Surgical periodontal therapy.
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Alveolectomy↗
Biomedical subjects
H Greenwell
Publications and source records attributed to H Greenwell.
A comparison of porous and non-porous teflon membranes plus demineralized freeze-dried bone allograft in the treatment of class II buccal/lingual furcation defects: a clinical reentry study.
BACKGROUND: The aim of this 9-month reentry study was to compare the regenerative healing using porous (P) and non-porous (NP) teflon barrier membranes plus demineralized freeze dried bone allografts (DFDBA) in Class II buccal/lingual furcation defects. METHODS: Twenty-four patients, 13 males and 11 females, ages 38 to 75 (mean 54 +/- 10), were included in this study. Each patient had adult periodontitis and one Class II furcation defect measuring > or = 3 mm open horizontal probing depth. Twelve patients were randomly selected to receive the NP treatment and 12 received the P membrane. All defects received a DFDBA graft. Measurements were performed by a masked examiner. RESULTS: No statistically significant differences (P>0.05) were found between NP and P groups at any time with respect to any open or closed measure. Improvement in mean open horizontal probing depth was significant for both the NP (2.33 +/- 0.78 mm) and P (2.75 +/- 0.75 mm) groups. Mean clinical attachment level gains at 9 months were significant for both NP (1.50 +/- 1.62 mm) and P (2.50 +/- 2.11 mm) groups. Seventeen of 24 defects had an intrabony component and > or = 50% fill was obtained in 100% of these defects. CONCLUSIONS: The results of this 9-month reentry study comparing the use of porous and non-porous barrier membranes with a DFDBA graft indicate that there were no statistically significant differences between groups. Both groups showed a statistically significant improvement following the treatment of Class II furcation defects in humans.
Adult↗
Position paper: Guidelines for periodontal therapy.
The American Academy of Periodontology offers the following Guidelines for Periodontal Therapy. These guidelines are intended to fulfill the Academy's obligation to the public and to the dental profession. This paper sets forth the clinical objectives and scope of periodontal therapy. These guidelines are designed to give guidance to state legislatures and agencies that regulate the practice of periodontology and should be considered in their entirety.
Combined Modality Therapy↗
Predictable multiple site root coverage using an acellular dermal matrix allograft.
BACKGROUND: The primary aim of this randomized, controlled, blinded clinical investigation was to determine if orientation of an acellular dermal matrix (ADM) allograft, basement membrane side against the tooth or connective tissue side against the tooth, affected the percent root coverage. Additional aims were to: 1) compare results of this study with results obtained from other root coverage studies; 2) determine if multiple additional sites could be successfully covered with the same surgery; 3) determine the effect of the procedure on keratinized tissue; and 4) evaluate the amount of creeping attachment obtained. METHODS: Ten patients with 2 Miller Class I or II buccal recession defects > or =3 mm were treated with a coronally positioned flap plus ADM and followed for 12 months. Test sites received ADM with the basement membrane side against the root (AB), while the control sites received the connective tissue side against the root (AC). Multiple additional recession sites were treated with the same flap procedure. RESULTS: Mean baseline recession for the AB sites was 4.2 mm and for the AC sites, 3.7 mm. Mean root coverage of 95% was obtained for both AB and AC sites. Sixty-eight additional Class I or II AB and AC sites obtained about 93% root coverage. The mean increase in keratinized tissue for both treatments was 0.80 mm. No additional root coverage was gained due to creeping attachment between 2 and 12 months. CONCLUSIONS: Treatment with ADM was an effective and predictable procedure for root coverage. The orientation of the material did not affect the treatment outcome for any of the parameters tested.
Adult↗
Statistical versus clinical significance.
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Clinical Trials as Topic↗
Periodontitis as a risk factor for cardiovascular disease.
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Cardiovascular Diseases↗
The deceptive nature of root coverage results.
BACKGROUND: The purposes of this article are to: 1) propose a new method of reporting root coverage data; 2) compare existing root coverage techniques using the proposed data analysis method; and 3) discuss additional refinements to root coverage data analysis. Past studies have equated percent defect coverage with root coverage. This gives deceptive information about the magnitude of the residual recession defect. Defect coverage of 67% could actually amount to 92% root coverage. METHODS: The use of mean root lengths will permit the determination of true root coverage data. This should be reported in addition to defect coverage data. Also including frequency data will provide a better assessment of the predictability of the surgical techniques. RESULTS: A comparison table of root coverage studies demonstrates that the connective tissue graft is the most effective and predictable method that has been tested. CONCLUSIONS: Further refinements to data analysis may help researchers identify the determinants of predictable root coverage.
Connective Tissue↗
Improved closure rate of Class III furcations using a layered GTR technique.
In this study, 24 furcation defects in 12 patients were treated by either (1) a polylactide resorbable membrane (Guidor) plus a polyglactin mesh (Vicryl) and demineralized freeze-dried bone allograft (DFDBA), or (2) a polylactide resorbable membrane and DFDBA. All defects were reentered after 9 months. Class III furcations closed 66% of the time when treated by the first method, while the closure rate was only 33% when treated by the second method (no polyglactin mesh). Defects with a vertical opening of < or = 4 mm closed 74% of the time, while those with vertical openings > 4 mm closed only 11% of the time.
Absorbable Implants↗
Hard tissue ridge augmentation using a resorbable membrane and a particulate graft without complete flap closure.
Twelve patients with isolated alveolar ridge defects bordered by teeth on each side were treated and followed for 12 months. The treatment involved use of a resorbable membrane and a particulate graft without complete flap closure. Measurements taken at 12 months showed a significant mean osseous gain of 3.27 +/- 3.73 mm in mid-defect ridge width and an increase in height of 1.90 +/- 2.50 mm.
Absorbable Implants↗
Improved bone regeneration and root coverage using a resorbable membrane with physically assisted cell migration and DFDBA.
Twelve patients with 2 Miller Class I or II buccal recession defects measuring > or = 3.0 mm were treated using the principles of guided tissue regeneration and followed for 12 months. The effectiveness of a polylactide (Guidor) resorbable membrane (GA sites) was compared to a combination treatment of polylactide membrane plus polyglactin root-lining mesh (Vicryl) and demineralized freeze-dried bone allograft (DFDBA) (GVB sites) designed to enhance cell migration and bone regeneration. There was 90% mean soft tissue root coverage for the GVB sites and 78% for the GA sites. The mean osseous dehiscence area coverage with hard tissue was 75% for GVB sites and 30% for GA sites.
Absorbable Implants↗
Root coverage using Alloderm acellular dermal graft material.
This report describes a surgical technique for root coverage using an acellular dermal graft material and a coronally positioned flap. Video clips of a root coverage surgery are included using the graft material to cover multiple teeth in the same quadrant. Three additional completed cases are presented in which a mean root coverage of 97% was achieved, resulting in 100% coverage on 9 of 11 teeth. The results from this case series conform with the available evidence on the use of acellular dermal graft material in root coverage procedures.
Adult↗
The effect of postsurgical naproxen and a bioabsorbable membrane on osseous healing in intrabony defects.
BACKGROUND: Previous reports in the literature have shown that non-steroidal anti-inflammatory drugs (NSAID) may affect osseous tissues by either stimulating or inhibiting bone formation. This effect can be drug specific and different NSAIDs may produce opposite results. There are also reports showing that NSAIDs inhibit bone loss due to inflammatory disease process. The purpose of this randomized, controlled, blinded, clinical investigation was to determine the effect of a one week course of postsurgical naproxen on the osseous healing in intrabony defects. METHODS: Twenty-four vertical osseous defects in 24 patients were treated with either a bioabsorbable membrane plus twice daily postsurgical naproxen 500 mg for one week (test or GPN group) or with a polylactide bioabsorbable membrane alone (control or GA group). Twelve patients were included in each group. Treatment was performed on either 2- or 3-wall or combination defects. All measurements were taken from a stent by a calibrated, blinded examiner and open measurements were repeated at the 9-month second stage surgery. Power analysis to determine superiority of naproxen treatment showed that a 12 per group sample size would yield 87% power to detect a 2.0 mm difference and 64% power to detect a 1.5 mm difference. RESULTS: Open defect measurements from baseline to 9 months showed a statistically significant (P < 0.05) mean defect fill of 1.96 +/- 1.27 mm and 2.04 +/- 1.71 for the GPN and GA groups, respectively. This corresponded to a mean defect fill of 42% and a mean defect resolution of approximately 75% for both groups. The differences between GPN and GA groups were not statistically significant (P > 0.05). Defect fill of > or = 50% was seen in 6 defects (50%) in the GPN group and in 5 defects (42%) in the GA group. CONCLUSIONS: The administration of postsurgical naproxen failed to produce osseous healing that was statistically superior to that obtained with polylactide bioabsorbable membranes alone.
Absorbable Implants↗
The effect of postsurgical antibiotics and a bioabsorbable membrane on regenerative healing in Class II furcation defects.
BACKGROUND: The purpose of this randomized, controlled, blinded, clinical investigation was to determine the effect of postsurgical antibiotics on osseous healing in Class II furcation defects. METHODS: Twenty-four Class II furcation defects in 24 patients were treated with either a polylactide bioabsorbable membrane, demineralized freeze-dried bone allograft (DFDBA) plus antibiotics (GBA or test group) or with a polylactide membrane and DFDBA alone (GB or control group). Twelve patients were included in each group. The antibiotic regimen consisted of ciprofloxacin 250 mg twice daily and metronidazole 250 mg tid for 1 week followed by a 7-week regimen of doxycycline hyclate 50 mg daily. Treatment was performed on either mandibular buccal or lingual, or maxillary buccal Class II furcation defects. Defects were randomly selected by a coin toss for treatment and all open and closed measurements were performed by a blinded examiner. Final open and closed measures from a stent were repeated at the 9-month second stage surgery. Power analysis to determine superiority of antibiotic treatment showed that a 12 per group sample size would yield 93% power to detect a 1.5 mm difference and 64% power to detect a 1 mm difference. RESULTS: Mean open horizontal probing depth reductions at 9 months were greater for the GBA group than for the GB group (2.92+/-1.78 versus 2.50+/-1.62 mm); however, these differences were not statistically significant. Seven of 12 furcations (58%) in the GBA group demonstrated >50% vertical defect fill at 9 months compared to 8 of 12 furcations (67%) in the GB group. There were no significant differences in mean open horizontal probing depth reduction between smokers and non-smokers in either the GBA or GB groups. Membrane exposure did not appear to affect regenerative healing in either the GBA or GB groups. CONCLUSIONS: The administration of postsurgical antibiotics did not produce statistically superior osseous healing of Class II furcation defects. This result may be attributable to membrane design which facilitates connective tissue ingrowth, thereby preventing bacterial downgrowth and contamination of the newly regenerated tissues.
Absorbable Implants↗
Root trunk dimensions of 5 different tooth types.
The primary purpose of this study was to document mean, standard deviation, and range of root trunk dimensions of multirooted tooth types. A total of 412 extracted teeth were examined and classified as: maxillary first molars, maxillary second molars, maxillary first premolars, mandibular first molars, and mandibular second molars. The distance from the cementoenamel junction (CEJ) to the root groove and from the CEJ to the root division was measured. Mean CEJ to root groove distances ranged from 1.35 to 1.65 mm for maxillary first molars, from 1.49 to 1.89 mm for maxillary second molars, from 1.71 to 1.73 mm for maxillary first premolars, from 1.16 to 1.22 mm for mandibular first molars, and from 1.53 to 1.76 mm for mandibular second molars.
Bicuspid↗
Furcation depth and interroot separation dimensions for 5 different tooth types.
The purpose of this study was to document mean, standard deviation, and range of furcation depth and Interroot separation dimensions of 5 multirooted tooth types. A total of 412 extracted teeth were examined and classified as: maxillary first molar, maxillary second molar, maxillary first premolar, mandibular first molar, and mandibular second molar. The furcation depth was measured at the level of the furcation dome and 3 and 5 mm apical to the dome. Interroot separation was measured 3 and 5 mm apical to the furcation dome. Mean furcation depth at the dome was 7.48 mm buccally and 6.67 mm mesiodistally for maxillary first molars; 6.69 mm buccally and 5.94 mm mesiodistally for maxillary second molars; 3.54 mm mesiodistally for maxillary first premolars; 7.96 mm buccolingually for mandibular first molars; and 7.46 mm buccolingually for mandibular second molars. Interroot separation dimensions 3 mm apical to the dome were: 2.58 mm buccally, 4.17 mm mesially, and 4.48 mm distally for maxillary first molars; 1.92 mm buccally, 3.89 mm mesially, and 4.04 mm distally for maxillary second molars; 2.47 mm mesially and 2.58 mm distally for maxillary first premolars; 3.15 mm buccally and 2.95 mm lingually for mandibular first molars; and 2.54 mm buccally and 2.75 mm lingually for mandibular second molars.
Bicuspid↗
Comparison of a bioabsorbable GTR barrier to a non-absorbable barrier in treating human class II furcation defects. A multi-center parallel design randomized single-blind trial.
This multi-center single-blind study compared clinical outcomes following guided tissue regeneration (GTR) treating human Class II furcation defects with a new polylactic-acid-based bioabsorbable barrier (test treatment) or a non-absorbable ePTFE barrier (control treatment). Clinical parameters evaluated were change in vertical attachment level (VAL), horizontal attachment level (HAL), probing depth (PD), and gingival margin location (REC). Surgical treatment resulted in clinically and statistically equivalent changes when comparisons were made between test and control treatments. VAL gain was 2.0 mm for test and 1.6 mm for control groups; HAL gain was 2.1 mm for both test and control groups. PD reduction was 2.3 mm for the test group and 2.1 mm for the control group. Test sites experienced an additional 0.3 mm of recession beyond baseline; control sites, 0.5 mm. Within-group comparisons showed that the amount of recession was not significantly different from baseline in the test group. Recession in the control group was significantly different from baseline. All other parameters in both the test and control groups were significantly different from baseline. Evaluation of safety data indicated no significant differences between test and control treatments, although there was a strong trend for the control group to have more postoperative abscess or suppuration than test sites (control = 11; test = 4; P = 0.06).
Absorption↗
Periodontal indices of patients taking isoniazid and rifampin: a pilot study.
A significant reduction in the incidence of tuberculosis (TB) has resulted from the use of medications such as isoniazid (INH) and rifampin. Unfortunately, there has been a resurgence of TB since the mid 1980s. The purpose of this pilot study was to evaluate the effects of INH and rifampin on periodontal indices of patients with positive tuberculin skin tests (PPD). The gingival index, plaque index, and periodontal scoring and recording were recorded in PPD-positive patients at baseline and 1 month. Control patients received no medications during the study and were evaluated at baseline and 1 month. Mean values for each patient were obtained and analyzed using unpaired t tests (N = 8). Statistically, within the limits of this study, it was found that patients taking INH and/or rifampin had a significant decreased (p < 0.05) in gingival inflammation from baseline.
Adult↗
Assessing hyperanticoagulation of dental patients undergoing warfarin therapy.
Patients often undergo a number of dental procedures that may cause bleeding. Usually these procedures can be performed with little risk to the patient. However, patients on medications such as warfarin (Coumadin) have an altered ability to control, bleeding and may develop bleeding problems subsequent to treatment. Once this potential problem has been recognized, measures can be taken to minimize the risks. Patients on warfarin are on specific medication protocols and often exhibit episodes of hyperanticoagulation. The purpose of this study was to assess patients on warfarin protocols for episodes of hyperanticoagulation. Sixty-two patients undergoing anticoagulation therapy with warfarin were assessed for episodes of hyperanticoagulation with the prothrombin test. Based on these results, it can be concluded that patients taking warfarin had an approximately 42% chance of at least one episode of hyperanticoagulation. No specific warfarin protocol demonstrated any statistical significance for an increased chance of hyperanticoagulation.
Adult↗