Early and late implant loss in a university-based periodontal setting: A retrospective analysis on 1821 patients and 2639 implants over a period of 18 years

The aim of this study was to retrospectively analyze the implant failure rate, not due to peri-implantitis, in periodontally compromised patients rehabilitated with at least one dental implant placed in a specialist university setting over the last 18 years. Records of patients receiving dental implants at the Department of Periodontology, University of Bern, Switzerland, between 2005 and 2022 were analyzed. Data on 1821 patients with 2639 implants were retrieved. Fifty-nine patients experienced implant loss (rate at patient level: 3.2%) out of which 2.1% were early and 1.1% late implant losses, respectively. The majority of the 59 patients were males (68%) and 27.1% were smokers. Eight mm implants were lost with the highest rate (42.4%) followed by 10 mm implants (31.8%). The rate of lost maxillary implants was more than twice as high compared with that of mandibular implants (69.7 vs. 30.3%). Within the study limitations, the implant failure rate in this cohort of patients enrolled in regular supportive periodontal and peri-implant care, was low.

[Comparison of two-year stability between immediate implant action and delayed implantation for anterior teeth with periodontal disease]

PURPOSE

To investigate the feasibility of immediate implantation after extraction of anterior teeth in patients with periodontal disease and its clinical effect within 2 years.

METHODS

Thirty patients (36 implants) who underwent anterior dental implant treatment for periodontal disease from 2016 to 2018 were randomly divided into immediate implantation group (17 implants) and delayed implantation group (19 implants). The patients were followed up for 2 years, the clinical parameters such as periodontal probing depth, pink esthetic score（PES）and implant neck bone resorption volume of implant neck were obtained. The data was statistically analyzed with SPSS 21.0 software package.

RESULTS

During the 2-year follow-up period, no implant loss, and there was no significant difference in the depth of peri-implant probing between the two groups at each time point(P＞0.05). There was no significant difference in the volume of bone resorption at implant neck between the two groups(P>0.05). At 6, 12 and 24 months after completion of superstructure repair, there was no significant difference in pink esthetic score（PES）between the two groups (P＞0.05), but there was significant difference in pink esthetic score（PES) at the third month after restoration (P＜0.05). The immediate implantation group obtained more satisfactory soft tissue morphology around the implants.

CONCLUSIONS

Under appropriate treatment conditions, there is no significant difference in implant success rate between immediate implantation and delayed implantation of anterior teeth in patients with periodontal disease. At the same time, it reduces the number of operations and shortens the course of treatment. In terms of soft tissue aesthetics, immediate implantation is slightly better than delayed implantation in the early stage after restoration, and can maintain a good soft tissue aesthetic effect.

Utilizing a novel radiographic image segmentation method for the assessment of periodontal healing following regenerative surgical treatment

OBJECTIVE

The aim of the current article was to present a radiographic method to determine the surface area of newly formed periodontal attachment, as well as to analyze volumetric and morphologic changes after regenerative periodontal treatment.

METHOD AND MATERIALS

In this retrospective study, 11 singular intrabony periodontal defects were selected for minimally invasive surgical treatment and 3D evaluation. 3D virtual models were acquired by the segmentation of pre- and postoperative CBCT scans. This study determined the surface area of baseline periodontal attachment (RSA-A) and defect-involved root surface (RSA-D) on the preoperative 3D models, and the surface area of new periodontal attachment (RSA-NA) on the postoperative models. Finally, cumulative change of periodontal attachment (∆RSA-A) was calculated and Boolean subtraction was applied on pre- and postoperative 3D models to demonstrate postoperative 3D hard tissue alterations.

RESULTS

The average RSA-A was 84.39 ± 33.27 mm2, while the average RSA-D was 24.26 ± 11.94 mm2. The average surface area of RSA-NA after regenerative periodontal surgery was 17.68 ± 10.56 mm2. Additionally, ∆RSA-A was determined to assess the overall effects of ridge alterations on periodontal attachment, averaging 15.53 ± 12.47 mm2, which was found to be statistically significant (P = .00149). Lastly, the volumetric hard tissue gain was found to be 33.56 ± 19.35 mm3, whereas hard tissue resorption of 26.31 ± 38.39 mm3 occurred.

CONCLUSION

The proposed 3D radiographic method provides a detailed understanding of new periodontal attachment formation and hard tissue alterations following regenerative surgical treatment of intrabony periodontal defects.

[Evaluation of the clinical effectiveness of the use of a navigational surgical template in the vestibuloplasty protocol in patients with periodontal diseases]

THE AIM OF THE STUDY

Was to evaluate the clinical effectiveness of the use of a navigational surgical template in the vestibuloplasty protocol in patients with periodontal diseases.

MATERIALS AND METHODS

There were 48 people selected to participate in the study and randomly divided into 2 equal groups. The patients of the main group underwent vestibuloplasty procedure using a free gingival graft modeled using the developed protocol and a navigational surgical template. Patients in the control group underwent a similar operation using classical technology. The study assessed postoperative pain, the index of early wound healing, Doppler fluometry of the transplanted flap and flap morphometric measurements.

RESULTS

The results of all conducted studies confirmed the effectiveness of the developed clinical protocol.

CONCLUSION

According to objective and subjective assessments, the use of a surgical navigation template can reduce the time and invasiveness of vestibuloplasty surgery, make it more comfortable for the patient and get a more predictable clinical result.

Update on Antimicrobial Therapy in Management of Acute Odontogenic Infection in Oral and Maxillofacial Surgery

This article focuses on the antimicrobial therapy of head and neck infections from odontogenic origin. Odontogenic infections are among the most common infections of the oral cavity. They are sourced primarily from dental caries and periodontal disease (gingivitis and periodontitis). Many odontogenic infections are self-limiting and may drain spontaneously. However, these infections may drain into the anatomic spaces adjacent to the oral cavity and spread along the contiguous facial planes, leading to more serious infections. Antibiotics are an important aspect of care of the patient with an acute odontogenic infection. Antibiotics are not a substitute for definitive surgical management.

Pharmacological management of pain after periodontal surgery: a systematic review with meta-analysis

OBJECTIVES

To assess and compare the pharmacological effect of different drugs on pain relief after periodontal surgery.

MATERIALS AND METHODS

Five databases were searched up to September 2019. The eligible studies comprised randomized clinical trials, involving only adult individuals that received any periodontal surgery and presenting two distinct groups of therapeutic regimens to control postoperative pain. Placebo groups could be included. The risk of bias was assessed with the RoB 2 Cochrane tool and the GRADE system. Meta-analyses were performed using different follow-up and drug comparisons.

RESULTS

Overall, 2398 studies were identified, of which 35 were included. Low risk of bias was determined for the majority of the studies. The meta-analyses showed that the comparison of dexamethasone or non-steroidal anti-inflammatory drugs (NSAID) versus placebo favored the use of both interventions in a follow-up of 1 to 8 h for open flap procedures (OFP). However, no statistical difference was found for the comparison between NSAID and dexamethasone for OFP.

CONCLUSIONS

Patients may benefit from several pharmacological schemes for pain relief after periodontal surgeries. However, due to the high heterogeneity among studies, no fixed pharmacological protocol could be proposed.

CLINICAL RELEVANCE

There is not enough evidence to recommend one therapeutic scheme. However, untreated pain is harmful to the patients and it is not advisable.

Association between intensive periodontal treatment and spontaneous intracerebral hemorrhage-a nationwide, population-based cohort study

Periodontal disease is a chronic inflammation of periodontium and has a high prevalence. Periodontal disease has been discovered to be a possible risk factor for cerebrovascular diseases. The available evidence are not enough to set up a causal relationship between periodontal disease and cerebrovascular diseases. Patients with spontaneous intracerebral hemorrhage have high mortality rates. The present study investigated whether intensive periodontal treatment is a protective factor of spontaneous intracerebral hemorrhage and can reduce the risk of spontaneous intracerebral hemorrhage.In total, 64,960 patients with a history of periodontal disease were picked out from the National Health Insurance Research Databases as a case-cohort from January 01, 2000 to December 31, 2010. They were divided on the basis of whether periodontal disease patients received intensive surgical treatment (treatment cohort) or not (control cohort). The periodontal disease patients in treatment and control cohorts were selected by propensity score matching at a ratio of 1:1. Incidences of spontaneous intracerebral hemorrhage in both cohorts were analyzed and compared.The total hazard of spontaneous intracerebral hemorrhage was significantly decreased in the treatment cohorts compared with the control cohorts (adjusted hazard ratio = 0.60, 95% confidence interval = 0.45-0.79).Compared with the control cohort, intensive periodontal treatment may reduce the overall incidence of spontaneous intracerebral hemorrhage, particularly in elderly patients, males, and those who received more than 2 intensive treatments.

Effects of Quartz Splint Woven fiber periodontal fixtures on evaluating masticatory efficiency and efficacy

Masticatory efficiency is altered by mobile teeth resulting from periodontal disease. The goal of our study was to investigate changes before and after fixation of mobile teeth with a Quartz Splint Woven high-strength quartz fiber splint and evaluate the fixation effect.Forty-two patients with chronic severe periodontal disease and 2 to 3 degree tooth mobility underwent fixation with Quartz Splint Woven quartz fiber splints. Masticatory efficiency was determined before and 1 month after periodontal treatment, and 1 month after fixation. Changes in periodontal probing depth (PD) and periodontal attachment level (AL) were measured and clinical efficacy was evaluated.Masticatory efficiency significantly increased from 39.32% to 50.95% after treatment (P < .001). One month post-fixation, mastication efficiency increased to 67.99% (P < .001). At 3 months post-fixation, efficacy was 100% and at 6 months it was 95.24%; PD decreased from (4.91 ± 0.63) to (4.19 ± 0.60) mm at 1 month post-periodontal treatment, and significantly decreased to (3.73 ± 0.60) mm 1 month post-fixation (P < .001); AL decreased from (4.43 ± 0.58) to (3.96 ± 0.51) mm 1 month after periodontal treatment. One month post-fixation, AL reduced to (3.64  ± 0.46) mm (P < .001).Masticatory efficiency improved after periodontal treatment. Using Quartz Splint Woven quartz fiber periodontal splint for mobile tooth fixation can further improve mastication efficiency and periodontal condition. A stable and ideal fixation can be achieved within 6 months, which provides a clinical basis for treatment and preserving mobile teeth in severe periodontal disease. Mastication efficiency may be recommended as the index for evaluating curative effects of periodontal disease treatment.

Accuracy and Usefulness of CBCT in Periodontology: A Systematic Review of the Literature

A systematic literature review was performed regarding the accuracy and usefulness of cone beam computed tomography (CBCT) in the field of periodontology. A total of 580 articles were identified, of which 13 met the inclusion criteria. Results showed a high accuracy of CBCT in visualizing periodontal structures and the demonstrated the usefulness of CBCT in regenerative periodontal surgery of maxillary molars. It remains questionable whether this gain of additional information actually leads to a better clinical outcome in periodontal treatment. Currently, the use of CBCT in periodontology should be restricted to complex periodontal cases, particularly those involving maxillary molars.

The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-A systematic review and meta-analysis

OBJECTIVES

To evaluate the effect of local and/or systemic statin use as an adjunct to non-surgical and/or surgical periodontal therapy.

DATA

Literature search according to PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) interventional studies; (c) statins as monotherapy or as an adjunct to non-surgical and/or surgical treatment of periodontitis; (d) clinical and/or radiographic treatment effect size of statin intake reported.

SOURCES

Medline (PubMed), Embase (Ovid), CENTRAL (Ovid).

STUDY SELECTION

Thirteen clinical studies regarding local application and 2 with systemic administration of statins as an adjunct to non-surgical treatment (SRP) and 4 studies regarding intrasurgical statin application with a maximum follow-up of 9 months could be included; simvastatin, atorvastatin, and rosuvastatin were used. Local but not systemic statin application as an adjunct to SRP yielded significantly larger probing pocket depth (PD), radiographic defect depth (RDD), and bleeding index reduction, and larger clinical attachment level gain, and less residual PD and RDD (p≤0.016); rosuvastatin appeared as the most efficacious. Three of 4 studies reported a significant positive effect of intrasurgical statin application. No adverse events were reported after statin use. The vast majority of the included studies were from the same research group.

CONCLUSIONS

Significant additional clinical and radiographic improvements are obtained after local, but not systemic, statin use as an adjunct to SRP in deep pockets associated with intrabony defects and seemingly with furcation defects; intrasurgical statin application seems similarly beneficial. Confirmation of these results, and especially of the effect size, from other research groups is warranted.

Spontaneous Correction of Accentuated Retraction of Maxillary Central Incisors After Autogenous Graft in Midline, Mesialization, and Lingual Torque of Incisor Roots

In the present clinical case, the authors report the orthodontic treatment of an adult patient with Class II malocclusion with periodontal disease and extensive bone destruction in the anterior region of the median palatine suture. Before orthodontic treatment, the patient presented precarious oral health. The treatment proposed for the case was insertion of an autogenous graft and subsequent orthodontic movement of the teeth to the area of the graft. The results obtained were correction of the malocclusion with significant improvement in gingival retraction and smile esthetics. With this clinical case, it could be concluded that well-performed orthodontic treatment can improve periodontal condition.

Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery

Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine.

A randomized controlled clinical trial on the effectiveness of three different mouthrinses (chlorhexidine with or without alcohol and C31G), adjunct to periodontal surgery, in early wound healing

OBJECTIVES

The use of chlorhexidine (CHX) with or without alcohol has been recommended for a number of clinical applications. On the other hand, there is a plethora of widely subscribed antiseptics, such as agent C31G (alkyl dimethyl glycine/alkyl dimethyl amine oxide), which has not yet been evaluated postsurgically. The effectiveness of three different mouthrinses (CHX with and without alcohol, C31G) in plaque control and early wound healing was compared postoperatively.

MATERIALS AND METHODS

In this, randomized, double-blind, controlled clinical trial 42 patients were allocated to three groups assigned to 2 weeks rinsing after non-regenerative periodontal flap surgery with or without osseous surgery with C31G (group A), alcohol-free CHX 0.12% (group B) or alcohol-based CHX 0.12% (group C). At days 7 and 14, plaque and early wound healing indices were recorded. At day 14, total bacterial counts were estimated utilizing real-time quantitative polymerase chain reaction (qPCR). Statistics included linear and generalized linear mixed models.

RESULTS

At day 7, healing response was not significantly different among groups. At day 14, group A revealed the highest while group C demonstrated the lowest plaque index values (B vs A, odds ratio-OR = 0.18, p = 0.012; C vs A, OR = 0.01, p < 0.001; C vs B, OR = 0.06, p < 0.001). Group C demonstrated the lowest bacterial counts levels at day 14 (38.470 × 10⁶, 48.190 × 10⁶, and 3.020 × 10⁶ for groups A, B, and C, respectively). At day 14, healing was significantly better in group C compared to B (p = 0.007). Group A showed no significant differences compared to other groups.

CONCLUSIONS

(1) The presence of alcohol may increase the effectiveness of CHX in early wound healing, (2) C31G might be an alternative solution prescribed during early postoperative period after non-regenerative periodontal flap surgery.

CLINICAL RELEVANCE

The present study found that active agent C31G displayed no significant differences to CHX formulations regarding periodontal wound healing improvement and might be used alternatively after non-regenerative periodontal flap surgery. In addition, an alcohol based 0.12% CHX mouthwash was more effective than an alcohol-free 0.12% CHX and C31G mouthrinse on plaque control in the absence of mechanical oral hygiene.

The periodontal pocket

Periodontal disease is synonymous with the presence of periodontal pockets, and very often the clinical success of periodontal therapy is based on periodontal pocket depth reduction. Therefore, in the fields of periodontology and implant dentistry, significant research effort has been placed on the etiopathogenesis, diagnosis and treatment of periodontal/peri-implant disease and as a consequence on pocket pathology. In this volume of Periodontology 2000, the in-depth reviews include topics ranging from preclinical models, anatomy and structure of tissues, and molecular and bacterial components, to treatments of pockets around teeth and implants. These reviews aim to provide the readers with current and future perspectives on the different areas of research into the periodontal pocket.

Surgical treatment of the residual periodontal pocket

The ultimate goal of periodontal therapy is to prevent further disease progression in order to reduce the risk of tooth loss. This objective can be achieved through a number of therapeutic modalities comprising both the nonsurgical and surgical phases of periodontal therapy. Nonsurgical periodontal treatment has been shown to control periodontal infection and to arrest progression of the disease in a significant number of cases. However, despite completion of nonsurgical treatment, a number of periodontal pockets, defined as 'residual', often remain. The presence of residual pockets may jeopardize tooth survival and be a risk factor of further disease progression, and ultimately tooth loss. Therefore, the aim of this review is to analyze the knowledge available on the indications for and the performance of periodontal surgical treatment of residual pockets in terms of 'traditional' (clinical, microbiological), patient-based and systemic health outcomes.

Traditional or regenerative periodontal surgery?-a comparison of the publications between two periodontal journals over time

OBJECTIVES

The objective is to compare the amount and content of publications regarding traditional or regenerative periodontal surgery in the years 1982/1983 and 2012/2013 in two leading periodontal journals of North America and Europe.

MATERIAL AND METHODS

The search was carried out in the Journal of Periodontology and Journal of Clinical Periodontology. Four reviewers screened the articles and allocated the topics with respect to periodontal surgery. The distribution of articles with respect to traditional or regenerative periodontal surgery was then compared between the journals and the respective time periods.

RESULTS

Out of 1084 screened articles, 145 articles were included. Articles with periodontal surgery content amounted to 18% for the first time period and to 11% for the second time period. In the years 1982/1983, 7% of articles in the Journal of Periodontology and 8% in the Journal of Clinical Periodontology referred to traditional periodontal surgery, while 8% (Journal of Periodontology) and 5% (Journal of Clinical Periodontology) examined regenerative periodontal surgery. The distribution changed 30 years later, with 1% (Journal of Periodontology) and 3% (Journal of Clinical Periodontology) traditional periodontal surgery and 7% and 6% regenerative periodontal surgery content.

CONCLUSION

While the clinical need for traditional periodontal surgery remained, research in this important field decreased. Publications rather tended to focus on adjunctive regenerative measures.

CLINICAL RELEVANCE

Periodontal surgery with adjunctive regenerative measures is an established and well-documented clinical procedure. However, with respect to the dominance of horizontal bone loss in periodontally diseased patients, there is a need for ongoing research with focus on traditional periodontal surgery.

Filling bone defects with β-TCP in maxillofacial surgery: A review

Reconstruction of bone defects prior to implant placement now involves synthetic substitutes such as β-TCP because of its ability to promote bone remodeling. Its capacity to be progressively substituted by the patient's bone allows to regenerate a dense bone volume. In addition, its availability in large quantities, avoiding the morbidity observed with harvesting autogenous bone, widens the operative indications. In this paper, the main indications of β-TCP in maxillofacial surgery (dentistry, parodontology and dental implant surgery) are reviewed. They include periodontal bone disease, bone disjunction, pre-implant surgery (sinus floor elevation and lateralization of the inferior alveolar nerve).

An Evaluation of Antibiotic Use in Periodontal and Implant Practices

In past decades, warnings about overprescription and misuse of antibiotics- which are now considered to be responsible for antimicrobial resistance, allergies, ineffectiveness, and suprainfections-have been made to both medical and dental clinicians. To help assess the antibiotic prescribing habits of dentists, a survey was created and emailed through the Survey Monkey tool to 102 randomly selected board-certified periodontists. Each was asked to answer multiple-choice questions regarding their use of an antibiotic protocol in 10 specific periodontal or implant-related clinical circumstances. This group of practitioners and the 10 clinical circumstances were chosen to limit the wide variety of clinical conditions treated by dentists and to narrow the scope of variables when antibiotics are considered. All 102 participants returned the questionnaire, and 96% to 100% of respondents reported that they had treated 8 of the 10 circumstances, with 89.9% and 80.8% having treated the other two conditions listed in the survey; this allowed subsequent questioning of the respondents on their antibiotic prescribing protocols. Although the validity of antibiotics for dental procedures may be questioned based on present information, as many as 50% or more of the dentists answering the survey prescribed antibiotics. The prescription, initiation, and duration of antibiotics varied considerably in many of the 10 specific circumstances, including treatment of acute and chronic periodontitis, sinus or ridge augmentation, and immediate or delayed implant placement. Based on the results of the survey, it was obvious that definitive guidelines and protocols are needed as well as expanded postgraduate training regarding antibiotic use.

Minimally Invasive Surgery in Periodontal Regeneration: A Review of the Literature

New techniques have emerged to achieve periodontal regeneration without the drawbacks associated with conventional flap surgery. Minimally invasive surgery (MIS) is a method of surgical access that minimizes flap reflection and tissue trauma, resulting in maintenance of critical blood supply, stability of the blood clot within the wound site, and less postoperative recession over time. As advancements in materials and techniques are made, MIS in periodontal regeneration continues to evolve. The emergence of a videoscope for use during MIS (VMIS) has improved visual access to surgical sites, facilitating improved defect debridement and root planing. As demonstrated, VMIS has resulted in an actual gain in soft-tissue height up to 3 years postoperatively.

Transreplantation: An alternative for periodontally hopeless teeth

The periodontal therapy of severely damaged teeth that have advanced bone loss, a significant degree of mobility, and often tooth migration and elongation, frequently exposes the dental clinician to difficult decisions regarding the appropriate therapy for the patient. Extensive rehabilitation, with the replacement of periodontally hopeless teeth, has biologic, prognostic, and financial limitations. A possible alternative in such cases is the transreplantation of periodontally hopeless teeth. Ankylosis of the tooth is induced by appropriate extraoral pretreatment and thus the mobility disappears and the alveolar bone is reformed. This little-known technique is described step by step, with reference to a clinical case.

[Interest of prosthodontic periodontal surgery in the success of anterior fixed prostheses]

INTRODUCTION

Periodontal prosthodontic surgery plays a major role in the integration of aesthetic and functional prosthetic restorations, including in the anterior area. Indeed, any dento-gingival disharmony of volume or shape must be corrected beforehand, thus justify a plastic periodontal surgery.

OBSERVATION

This is a 20-year-old patient, who consulted for essentially aesthetic motive: the restoration of the fracture 11. Clinical examination revealed the presence of a defective provisional prosthesis on 11, an unsightly filling composite resin on the 21, asymmetry of the gingival contour, as well as a low located upper labial brake. Juxta-bone decay of the lingual wall of the 11 was prominent on the retro-alveolar.

DISCUSSION

To meet the growing aesthetic demand of the patient, a multidisciplinary care was considered: a gingivectomy has been carried out, in order to align the collar of the 11 with that of the 21, associated with a coronal elongation landscaping biological space on the lingual side of the 11. And to optimize the therapeutic outcome, a frenectomy of the upper labial brake was performed.

Influence of suturing on wound healing

The present article describes the significance of suturing and appropriate suture materials in current periodontal and implant surgery. Synthetic, nonresorbable, monofilament threads appear to be advantageous. The physical and biological properties of such threads remain unchanged with use and, when used in small diameters (i.e. with lower breaking resistance), seem to promote passive wound closure. Wound healing at hard, nonshedding surfaces is conceptually a more complex process than is wound healing in most other sites of the oral cavity. Firm adaptation and stabilization of the flaps by optimal suturing ensures adhesion of the delicate fibrin clot to the nonshedding surface. The early formation and mechanical stability of the blood clot between the mucosal or mucoperiosteal flap and the wound bed are of paramount importance and hence suturing techniques must be considered as a key prerequisite to ensure optimal surgical outcomes. With the sophisticated surgical procedures now applied, there is a greater need for knowledge with regard to the various types of suturing techniques and materials available in order to achieve the above-mentioned goals.

Dental care in patients with antiphospholipid syndrome: two case reports

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease that may be classified as primary or secondary. Treatment consists of oral anticoagulant, antiplatelet, and/or immunosuppressant drugs. This report describes the dental treatment of 2 women with APS and multiple dental concerns, including periodontal disease, caries, and missing teeth. The invasive dental procedures were performed in an outpatient setting with hematologic monitoring and use of local hemostatic measures. Neither interruption of anticoagulant medications nor administration of blood products was necessary. All of the procedures were performed without complications. To date, no recommendations for the dental care of patients with APS have been established, demonstrating a need to investigate the risks for bleeding and infection, among other concerns, during dental treatment of these patients.

Current status of the influence of osteoporosis on periodontology and implant dentistry

PURPOSE OF REVIEW

This review summarizes recent evidence on the impact of osteoporosis on periodontonlogy and implant dentistry, prevalence of diseases, pathophysiology and treatment outcomes.

RECENT FINDINGS

Patients with osteoporosis should be advised about the importance of returning for periodical periodontal maintenance as inadequate oral care may lead to a faster development of periodontitis. There is no definitive information on the development of bisphosphonate-related osteonecrosis of the jaw associated with dental implant therapy. Patients presenting severe periodontitis, undergoing intravenous bisphosphonate therapy (for long-term periods) and submitted to more invasive periodontal/peri-implant surgical procedures (that can promote superior dentoalveolar surgical trauma) might be advised about the possibility of developing bisphosphonate-related osteonecrosis of the jaw following dental therapy. Thus, individualized risk evaluation must be undertaken by both the medical and dental teams prior to any dental treatment.

SUMMARY

The most recent literature on the impact of osteoporosis on the periodontal and peri-implant tissues was reviewed to emphasize the importance of oral hygiene measures, and the combined medical/dental assessment of importance when osteoporotic patients are in need of dentoalveolar surgical procedures (e.g. tooth extraction and dental implant placement).

The effect of EDTA root conditioning on periodontal surgery outcome: A meta-analysis

OBJECTIVE

Chemical root conditioning is a procedure to remove the smear layer, which influences periodontal healing. The purpose of this study was to determine the effect of using ethylenediaminetetraacetic acid (EDTA) as a root conditioning agent on periodontal surgery outcomes.

METHOD AND MATERIALS

The databases searched from their earliest records to February 2015 included Pubmed, Embase, the Cochrane library, and ISI Web of Science. Quality assessment of the methodologies of all the included studies and data was performed with Review Manager software. Probing depth (PD) and clinical attachment level (CAL) were analyzed using inverse variance.

RESULTS

The evaluation of the three articles that met the inclusion criteria showed that the differences between the EDTA groups and the control groups were not statistically significant (6 months PD: mean difference [MD] = -0.15 mm, Z = 1.09, P = .27; CAL: MD = 0.15 mm, Z = 0.89, P = .37).

CONCLUSION

EDTA was not able to significantly improve the PD and CAL. A positive outcome of using EDTA as a root conditioning agent was not evident. Thus, future research should focus on EDTA in combination with other drugs or a better alternative drug to EDTA.

A systematic review and meta-analysis on the effects of crown lengthening on adjacent and non-adjacent sites

OBJECTIVES

The objective of the study was to assess the impact of periodontal crown lengthening surgery on clinical parameters at adjacent and non-adjacent sites compared to treated sites.

MATERIAL AND METHODS

An electronic search was carried out on MEDLINE-PubMed, The Cochrane Library, and ISI Web of Science databases between 1978 and 2015. Methodological quality assessment was based on Cochrane recommendations. Meta-analyses were assessed with RevMan 5.0 and heterogeneity between studies by the Higgin test (I ²). Clinical attachment level (CAL) and probing depth (PD) were the primary outcome variables. Four case series studies were included and three in the meta-analysis. All studies showed high risk of bias.

RESULTS

The surgery promoted significant changes in treated, adjacent, and non-adjacent sites. There were greater changes in PD (mean difference -0.14, 95 % CI -0.18 to -0.10, p < 0.00001) and CAL (mean difference 0.16, 95 % CI 0.13 to 0.20, p < 0.00001) in treated sites when compared to adjacent and non-adjacent sites for PD (mean difference -0.09, 95 % CI -0.12 to -0.05, p < 0.00001) and CAL (mean difference 0.91, 95 % CI 0.87 to 0.94, p < 0.00001).

CONCLUSION

Crown lengthening surgery results in changes of clinical parameters in treated, adjacent, and non-adjacent sites.

CLINICAL RELEVANCE

Clinical and esthetic alterations on the adjacent/non-adjacent teeth can lead to clinical and esthetic alterations, which must be considered in surgical planning.

Resective or Regenerative Periodontal Therapy: Considerations during Treatment Planning: A Case Report

Successful long-term management of molars having advanced periodontal disease with secondary endodontic involvement is a challenge to the periodontist. Several treatment options exist for the periodontist based upon various factors. A patient with a deep periodontal pocket on the right mandibular first molar reported for dental treatment. Periapical radiographs revealed bone loss extending to the apex of the mesial root. The treatment plan included scaling, root planing, endodontic therapy and periodontal surgery for the involved tooth. During periodontal surgery, resective and regenerative treatment options were evaluated and explained to the patient. Considering the prognosis of the case, risk-benefit ratio and the patient's choice, regenerative periodontal therapy was performed. The case has been followed for two years, with gain in clinical attachment and radibgraphic bone fill. The authors discuss factors to be considered when choosing regenerative periodontal therapy over resective periodontal therapy.

Management of Multiple Dental Infections in a Dog with Diabetes Mellitus

A dog with diabetes mellitus was treated for multiple dental fractures and refractory hyperglycemia. Five teeth were found to have endodontic infections. Three extractions and two root canal procedures were performed to resolve these infections, resulting in improved regulation of blood glucose levels. Treatment planning included special considerations in management of diabetes in the anesthetic and perioperative periods.

Bilateral Maxillary Periodontal Ligament Hamartoma in a Dog

A 12.5-year-old dog was presented for severe periodontal disease and bilateral maxillary enlargement. Radiographs of the maxilla showed generalized root resorption, ankylosis, and rarefaction of bone with focal radiodense areas. Surgical tooth extraction of multiple maxillary teeth and bilateral incisional biopsies of the periodontal tissue and maxilla in the legion of the maxillary fourth premolars were performed. Histopathologic examination showed features typical of fully differentiated periodontal ligament with abundant cementum/alveolar lining bone and sparce odontogenic epithelial cell rests. Histopathology in conjunction with radiographic and clinical signs suggested a diagnosis of bilateral periodontal ligament hamartoma. Examination 3-months postoperatively indicated uncomplicated healing of the extraction and biopsy sites with no resolution of the maxillary enlargement.

Inflammatory collateral cyst associated with a palatoradicular groove: report of a case and discussion of nomenclature

The aims of this article are to present a case demonstrating the connection between palatoradicular grooves and inflammatory collateral cysts and to discuss the related nomenclature. Radiographs in a 21-year-old man revealed a radiolucent, unilocular, well-defined area near the vital maxillary right lateral incisor and canine. Palatal swelling was present, and a 6-mm-deep periodontal pocket was found at the palatal surface of the right lateral incisor. The differential diagnoses were keratocystic odontogenic tumor, developmental lateral periodontal cyst, and inflammatory lateral periodontal cyst. The area was explored surgically, and the lesion was excised. Surgical exploration revealed a palatoradicular groove, which was scaled and planed with the aid of manual curettes with the intention of creating a flat surface to promote insertion of the periodontal fibers. Histopathologic analysis revealed that the lesion was an inflammatory cyst. The presence of a palatoradicular groove can put the periodontium at risk because a resulting lack of fiber insertion makes oral hygiene difficult. This established inflammatory process can initiate development of an inflammatory collateral cyst that may be misdiagnosed, hindering successful management. In this case, bone grafting and placement of a resorbable membrane were used to promote bone formation and subsequent sealing of the periodontal space.

Effect of angiotensin-converting enzyme inhibitors on vascular endothelial function in hypertensive patients after intensive periodontal treatment

There is a relation between vascular endothelial function, atherosclerotic disease, and inflammation. Deterioration of endothelial function has been observed twenty-four hours after intensive periodontal treatment. This effect may be counteracted by the action of angiotensin-converting enzyme inhibitors, which improve endothelial function. The aim of the present study was to evaluate vascular endothelial function after intensive periodontal treatment, in hypertensive patients treated with angiotensinconverting enzyme inhibitors. A prospective, longitudinal, comparative study involving repeated measurements was conducted. Fifty-two consecutive patients with severe periodontal disease were divided into two groups, one comprising hypertensive patients treated with converting enzyme inhibitors and the other comprising patients with no clinical signs of pathology and not receiving angiotensin-converting enzyme inhibitors. Endothelial function was assessed by measuring postischemic dilation of the humeral artery (baseline echocardiography Doppler), and intensive periodontal treatment was performed 24h later. Endothelial function was re-assessed 24h and 15 days after periodontal treatment.

STATISTICAL ANALYSIS

Results were analyzed using the SPSS 20 statistical software package. Student's t test and MANOVA were calculated and linear regression analysis with 95% confidence intervals and α<0.05 was performed. Arterial dilation at 24 hours was lower compared to baseline in both groups; values corresponding to the groups receiving angiotensin-converting enzyme inhibitors were 11.89 ± 4.87 vs. 7.30 ± 2.90% (p<0.01) and those corresponding to the group not receiving ACE inhibitors were 12.72 ± 4.62 vs. 3.56 ± 2.39 (p<0.001). The differences between groups were statistically significant (p<0.001).

CONCLUSION

The increase in endothelial dysfunction after intensive periodontal treatment was significantly lower in hypertensive patients treated with angiotensin-converting enzyme inhibitors. Endothelial function improved 15 days after periodontal treatment, reaching baseline values. These results support the protective effect of angiotensin converting enzyme inhibitors on the endothelial function after intensive periodontal treatment.

The use of resorbable cortical lamina and micronized collagenated bone in the regeneration of atrophic crestal ridges: a surgical technique. Case series

Some graft materials, such as micronized and collagenated bone, have an excellent capacity to be reabsorbed, allowing for the reformation of good-quality bone, but do not have the mechanical characteristics that would allow for stability in terms of shape and size. In this study, a technique is proposed which makes use of resorbable cortical lamina in order to create recipient sites that can be filled with micronized collagenated bone paste. The adequate vascularization of the graft combined with the integration of the lamina, which does not need to be removed, makes it possible to propose this technique as a potential alternative to those used to date.

Combined orthodontic-periodontal treatment in periodontal patients with anteriorly displaced incisors

INTRODUCTION

Flared and elongated incisors are associated with different types of periodontal bone defects, usually horizontal. Combined orthodontic-periodontal treatment is being used in periodontal patients with anterior displacement of the incisors. The purpose of this study was to investigate the changes in periodontal health and the shape of bone defects in the incisors after such combined treatment.

METHODS

Fourteen adults were included in the study. In total, 56 elongated maxillary incisors with horizontal bone defects received orthodontic-periodontal treatment with circumferential supracrestal fibrotomy. To improve bone morphology, periodontal regenerative surgery and guided tissue regeneration were performed on the anterior teeth with angular bone defects after orthodontic treatment. Cone-beam computed tomography scans were taken before treatment (T0), at the end of the orthodontic intrusion (T1), and 6 months after the guided tissue regeneration surgery (T2). Probing pocket depth and clinical attachment loss were examined at T0, T1, and T2. The data were analyzed using paired t tests.

RESULTS

From T0 to T1, clinical attachment loss decreased significantly by 0.29 mm (P <0.05). The distance from the cementoenamel junction to the marginal bone crest decreased by 0.66 mm (P <0.05). The labial side of alveolar bone thickness increased by 0.54 mm (P <0.05), and the lingual side of alveolar bone thickness decreased by 0.46 mm (P <0.05). The shape of the bone defect was changed from horizontal to vertical on some teeth. From T1 to T2, both probing pocket depth and clinical attachment loss improved significantly, and the radiographic examinations showed bone redepositions of 2.15 ± 0.68 mm (P <0.05) vertically and 1.44 ± 0.92 mm (P <0.05) horizontally. The distance from the most apical point of the bone defect to the cementoenamel junction after combined treatment decreased by 2.11 ± 1.30 mm (P <0.05).

CONCLUSIONS

Combined orthodontic-periodontal treatment improved the periodontal conditions of the defective bone sites. Bone morphology, altered by orthodontic intrusion with fibrotomy, can improve the results of subsequent guided tissue regeneration.

Database analysis of a French type 2 diabetic population shows a specific age pattern of tooth extractions and correlates health care utilization

AIMS

To assess the relationship between type 2 diabetes and tooth loss and the predictive value of health behavior and routine dental care in regard to both dental and medical follow-ups.

METHODS

Cross-sectional study from a national database of a French population of railways transport workers was conducted with a descriptive analysis between registered diabetic patients and non-diabetic subjects. The relationship between oral health and diabetes was measured by tooth extraction prevalence in regard to the frequency of scaling-prophylaxis sessions and the number of medical and dental appointments.

RESULTS

The prevalence of tooth extractions in the type 2 diabetic population is 1.88 higher than the non-diabetic population. Diabetic patients tend to undergo dental extractions earlier and more often than non-diabetic individuals. They also have more medical appointments and less dental check-ups and scaling sessions than the non-diabetic population.

CONCLUSION

Measured by tooth loss, type 2 diabetic patients have a significantly earlier detrimental oral status when compared to the non-diabetic population. They exhibit a different pattern in health care utilization of outpatient medical resources. Oral health surveillance is not correctly addressed by the medical and dental coverage of these diabetic patients. Emphasis should be directed on specific dental care programs aimed at preventing tooth loss.

Dental issues in Rett syndrome

The advancements in science and technology allowed saving the lives of children, who had no chance of survival before. Hence the problem of so called rare diseases, usually genetically determined. It is a new challenge for both the physicians and the health services. These children require a coordinated multi specialist oriented health care, which includes also dentists. This situation is reflected by the case of an 18 years old girl with Rett Syndrome, described by us. In this patient despite numerous visits to various dental practices, no decision of a radical surgical extraction of the tooth has been conducted. In our Department the extraction of teeth 22, 16 and 14 has been performed, as a part of 1 day surgery procedures, thus eliminating the dental infections and pain. Conclusion: Elaboration and introduction into praxis principles of dental care in children and young adults with rare diseases are needed.

Determinants of length of hospitalization due to acute odontogenic maxillofacial infections: a 2009-2013 retrospective analysis

OBJECTIVES

To investigate the determinants of the length of hospitalization (LOH) due to acute odontogenic maxillofacial infections (AOMIs) from 2009 to 2013.

MATERIALS AND METHODS

Dental records of adult patients with AOMIs and related data were retrieved from the Vilnius University's dental hospital. The LOH was related to several determinants in each of the following domains: outpatient primary care, severity of AOMIs, lifestyle and disease domains. Determinants were also associated with the LOH using multivariate analysis.

RESULTS

A total of 285 patients were hospitalized with AOMIs, of which 166 (58.2%) were males and 119 (41.8%) were females. The mean LOH was 8.3 ± 4.9 days. The bivariate analysis did not reveal any statistically significant differences in LOH between patients with AOMIs who received urgent outpatient primary care and those who did not receive such care prior to hospitalization. All AOMI severity-related determinants were associated with the LOH. The LOH was related to coexisting systemic conditions but not to the higher severity of dental or periodontal diseases. Both bivariate and multivariate analyses revealed similar trends, where the most significant determinants of a longer LOH were related to the severity of AOMIs.

CONCLUSION

The most important determinants regarding longer hospitalization were indicators of infection severity such as an extension of the odontogenic infection and the need for an extraoral incision to drain the infection.

Is there a place for lasers in periodontal therapy?

This article aims to provide an overview on the clinical applications of lasers in periodontics.

Treatment of amalgam tattoo with a subepithelial connective tissue graft and acellular dermal matrix

A 54-year-old female was referred for management of a large amalgam tattoo involving the alveolar mucosa between teeth #6 and #9. The lesion had been present for over 20 years following endodontic treatment of teeth #7 and #8. A two-stage surgical approach was used to remove the pigmentation, beginning with removal of amalgam fragments from the underlying bone and placement of a subepithelial connective tissue graft and acellular dermal matrix to increase soft tissue thickness subadjacent to the amalgam. Following 7 weeks of healing, gingivoplasty was performed to remove the overlying pigmented tissue. At the 21-month follow-up appointment, the patient exhibited naturally appearing soft tissue with no evidence of amalgam tattoo.

Regenerative periodontal therapy: 30 years of lessons learned and unlearned

In this review, we reflect upon advances and hindrances encountered over the last three decades in the development of strategies for periodontal regeneration. In this soul-searching pursuit we focus on revisiting lessons learned that should guide us in the quest for the reconstruction of the lost periodontium. We also examine beliefs and traditions that should be unlearned so that we can continue to advance the field. This learned/unlearned body of knowledge is consolidated into core principles to help us to develop new therapeutic approaches to benefit our patients and ultimately our society.

Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts

This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. Advances in technology have resulted in the introduction of a range of new methods for use in nonsurgical periodontal therapy, including machine-driven instruments, lasers, antimicrobial photodynamic therapy and local antimicrobial-delivery devices. However, these methods have not been shown to offer significant benefits over and above nonsurgical debridement using hand instruments. The method of debridement is therefore largely dependent on the preferences of the operator and the patient. Recent evidence indicates that specific systemic antimicrobials may be indicated for use as adjuncts to nonsurgical debridement in patients with advanced disease. Full-mouth disinfection protocols have been proven to be a relevant treatment option. We have learned that while nonsurgical and surgical methods result in similar long-term treatment outcomes, surgical therapy results in greater probing-depth reduction and clinical attachment gain in initially deep pockets. The surgical technique chosen seems to have limited influence upon changes in clinical attachment gain. What has not changed is the importance of thorough mechanical debridement and optimal plaque control for successful nonsurgical and surgical periodontal therapy.

Assessment of anxiety related to dental treatments among patients attending dental clinics and hospitals in Ranga Reddy District, Andhra Pradesh, India

PURPOSE

To assess the levels of dental anxiety among patients anticipating dental treatments in dental clinics/hospitals of Ranga Reddy district.

MATERIALS AND METHODS

A cross-sectional study was conducted among a representative sample of 1200 subjects (at least 18 years old) in dental clinics/hospitals which were selected from a list obtained through systematic random sampling. The data were collected using a pre-tested and calibrated questionnaire consisting of the Modified Corah Dental Anxiety Scale (MDAS) to assess anxiety levels.

RESULTS

The majority (52.4%) of subjects showed a low level of anxiety. Females (11.44 ± 4.41) were found to have higher mean MDAS scores than males, and the highest mean MDAS scores were found among 18- to 34-year-olds (11.28 ± 4.67) (P < 0.05). Significant differences were found among subjects anticipating different treatments, with higher MDAS scores for extraction (11.25 ± 5.4), followed by examination, root canal treatment, gum surgery, scaling, restoration and others, e.g. orthodontic treatment, restoration with crowns, bridges and dentures (7.79 ± 3.80). The highest mean MDAS scores were found among subjects who were apprehensive due to 'past difficult experience in dental treatments', followed by 'drill' and 'injection', with the lowest scores among subjects indicating 'other reasons' (7.82 ± 3.84).

CONCLUSION

The present data show that anxiety levels are higher in patients who have to undergo extractions than those who must be fitted with dentures. Thus, dental health care providers should pay more attention to patients' anxiety levels associated with different types of treatment.