Proliferating and differentiating effects of three different growth factors on pluripotent mesenchymal cells and osteoblast like cells.

J Orthop Surg. 2007 Dec 20;2(1):27

Authors: Wildemann B, Burkhardt N, Luebberstedt M, Vordemvenne T, Schmidmaier G

ABSTRACT: Growth factors are in clinical use to stimulate bone growth and regeneration. BMP-2 is used in long bone and spinal surgery, PDGFbb for the treatment of periodontal defects and children with growth hormone receptor deficiency are treated with IGF-I. Aim of the present study was the comparative analysis of the effect of these growth factors released from a local drug delivery system on cells of the osteogenic lineage at differing differentiation stages. The experiments with the mesenchymal cell line C2C12 revealed a proliferating effect of all three growth factors and a differentiating effect of BMP-2 with a dramatic increase in alkaline phosphatase activity. None of the growth factors stimulated cell migration. Human osteoblast like cells showed similar results with an increase in proliferation after stimulation with IGF-I or PDGFbb. The enzymatic activity of alkaline phosphatase was enhanced only in the cells stimulated with BMP-2. This group showed also more mineralized matrix compared to the other groups. In conclusion, the growth factors IGF-I and PDGFbb delivered with a local drug delivery system stimulated cell proliferation, whereas BMP-2 showed a dramatic effect on differentiation on osteoblast precursor cells and osteoblast like cells.

PMID: 18093345 [PubMed - as supplied by publisher]

Mucoadhesive bilayered tablets for buccal sustained release of flurbiprofen.

AAPS PharmSciTech. 2007;8(3):E54

Authors: Perioli L, Ambrogi V, Giovagnoli S, Ricci M, Blasi P, Rossi C

The aim of this work was the design of sustained-release mucoadhesive bilayered tablets, using mixtures of mucoadhesive polymers and an inorganic matrix (hydrotalcite), for the topical administration of flurbiprofen in the oral cavity. The first layer, responsible for the tablet retention on the mucosa, was prepared by compression of a cellulose derivative and polyacrylic derivative blend. The second layer, responsible for buccal drug delivery, was obtained by compression of a mixture of the same (first layer) mucoadhesive polymers and hydrotalcite containing flurbiprofen. Nonmedicated tablets were evaluated in terms of swelling, mucosal adhesion, and organoleptic characteristics; in vitro and in vivo release studies of flurbiprofen-loaded tablets were performed as well. The best results were obtained from the tablets containing 20 mg of flurbiprofen, which allowed a good anti-inflammatory sustained release in the buccal cavity for 12 hours, ensuring efficacious salivary concentrations, and led to no irritation. This mucoadhesive formulation offers many advantages over buccal lozenges because it allows for reduction in daily administrations and daily drug dosage and is suitable for the treatment of irritation, pain, and discomfort associated with gingivitis, sore throats, laryngopharyngitis, cold, and periodontal surgery. Moreover, it adheres well to the gum and is simple to apply, which means that patient compliance is improved.

PMID: 17915804 [PubMed - indexed for MEDLINE]

[Alveolar osteotomy and rapid orthodontic treatments]

Orthod Fr. 2007 Sep;78(3):217-25

Authors: Sebaoun JD, Ferguson DJ, Wilcko MT, Wilcko WM

When combined with orthodontics, selective periodontal decortication has been shown to be clinically effective in eliminating severe malocclusions three to four times more rapidly than conventional orthodontic treatment. Our technique combines surgical scarring of the cortical bone on both labial and lingual sides of the teeth to be moved, with an augmentation graft to increase alveolar volume. Alveolar spongiosa undergoes rapid transformation as the body attempts to heal the wounds to the cortices resulting in marked tissue turnover. The patient is seen every two weeks and most cases are completed within six months of orthodontic treatment. Moreover, this technique significantly expands the scope of treatment in resolving many skeletal problems such as openbites and severe maxillary constrictions, conditions typically relegated to orthognathic surgery. Clinical outcomes research has shown that the immediate post treatment results settle better during retention and that the long term results become more stable. These facts are likely due to the high tissue turnover induced by decortication as well as the thicker cortical bone resulting from the augmentation grafting.

PMID: 17878040 [PubMed - indexed for MEDLINE]

Dental trauma: restorative procedures using composite resin and mouthguards for prevention.

J Contemp Dent Pract. 2007;8(6):89-95

Authors: Santos Filho PC, Quagliatto PS, Simamoto PC, Soares CJ

AIM: The aim of this article is to describe a step-by-step protocol for emergency care of a patient with a dentoalveolar injury in the anterior region of the mouth as well as the fabrication of a mouthguard to prevent future trauma. BACKGROUND: Dental trauma is one of the most serious oral health problems in active children and adolescents. Care of traumatized patients requires immediate initial emergency treatment followed by integrated procedures to restore damaged oral structures along with a subsequent trauma prevention strategy. Dentoalveolar injuries in the anterior region of the mouth are often characterized by tooth avulsion and coronal fracture. They are managed using procedures such as dental splinting, endodontic therapy with its unique characteristics, and restorative techniques to re-establish function and esthetics as well as protective mouthguards. REPORT: A 16-year-old male presented with avulsion of his maxillary central incisors as a result of a direct, unintentional impact with an opponent during a basketball game. The teeth had been stored in physiological serum immediately following the injury and the patient received immediate care. On clinical examination, the right central incisor was fractured at the incisal third of the crown but no bone fractures were found. The teeth were reimplanted and splinted. The fractured right central incisor was restored following endodontic treatment and a mouthguard was fabricated for the patient. SUMMARY: The dentist must be knowledgeable about the most efficient and suitable treatment for each traumatic scenario in order to provide appropriate care for dental injuries. Coordinated multi-disciplinary action is fundamental in the successful treatment of these injuries. The dental mouthguard is an effective device for protecting the teeth and supportive structures during physical activities and must be part of the protective equipment used by athletes. It is the responsibility of the dental professional to make parents, trainers, and athletic associations aware of the risks associated with physical activities without orofacial protection; this should encourage the proper use of all protective devices to prevent dentoalveolar injuries that compromise oral functions, esthetics, and increase the cost of healthcare.

PMID: 17846676 [PubMed - indexed for MEDLINE]

Total impaction of deciduous maxillary molars: two case reports.

J Contemp Dent Pract. 2007;8(6):64-71

Authors: Gündüz K, Muğlali M, Inal S

AIM: The purpose of this report is to present two cases of totally impacted maxillary deciduous molars, considered a rarity in dental practice. BACKGROUND: Primary tooth impaction is quite rare during the development of primary dentition. Various factors contribute to the impaction of a deciduous tooth, including anklyosis, congenitally missing permanent teeth, defects in the periodontal membrane, trauma, injury of the periodontal ligament, precocious eruption of the first permanent molar, defective eruptive force, or a combination of these factors. REPORTS: Case #1: An 18-year-old male presented with a complaint of spontaneous repetitious pain in the maxillary right premolar region. The maxillary right second premolar was clinically absent. Panoramic and periapical radiographs revealed an impacted second premolar close to the inferior wall of the maxillary sinus and an impacted deciduous molar deeply embedded in bone within the maxillary sinus. Case #2: A 14-year-old girl presented with a complaint of crowding of the maxillary teeth. The maxillary right second premolar and the maxillary permanent canines were clinically absent. A panoramic radiograph revealed an impacted maxillary right second premolar and an impacted deciduous molar embedded within bone close to the inferior wall of the maxillary sinus. SUMMARY: The total impactation of deciduous teeth is a rare condition, and few cases have been reported in the literature. The condition generally affects the mandibular second deciduous molar and the maxillary first deciduous least often. In this paper, two cases of totally impacted maxillary deciduous molars are reported.

PMID: 17846673 [PubMed - indexed for MEDLINE]

A comparative evaluation of the effectiveness of an anorganic bone matrix/cell binding peptide with an open flap debridement in human infrabony defects: a clinical and radiographic study.

J Contemp Dent Pract. 2007;8(6):25-34

Authors: Bhongade ML, Tiwari IR

AIM: The development of biologic modalities designed to enhance bone regeneration and wound healing of specific periodontal sites continues to unfold. This is accomplished through the cell binding activity of Type-I collagen provided by a synthetic cell binding peptide (P-15) which is incorporated in a scaffold of anorganic bovine matrix (ABM). This combination is designed to facilitate the attachment, migration, and differentiation of cells. The objective of this study is to clinically and radiographically evaluate the effectiveness of the combination of ABM and P-15 (ABM/P-15) 'putty' during regenerative periodontal procedures. METHODS AND MATERIALS: A total of 20 interproximal intraosseous defects in 16 patients, (8 males, 8 females), age 22-48 years (mean 34.45) were recruited and divided equally into two experimental groups. Following open flap debridement (OFD), the defect sites in a test group were grafted with a bovine-derived xenograft enriched with a cell binding peptide. The defect sites in a control group were treated with only OFD. Appropriate periodontal maintenance schedules were followed; at six months, clinical and radiographic assessments for soft tissue and hard tissue were performed for documentation and finalization of results. RESULTS: Statistical analysis using student paired 't' test analyses of the patient mean value from the 16 patients revealed the ABM/P-15 'putty' graft group demonstrated significantly better mean defect fill of 3.4 + 0.7 mm (70.5%) versus mean defect fill of 0.9 mm (17.33%) for defects treated with only OFD. Soft tissue findings showed significant differences among treatment with ABM/P-15 compared to OFD. CONCLUSIONS: These results indicate the use of P-15 synthetic cell binding peptide combined with ABM yields better clinical results in conjunction with OFD than with OFD alone.

PMID: 17846668 [PubMed - indexed for MEDLINE]

Effectiveness of proliferating tissues in combination with bovine-derived xenografts to intrabony defects of alveolar bone in dogs.

Biomed Res. 2007 Apr;28(2):107-13

Authors: Fujinami K, Yamamoto S, Ota M, Shibukawa Y, Yamada S

The aim of this study was to investigate the effect of proliferating tissue used in combination with bovine-derived xenograft (BDX) on the formation of new cementum and bone in dogs. Intrabony defects were treated with either BDX in conjunction with autogenous proliferating tissues (BDXplus-proliferating tissues: BDX-P group) or BDX alone (BDX-alone group). The control group received no BDX or proliferating tissues. The animals were sacrificed after 2, 4, and 8 weeks of the treatment, and tissues were histologically examined. Specimens from the control group were characterized by long junctional epithelium and little bone formation. The BDX-P group showed a statistically significant increase in new bone and cementum formation compared to the BDX-alone group (30.9% vs. 18.7, p < 0.01 and 87.8% vs. 61.8, p < 0.01). The ratio of proliferating cell nuclear antigen (PCNA)-positive cells in the newly formed connective tissue of the BDX-P group was significantly greater than that in the BDX-alone group. These findings suggest that the use of proliferating tissues in combination with BDX enhances new bone and cementum formation, offering potential as therapeutic material in periodontal regeneration.

PMID: 17510496 [PubMed - indexed for MEDLINE]

Healing of periodontal flaps when closed with silk sutures and N-butyl cyanoacrylate: a clinical and histological study.

Indian J Dent Res. 2007 Apr-Jun;18(2):72-7

Authors: Kulkarni S, Dodwad V, Chava V

BACKGROUND: The closure of the periodontal flaps post-surgery is a necessity for attainment of a primary union between the flap margins and the establishment of a healthy dentogingival junction. N-butyl cyanoacrylate is a tissue adhesive, which can be used for the closure of the incised wounds to overcome the problems associated with conventional suture materials like silk. OBJECTIVE: The present study was carried out to assess the healing of the periodontal flaps when closed with the conventional silk sutures and N-butyl cyanoacrylate. MATERIALS AND METHODS: The study was carried out on 24 patients who needed flap surgical procedure for pocket therapy. RESULTS: It was found that healing with the cyanoacrylate is associated with less amount of inflammation during the first week when compared with silk. However, over a period of 21 days to 6 weeks, the sites treated with both the materials showed similar healing patterns. CONCLUSION: It can be concluded that cyanoacrylate aids in early initial healing.

PMID: 17502712 [PubMed - indexed for MEDLINE]

Periodontal disease associated to systemic genetic disorders.

Med Oral Patol Oral Cir Bucal. 2007 May;12(3):E211-5

Authors: Nualart Grollmus ZC, Morales Ch&#xE1;vez MC, Silvestre Donat FJ

A number of systemic disorders increase patient susceptibility to periodontal disease, which moreover evolves more rapidly and more aggressively. The underlying factors are mainly related to alterations in immune, endocrine and connective tissue status. These alterations are associated with different pathologies and syndromes that generate periodontal disease either as a primary manifestation or by aggravating a pre-existing condition attributable to local factors. This is where the role of bacterial plaque is subject to debate. In the presence of qualitative or quantitative cellular immune alterations, periodontal disease may manifest early on a severe localized or generalized basis--in some cases related to the presence of plaque and/or specific bacteria (severe congenital neutropenia or infantile genetic agranulocytosis, Chediak-Higiashi syndrome, Down syndrome and Papillon-Lef&#xE9;vre syndrome). In the presence of humoral immune alterations, periodontal damage may result indirectly as a consequence of alterations in other systems. In connective tissue disorders, bacterial plaque and alterations of the periodontal tissues increase patient susceptibility to gingival inflammation and alveolar resorption (Marfan syndrome and Ehler-Danlos syndrome). The management of periodontal disease focuses on the control of infection and bacterial plaque by means of mechanical and chemical methods. Periodontal surgery and even extraction of the most seriously affected teeth have also been suggested. There are variable degrees of consensus regarding the background systemic disorder, as in the case of Chediak-Higiashi syndrome, where antibiotic treatment proves ineffective; in severe congenital neutropenia or infantile genetic agranulocytosis, where antibiotic prophylaxis is suggested; and in Papillon-Lefévre syndrome, where an established treatment protocol is available.

PMID: 17468717 [PubMed - indexed for MEDLINE]

Periodontal pathogens in periodontal pockets and in carotid atheromatous plaques.

Minerva Stomatol. 2007 Apr;56(4):169-79

Authors: Romano F, Barbui A, Aimetti M

AIM: In the last years the relationship between periodontitis and cardiovascular diseases has been a subject of increasing research. The identification of periodontopathic bacteria in atheromas can contribute to our knowledge of such an association. The aim of our study was to assess the concomitant presence of 5 periodontal pathogens (Actinobacillus actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) in periodontal pockets and in carotid atheromas recovered from the same individuals. METHODS: Twenty-one patients with chronic periodontitis scheduled for endarterectomy for carotid stenosis were enrolled in the study. Subgingival plaque samples and carotid atheromas were examined using the polymerase chain reaction and reverse hybridization techniques by means of specific probes for periodontal bacteria. Human beta-globin amplification was used as internal polymerase chain reaction efficiency control. RESULTS: Three patients were excluded because the endarterectomy specimens were negative to DNA amplification. All subgingival plaque samples were positive for at least one target micro-organism. The prevalence of Tannerella forsythia, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Actinobacillus actinomycetemcomitans was 72.22%, 61.11%, 55.56%, 50%, and 33.33%, respectively. No periodontal bacteria DNA was detected in any endarterectomy specimen. CONCLUSIONS: The presence of periodontal bacteria in atheromatous plaques was not confirmed by this investigation and, thus, no correlation between periodontitis bacteria and micro-organisms involved in the atherosclerotic lesions could be drawn.

PMID: 17452955 [PubMed - indexed for MEDLINE]

Association of common chronic infections with coronary artery disease in patients without any conventional risk factors.

Indian J Med Res. 2007 Feb;125(2):129-36

Authors: Goyal P, Kalek SC, Chaudhry R, Chauhan S, Shah N

BACKGROUND & OBJECTIVES: Report from the west suggest an association of infections and inflammation with atherosclerotic coronary artery disease (CAD). Entire microbial burden from several simultaneous chronic infections could be more important than a single infection in promoting atherosclerosis. No study has been done in Indian population, investigating the association of various chronic infections with CAD. We therefore evaluated the presence of markers of chronic infections in CAD patients having no conventional risk factors and healthy individuals in a tertiary care hospital in north India. METHODS: Seropositivity to IgG antibodies was investigated for Chlamydia pneumoniae, Mycoplasma pneumoniae, and Helicobacter pylori in 30 CAD patients with no conventional risk factors scheduled for coronary artery bypass surgery and in healthy blood donors. Periodontal pathogens were isolated by aerobic and anaerobic culture. RESULTS: All patients except one were < 55 yr of age and six were younger than 40 yr. Seropositivity to C. pneumoniae was significantly higher in CAD patients than healthy controls (63.3 vs. 23.3%, P<0.01). Combined seropositivity to both C. pneumoniae and M. pneumoniae was significantly higher in CAD patients with myocardial infarction (MI) than those without MI (61.5 vs. 11.8%, P<0.05). Aerobic and anaerobic cultures for the isolation of periodontal pathogens were positive in seven patients and five healthy blood donors. INTERPRETATION & CONCLUSION: C. pneumoniae seropositivity was significantly higher (P<0.001) in CAD patients without any of the conventional risk factors for CAD. Combined seropositivity to C. pneumoniae and M. pneumoniae was significantly higher (P<0.05) in CAD patients with MI than in those without MI. Possibly CAD in young is not (or less) governed by conventional risk factors, and infectious agents can be potential risk factors for the development of atherosclerosis and CAD in this subset of patients.

PMID: 17431281 [PubMed - indexed for MEDLINE]

Hematoma following periodontal surgery with a torus reduction: a case report.

J Contemp Dent Pract. 2007;8(3):72-80

Authors: Mantzikos K, Segelnick SL, Schoor R

BACKGROUND: There are no published case reports that hematomas occur on the floor of the mouth as a result of periodontal surgery. REPORT: These three case reports document post surgical hematoma formation on the floor of the mouth that pose problems with the diagnosis, prognosis, and patient management. All cases involved periodontal surgery where extensive reduction of tori and bony exostoses were required. Two cases resulted in hematomas in the floor of the mouth. However, a change in the post surgical management for a third case demonstrated possible prevention of hematoma formation. SUMMARY: Hematomas in the floor of the mouth can be a resolving post surgical phenomenon or a serious vascular insult to this region of the oral cavity. This report clarifies the diagnosis, prognosis, and the best management protocol through the presentation of three cases.

PMID: 17351684 [PubMed - indexed for MEDLINE]

Physiological features of periodontal regeneration and approaches for periodontal tissue engineering utilizing periodontal ligament cells.

J Biosci Bioeng. 2007 Jan;103(1):1-6

Authors: Benatti BB, Silv&#xE9;rio KG, Casati MZ, Sallum EA, Nociti FH

Experimental studies have shown that the potential of periodontal regeneration seems to be limited by the regenerative capacity of the cells involved. The regeneration of damaged periodontal tissues is mediated by various periodontal cells and is regulated by a vast array of extracellular matrix informational molecules that induce both selective and nonselective responses in different cell lineages and their precursors. In this paper, we first review periodontal ligament tissue and its different cell subpopulations including fibroblasts and paravascular stem cells, and their functions during the development and homeostasis of periodontal tissues. Because conventional periodontal regeneration methods remain insufficient to obtain a complete and reliable periodontal regeneration, the concept of periodontal tissue engineering has been based on the generation of the conditions necessary to improve the healing of periodontal tissues. Additionally, the potential of periodontal ligament cells for use in periodontal tissue engineering to overcome the limitations of conventional periodontal regenerative therapies is discussed, followed by an update of the recent progress and future directions of research utilizing periodontal ligament cells for predictable periodontal regeneration.

PMID: 17298893 [PubMed - indexed for MEDLINE]

Augmentation of keratinized gingiva through bilaminar connective tissue grafts: a comparison between two techniques.

Minerva Stomatol. 2007 Jan-Feb;56(1-2):3-20

Authors: Bertoldi C, Bencivenni D, Lucchi A, Consolo U

AIM: A mucogingival deficiency is considered a potential risk factor for periodontal disease. In particular, mucogingival deficiency can lead to gingival recession, which is a pathological entity per se, due to the increased risk for dental hypersensitivity and root caries. The aim of this study was to evaluate and compare 2 bilaminar grafting techniques normally employed to achieve root coverage. METHODS: Thirty-five patients were divided into 2 groups. Group 1 included 19 patients with 49 gingival recessions treated by Nelson technique (as modified by Harris), while group 2 included 15 patients with 40 recessions treated by Langer technique. Clinical evaluation was performed at preoperative level (T0), after 1 month (T1) and after 1 year (T2). Statistical analysis was performed by means of Friedmann and Wilcoxon test and U-Mann-Whitney test. RESULTS: The statistical analysis did not reveal any significant difference between groups, both in terms of percentage of root coverage and of width of keratinizaed gingiva gain. A significant difference was only observed within each group, for the amount of keratinized gingiva at T1 vs T0 and at T2 vs T1. CONCLUSIONS: This study did not show any statistical difference between the Nelson and the Langer technique as to root coverage and gain in keratinized gingiva.

PMID: 17287702 [PubMed - indexed for MEDLINE]

Er:Yag laser irradiation of the microbiological apical biofilm.

Braz Dent J. 2006;17(4):296-9

Authors: Araki AT, Ibraki Y, Kawakami T, Lage-Marques JL

One problem in cases of healing-resistant periapical lesions is to eradicate the contamination at the periapical area. This contamination is due to the microbiological biofilm formed by microorganisms and their subproducts lodged in apical third of the root, on both cementum and dentin surface. Paraendodontic surgery consists of the mechanical removal of harmful agents to promote healing and periapical health. The purpose of this study was to assess the results of Er:YAG laser irradiation on the apical root third of newly extracted teeth to eliminate microbial contamination on root apex surface. Apical irradiation was performed with an Er:YAG laser device using an experimental contact tip, at 100 mJ, 10 Hz, 1 W, 39 J/cm(2), 3 times on the target area. SEM analysis showed the elimination of part of the irradiated cementum and the formation of small roughened without exposing the subjacent dentin. Vaporization of the remaining periodontal tissue and removal of microbiological apical biofilm (MAB) were also observed on the irradiated areas. Under the tested conditions and based on the findings of this study, Er:YAG laser may be considered effective for removal of microbiological apical biofilm.

PMID: 17262142 [PubMed - indexed for MEDLINE]

Estrogen deficiency and periodontal condition in rats: a radiographic and macroscopic study.

Braz Dent J. 2006;17(3):201-7

Authors: Anbinder AL, Prado Mde A, Spalding M, Balducci I, Carvalho YR, da Rocha RF

The purpose of this study was to evaluate the impact of ovariectomy-induced estrogen deficiency as a risk factor of periodontal disease in rats. Forty 90-day old female rats were either ovariectomized (OVX; n=20) or sham operated (SHAM; n=20). After 30 days, periodontitis was induced by placement of a cotton ligature around the upper second molars of 10 OVX and 10 SHAM animals. All animals were sacrificed 5 weeks later. Body weight was assessed before all surgical procedures. The left hemimaxillas were removed and the percentage of periodontal bone support was determined radiographically and buccal alveolar bone loss was determined macroscopically using an image-analysis software. Furcation involvement was also evaluated. Data were analyzed statistically by ANOVA at 5% significance level. Within the evaluated period, the ovariectomized rats gained more weight than the sham-operated animals (p<0.001). The animals in which periodontitis was induced had less bone support, greater alveolar bone loss and furcation involvement than those without ligature (p<0.001). However, there was no difference between ovariectomized and sham-operated animals (p>0.05). Based on the findings of this study, estrogen deficiency could not be considered as a risk factor for periodontal disease.

PMID: 17262125 [PubMed - indexed for MEDLINE]

Densitometric analysis of the autogenous demineralized dentin matrix on the dental socket wound healing process in humans.

Braz Oral Res. 2006 Oct-Dec;20(4):324-30

Authors: Gomes MF, Abreu PP, Morosolli AR, Ara&#xFA;jo MM, Goulart MG

The aim of this study was to evaluate the effects of the autogenous demineralized dentin matrix (ADDM) on the third molar socket wound healing process in humans, using the guided bone regeneration technique and a polytetrafluoroethylene barrier (PTFE). Twenty-seven dental sockets were divided into three groups: dental socket (Control), dental socket with PTFE barrier (PTFE), and dental socket with ADDM slices associated to PTFE barrier (ADDM + PTFE). The dental sockets were submitted to radiographic bone densitometry analysis and statistical analysis on the 15th, 30th, 60th and 90th days using analysis of variance (ANOVA) and Tukey's test (p < or = 0.05). The radiographic analysis of the ADDM + PTFE group showed greater homogeneity of bone radiopacity than the Control group and the PTFE group, during all the observation times. The dentin matrix gradually disappeared from the dental socket during the course of the repair process, suggesting its resorption during the bone remodeling process. It was concluded that the radiographic bone density of the dental sockets treated with ADDM was similar to that of the surrounding normal bone on the 90th day. The ADDM was biocompatible with the bone tissue of the surgical wounds of human dental sockets. The radiographic analysis revealed that the repair process was discreetly faster in the ADDM + PTFE group than in the Control and PTFE groups, although the difference was not statistically significant. In addition, the radiographic image of the ADDM + PTFE group suggested that its bone architecture was better than that of the Control and PFTE groups.

PMID: 17242793 [PubMed - indexed for MEDLINE]

Antimicrobial prophylaxis in oral surgery and dental procedures.

Med Oral Patol Oral Cir Bucal. 2007 Jan;12(1):E44-52

Authors: Maestre Vera JR, Gómez-Lus Centelles ML

Transient bacteraemia is a known risk factor following oral surgery and invasive dental procedures in patients with altered immune system response and those with a susceptible site of infection (patients with heart valve prostheses or recent joint replacements, etc.) The most commonly isolated aerobic bacteria in postoperative bacteraemia are Streptococcus Viridans. However, other periodontal pathogenic anaerobic bacteria are found in up to 64% in blood cultures (mixed bacteria or anaerobic bacteria alone). Dental pathogenic bacteria do not appear to be covered by standard amoxicillin or clindamycin prophylactic regimens. This is partly due to the fact that these anaerobic bacteria often produce beta lactamase and also in view of results of antimicrobial sensitivity tests observed in recent studies. A personal history of exposure to dental pathogenic bacteria may have an impact on the patient s global health, not only because of classical local or systemic infectious complications, but also because dental pathogenic bacteria have been found in atheromatous plaques in coronary and carotid arteries. This finding, along with epidemiological data, suggests that such bacteria may contribute to the progression of vascular arteriosclerotic lesions and the occurrence of cardiovascular and/or cerebrovascular accidents, although the pathogenic mechanisms involved are not yet well known. Taking these facts into consideration, and in view of antimicrobial sensitivity data available at present, we believe that the use of amoxicillin/clavulanic acid is the most appropriate option for prophylaxis of all infectious risks associated with bacteraemia of oral origin, due to its broader cover of dental pathogenic bacteria and its pharmacokinetic profile.

PMID: 17195828 [PubMed - indexed for MEDLINE]

Novel KIND1 gene mutation in Kindler syndrome with severe gastrointestinal tract involvement.

Arch Dermatol. 2006 Dec;142(12):1619-24

Authors: Sadler E, Klausegger A, Muss W, Deinsberger U, Pohla-Gubo G, Laimer M, Lanschuetzer C, Bauer JW, Hintner H

BACKGROUND: Kindler syndrome (online Mendelian Inheritance in Man No. 173650) is an autosomal recessive genodermatosis characterized by acral trauma-induced blistering that improves with age and by progressive poikiloderma in later life. Other clinical features include photosensitivity, webbing of the fingers and toes, nail dystrophy, periodontal disease, and mucosal alterations. Aside from esophageal or anal stenosis, gastrointestinal tract involvement seems to be rare in Kindler syndrome. Recently, mutations in the KIND1 gene that encodes for the membrane-associated protein kindlin-1 have been identified. Kindlin-1 links the actin cytoskeleton to the extracellular matrix and is supposed to have cell-signaling functions owing to different functional domains. In particular, a domain with high homology to 4.1/ezrin/radixin/moesin (FERM) proteins is closely related to the sequences of talin that mediate integrin binding and therefore may play a role in integrin-dependent processes such as cell growth, differentiation, and apoptosis. OBSERVATION: Complete loss of this multifunctional protein in our patient with Kindler syndrome resulted in severe gastrointestinal tract involvement with hemorrhagic colitis. Mucosa of the descending and sigmoid colon and the rectum showed erosions and ulcers with pseudomembranous alterations of an overall highly vulnerable mucosa. Mutation analysis revealed a homozygous status for the novel mutation 20/21delTT in exon 2 of the KIND1 gene resulting in a preterminal stop codon creating a nonfunctional peptide 17 amino acids in length. CONCLUSION: Because of our experience with this and another patient, we propose that gastrointestinal tract involvement should be looked at more frequently in Kindler syndrome.

PMID: 17178989 [PubMed - indexed for MEDLINE]

Root coverage with free gingival autografts--a clinical study.

Indian J Dent Res. 2006 Jul-Sep;17(3):126-30

Authors: Deepalakshmi D, Arunmozhi U

AIM: To assess the percentage of root coverage with autogenous free gingival grafts. MATERIALS & METHODS: Ten non-smoking patients with Miller's class I or class II recessions were included in the study. The clinical parameters such as recession depth, recession width, probing pocket depth, clinical attachment level and width of the keratinized gingiva were recorded at the baseline, at the end of 1 month, 3 months, and 6 months after the surgical procedure. Autogenous free gingival grafts harvested from the palatal mucosa were used to cover the denuded roots. RESULTS: Four out of ten sites showed 100% root coverage. A mean percentage of 80.3% of root coverage was achieved.

PMID: 17176829 [PubMed - indexed for MEDLINE]

Reasons for third molar teeth extraction in Jordanian adults.

J Contemp Dent Pract. 2006 Nov 1;7(5):88-95

Authors: Hamasha AA, Al Qudah MA, Bataineh AB, Safadi RA

AIMS: To assess reasons for third molar teeth extractions in a sample of Jordanian dental patients and to evaluate the association of extractions with other independent variables. METHODS AND MATERIALS: The study sample was comprised of dental patients in North Jordan who had third molar extractions. Data were collected from 36 dentists who were instructed to administer questionnaires to their adult patients undergoing third molar extractions and then to record the primary reason for those extractions. The data in this study was analyzed using a descriptive summary and chi square statistics. RESULTS: Dentists performed 810 extractions for 648 patients. The reasons for the extractions were: dental caries and its consequences about 42%, eruption problems 39%, periodontal diseases about 7%, and approximately 9% of extractions were a result of the dentist's choice. The percentage of extractions due to dental caries significantly increased with increasing age. However, significant numbers of teeth were extracted due to eruption problems (51%-69%) in young adults. For 46+ year olds, 23% of extractions were caused by periodontal diseases. Extraction due to dental caries was distributed equally among the sexes. Persons with irregular tooth brushing and fewer dental visits had significantly more third molar teeth extracted due to caries and periodontal diseases compared to persons with regular tooth brushing and dental visits.

PMID: 17091144 [PubMed - indexed for MEDLINE]

Effect of platelet-rich plasma in the treatment of periodontal intrabony defects in humans.

Chin Med J (Engl). 2006 Sep 20;119(18):1511-21

Authors: Ouyang XY, Qiao J

BACKGROUND: Platelet-rich plasma (PRP) is a kind of natural source of autologous growth factors, and has been used successfully in medical community. However, the effect of PRP in periodontal regeneration is not clear yet. This study was designed to evaluate the effectiveness of PRP as an adjunct to bovine porous bone mineral (BPBM) graft in the treatment of human intrabony defects. METHODS: Seventeen intrabony defects in 10 periodontitis patients were randomly treated either with PRP and BPBM (test group, n = 9) or with BPBM alone (control group, n = 8). Clinical parameters were evaluated including changes in probing depth, relative attachment level (measured by Florida Probe and a stent), and bone probing level between baseline and 1 year postoperatively. Standardized periapical radiographs of each defect were taken at baseline, 2 weeks, and 1 year postoperatively, and analyzed by digital subtraction radiography (DSR). RESULTS: Both treatment modalities resulted in significant attachment gain, reduction of probing depth, and bone probing level at 1-year post-surgery compared to baseline. The test group exhibited statistically significant improvement compared to the control sites in probing depth reduction: (4.78 +/- 0.95) mm versus (3.48 +/- 0.41) mm (P < 0.01); clinical attachment gain: (4.52 +/- 1.14) mm versus (2.85 +/- 0.80) mm (P < 0.01); bone probing reduction: (4.56 +/- 1.04) mm versus (2.88 +/- 0.79) mm (P < 0.01); and defect bone fill: (73.41 +/- 14.78)% versus (47.32 +/- 11.47)% (P < 0.01). DSR analysis of baseline and 1 year postoperatively also showed greater radiographic gains in alveolar bone mass in the test group than in the control group: gray increase (580 +/- 50) grays versus (220 +/- 32) grays (P = 0.0001); area with increased gray were (5.21 +/- 1.25) mm(2) versus (3.02 +/- 1.22) mm(2) (P = 0.0001). CONCLUSIONS: The treatment with a combination of PRP and BPBM led to a significantly favorable clinical improvement in periodontal intrabony defects compared to using BPBM alone. Further studies are necessary to assess the long-term effectiveness of PRP, and a larger sample size is needed.

PMID: 16996004 [PubMed - indexed for MEDLINE]

[Influence of smoking on apoptosis in human gingival epithelium]

Shanghai Kou Qiang Yi Xue. 2006 Aug;15(4):351-5

Authors: Yu XJ, Li S, Xue LD, Xiao CJ

PURPOSE: Cigarette smoking was a major risk factor for oral hygiene and periodontal status. The study was to investigate the relationship between different exposure to cigarette smoke and apoptosis in stratum spinosum and stratum basale cells of human gingival epithelium. METHODS: 47 smoking patients with crown lengthening surgery or extraction of the impacted teeth were enrolled. It comprised 41 males and 6 females. Their age ranged from 18 to 29 years old (average age: 21.4). According to smoke history (SH), average cigarettes per day (ACD) and total smoke number (TSM), 47 smokers were divided into group I (SH<5a or ACD<10 and TSM<15 thousand, n=19), group II (5a< or = SH or 10< or = ACD and 15 thousand < or =TSM, n=28). Another 10 non-smoking patients were chosen as control. Apoptosis was identified by the terminal deoxy-transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) method. Differences between the two groups were analyzed using Student-Newman-Keuls (SNK).The criteria for statistical significance was accepted at the probability level P<0.05. RESULTS: There was increased apoptosis in stratum spinosumin and stratum basale cells of smokers compared to that of non-smokers. Apoptosis in stratum spinosumin cells was significantly different between smokers and non-smokers (P<0.01), between group I and group II (P<0.01). CONCLUSION: It is conclude that exposure to cigarette smoke can increase apoptosis in stratum spinosumin cells of human gingival epithelium, which may influence its normal metabolism and protein secretion.

PMID: 16955155 [PubMed - in process]

Reasons for permanent tooth extractions in Japan.

J Epidemiol. 2006 Sep;16(5):214-9

Authors: Aida J, Ando Y, Akhter R, Aoyama H, Masui M, Morita M

BACKGROUND: There has been no nationwide study in Japan on reasons for extraction of permanent teeth. This survey was aimed to determine the reasons for extraction of permanent teeth in Japan. METHODS: Five thousand, one hudred and thirty-one dentists were selected by systematic selection from the 2004 membership directory of the Japan Dental Association. The dentists selected were asked to record the reason for each extraction of permanent teeth during a period of one week from February 1 through 7, 2005. Reasons for tooth extraction were assigned to five groups: caries, fracture of teeth weakened by caries or endodontics, periodontal diseases, orthodontics, and other reasons. RESULTS: A total of 2,001 dentists (response rate of 39.1%) returned the questionnaires, and information on 9,115 extracted teeth from 7,499 patients was obtained. The results showed that caries and its sequela (totally 43.3%, 32.7% and 10.6%, respectively) and periodontal disease (41.8%) were the main reasons for teeth extraction. Extraction due to caries or fracture was commonly observed in all age groups over 15 years of age, whereas periodontal disease was predominant in the groups over 45 years of age. CONCLUSIONS: Most of the permanent teeth were extracted due to caries and its sequela and periodontal disease. Prevention and care for dental caries for all age groups and periodontal disease for over middle age groups are required.

PMID: 16951541 [PubMed - indexed for MEDLINE]

Systemic conditions, oral findings and dental management of chronic renal failure patients: general considerations and case report.

Braz Dent J. 2006;17(2):166-70

Authors: Hamid MJ, Dummer CD, Pinto LS

Chronic renal failure is a relatively common systemic disease. Systemic abnormalities such as anemia, platelet disorders and hypertension as well as oral manifestations including xerostomia, uremic stomatitis, periodontal disease and maxillary and mandibular radiographic alterations can be observed in individuals with chronic renal disease. In view of its frequent occurrence and the need of knowledge by dentists dealing with this condition, this paper discusses the most important issues regarding chronic renal failure, addressing its systemic and oral manifestations and the dental management of chronic renal patients. A case report is presented.

PMID: 16924347 [PubMed - indexed for MEDLINE]

[Recurrent brain abscess caused by Nocardia asteroides in a patient with primary polycythaemia]

Arq Neuropsiquiatr. 2006 Jun;64(2B):526-9

Authors: Aboal C, Salamano R, Braselli A, Mansilla M, Galaret M, Pedreira W

Nocardiosis of the central nervous system (CNS) is an uncommon disease, but its frequency has increased due to the high number of immunosuppressive treatments. People become infected by inhalation, direct traumatic cutaneous inoculation and eating contaminated food after a periodontal abscess. Lung localization is the most frequent one, being the origin of haematic dissemination, with a high incidence in skin, subcutaneous tissue and the CNS. The preference of Nocardia for the CNS is well-known. These abscesses are a diagnostic and therapeutic challenge, since they are associated to high mortality rates, specially in immunocompromised patients; the best therapeutic management remains unclear. In spite of the existing controversy with regard to the surgical management of these lesions, an early diagnosis through stereotactic aspiration and the beginning of an antimicrobial therapy are essential to the patients good evolution. This paper presents a patient with a primary polycythaemia and a recurrent brain abscess by Nocardia asteroides, probably of dental origin.

PMID: 16917633 [PubMed - indexed for MEDLINE]

Development of a nonrigid, durable calcium phosphate cement for use in periodontal bone repair.

J Am Dent Assoc. 2006 Aug;137(8):1131-8

Authors: Xu HH, Takagi S, Sun L, Hussain L, Chow LC, Guthrie WF, Yen JH

BACKGROUND: Calcium phosphate cement (CPC) hardens in situ to form hydroxyapatite and has been used in dental and craniofacial restorative applications. However, when CPC was used in periodontal osseous repair, tooth mobility resulted in the fracture and exfoliation of the brittle CPC implant. The objective of the authors' study was to develop a strong and nonrigid CPC to provide compliance for tooth mobility without fracturing the implant. METHODS: The authors used tetracalcium phosphate, dicalcium phosphate anhydrous and biopolymer chitosan to develop a strong and nonrigid CPC. They used a powder:liquid ratio of 2:1, compared with the 1:1 ratio of a previously developed nonrigid CPC control. Specimens were characterized using a flexural test, scanning electron microscopy and powder X-ray diffraction. RESULTS: After 28 days of immersion, the new cement had a flexural strength (mean +/- standard deviation; n = 6) of 5.2 +/- 1.0 megapascals, higher than 1.8 +/- 1.5 MPa for the control (P < .05) and overlapping the reported strengths of sintered hydroxyapatite implants and cancellous bone. This cement showed a high ductility with a strain at peak load of 6.5 +/- 1.3 percent, compared with 4.4 +/- 1.9 percent for the control; both were 20-fold higher than the 0.2 percent of the conventional CPC. Nanosized hydroxyapatite crystals, similar to those in teeth and bones, were formed in the cements. CONCLUSIONS: The new nonrigid cement, containing nanohydroxyapatite crystals, possessed a high ductility and superior fracture resistance. This strong, tough and nonrigid CPC may be useful in periodontal repair to provide compliance for tooth mobility without fracture. CLINICAL IMPLICATIONS: The results of this study may yield the first self-hardening and nonrigid hydroxyapatite composite with high strength and durability and large deformation capability to be useful in the regeneration of periodontal osseous defects.

PMID: 16873330 [PubMed - indexed for MEDLINE]

Osteonecrosis of the jaw and oral bisphosphonate treatment.

J Am Dent Assoc. 2006 Aug;137(8):1115-9; quiz 1169-70

Authors: Nase JB, Suzuki JB

BACKGROUND: Bisphosphonates are becoming recognized increasingly as having a significant impact on dental therapies. This case report describes adverse clinical sequelae and successful treatment following periodontal surgery in a dental patient receiving bisphosphonate treatment. CASE DESCRIPTION: A 78-year-old woman experienced a nonhealing interproximal wound subsequent to a minor periodontal procedure performed to facilitate restoration of an adjacent tooth. Her medical history revealed that she had been taking an oral bisphosphonate every day for the previous five years for treatment of osteoporosis. After three months of periodic d&#xE9;bridement and meticulous oral home care, one of the authors recovered a large piece of necrotic bone. The wound healed after the author performed surgery at the site. CLINICAL IMPLICATIONS: Dentists should exercise caution when considering surgical procedures for patients with a history of oral bisphosphonate use. Thorough treatment of nonhealing wounds in these patients can lead to favorable outcomes.

PMID: 16873327 [PubMed - indexed for MEDLINE]

Stress and inflammation as a detrimental combination for peri-implant bone loss.

J Dent Res. 2006 Aug;85(8):711-6

Authors: Heckmann SM, Linke JJ, Graef F, Foitzik Ch, Wichmann MG, Weber HP

The causes of peri-implant bone loss continue to be controversial. To determine the impact of biomechanical stress and inflammation, we investigated a total of 80 interforaminal implants in situ for more than 10 years. Two stress groups, with 14 patients each, were established: a low-stress situation with single-standing implants, and an increased-stress situation with splinted implants. To categorize inflammation, we introduced a Composite Inflammation Score using 4 inflammatory parameters. Peri-implant bone loss was calculated from digital panoramic radiographs. To differentiate between the effects of stress and inflammation, we compared bone loss in both stress groups at equivalent levels of inflammation. With greater Composite Inflammation Score values, a clear discrepancy between single-standing and splinted implants was evident (p = 0.117/0.000, regression analysis; p = 0.135/0.000, analysis of variance; p = 0.002, t tests). While stress and inflammation alone may not necessarily be detrimental factors, the presence of stress heightens peri-implant bone loss significantly as inflammation increases.

PMID: 16861287 [PubMed - indexed for MEDLINE]

Oral malodor associated with internal resorption.

J Oral Sci. 2006 Jun;48(2):89-92

Authors: Yoneda M, Naito T, Suzuki N, Yoshikane T, Hirofuji T

We report a case of oral malodor associated with internal resorption. A 39-year-old male attended our hospital complaining of oral malodor. Utilizing organoleptic measurement, the halimeter test and gas chromatography, it was diagnosed as a strong halitosis caused by oral origin. The pocket probing depth of tooth 21 was 10 mm, and X-ray examination revealed a vertical bone loss around this tooth. The patient had received periodontal treatment at two dental offices previously, but the periodontal conditions and oral malodor persisted. We performed an initial periodontal preparation, however a deep pocket remained. We therefore performed a surgical inspection including flap reflection, and found that the tooth had a large perforating defect in the distal surface. The extracted tooth had multiple perforating defects covered with granulation tissues on all root surfaces including the root apex. Taking into consideration the anamnesis and X-ray examination of the extracted tooth, internal absorption was considered to have been the cause of the multiple perforating defects. After extraction of the causative tooth, oral malodor dramatically decreased. To our knowledge, this is the first report of an oral malodor associated with internal resorption.

PMID: 16858138 [PubMed - indexed for MEDLINE]

Periodontal regeneration following transplantation of proliferating tissue derived from periodontal ligament into class III furcation defects in dogs.

Biomed Res. 2006 Jun;27(3):139-47

Authors: Murano Y, Ota M, Katayama A, Sugito H, Shibukawa Y, Yamada S

The aim of this study was to evaluate the healing of class III furcation defects following transplantation of proliferating tissue derived from periodontal ligament (pPDL). Two weeks after removing alveolar bone, pPDL was excised. Class III furcation defects were created in the mandibular premolars. pPDL was transplanted into the furcation defects in the experimental group, while no treatment was performed on the furcation defects in the controls. Two, four and eight weeks after surgery, histologic examination, quantitative RT-PCR, and immunohistochemistry were carried out. bFGF and VEGF mRNA showed a significant increase in pPDL. In the pPDL treatment group, new cementum regenerated around almost the entire circumference of the furcation, with new bone filling most of the defect, while the control group presented epithelial downgrowth and defects filled with connective tissue. These results provide histological evidence that pPDL plays an important role in wound healing by promoting periodontal regeneration in class III furcation defects.

PMID: 16847360 [PubMed - indexed for MEDLINE]

The impact of primary hyperparathyroidism on the oral cavity.

J Clin Endocrinol Metab. 2006 Sep;91(9):3439-45

Authors: Padbury AD, T&#xF6;züm TF, Taba M, Ealba EL, West BT, Burney RE, Gauger PG, Giannobile WV, McCauley LK

CONTEXT: Primary hyperparathyroidism (HPT) is a systemic disease causing bone loss. Periodontal disease is a local inflammatory disease characterized by alveolar bone loss. The older literature records that HPT is associated with loss of radicular lamina dura and brown tumors of the bone, but contemporary studies are lacking. OBJECTIVE: The objective of the study was to determine the effects of HPT on oral bony structures and periodontal disease in a contemporary population. DESIGN: This was a cross-sectional, case-controlled study. Setting: The study was conducted at the clinics of endocrine surgery and hospital dentistry. PATIENTS AND OTHER PARTICIPANTS: Fifty-nine patients, 39 with HPT and 20 thyroid controls, were included in the study. MAIN OUTCOME MEASURES: Periodontal clinical measures and dental radiographic analyses were used in this study. RESULTS: HPT patients were more likely to have tori and reductions in radicular lamina dura on dental radiographs. Widening of the periodontal ligament space surrounding teeth correlated with serum PTH levels. Panoramic radiographs demonstrated reduced cortical bone thickness at the angle of the mandible in HPT patients but no evidence of brown tumors or other overt pathologies. CONCLUSIONS: Changes in the oral cavity observed in patients with HPT suggested both decreased cortical density and increased likelihood of oral tori. The contemporary oral manifestations of primary HPT are different from those previously reported, and health care providers should be aware of newer, more subtle findings that may be present when treating patients with HPT.

PMID: 16822829 [PubMed - indexed for MEDLINE]

Periodontal regeneration in clinical practice.

Med Oral Patol Oral Cir Bucal. 2006 Jul;11(4):E382-92

Authors: Alpiste Illueca FM, Buitrago Vera P, de Grado Cabanilles P, Fuenmayor Fernandez V, Gil Loscos FJ

The regeneration or restitution of lost supporting tissue has always been considered the ideal objective of periodontal therapy. However, attempts to convert this intention into solid clinical practice can become tremendously complex, the results of which are very different from the original intention. The aim of this article is to offer an up-to-date, general perspective on periodontal regeneration, orienting the clinician within the global strategy for oral treatment. To this end, we revise the healing process of periodontal injury, the different therapeutic approaches, the interpretation of the results, and finally, limiting factors in periodontal regeneration.

PMID: 16816809 [PubMed - indexed for MEDLINE]

The effect of periodontal surgery on bite force, occlusal contact area and bite pressure.

J Am Dent Assoc. 2006 Jul;137(7):978-83; quiz 1028

Authors: Alkan A, Keskiner I, Arici S, Sato S

BACKGROUND: Tooth mobility resulting from the loss of periodontal support or trauma induced by periodontal surgery may change the amount of bite force (BF) and bite pressure (BP) and number of occlusal contact areas (OCAs). The aim of the authors' study was to compare BF, BP and OCA of teeth with periodontal disease before and after periodontal surgery with similar values of healthy teeth. METHODS: The authors performed quantitative analysis of BF, BP and OCA using a pressure measurement film. Ten patients with periodontitis who needed periodontal surgery served as the test group. The authors took measurements of BF, BP, OCA and mobility (using Miller's Mobility Index) just before surgery and at one, four and 12 weeks after surgery. They also measured clinical attachment levels (CAL) before surgery and 12 weeks after surgery. Ten subjects without periodontitis served as the control group. RESULTS: Although BF and OCA increased the first week after periodontal surgery, analysis of variance (ANOVA) showed no statistically significant differences at a 95 percent confidence interval. There were statistically significant differences between first-week mobility and that at four and 12 weeks (P = .001). A factorial ANOVA showed significant interaction between BF and mobility (P < .05). CONCLUSIONS: The authors' findings suggest that changes in BF, BP and OCA were not affected by periodontal surgery. However, mean mobility values and BF are correlated. Further investigations of this measurement method involving larger study populations and a longer follow-up period are needed. CLINICAL IMPLICATIONS: It seems to be helpful to follow occlusal changes after periodontal surgery using a pressure measurement film. It also may be suggested that this measurement method could be used to evaluate the treatment prognosis.

PMID: 16803824 [PubMed - indexed for MEDLINE]

Endodontic or dental implant therapy: the factors affecting treatment planning.

J Am Dent Assoc. 2006 Jul;137(7):973-7; quiz 1027-8

Authors: Torabinejad M, Goodacre CJ

BACKGROUND: Clinicians are confronted with difficult choices regarding whether a tooth with pulpal and/or periapical disease should be saved through endodontic treatment or be extracted and replaced with an implant. METHODS: The authors examined publications (research, literature reviews and systematic reviews) related to the factors affecting decision making for patients who have oral diseases or traumatic injuries. RESULTS: The factors to be considered included patient-related issues (systemic and oral health, as well as comfort and treatment perceptions), tooth- and periodontium-related factors (pulpal and periodontal conditions, color characteristics of the teeth, quantity and quality of bone, and soft-tissue anatomy) and treatment-related factors (the potential for procedural complications, required adjunctive procedures and treatment outcomes). CONCLUSIONS: On the basis of survival rates, it appears that more than 95 percent of dental implants and teeth that have undergone endodontic treatment remain functional over time. CLINICAL IMPLICATIONS: Clinicians need to consider carefully several factors before choosing whether to perform endodontic therapy or extract a tooth and place an implant. The result should be high levels of comfort, function, longevity and esthetics for patients.

PMID: 16803823 [PubMed - indexed for MEDLINE]

Anesthetic management of a patient with Sturge-Weber syndrome undergoing oral surgery.

Anesth Prog. 2006;53(1):17-9

Authors: Yamashiro M, Furuya H

This case involves a possible complication of excessive bleeding or rupture of hemangiomas. Problems and anesthetic management of the patient are discussed. A 35-year-old man with Sturge-Weber syndrome was to undergo teeth extraction and gingivectomy. Hemangiomas covered his face and the inside of the oral cavity. We used intravenous conscious sedation with propofol and N2O-O2 to reduce the patient's emotional stress. It was previously determined that stress caused marked expansion of this patient's hemangiomas. Periodontal ligament injection was chosen as the local anesthesia technique. Teeth were extracted without excessive bleeding or rupture of hemangiomas, but the planned gingivectomies were cancelled. Deep sedation requiring airway manipulation should be avoided because there are possible difficulties in airway maintenance. Because this was an outpatient procedure, propofol was selected as the sedative agent primarily because of its rapid onset and equally rapid recovery. Periodontal ligament injection with 2% lidocaine containing 1: 80,000 epinephrine was chosen for local anesthesia. Gingivectomy was cancelled because hemostasis was challenging. As part of preoperative preparation, equipment for prompt intubation was available in case of rupture of the hemangiomas. The typically seen elevation of blood pressure was suppressed under propofol sedation so that expansion of the hemangiomas and significant intraoperative bleeding was prevented. Periodontal ligament injection as a local anesthetic also prevented bleeding from the injection site.

PMID: 16722280 [PubMed - indexed for MEDLINE]

Comparative clinical evaluation of acellular dermal matrix allograft and connective tissue graft for the treatment of gingival recession.

J Contemp Dent Pract. 2006 May 1;7(2):63-70

Authors: Rahmani ME, Lades MA

AIMS: "Gingival recession is a condition reported to occur due to abnormal periodontal anatomy, poor hygiene, excessive occlusal forces, toothbrush abrasion, and even iatrogenic or factitious causes. Though various surgical techniques are available to treat this problem, the most common is the palatal soft tissue autograft. Recently, an acellular dermal matrix allograft (ADMA) has been available as a substitute for the palatal tissue harvest. The aim of this study is to compare the ADMA with the conventional subepithelial connective tissue graft (SCTG) in the treatment of gingival recession." METHODS AND MATERIALS: Fourteen patients with 20 gingival recessions of Miller's grade I and II were selected and randomized in two groups of control (SCTG ) and test (ADMA). In each group ten recession defects were treated. The following parameters were measured at baseline and then at six months post surgery: recession height (RH), recession width (RW), probing depth (PD), attached gingiva (AG), keratinized gingiva (KG), and clinical attachment level (CAL). All parameters were analyzed using the two-sample t-test. Data analysis was performed using SPSS (version 11) software. RESULTS: The following mean changes (mm) occurred in SCTG and ADMA, respectively: 2.60+/-0.97 and 2.90+/-0.81 decrease in RH; 1.70+/-1.01 and 1.65+/-0.67 decrease in RW; 2.50+/-0.97 and 2.95+/-0.69 increase in KG; 2.25+/-0.92 and 2.65+/-0.85 increase in AG; 2.60+/-1.08 and 2.75+/-0.92 decrease in CAL; and finally 0.05+/-0.50 and 0.10+/-0.46 decrease in PD for the SCTG and ADMA groups, respectively. The percentage of root coverage for the two groups was 70.12%+/-22.81% and 72.08%+/-14.12%, respectively. The changes from baseline to the six-month visit were significant for both groups in terms of all parameters but PD. However, the differences in mean changes were not significant between the two groups in any of the parameters. CONCLUSION: These findings imply the ADMA and SCTG techniques could produce the same results when used for the successful treatment of gingival recessions. In addition the ADMA could be used as an adequate alternative treatment modality for conventional techniques.

PMID: 16685296 [PubMed - indexed for MEDLINE]

Clinical effectiveness of dentin sealer in treating dental root sensitivity following periodontal surgery.

Medicina (Kaunas). 2006;42(3):195-200

Authors: Vaitkeviciene I, Paipaliene P, Zekonis G

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a commercially available light-cured, resin-based dentin sealer in the treatment of postoperative sensitivity of roots with gingival recession of different extent. MATERIALS AND METHODS: The study was a case control, randomized, blind design. A total of 62 patients with the presence of chronic periodontitis, who required periodontal surgery, participated in this study. All recipients underwent flap operation. After the periodontal surgery 641 teeth were selected for the study. The pain intensity was determined by using visual analogue scale (VAS). The extent of gingival recession was measured using William's periodontal probe. After recording the initial baseline VAS scores, the patients were randomly divided into two groups according to the materials used in the study. The resin-based dentin sealer in the test group was applied following the manufacture's recommendations. Water was used in the control (placebo) group. Hypersensitivity measurements on VAS were repeated 5 minutes, 7 and 30 days after the application of the materials. RESULTS: It was observed that the efficacy of the desensitizing material differed from placebo. The dentin sealer effectively reduced the root sensitivity. The statistically significant (p<0.001) decrease in the intensity of root sensitivity after the application of materials was noted in test and control groups. However, the difference in the reduction of pain intensity between the groups was significant and remained such throughout the study period. The root sensitivity on the day 7 and 30 in both groups showed little change compared to the measurements made right after the application of the materials. No significant difference in measurements of pain intensity in the presence of different extent of gingival recession was noted in none of the groups. CONCLUSION: The results of the study showed that dentin sealer used provided quick and effective reduction in root sensitivity after the surgery and its desensitizing effect lasted beyond 30 days.

PMID: 16607061 [PubMed - indexed for MEDLINE]

A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections.

Anesth Prog. 2005;52(4):122-7

Authors: Kaufman E, Epstein JB, Naveh E, Gorsky M, Gross A, Cohen G

Intraoral local anesthesia is essential for delivering dental care. However, it is often perceived by some patients as the most painful and in some instances as the only painful part of the treatment, leading in extreme cases to avoidance of dental care. The present study measured the variables of pain, pressure, and discomfort caused by 4 commonly used local anesthesia injections: local infiltration, mental nerve block, inferior alveolar nerve block, and periodontal ligament injections. Patients were asked to grade pain, discomfort, and pressure on a visual analog scale as associated with needle insertion, operator finger position in the mouth, and pressure at injection. The inferior alveolar injection was graded to be the most painful followed by periodontal ligament and then mental nerve block injections. The periodontal ligament injections yielded the highest pressure scores. The inferior alveolar block injection yielded significantly more discomfort than local infiltration and mental nerve block injections when comparing finger and needle position. Local infiltration in the anterior maxillary region yielded the highest needle insertion and finger position discomfort scores. The present study suggests that the dental operator should be aware of local anesthesia injection pain, pressure, and discomfort together with efficacy of technique.

PMID: 16596910 [PubMed - indexed for MEDLINE]

Odontogenic orbital inflammation: clinical and CT findings--initial observations.

Radiology. 2006 Apr;239(1):187-94

Authors: Caruso PA, Watkins LM, Suwansaard P, Yamamoto M, Durand ML, Romo LV, Rincon SP, Curtin HD

PURPOSE: To retrospectively review computed tomographic (CT) and clinical findings in patients with odontogenic orbital infection. MATERIALS AND METHODS: Approval from the institutional review board was obtained for chart and scan review, and informed consent was waived for this HIPAA-compliant study. Five patients, two male and three female (median age, 37 years; age range, 13-55 years), who had odontogenic orbital cellulitis underwent clinical evaluation, CT scanning, and treatment. CT findings, including periapical lucency suggesting abscess, sinus opacification, and the route of spread of infection, were analyzed in each patient. Imaging, clinical, and surgical findings, including the initial clinical diagnosis and the presence of a periapical abscess at surgery and at pathologic examination, were compared. RESULTS: Periapical lucency and sinus opacification were seen in all patients. The route of infection spread was through either the premalar soft tissues or the maxillary sinuses. The odontogenic origin of the orbital infection was not clinically suspected in any patients. Correct diagnosis was later made at CT in all patients. Four patients had periapical abscesses at pathologic analysis, and the fifth patient had apical periodontitis at clinical analysis and granuloma at pathologic analysis. Dental surgery was required in each of the five patients for resolution of infection; four patients underwent extraction of the infected tooth, and one patient underwent incision and drainage of a periapical abscess. CONCLUSION: Abnormal periapical lucency, widening of the periodontal ligament space, and the presence of a subperiosteal abscess suggested an odontogenic origin of orbital infection.

PMID: 16567486 [PubMed - indexed for MEDLINE]

Scope of practice comparison: a tool for curriculum decision making.

J Dent Educ. 2006 Mar;70(3):231-45

Authors: Solomon E, Murray J, Dodge WW, Redding SW, Valenza JA, Flaitz CM, Cole JS, Kalkwarf KL

The proportion of claims filed for specific dental procedures (ADA codes # 05110, 05120, 03320, 03330, 04260, 02150) between January 1, 2000 and June 30, 2004 by Texas general practitioners participating in a preferred provider network was compared to the proportion of these procedures performed by students graduating from the three Texas dental schools during the same period. Analysis of the data revealed that Texas dental students provide class two amalgam restorations in permanent teeth (02150) at approximately the same frequency as Texas general practitioners. Both groups provide periodontal osseous surgery (04260) at an extremely low frequency (<0.02% of total procedures). Bicuspid endodontic procedures (03320) were performed at a slightly higher frequency by students (0.43% of all procedures) than by general practitioners (0.36% of all procedures), and molar endodontic procedures (03330) were performed at a slightly higher frequency by general practitioners (0.65%) than by students (0.36%). Significant discrepancies between the groups were noted for the two complete denture procedures (05110, 05120). Students provided these procedures at frequencies fifteen times (05110) and twenty-five times (05120) greater than general practitioners. Dental schools should use data provided by scope of practice analyses to help determine an appropriate breadth and depth for their educational programs.

PMID: 16522752 [PubMed - indexed for MEDLINE]

The relationship between cigarette smoking and perceived dental treatment needs in the United States, 1988-1994.

J Am Dent Assoc. 2006 Feb;137(2):224-34

Authors: Dye BA, Morin NM, Robison V

BACKGROUND: Although factors affecting perceived dental treatment needs have been investigated, the effect of smoking status on perceptions of dental needs has not been examined. METHODS: The authors examined data on 13,227 dentate people aged 20 to 79 years from the Third National Health and Nutrition Examination Survey (NHANES III). Information was collected information on sociodemographic characteristics, cigarette smoking, perceived dental treatment needs and other factors during a home interview, and clinical oral health information was collected at a mobile examination center. RESULTS: In univariate analyses, current smokers were more likely than nonsmokers to perceive dental needs in all categories, except for the need for a dental cleaning. Multivariate regression results indicate that current smokers were more likely to report a need for periodontal treatment and dental extractions compared with nonsmokers (odds ratio [OR] = 1.40; 95 percent confidence interval [CI] = 1.05-1.87 and OR = 1.61; 95 percent CI = 1.22-2.14, respectively). The authors found an interaction between smoking and race/ethnicity in models describing the need for teeth to be filled/replaced and for orthodontic/cosmetic work. CONCLUSIONS: Current smokers were more likely to have more perceived dental needs compared with nonsmokers. Practice Implications. These results may be important for the advancement of efforts directed toward tobacco-use cessation programs and to understand factors that could affect dental care utilization.

PMID: 16521389 [PubMed - indexed for MEDLINE]

Evaluation of 80 implants subjected to immediate loading in edentulous mandibles after two years of follow-up.

Med Oral Patol Oral Cir Bucal. 2006 Mar;11(2):E165-70

Authors: Mart&#xED;nez-González JM, Barona-Dorado C, Cano-Sánchez J, Fernández-Cáliz F, Sánchez-Turrión A

AIM: An analysis is made of the clinical and radiological behavior of 80 implants with a new surface subjected to etching with a sulfuric and hydrofluoric acid solution followed by thermal treatment, and subjected to immediate loading in patients with lower overdentures. STUDY DESIGN: A prospective observational study was made of 20 patients with lower overdentures supported by four implants measuring 13 mm in length. All patients were included after the obtainment of informed consent, anamnesis, clinical examination and radiological study, with prior clinical elaboration of the lower dentures. RESULTS: Over two years of follow-up, no important plaque or tartar accumulation was observed (with Silness and Loe indexes of 0-1). Periodontal probing proved favorable, with no pocket depths of over 2 mm in any case. The radiological controls showed no implant failures during follow-up. No cervical bone loss was recorded in the first year in a large proportion of cases (65%), while reabsorption of the cervical half was observed in 10%, and of three-quarters of the cervical portion in the remaining 35%. Performance in the second year was compatible with the standard references--with losses of between 0.5-1.5 mm. CONCLUSIONS: Rehabilitation with lower overdentures should be regarded as a priority indication, and implantological treatment substitution by conventional and/or early resting periods should be considered.

PMID: 16505797 [PubMed - indexed for MEDLINE]

Sterilizing effects of the Erbium:Yag laser upon dental structures: an in vitro study.

Med Oral Patol Oral Cir Bucal. 2006 Mar;11(2):E158-61

Authors: Leco-Berrocal MI, Martínez-González JM, Donado-Rodríguez M, López-Carriches C

AIM: An evaluation was made of the sterilizing effects of the Erbium:YAG laser at different power ratings upon dental structures in vitro. DESIGN: An in vitro study was made of 47 single-root teeth removed for periodontal reasons in the Oral and Maxillofacial Surgery Teaching Unit (Department of Medicine and Orofacial Surgery, Madrid Complutense University Dental School, Spain). The teeth were divided into three laser irradiation groups (250, 350 and 450 mJ) and a non-irradiated control group. The teeth were then immersed in an enrichment medium for 72 hours under conditions of anaerobiosis, with visual controls after 24, 48 and 72 hours. Posteriorly, microbiological cultures were made in blood agar to confirm the results of the visual inspections. RESULTS: Increased percentage sterilization of the samples was recorded with increasing irradiation power - statistically significant differences being observed between all irradiated groups versus the controls. CONCLUSIONS: The Erbium:YAG laser exerts a sterilizing effect upon dental structures in vitro. This effect increases with increasing laser power ratings.

PMID: 16505795 [PubMed - indexed for MEDLINE]

Selective COX-2 inhibitor reduces bone healing in bone defects.

Braz Oral Res. 2005 Oct-Dec;19(4):312-6

Authors: Gurgel BC, Ribeiro FV, Silva MA, Nociti FH, Sallum AW, Sallum EA, Toledo S, Casati MZ

Anti-inflammatory agents have been reported to regulate bone healing. The aim of this study was to investigate the effect of a selective cyclooxygenase-2 inhibitor (meloxicam) on bone healing in calvarial defects in rats. Thirty-six adult male Wistar rats were included. After anesthesia, a linear incision was made through the skin of the scalp, a full-thickness flap was reflected and a 4 mm round defect was made with a trephine drill. The animals were randomly assigned to one of the following 4 treatment groups (9 animals each), including daily subcutaneous injections: A: saline solution for 15 days; B: saline solution for 45 days; C: 3 mg/kg of meloxicam for 15 days and D: 3 mg/kg of meloxicam for 45 days. The animals were sacrificed and the specimens, routinely processed. The bone filling was histometrically measured and statistical analysis, performed. Intergroup comparisons demonstrated that the meloxicam groups presented a significant reduction in bone healing when compared to their respective controls (group A, 44.5 +/- 5.75%, against group C, 57.5 +/- 7.25%, p < 0.05; group B, 40.25 +/- 13.75%, against group D, 52.25 +/- 17.25%). Within the limits of the present study, it can be concluded that selective cyclooxygenase-2 inhibitors may reduce bone healing in calvarial defects in rats after continuous administration.

PMID: 16491262 [PubMed - indexed for MEDLINE]

A clinical evaluation of anorganic bovine bone graft plus 10% collagen with or without a barrier in the treatment of class II furcation defects.

J Contemp Dent Pract. 2006 Feb 15;7(1):60-70

Authors: Reddy KP, Nayak DG, Uppoor AS

The use of bone replacement grafts with barrier membranes in class II furcation defects are aimed at improving the outcome of the regenerative technique. In this regard, however, there is a paucity of studies comparing the results obtained with bone grafts alone or in combination with barrier membranes. The aim of this study was to clinically compare an anorganic bovine bone graft plus 10% collagen (BO) with or without a bioresorbable collagen barrier (BG) in human mandibular molar class II furcation defects. METHODS AND MATERIALS: Twenty mandibular class II furcation defects (ten patients with bilateral defects) were treated either with BO (group I) or a combination of BO/BG (group II). Each defect was randomly assigned to either group I or group II. The soft tissue and hard tissue measurements including vertical probing depth (VPD), horizontal probing depth (HPD), clinical attachment level (CAL), gingival recession (GR), vertical depth of furcation defect (VDF), and horizontal depth of furcation defect (HDF) were recorded at baseline and six months after surgery. RESULTS: Both treatment procedures resulted in statistically significant reduction in VPD and HPD, gain in CAL, and reduction in VDF and HDF. There was a statistically significant difference between group I and group II in all soft and hard tissue parameters with the exception of VPD reduction and gingival recession. CONCLUSION: The findings of this study suggest superior clinical results with BO/BG treatment when compared to BO treatment in mandibular class II furcation defects.

PMID: 16491148 [PubMed - indexed for MEDLINE]

Surgical repositioning of a developing maxillary permanent central incisor in a horizontal position: spontaneous eruption and root formation.

Eur J Orthod. 2006 Jun;28(3):206-9

Authors: Kuroe K, Tomonari H, Soejima K, Maeda A

This report describes the surgical repositioning of a developing maxillary permanent central incisor in a horizontal position, followed by spontaneous eruption and root formation without orthodontic traction. Surgical exposure of the right central incisor was achieved. A 7-year-old boy referred for orthodontic consultation. Radiographic examination showed the crown of a maxillary right central incisor to be positioned horizontally with root formation at the initial stage. The surgically repositioned incisor (by a close-eruption surgical flap technique) spontaneously erupted into correct alignment after 2 years 3 months. The erupted incisor remained vital and responded normally to percussion, mobility and sensitivity testing. The soft tissue, periodontal attachment, gingival contour and probing depths were normal. Follow-up radiographs confirmed the continued development of the root, with revascularization of the pulp and a normal appearance of the periodontal space and lamina dura. There was, however, shorter root formation and a narrower root cavity compared with the contralateral incisor. As a result, no orthodontic traction and alignment were required. This method of surgical repositioning is a viable alternative to the traditional approach of extraction or surgical exposure followed by orthodontic traction for a developing maxillary permanent central incisor in a horizontal position.

PMID: 16464872 [PubMed - indexed for MEDLINE]

Rosiglitazone reduces the evolution of experimental periodontitis in the rat.

J Dent Res. 2006 Feb;85(2):156-61

Authors: Di Paola R, Mazzon E, Maiere D, Zito D, Britti D, De Majo M, Genovese T, Cuzzocrea S

The peroxisome proliferator-activated receptor-gamma (PPAR-gamma) receptor appears to play a pivotal role in the regulation of cellular proliferation and inflammation. Recent evidence also suggests that rosiglitazone, a PPAR-gamma agonist, reduces acute and chronic inflammation. We hypothesized that rosiglitazone would attenuate periodontal inflammation. In the present study, we investigated the effects of rosiglitazone in a rat model of ligature-induced periodontitis. At day 8, ligation significantly induced an increase in neutrophil infiltration, as well as of gingivomucosal tissue expression of iNOS, nitrotyrosine formation, and poly (ADP-ribose) polymerase activation. Ligation significantly increased Evans blue extravasation in gingivomucosal tissue and alveolar bone destruction. Intraperitoneal injection of rosiglitazone (10 mg/kg 10% DMSO daily for 8 days) significantly decreased all of the parameters of inflammation, as described above. Analysis of these data demonstrated that rosiglitazone exerted an anti-inflammatory role during experimental periodontitis, and was able to ameliorate the tissue damage associated with ligature-induced periodontitis.

PMID: 16434734 [PubMed - indexed for MEDLINE]

The role of heparan sulfate and perlecan in bone-regenerative procedures.

J Dent Res. 2006 Feb;85(2):122-32

Authors: DeCarlo AA, Whitelock JM

Tissue engineering, grafting procedures, regeneration, and tissue remodeling are developing therapeutic modalities with great potential medical value, but these regenerative modalities are not as effective or predictable as clinicians and patients would like. Greater understanding of growth factors, cytokines, extracellular matrix molecules, and their roles in cell-mediated healing processes have made these regenerative therapies more clinically viable and will continue advancing the fields of tissue engineering and grafting. However, millions of oral and non-oral bone-grafting procedures are performed annually, and only a small percentage yield the most desirable results. Here we review the heparan-sulfate-decorated extracellular biomolecule named perlecan and the research relating to its potential as an adjunct in bone-regenerative procedures. The review includes an overview of bone graft substitutes and biological adjuncts to bone-regenerative procedures in medicine as they apply to periodontal disease, alveolar ridge augmentation, and barrier membrane therapy. Perlecan is discussed as a potential biological adjunct in terms of growth factor sequestration and delivery, and promoting cell adhesion, proliferation, differentiation, and angiogenesis. Further, we propose delivery and application schemes for perlecan and/or its domains in bone-regenerative procedures, with particular emphasis on its heparan-sulfate-decorated domain I. The perlecan molecule, with its heparan sulfate glycosylation, may provide a multi-faceted approach for the delivery of a more comprehensive stimulus than other single potential adjuncts currently available for bone-regenerative procedures.

PMID: 16434729 [PubMed - indexed for MEDLINE]

A novel inhibitor of vacuolar ATPase, FR202126, prevents alveolar bone destruction in experimental periodontitis in rats.

J Toxicol Sci. 2005 Dec;30(4):297-304

Authors: Niikura K, Takeshita N, Chida N

An acidic microenvironment formed by vacuolar ATPase (V-ATPase) expressed in plasma membranes of osteoclasts is thought to be indispensable for bone resorption. This study examined the efficacy of a novel V-ATPase inhibitor, FR202126, in reducing alveolar bone loss caused by experimental periodontitis in rats. FR202126 inhibited H+ transport in plasma membrane vesicles of murine osteoclasts, whereas FR202126 exerted no effect on H+ transport of mitochondrial ATPase or gastric H+,K+-ATPase, indicating that FR202126 is a specific inhibitor of V-ATPase. As expected from the mechanism, FR202126 remarkably inhibited in vitro bone resorption whatever bone resorptive factors were added. Moreover, FR202126 was also able to exert an inhibitory effect on in vivo bone resorption. Experimental periodontitis was induced by ligature wire tied around the contact between the first and second maxillary molars. Insertion of ligature wire for 7 days induced alveolar bone destruction by activating osteoclasts. Oral administration of FR202126 (u.i.d.) significantly prevented alveolar bone loss in experimental periodontitis which may offer a new approach to treatment of periodontal disease.

PMID: 16404138 [PubMed - indexed for MEDLINE]