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PubMed1993

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

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

Adult↗
PubMed1996

Treatment of stripping perforations.

Strippings are problems that are frequent on thin and concave roots. Treatment and prognosis differ from that of a lateral root perforation because of the size, oval shape, and thin edges of the striping. We propose a two-step technique: an endodontic phase in which the root canal system is sealed with gutta-percha overflowing through the stripping perforation and a surgical second step that will allow elimination of this excess.

Adolescent↗
PubMed1998

Seven canals in a lower first molar.

This case report examines a mandibular first molar retreatment in which seven canals were cleaned, shaped, and filled/refilled, thus leading to resolution. This report points out the importance of looking for additional canals and an unusual canal morphology associated with a mandibular first molar.

Adult↗
PubMed1998

Perforation repair comparing mineral trioxide aggregate and amalgam using an anaerobic bacterial leakage model.

The purpose of this study was to evaluate the ability of mineral trioxide aggregate (MTA) and amalgam to seal furcal perforations in extracted human molars using an anaerobic bacterial leakage model. Furcal perforations were made in 39 maxillary and mandibular human molars with a high-speed bur. These were randomly divided into two experimental groups of 18, with the remaining three teeth used as positive controls. Experimental group 1 was repaired with MTA and group 2 with amalgam. Three additional teeth without perforations served as negative controls. A dual chamber anaerobic bacterial leakage model was assembled. Brain heart infusion broth with yeast extract, hemin, menadione, and the chromogenic indicator bromcresol purple was used as the culture broth for Fusobacterium nucleatum. Eight of 18 amalgam samples leaked, whereas none of the 18 MTA samples leaked. MTA was significantly better than amalgam in preventing leakage of F. nucleatum past furcal perforation repairs.

Aluminum Compounds↗
PubMed1998

Artificial floor technique used for the repair of furcation perforations: a microleakage study.

Access openings and furcation perforations were prepared in 45 human extracted teeth randomly divided into three equal groups. Furcation perforations were obtruded using only a resin-modified, glass-ionomer material (Vitrebond) in the first group. Calcium sulfate and hydroxylapatite were used as artificial floors under the Vitrebond in the second and third groups, respectively. Pulp chambers and access openings were filled with composite resin. After immersion in 2% methylene blue solution for 2 wk, the teeth were sectioned and dye penetration was measured under a stereomicroscope using a NIH Image 1.47 Macintosh program. Results indicated that calcium sulfate and hydroxylapatite artificial floors significantly improved the sealing ability of Vitrebond and provided successful barriers against its overextension.

Biocompatible Materials↗
PubMed1997

Managing treatment for the orthodontic patient with periodontal problems.

Some adult patients have mild to moderate periodontal disease before orthodontic treatment. These patients may be at risk of developing further periodontal breakdown during orthodontic therapy. However, careful diagnosis and judicious management of these potentially volatile patients can alleviate the risk. In this article, the diagnosis and management of several periodontal problems is discussed. The need for and timing of preorthodontic periodontal surgery for these situations is elucidated. In addition, the types of tooth movement that will ameliorate these problematic situations is described. This information is valuable for the orthodontist who treats patients with underlying periodontal problems.

Adult↗
PubMed1997

The buccal bifurcation cyst: a prospective study of treatment outcomes in 44 sites.

OBJECTIVE: The clinical, radiographic, and histologic features of the mandibular buccal bifurcation cyst were studied to further define this lesion. The treatment and outcomes were also analyzed. STUDY DESIGN: This prospective study, which spanned 3 years, included 32 patients. Their ages ranged from 5.5 to 11 years (mean of 7.5). A total of 44 buccal bifurcation cysts were treated solely with enucleation, and patients were followed up for 2.5 to 3 years. RESULTS: All lesions were located at the buccal bifurcation of the mandibular first molar. Tilting of the buccal cusps, causing prominence of the lingual cusps, occurred in 75% of the cases. The lesion extended from the buccal bifurcation to the tooth apex in 81.2%, and a periosteal reaction on the lateral surface of the mandible adjacent to the cyst was noted in 68.8% of the cases. All of the 44 histologic reports were nonspecific, but showed a cyst lining of stratified squamous epithelium with chronic inflammation. Microbiology consisted of mixed oral flora. Complete radiographic healing in all sites without recurrence was noted in 2.5-year follow-up. The periodontal pocket depth around all the involved teeth was normalized. No loss of the mandibular first molars occurred. CONCLUSIONS: The mandibular buccal bifurcation cyst is a distinct site-specific and age-specific clinical entity treatable by enucleation without tooth extraction.

Age Factors↗
PubMed1998

A diagnostic comparison of panoramic and intraoral radiographs.

OBJECTIVE: This study compared panoramic and intraoral radiographic surveys in the evaluation of specific dental pathoses in Air Force personnel. STUDY DESIGN: The radiographs of 30 subjects were read singly and in various combinations: panoramic survey only; periapicals plus bitewings; panoramic survey plus bitewings; and panoramic survey plus periapicals plus bitewings. Three independent, blinded examiners using standardized viewing conditions assessed the radiographs in random order for the presence of caries, periapical pathoses, bone loss, furcation involvement, impacted/unerupted teeth, internal/external root resorption, and retained roots. The consensus radiographic standard of true pathosis was the simultaneous interpretation by the three examiners of all radiographs for each subject. RESULTS AND CONCLUSIONS: The panoramic survey by itself was shown to have the lowest correlation with the consensus radiographic standard when basic military trainees with generalized dental pathoses were evaluated. The combination of panoramic survey plus bitewing radiographs exhibited a diagnostic yield for specific pathoses that was comparable to that of panoramic survey plus bitewings plus periapicals.

Adolescent↗
PubMed1998

Periodontitis detection efficacy of film and digital images.

OBJECTIVE: The objective of this study was to evaluate the accuracy of alveolar crestal bone detection in a comparison of unenhanced and enhanced Sidexis (Siemens Medical Systems, Inc., Bensheim, Germany) digital images with Ektaspeed Plus (Eastman Kodak, Rochester, N.Y.) films by means of receiver operating characteristic analysis. STUDY DESIGN: More than 100 proximal and furcal areas in the anterior and posterior areas of the mandible and maxilla of each of three tissue-equivalent human skull phantoms were imaged with film, direct digital images, and contrast- and brightness-enhanced digital images. Alveolar crest status was assessed by a consensus panel of three experts who used the Delphi method and evaluated information from all of the imaging modalities concurrently. Five observers assessed all images for the presence or absence of crestal bone loss using a five-point confidence scale. Receiver operating characteristic curves were generated, and calculated areas (Az) were analyzed by means of analysis of variance. RESULTS: The expert panel determined that of 106 crestal areas, 48 were disease free and 58 exhibited bone loss greater than 2 mm apical to the cemento-enamel junction. Analysis of variance of observer Az scores showed significant differences among readers (p < 0.001) and among readings (p = 0.027), but not among modalities (p = 0.435). Mean Az values for the different modalities were as follows: Sidexis, 0.70; enhanced Sidexis, 0.71; Ektaspeed Plus films, 0.735. CONCLUSION: The Sidexis digital imaging system was not significantly different from Ektaspeed Plus film for crestal bone evaluation in this in vitro study.

Alveolar Bone Loss↗
PubMed2003

Topographic study of extracted molars with advanced furcation involvement: furcation entrance dimension and molar type.

This study investigated the topography of the furcation entrance dimension (FED) on molars with advanced furcation involvement (FI). The sample pool consisted of 169 maxillary and mandibular molars from a group of 165 individuals with severely advanced periodontal destruction. The subjects included men and women aged 24 to 84 years (mean, 47.8 +/- 7.2 years). The FEDs of the maxillary buccal, mesial, and distal surfaces as well as the mandibular buccal and lingual surfaces were measured under a stereomicroscope and clarified into grades I (FED < 0.55 mm), II (0.55-0.75 mm), and III (> 0.75 mm) using automatic grading system software designed by our research associates. The differences and relationships among molar location, furcation site, and FED grade were analyzed using the chi-square test. There was a significant difference among buccal (BFED), mesial (MFED), and distal (DFED) FEDs in both the maxillary first (chi2(4) = 58.915, p < 0.001) and second (chi2(4) = 66.839, p < 0.001) molars. The relationship between molar type and FED grade was statistically significant for both the BFED (p < 0.001) and the DFED (p < 0.001) of maxillary molars, as well as for both the BFED (p < 0.0001) and LFED (p < 0.0001). The difference in FED grade between the first and second molars was statistically significant in both maxillary (p < 0.001) and mandibular (p < 0.0001) molars. There was a significant relationship between FED grade and tooth location at molars with advanced FI.

Adult↗
PubMed1999

Effect of different frequencies of preventive maintenance treatment on periodontal conditions. 5-Year observations in general dentistry patients.

The protocol for this study was designed to evaluate the effects of supportive recall treatments provided with different frequencies, viz. at 3-, 6-, 12- and 18-month intervals. The subjects for the study were recruited from patients attending a public, general dentistry clinic. Prior to baseline, the subjects were given necessary dental treatments to provide a proper baseline for the study. Baseline, intermittent and final recordings included scores of dental plaque, bleeding on probing, probing depth and probing attachment level. Results were evaluated statistically by intergroup comparisons of changes for the various parameters from baseline to final examination after 5 years. The analyses showed some advantage to shorter recall intervals for plaque and bleeding scores. Although not statistically significant, there was a trend suggesting some rebound of sites > or =6 mm deep at the end of the study for the 18-month group, but not for the other groups. Similarly, there was a trend that the 18-month group showed a higher percentage of buccal/lingual furcation sites with attachment loss > or = 1.0 mm than the other groups. Apart from these trends, the analyses failed to demonstrate differences between the groups for either changes of probing depths or probing attachment levels. The negative observations included identification of individuals with 'disease progression' in the various groups, using a series of arbitrary definitions for this parameter. The results of this trial suggest that recall intervals extended to a year may be acceptable for the purpose of reducing periodontal disease progression in individuals with a history of limited susceptibility to the disease.

Adult↗
PubMed1999

Furcation diagnosis.

One of the most important and at present unsolved problems in clinical periodontology is the predictable successful treatment of periodontitis-affected furcations of multirooted teeth. Since several therapeutic approaches are proposed, i.e., conservative, resective or regenerative, a proper diagnosis of these lesions is demanding. The aim of the present article is to review the current information on the impact of a proper diagnosis of a furcational lesion as well as tooth morphology on decision making with regard to different treatment modalities and to emphasize the need for a detailed clinical, radiographical and intraoperative diagnosis of the furcation lesion beyond the usually performed diagnosis of the degree of furcation involvement.

Bicuspid↗
PubMed1999

Root debridement of molars with furcation involvement using diamond-coated sonic scaler inserts during flap surgery -- a pilot study.

In our laboratory, we modified sonic scaler inserts to increase effectivity of root surface instrumentation of molars with furcation involvement during flap surgery. The working end of conventional sonic scaler inserts was thickened ellipsoidally and diamond coated. Inserts with variously angled shafts were designed in order to facilitate insertion into the furcation. A clinical, split-mouth study examined the debridement of molars with furcation involvement during flap surgery using either hand instruments or diamond-coated sonic scaler inserts with 15 patients. Average treatment time was cut by ca. 50%, using diamond-coated inserts as compared to hand instruments for root surface debridement during surgery. 2 years after surgery, the clinical parameters had not been influenced by type of instrument used.

Adult↗
PubMed2000

Diamond-coated sonic tips are more efficient for open debridement of molar furcations. A comparative manikin study.

BACKGROUND/AIMS: The aim of this study was to compare the efficacy of open debridement of class II and III furcations by a new diamond-coated sonic instrument tip (Sonicparo) with a conventional sonic insert (Sonicrecall) and hand instruments (Gracey curettes). METHOD: Open debridement was simulated using a manikin head and standardised plastic teeth. The efficacy of debridement was examined by 3 parameters: residual root surface marker, 'tooth' weight loss and time taken for debridement. The teeth used were 1st and 2nd upper and lower molars. Upper left and lower right molars were chosen to represent class II furcation involvements and upper right and lower left molars class III furcation involvements. Each tooth was debrided 4 times with each instrument for both class of furcations. RESULTS: The results of this study showed significantly less residual marker area comparing Sonicparo with Gracey curettes (mean difference 2.52 mm2, p<0.001). However, no significant differences in marker removal were observed between Sonicrecall inserts and the other instruments. Sonicparo inserts also took significantly less time to debride the furcation than Gracey curettes (mean difference 98.3 s, p<0.001) or Sonicrecall instruments (mean difference 74.3 s, p<0.001). However no significant differences were found between instruments concerning weight loss of the plastic teeth. CONCLUSIONS: It was concluded from this in-vitro study that the Sonicparo insert was a more efficient instrument for open molar furcation debridement than Sonicrecall and hand instruments (Gracey curettes) when considering both marker removal and debridement time.

Analysis of Variance↗
PubMed2001

A clinical application of autotransplantation using furcation-involved root.

BACKGROUND, AIMS: The present case report describes the clinical application of autotransplantation using furcation involved roots. METHOD: After initial therapy, root resection was performed upon the patient's molar teeth with furcation involvement in the mandible. 2 distal roots of the molar teeth were autotransplanted as abutments to replace missing premolar and molar teeth in the mandible. RESULTS: On re-examination, 1 year after the transplantation, these roots showed no signs of periodontal or technical complications. The results suggest the potential use of autotransplantation techniques using furcation involved roots in reconstructive therapy. This may be a new approach in periodontal therapy.

Bicuspid↗
PubMed2001

Retrospective comparison of clinical variables between compliant and non-compliant patients.

BACKGROUND: The aim of this retrospective study was to evaluate if patients with moderate to advanced periodontitis had comparable periodontal conditions at baseline and during supportive periodontal therapy (SPT) whether they were compliant or not. METHOD: Patient-related variables were compared: age, tooth mobility, furcation involvement, number of teeth, pocket probing depth, plaque index. Compliant patients (n = 142) received complete periodontal treatment and were followed over at least 10 years (group A). Non-compliant patients either discontinued supportive periodontal therapy (n = 42, group B) or dropped out before or during periodontal surgery (n = 44, group C). RESULTS: At baseline, there were no significant differences between the 3 groups except for mobility. During SPT, mean pocket probing depth and plaque index differed significantly. CONCLUSION: These results indicate that non-compliant patients compared to compliant patients had similar periodontal conditions at baseline, but responded less favourably to periodontal surgery and maintenance.

Adult↗
PubMed2001

PMN responses following use of 2 biodegradable GTR membranes.

OBJECTIVES: In the present prospective trial, the PMN response following resorbable GTR barrier placement was evaluated in mandibular class II furcation lesions. MATERIALS AND METHODS: In 10 patients with treated chronic periodontitis, we randomly selected the 1st molars in the mandible with buccal degree II furcation involvement for either polylactic-citric-acid-ester (PLA) or glycolide-lactic-copolymer (PGL) GTR membrane therapy. We examined contralateral healthy molar sites as untreated controls. We then evaluated the PMN-derived inflammatory tissue response at baseline, weekly up to 6 weeks post-therapy and at 12 and 24 weeks using GCF myeloperoxidase (MPO), beta-glucuronidase (betaG) and beta-N-acetyl-hexosaminidase (betaNAH). RESULTS: The enzyme levels increased from baseline to the 6-week examination. After the 6-week reappointment, enzyme levels dropped reaching the baseline scores at both the 12- and 24-week visit. At PGL sites, the enzyme levels decreased earlier. Compared with healthy control sites, the MPO, betaNAH and betaG tests revealed different maximum levels at week 2 and 3 (PGL) and week 4, 5 and 6 (PLA). For both of the barriers the clinical parameters revealed a sustained improvement following therapy. CONCLUSION: The release of PMN enzymes following placement of bioabsorbable membranes reflects the early soft tissue healing process. Our results suggest that the PMN response is barrier-dependent with the maximum response occuring at different times. However, the host response did not measureably affect the course of clinical healing.

Absorbable Implants↗
PubMed2002

Retrospective study of tooth loss in 92 treated periodontal patients.

BACKGROUND/AIMS: In this retrospective study, the efficacy of periodontal therapy and maintenance in preventing tooth loss was evaluated. METHODS: The study included 92 patients with 2310 teeth diagnosed with chronic adult periodontitis and observed over a mean period of 6.7 years, with each patient receiving surgical therapy in two or more quadrants. The group was divided into two subgroups: those who complied with the recommended maintenance schedule and those whose compliance was erratic. Individual tooth prognosis was assigned according to radiographic parameters. RESULTS: At the completion of active periodontal therapy, 2184 teeth were present. During the maintenance period, 44 teeth were lost due to periodontal reasons. Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.07/year. Molars were the teeth most frequently lost; canines the least. The number of teeth lost in the three prognostic categories was: one (0.07%) for teeth with good prognoses, 21 (3.63%) for questionable prognoses and 22 (11.34%) for hopeless prognoses. Patients complying erratically with supportive periodontal therapy were at a 5.6 times greater risk for tooth loss following active therapy than regularly compliant patients. CONCLUSIONS: The results demonstrated a low tooth mortality rate in periodontal patients following active treatment combined with a strict maintenance program.

Adult↗