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Biomedical subjects

K L Kalkwarf

Publications and source records attributed to K L Kalkwarf.

At least 19 recordsLinked to original sources
PubMed2000

The UTHSCSA Dental School in the new millennium.

The UTHSCSA Dental School, just short of 30 years in existence, has made great strides to be a leader in dental education. Although increased use of computers has the greatest potential for revolutionizing dental education, there are other components that must constantly be evaluated and improved. A major curriculum review is in progress. The process is a grass roots effort to allow input from faculty, students, alumni and outside consultants. The school's competencies are being reevaluated to assure they are contemporary and the methods to assess them are valid and reliable. The way we evaluate applicants is an ongoing evolution. Our appropriate role in the community (local, national, and international) continues to be a challenge. Success will be measured by how well we continuously evaluate our mission and goals, identify problems and find and implement solutions.

Competency-Based Education↗
PubMed1999

How the licensure process will evolve.

BACKGROUND AND OVERVIEW: All aspects of dental licensure are continuing to evolve. This article describes the changes that are occurring in the licensure process and projects the direction and magnitude of future changes. CONCLUSIONS: The author predicts that national board examinations will continue to move away from recall of facts and toward assessment of basic science and clinical principles as they apply to clinical decision making and delivery of care. Clinical examinations will continue their evolution to become even more reliable and valid. Licensure by credentials will be adopted by more states, thus addressing concerns about mobility that are expressed by many practitioners. PRACTICE IMPLICATIONS: Despite all of this projected progress, the dental profession should expect elevated public pressure for greater accountability unless it takes a proactive position to ensure the continued competency of all practitioners.

Clinical Competence↗
PubMed1997

Continued competency--a responsibility of the profession.

For the past decade the Continued Competency Committee of the American Association of Dental Examiners has explored issues in continued competency for the dental profession. The efforts have focused on creating policy and standards which must be met by any continued competency assessment mechanisms. Nine potential systems are under review. Some, such as examination for diplomate status in a recognized dental specialty are already in place. The development and pilot testing of four new mechanisms--simulations, continuing education with measurable outcomes, case presentation, and in-office audit--is being encouraged.

Certification↗
PubMed1997

Long-term prognosis following resectional and regenerative periodontal procedures.

The ultimate goal of both resective and regenerative periodontal procedures is the creation of soft- and hard-tissue architecture that is consistent with periodontal health. Osseous resective procedures predictably produce minimal clinical probing depth, but sacrifice periodontal support. An alternative method to treat anatomic defects not easily managed through resection is guided tissue regeneration (GTR). GTR provides clinicians with the opportunity to reverse the disease-related loss of periodontal attachment. However, at present, the outcomes of GTR procedures have not been shown to be predictable. Continued improvements in techniques and materials, and identification of patient-related factors significant to the success of the GTR procedures, should enhance the consistency of the clinical outcomes. An evidence-based approach to the use of both regenerative and resective therapies will enhance the clinical results achieved through these procedures.

Alveolar Bone Loss↗
PubMed1996

Assessing continued competency: an approach for dentistry.

Holding a license in a given profession does not guarantee competency. To help define criteria for periodic competency assessment of dentists, the American Association of Dental Examiners assembled a committee in 1993. In this article, the authors outline the criteria the committee established for such assessments and discuss several assessment models proposed by the committee.

Certification↗
PubMed1996

Long-term evaluation of periodontal therapy: II. Incidence of sites breaking down.

Eighty-two patients were treated in a split mouth design with coronal scaling (CS), root planing (RP), modified Widman surgery (MW), and flap with osseous surgery (FO) which were randomly assigned to the various quadrants in the dentition. Following phase I and phase II therapy, the patients received supportive periodontal treatment (SPT) at 3-month intervals for up to 7 years. Clinical attachment level (CAL) was determined initially, post-phase I, post-phase II and prior to each SPT appointment. If a site lost > or = 3 mm of CAL from its baseline, it was classified as a breakdown site. Baselines were the initial exam for sites treated by CS and 10 weeks post-phase II for sites treated by RP, MW, and FO. Data were grouped by probing depth (PD) severity at the initial exam and at post-phase II. The breakdown for CS sites was assessed separately from RP, MW, and FO sites because of different baselines and retreatment protocols. Sites treated by CS had a higher incidence of breakdown than the other therapies through year 1 of SPT. The breakdown incidences/year for RP and MW sites were similar and greater than for FO sites in 1 to 4 mm and 5 to 6 mm PD categories. Breakdown incidence of RP sites was greater than MW sites which was greater than FO sites initially > or = 7 mm. Differences in incidence of breakdown between therapies after recategorizing data by post-phase II PD were the same as above, except no difference was present between RP and MW sites > or = 7 mm. Breakdown incidences were greater in increasing PD severities regardless of when they were categorized. There was no further loss of CAL one year after retreatment in 88% of sites. Patients with higher breakdown incidences tended to be smokers at the initial exam.

Alveolectomy↗
PubMed1996

Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities.

Eighty-two periodontal patients were treated in a split mouth design with coronal scaling (CS), root planing (RP), modified Widman surgery (MW), and flap with osseous resection surgery (FO) which were randomly assigned to various quadrants in the dentition. Therapy was performed in 3 phases: non-surgical, surgical, and supportive periodontal treatment (SPT) < or = 7 years. Clinical data consisted of probing depth (PD), clinical attachment level (CAL), gingival recession (REC), bleeding on probing (BOP), suppuration (SUP), and supragingival plaque (PL). Because of the necessity to exit many CS treated sites due to breakdown, data for CS were reported only up to 2 years. All therapies produced mean PD reduction with FO > MW > RP > CS following the surgical phase for all probing depth severities. By the end of year 2 there were no differences between the therapies in the 1 to 4 mm sites. There were no differences in PD reduction between MW and RP treated sites by the end of year 3 in the 5 to 6 mm sites and by the end of year 5 in the > or = 7 mm sites. FO produced greater PD reduction in > or = 5 mm sites through year 7 of SPT. Following the surgical phase, FO produced a mean CAL loss and CS and RP produced a slight gain in 1-4 mm sites. RP and MW produced a greater gain of CAL than CS and FO following the surgical phase in 5 to 6 mm sites, but the magnitude of difference decreased during SPT. Similar CAL gains were produced by RP, MW, and FO in sites > or = 7 mm. These gains were greater than that produced by CS and were sustained during SPT. Recession was produced with FO > MW > RP > CS. This relationship was maintained throughout SPT. The prevalences of BOP, SUP, and PL were greatly reduced throughout the study and were comparable between sites treated by RP, MW, and FO while the CS sites had more BOP and SUP.

Adult↗
PubMed1996

Levels of cigarette consumption and response to periodontal therapy.

Seventy-four patients with moderate to advanced periodontitis were classified by cigarette consumption at the initial exam: heavy smokers (HS) > or = 20 cigarettes/day (n = 31); light smokers (LS) < or = 19 cigarettes/day (n = 15); past smokers (PS) had a history of smoking but had quit by the initial exam (n = 10); and non-smokers (NS) had never smoked (n = 18). All patients were treated with four modalities of periodontal therapy followed by supportive periodontal treatment (SPT) for a period of up to 7 years. Clinical parameters including probing depth (PD), clinical attachment level (CAL), recession (REC), presence of bleeding on probing (BOP), and supragingival plaque (PL) were assessed at six sites around each tooth. Horizontal probing attachment level (HAL) was obtained at molar furcation sites. Data were collected initially, 4 weeks after non-surgical therapy, 10 weeks after surgical therapy, and yearly during SPT. HS and LS demonstrated less PD reduction and less CAL gain than PS and NS following active treatment and throughout SPT. Following active treatment, HAL changes were similar for all groups, but during 7 years of SPT, HS and LS experienced greater loss of HAL. There were no differences in BOP among the four groups. HS demonstrated a higher percentage of PL positive sites compared to the other groups. In summary, HS and LS responded less favorably to therapy than PS and NS. A past history of smoking was not deleterious to the response to therapy.

Adult↗
PubMed1994

The effect of smoking on the response to periodontal therapy.

This study evaluated the effect of smoking on the clinical response to non-surgical and surgical periodontal therapy. 74 adult subjects with moderate to advanced periodontitis were treated according to a split-mouth design involving the following treatment modalities: coronal scaling, root planing, modified Widman surgery, and flap with osseous resectional surgery. Clinical parameters assessed included probing depth, probing attachment level, horizontal attachment level in furcation sites, recession, presence of supragingival plaque and bleeding on probing. Data were collected: initially, 4 weeks following phase-I therapy, 10 weeks following phase-II therapy and on a yearly basis during 6 years of maintenance care. Data analysis demonstrated that smokers exhibited significantly less reduction of probing depth and less gain of probing attachment level when compared to non-smokers immediately following active therapy and during each of the 6 years of maintenance (p < 0.05). A greater loss of horizontal attachment level was evident in smokers at each yearly exam during maintenance therapy (p < 0.05). There were no differences between groups in recession changes. In general, these findings were true for the outcomes following all 4 modalities of therapy and were most pronounced in the deepest probing depth category (> or = 7 mm). Statistical analysis showed a tendency for smokers to have slightly more supragingival plaque and bleeding on probing. In summary, smokers responded less favorably than non-smokers to periodontal therapy which included 3-month maintenance follow-up.

Adult↗
PubMed1993

Gingival fluid IL-1 and IL-6 levels in refractory periodontitis.

Selected gingival bacteria and cytokine profiles associated with patients who did not respond to conventional periodontal therapy (refractory) were evaluated. 10 subjects with a high incidence of post-active treatment clinical attachment loss (> 2% sites/year lost > or = 3 mm) were compared to 10 age-, race-, and supragingival plaque-matched patients with low post-treatment clinical attachment loss (< 0.5% sites/year) relative to the following parameters at 2 sites/patient with the deepest probing depths: (1) presence of 3 selected periodontal pathogens (Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Eikenella corrodens) in subgingival plaque as determined by selective culturing, and (2) gingival crevicular fluid (GCF) levels of 3 cytokines associated with bone resorption (IL-1 alpha, IL-1 beta, IL-6) as determined by two-site ELISA. Results indicated no significant differences in any clinical measurement (except incidence of clinical attachment loss), in the presence of any bacterial pathogen, or in GCF cytokine levels between refractory subject sites versus stable subject sites. However, when sites producing the greatest total GCF cytokine/patient were compared, sites from refractory patient produced significantly more IL-6 (30.1 +/- 4.0 versus 15.4 +/- 2.8 nM, p < 0.01). The subgingival presence of each of the 3 bacterial pathogens was associated with elevated GCF IL-1 concentrations. These data suggest that gingival IL-1 and IL-6 production is different in response to local and systemic factors associated with periodontitis, and that IL-6 may play a role in the identification and mechanisms of refractory periodontitis.

Adult↗
PubMed1993

A review of longitudinal studies that compared periodontal therapies.

There have been numerous longitudinal periodontal studies that have compared the effects of two or more therapies on various clinical parameters. These studies are reviewed and their results are compiled. Both surgical and non-surgical therapy produced improvement in periodontal health. Surgical therapy tended to create greater short-term probing depth reduction than non-surgical therapy; however, the advantage was lost in some studies over time. In shallow probing depths, surgery produced a greater loss of probing attachment than non-surgical therapy. In deeper probing sites, the short-term results comparing mean probing attachment change following non-surgical and surgical therapy were mixed. In most studies, no long-term differences in mean probing attachment level change were present between non-surgical and surgical therapy. There were no differences between surgical and non-surgical therapy in any of the gingival inflammatory indices.

Clinical Trials as Topic↗
PubMed1992

Patient preference regarding 4 types of periodontal therapy following 3 years of maintenance follow-up.

It has been shown that certain types of periodontal therapy result in greater post-therapy gingival recession. It has been suggested that this recession may lead to maintenance complications for patients. This study evaluated patient perceptions 3 years following the completion of 4 types of periodontal therapy (coronal scaling (CS), root planing (RP), modified Widman surgery (MW), and flap with osseous resectional surgery (FO)). 75 individuals completed split-mouth therapy and 3 years of maintenance follow-up. An interview survey of all patients categorized their perception for each treatment of their mouth concerning difficulty in cleaning, sensitivity to temperature, general "feeling" of the region, prevalence of localized symptoms, food retention, comfort of oral examination, and attitude toward repeating therapy. Responses to questions showed no statistically significant differences between treatment regions. Patterns demonstrated that FO-treated regions were perceived to have less food retention, but were more difficult to clean. It was generally found that at the end of 3 years of maintenance, patients felt their mouths were "normal", they experienced few localized symptoms, and were very willing to repeat any of the treatment regimens if necessary.

Chi-Square Distribution↗
PubMed1991

Surgical treatment of periodontal diseases: access flaps, bone resection techniques, root preparation, and flap closure.

Surgical periodontal therapy has been used for decades in an attempt to halt the progression of chronic, adult periodontitis. Numerous surgical techniques have been proposed, each generally aimed at mechanical debridement of the periodontal lesion and associated root surface, facilitation of healing, and creating an environment capable of being stabilized by a normal periodontal maintenance routine. Certain surgical approaches provide better access for debridement or assure flap repositioning at a level which results in an optimal anatomic relationship between soft tissue and teeth following healing.

Alveolar Process↗