSC measurements were non-significant. In an attempt to correlate odor judge results in terms of both VSC and diamines, we carried out stepwise forward multiple regression. Results showed that VSC and cadaverine both factor significantly in explaining each of the odor judge measurements, with multiple r values ranging from 0.545 (p = 0.0002) to 0.604 (p < 0.0001). The results suggest that cadaverine levels are associated with oral malodor, and that this association may be independent of VSC.

Correlation between the BANA test and oral malodor parameters

The purpose of the present investigation was to test the association between the BANA test (Perioscan, Oral-B), and oral malodor parameters. The subject population consisted of 52 Israeli adults, 43 of whom complained of oral malodor. Oral malodor measurements consisted of peak and steady-state volatile sulphide measurement by a portable sulphide monitor (Interscan Corp., model 1170), as well as organoleptic measurements of malodor from whole mouth, tongue, and saliva. Samples for the BANA test were obtained from four loci (shallow pocket, deep pocket, tongue dorsum, saliva); results were scored as negative (0), weak (1), or strong (2). BANA scores were significantly associated with odor-judge ratings, with the highest association obtained when BANA saliva scores and odor-judge saliva assessment were compared (r = 0.500; p < 0.001). BANA tests from the different loci were not significantly associated with sulphide monitor levels. Stepwise multiple-regression analysis of odor-judge measurements in terms of sulphide levels and average BANA scores showed that both log peak sulphide levels as well as BANA scores were significantly factored into the equations, yielding, in all cases, highly significant correlations (multiple r = 0.57, 0.50, and 0.59, respectively, with significance levels of 0.0001, 0.001, and < 0.0001, for whole mouth, tongue, and saliva malodor, respectively). The results suggest that the BANA scores are associated with a component of oral malodor which is independent of volatile sulphide measurements and suggest its use as an adjunct test to volatile sulphide measurement.

Inhibition of plaque formation by local application of a degradable controlled release system containing cetylpyridinium chloride

The effect of a degradable controlled release system containing cetylpyridinium chloride (CPC) on plaque accumulation and gingivitis was evaluated when applied on the anterior teeth of volunteers (16-17 years) over 4 weeks. At baseline, plaque index (PI) and gingival index (GI) of the Ramfjord teeth were measured in the experimental and placebo groups, including 23 and 21 participants respectively. Following scaling and root planning, the participants were instructed to brush, using one brush stroke, the film-forming solution on the buccal surface of the maxillary and mandibular incisors, 1 x a day before bedtime. The applied active solution contained 9 mg of CPC (approximately 80 mg of 11% CPC solution), while the placebo solution was identical in formation, but without the active agent. After 4 weeks, in the CPC-applied group, the recorded PI scores were 0.52 (+/- 0.56) in the anterior area and 1.31 (+/- 0.80) in the posterior area, whereas the corresponding areas in the placebo group reached 1.25 (+/- 0.74) and 1.51 (+/- 1.00), respectively. The PI = 0 frequency in the buccal anterior surfaces after 4 weeks was 54.6% (+/- 38.7%) in the experimental group as compared with 21.9% (+/- 29.0%) in the placebo group (p = 0.005). In contrast to the anterior teeth, there was no significant difference between groups with respect to the PI scores in the non-applied posterior teeth. It may be postulated that the impressive 58% inhibition of plaque accumulation at the site of application is the result of an increase of the substantivity of the CPC due to its incorporation in the film-forming degradable controlled release system.

Mucosal considerations for osseointegrated implants

Tissue resistance is determined by the nature of cells and intercellular contacts irrespective of the presence or absence of keratinization, masticatory mucosa, or skin. However, these tissues are more easily maintained and less vulnerable to inflammation when in contact with dental implants. Lack of masticatory mucosa and the presence of alveolar mucosa embracing the implant are often associated with plaque, which can induce inflammation resulting in subsequent peri-implant destruction. To facilitate proper mechanical oral hygiene maintenance, transplantation of autogenous masticatory mucosal grafts at the implant sites was performed in patients without attached gingiva, unfavorable vestibulum with submucosal muscular activity, and uncontrolled peri-implant mucositis. The rationale for having attached mucosa around osseointegrated implants and illustration of possible methods of mucosal management in the different phases of implant rehabilitation are presented.

Two approaches to the treatment of true combined periodontal-endodontal lesions

Periodontal endodontal lesions present a difficult diagnostic and treatment challenge to the clinician and treatment often requires a combined therapeutic effort. Both endodontal and periodontal surgical procedures may be indicated for access and treatment of these lesions. This case report presents an early onset periodontitis patient with bilateral periodontal-endodontal lesions on mandibular first molars. Treatment included apical surgery followed by repeated scaling and root planing on one tooth and root canal obturation followed by a periodontal bone grafting procedure on the other. Both procedures resulted in clinical attachment gain as well as radiographic evidence of alveolar bone gain. This case report once again demonstrates that proper diagnosis followed by removal of etiologic factors and nonsurgical therapy or periodontal regenerative procedures can restore health and function in cases of severe attachment loss.

Periodontal surgical techniques used to conserve maxillary anterior esthetics

The maxillary anterior region presents a difficult and unique therapeutic challenge in the treatment of periodontal disease. The periodontist should use therapeutic procedures to prevent or minimize esthetic problems, such as increased tooth length and loss of interdental papilla, without compromising the main goals of periodontal treatment. This article presents various periodontal treatment modalities that can be used in the anterior maxillary area with acceptable esthetic results. A better understanding of the problem, the treatment steps, and the various options available may improve the communication between the general practitioner and the periodontist, producing satisfactory long-term results.

The efficacy of Plax prebrushing rinse: a review of the literature

Removal of bacterial plaque is a prerequisite to the prevention and control of periodontal disease. In highly motivated patients, it is possible to control plaque successfully by mechanical means. Because most patients lack sufficient motivation and skill to perform effective plaque control on a regular basis, use of antimicrobial chemical agents is essential to gingival health. In 1985, Plax, a prebrushing oral rinse, was introduced. The manufacturer claims that the solution acts as a detergent that removes some bacterial plaque and loosens the remainder for easy removal by toothbrushing. A review of current dental research related to this claim is presented. The data provided do not support the use of Plax dental rinse as part of an oral hygiene program.

Histologic assessment of a contiguous autogenous transplant in a human intrabony defect. A case report

Increased blood supply, vital bone marrow cells, and minimal mobility may play a significant role in the success of osseous grafts, and are characteristics of the bone swaging grafting technique. As in all autogenous grafts, the risk of disease transmission is minimal. Previous reports of clinical success raise questions as to the type of tissue response to this procedure. This case report examines 8 months radiographic and histologic results of a clinically successful bone swaging graft.

Inhibition of plaque formation and gingivitis in beagle dogs by topical use of a degradable controlled-release system containing chlorhexidine

The in vivo efficacy of a newly-developed dental application of a film-forming, chlorhexidine-containing system was examined in beagle dogs. A self-disintegrating film-forming solution was applied three times weekly to the dentitions of 7 out of 13 dogs, which were fed a soft-food diet. Plaque accumulation (Plaque Index) and gingival inflammation (Gingival Index) were recorded at one, two, four, six, and eight weeks. The local delivery of low-dose chlorhexidine to dogs significantly inhibited gingivitis and plaque formation. It is concluded that the dental application of a film-forming system may be a preferable method of periodontal disease prophylaxis, and may enhance supragingival plaque control in areas of isolated periodontal problems associated with obvious local predisposing factors.

The "chewing wheel" device: plaque-removing efficiency and use in oral hygiene programs

Control of bacterial plaque on tooth surfaces is the most important method of controlling dental disease. The patient's ability to achieve good plaque control is of utmost importance in preventing the occurrence of periodontal disease and in maintaining periodontal health. The search for better methods that enable easier and more effective plaque control has led to the development of the "chewing wheel." A clinical trial was conducted to compare the plaque-removing efficiency of the chewing wheel to that of a manual toothbrush. The tested device removed 18% to 37% of the accumulated dental deposits. In spite of its limited efficiency, the wheel can be used as part of an oral hygiene program for individuals with perceptomotor dysfunctions.

Agranulocytosis--periodontal manifestations and treatment of the acute phase: a case report

A case report of oral and periodontal manifestation of agranulocytosis in a 12-year-old girl is presented. The agranulocytic state may have been caused by chronic brucellosis since childhood. On admission to the hospital, the acute oral symptoms were treated in order to enable the child to eat and perform standard oral hygiene measures. Chlorhexidine gluconate 0.2% was irrigated daily under pressure for supra- and subgingival plaque control. Resolution of inflammation was achieved without increase in white blood count and thus can be attributed to the control of the local etiologic factor, i.e., plaque.

Healing of sites within the dog periodontal ligament after application of cold to the periodontal attachment apparatus

The potential of periodontal ligament-derived tissues to regenerate periodontal attachment after cryosurgical trauma to the PDL in dogs was evaluated. The buccal alveolar plate of each canine tooth was exposed by a semi-lunar excision. A 3 mm thick cryoprobe, cooled to -81 degrees C, was placed on the bone 5 mm apical to the crest for 10 s. This induced cellular devitalization in the bone directly in contact with the probe and the PDL under it. The freezing-thawing cycle was repeated 3 times. Control sites were sham-operated at room temperature. Histologic sections from the center of the lesions were obtained from 1 h, 48 h and 30 d specimens. 1-h control and experimental histologic sections were similar. At 48 h post-surgery, the cellular component of the frozen PDL could not be identified and inflammatory response was minimal. The collagenous framework, however, appeared to form a continuum between the alveolar bone and cementum. Lacunae in the bone at the frozen segment were empty. The injured PDL was surrounded by normal PDL. Control specimens appeared normal. At 30 d, the PDL space in the frozen segments was populated by PDL-like tissue which did not differ significantly from the PDL coronal or apical to it. Collagen fibers appeared to be attached to the cementum on one side and to the alveolar bone on the other. Bone resorption or ankylosis was not observed in the experimental sites. It is suggested that the extracellular matrix in the devitalized area was preserved, supporting regeneration of the cryolesion.

Wedges in restorative dentistry: principles and applications

Overhanging margins of proximal restorations are a well-known, iatrogenic cause of periodontal pathology. The high incidence of such findings in Western societies should arose the concern of the dental community. However, overhanging margins represent only part of the iatrogenic problem created by the misuse of wedges in restorative procedures. Other causes include incorrect proximal contouring, inadequate contact points and under- or overfilling the restorative material. The understanding of the variables associated with wedge selection and positioning has a major role to play in the prevention of iatrogenic periodontal pathology associated with restorative procedures. It is concluded that: (i) the occlusion of the matrix band to the remaining healthy tooth structure of the gingival cavosurface line angle should be achieved solely by the correct application of the wedges; (ii) the effect of the wedges on the proximal contour and contact area should be carefully re-evaluated prior to insertion of the restorative material; (iii) various sizes and shapes of wedges and a sharp knife for carving must be readily available.

The effectiveness of the air-powder abrasive device on the tooth and periodontium: an overview

The characteristics of the air-powder abrasive device (APAD) was reviewed from the current dental literature and found to be an excellent alternative to traditional methods for stain and plaque removal. Access to crowded teeth, grooves and involved furcation areas are easily obtainable with less operator fatigue. The APAD slurry produces different root surface abrasiveness, depending on the method of use. Extended maintenance periods of exposed root surface using the APAD can result in an enormous loss of root structure. To avoid permanent damage of the root, the device should be used with overlapping strokes and root exposure to the APAD slurry should be minimized. The device can be used for total cementum removal with less operator fatigue and more reproducibility than with hand instruments, leaving smooth and clean surfaces. In addition, the device may be a valuable tool in the detoxification of root surfaces during periodontal surgery.

Scanning electron microscope evaluation of wear of stainless steel and high carbon steel curettes

Root planing depends on quality instrument cutting edges. The sharpness and wear of stainless steel (SS) and high carbon steel (HCS) dental curettes were compared before and after standardized root planing procedures. Forty working edges of dental curettes, 20 of each alloy, were examined by scanning electron microscope (SEM) prior to any root planing (control), after 15 strokes, and after 45 strokes. Root planing was carried out on freshly extracted, single-rooted teeth, mounted in natural positions in mannikin jaws. Working areas measuring 3 x 5 mm were marked on root surfaces previously exposed by periodontitis. Each working edge was examined at points 1 mm and 2 mm from the tip under the same magnification (x 240). Microscopic observations showed that edge deformation increased from the control (factory sharpened) group, to the "15 stroke" group, and from the "15" to the "45 stroke" group, in both SS and HCS curettes. SS curettes, however, demonstrated significantly more wear than HCS curettes. After 45 strokes, only 5% of the SS curettes were sharp, compared to 20% of the HCS curettes. While 65% of the SS curettes showed severe edge deformation by the end of the study, only 20% of the HCS curettes were severely deformed (P less than 0.01). The results indicate that HCS curettes are more resistant to wear than SS curettes. Further study is indicated to evaluate the relationship between actual bevel dimensions and root planing effectiveness.

Forced eruption combined with gingival fiberotomy. A technique for clinical crown lengthening

A new approach to clinical crown lengthening has been developed and described. The technique combines controlled eruptive tooth movement and incision of the supracrestal gingival attachment. The procedure was performed in patients with severe destruction of a tooth crown and in whom clinical crown lengthening procedures were essential before the teeth could be properly restored. Controlled eruptive forces were activated by simple orthodontic appliances. During the active phase of forced eruption, repeated intrasulcular incisions through the junctional epithelium and the supracrestal connective tissue attachment were performed. The technique prevented coronal displacement of the gingiva and the attachment apparatus during the orthodontic extrusion, thus overcoming the need for corrective osseous surgery.

Facial radicular groove in a maxillary central incisor. A case report

A facial radicular groove may occur in central maxillary incisors and act as a funnel for accumulating plaque and calculus. Since it is inaccessible to routine oral hygiene efforts of the patient and to treatment manipulations of the dentist, this anomaly predisposes the tooth to localized periodontal disease. Conservative or surgical treatment of such teeth should restore periodontal health by creating an environment more favorable for plaque control.

Cryosurgical depigmentation of the gingiva. A case report

Gingival melanin pigmentation (GMP) occurs in all races of man. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by fair-skinned people with moderate GMP. The present study was undertaken to test the effectiveness of cryosurgical destruction of the gingival epithelium in the removal of gingival melanin pigmentation. The patient was a fair-skinned Ashkenazi Jew with moderate GMP who demanded any possible "cosmetic therapy" which would convert her "black gums" to "normal". Gingival cryosurgery was carried out by segments. A gas expansion cryoprobe cooled to -81 degrees C was applied to the gingiva for 10 s. Frozen sites thawed spontaneously within 1 min. Superficial necrosis became apparent within a week. Treated sites were covered by epithelium within 2 weeks following freezing and keratinization was completed after 3-4 weeks. The treated gingiva appeared normal and remained depigmented until the present time, 20 months following freezing. It is concluded that cryosurgery may prove to be the treatment of choice when gingival depigmentation is indicated.

Cell surface hydrophobicity of Actinobacillus actinomycetemcomitans Y4

Oral bacteria colonize the dento-gingival tissues in a selective manner. Hydrophobic reactions have been suggested as one of the major mechanisms of adhesion. Hydrophobicity of Actinobacillus actinomycetemcomitans Y4 (Aa) cells was studied in vitro using adherence to the liquid hydrocarbon, octane. Adherence of Aa cells to octane varied from 60-90%, depending on the medium in which they were grown, age of the culture and the buffer in which the assay was carried out. These data suggest that Aa is a hydrophobic bacterium, the hydrophobicity of which is expressed to a varying degree, and may have a rôle in its adherence to oral tissues.