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[Influence of covering gingival sulcus with denture base on periodontal tissue--pH value in gingival sulcus and amount of gingival crevicular fluid].

The purpose of this study was to clarify the effect of covering gingival sulcus with denture base on periodontal tissue. Six subjects participated in this study. An experimental denture was inserted to a test tooth of each subject that was prepared for a full crown. Each experimental denture was designed to cover the gingival sulcus around the tooth. All subjects used them for two weeks. The parameters were as follows: 1) pH in gingival sulcus, 2) amount of gingival crevicular fluid, 3) tooth mobility, 4) temperature in gingival sulcus, 5) probing depth, 6) GI, and 7) P1I. Measurements were performed during the following periods: 1) pre-examination, 2) after cementation of provisional restoration, 3) during insertion of experimental denture, 4) after cementation of final restoration. A repeated-measures ANOVA was used for statistical analysis. The results were as follows: 1. pH value and amount of GCF increased after insertion of the experimental denture, and returned to same level as pre-examination after cementing of the final restoration. 2. Tooth mobility decreased during insertion of the experimental denture. 3. The changes of the other parameters were not significant. These results suggested that subclinical inflammatory change occurred in periodontal tissue in an early stage accompanied with covering of the gingival sulcus.

Adult↗

Restoration and retention of maxillary anteriors with severe root resorption.

BACKGROUND: The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused by ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth. CASE DESCRIPTION: The authors present the three cases of severe root resorption caused by ectopically erupting canines. They then discuss various prosthetic options; the indications, advantages and disadvantages of various treatment modalities; the long-term retention and esthetic concerns of the patients; and the inherent limitations of restorative treatment. CLINICAL IMPLICATIONS: Increased tooth mobility and long-term retention are significant concerns in cases of patients who have severe root resorption. Attaining stability with lingual splinting can cause esthetic problems. An interdisciplinary approach is necessary to provide optimal care for the patient.

Child↗

Self-reporting of periodontal health status.

OBJECTIVE: The objective was to develop a self-reporting questionnaire for use as an epidemiological measure of periodontal status. DESIGN: Oral survey. SUBJECTS AND METHODS: 100 (out of 102 who were approached) non-referred patients attending Dundee Dental Hospital and School agreed to complete a questionnaire concerning factors related to periodontal disease and then undergo a standardised periodontal examination in which four indicators were measured: the percentage of sites with plaque, the percentage of sites which showed bleeding on probing, tooth mobility and Community Index of Periodontal Treatment Needs scores. MAIN OUTCOME MEASURE: Sensitivity and specificity of questionnaire items to predict clinically measured periodontal disease indicators. Acceptable levels for sensitivity and specificity are largely dependent on the context of the test being evaluated, and many tests currently used in dentistry have very low sensitivity or specificity values. Nevertheless, in this case it was felt that any items which had a sensitivity and specificity greater than 0.80 would be reasonable predictors. RESULTS: Only four items were weakly predictive of the periodontal status indicators (sensitivity and specificity > 0.5). These concerned noticing gaps between teeth getting bigger, noticing tooth roots becoming more visible, experiencing pain when consuming hot, cold or sweet things and smoking. Other items, concerned with whether a dentist had told the patient they had periodontal disease or whether the person was aware of being treated for it, had very low sensitivities suggesting that people with periodontal disease indicators are failing to be informed of, or treated for it, by their dentist. CONCLUSIONS: Self-reporting of periodontal health was not successful as many people who had some indications of the periodontal diseases appeared to be unaware of their condition and also appeared not to have been informed nor were being treated for it.

Adult↗

Periodontal status of individuals in early stages of human immunodeficiency virus infection.

The purpose of this study was to evaluate the association of periodontal health and human immunodeficiency virus infection among individuals in the early stages of disease who were participating in randomized placebo-controlled clinical trials of zidovudine. Previous reports have described a rapidly progressive periodontitis and atypical gigivitis associated with late stages of infection by the human immunodeficiency virus. A health history was completed by each subject. Baseline oral examinations were completed on 97 asymptomatic patients and nine with AIDS-related complex (ARC) during their regular clinic visit. Follow-up examinations were conducted at 3-month intervals throughout the 48 weeks of the oral study. Evaluations of plaque, calculus, gingival abnormalities, caries, and periodontal disease were conducted. Periodontal measurements included plaque index (PI), gingival index (GI), bleeding index (BI), probing depth (PD), and observation for cratering, necrosis, and tooth mobility on six teeth in each patient. More than half of the subjects had visited their dentist during the previous year and had had an oral prophylaxis; less than 25% of them had had either restorative work or extractions. The mean scores for periodontal indices averaged over the course of the study in asymptomatic and ARC respectively were: PI: 0.9 (SE 0.04) and 0.9 (SE 0.08), 0.818; GI: 1.0 (SE 0.04) and 0.9 (SE 0.07), P = 0.412; BI: 0.6 (SE 0.04) and 0.4 (SE 0.07), P = 0.278; PD: 2.9 (SE 0.05) and 2.6 (SE 0.10), P = 0.140. There was no evidence of cratering, necrosis, or tooth mobility in either group. Few had calculus or dental caries. There were no clinically significant differences detected between ARC versus asymptomatic patients. Dental histories and oral examinations showed that two groups of patients in early stages of HIV-disease were in good periodontal health.

AIDS-Related Complex↗

Correlation between inflammatory periodontal diseases and cardiovascular diseases.

AIMS: Since cardiovascular diseases can exhibit a possible connection with chronic periodontal diseases, the aim of the present study was to examine the presence of periodontal impairment in patients with coronary heart diseases (CHD). METHODS: For this purpose periodontal charts were raised for 101 patients (78 male, 23 female, mean age 61.8 +/- 10.5 years) with cardiovascular diseases; comparison was drawn between theses charts and those for a control group of 101 healthy patients (59 male, 42 female, mean age 56.6 +/- 9.9 years). Over and above the dental diagnosis (probing depth [mm], vitality, tooth mobility, plaque index (PI), inclination towards sulcus bleeding) each related to 6 characteristic teeth, various habitual aspects (diet, smoke and drink patterns, stress, body weight) were recorded. RESULTS: Within the CHD-group the periodontal chart revealed for all teeth examined a mean probing depth of 3.4 +/- 1.1mm, with the corresponding reading for the control group being 2.8 +/- 0.9 mm. The mean bleeding index (Van-der-Weiden) read 1.1 +/- 0.7 for the CHD-group and 0.7 +/- 0.6 for the control group. The mean plaque index reading was 1.4 +/- 0.9 for the group suffering from heart diseases and 0.7 +/- 0.8 for the control group. Comparison of these periodontal charts showed statistically significant differences (p<= 0.01), whereas mean degrees of tooth mobility did not differ in a statistically significant way. In summary, the results described hint at a correlation between an existent coronary heart disease and the presence of a periodontitis. CONCLUSION: However, also for consideration below are further influential factors, such as diet, individual life conduct, smoking habits, Body-Mass-Index or microbiological aspects.

Adult↗

Intracoronal esthetic splinting.

Splinting is a well-accepted clinical treatment that has been us many years to control irreversible tooth mobilities through mechanical stabilization. With contemporary demands for quality-of-life dentistry, extracoronal or unesthetic splints can fall short of patient expectations. This article examines the rationale and technique for placing an intracoronal esthetic splint when full coverage restorations are no indicated or desired. This type of splint using bondable ceramic ropes is imperceptible both visually and to the patient's tongue, lips, and cheeks proprioceptively.

Aged↗

Processing and properties of strong and non-rigid calcium phosphate cement.

A calcium phosphate cement (CPC) sets to form hydroxyapatite and has been used in dental and craniofacial applications. However, when CPC was used in periodontal repair, tooth mobility resulted in the fracture and exfoliation of the brittle implants. The aim of this study was to develop CPC-chitosan lactate composites with higher strength and increased strain before failure. It was hypothesized that the incorporation of chitosan lactate would render CPC non-rigid with improved properties. Two-way ANOVA showed significant effects of chitosan lactate and powder:liquid ratio (p < 0.001) on flexural strength, strain-at-peak-load, work-of-fracture, and elastic modulus. At powder:liquid = 2, the strength (mean +/- SD; n = 6) at 20% chitosan lactate was 15.7 +/- 1.3 MPa, higher than 4.9 +/- 1.4 MPa of CPC without chitosan lactate. At powder:liquid = 1, the strain-at-peak-load was 0.2% for CPC without chitosan lactate; it increased to 15.8% for CPC containing 15% chitosan lactate. The work-of-fracture was increased by more than ten times. The novel strong and non-rigid CPC may provide compliance for tooth mobility without fracturing the implant, and may also extend the use of CPC into the repair of larger defects in stress-bearing locations.

Analysis of Variance↗

Loss of deciduous teeth and germs of permanent incisors in a 4-year-old child. An atypic prepubertal periodontitis? A clinical, microbiological, immunological and ultrastructural study.

A 4-year-old child was referred, in April 1988, to Rennes Dental School (France) for deciduous tooth mobility with premature loss of 4 deciduous teeth and germs of 2 permanent incisors. Microbiological examinations by culture revealed the presence of the periodontal pathogen Actinobacillus actinomycetemcomitans. Immunofluorescence of plaque samples revealed the presence of Porphyromonas gingivalis that had not been isolated by culture. Neutrophil functions were within normal ranges. Transmission electron microscopy of gingiva showed a disorganised epithelium. The connective tissue was infiltrated by inflammatory cells. The basement membranes were normal, but the connective tissue-epithelium interface was mainly composed of short rete pegs. Scanning electron microscopy of extracted deciduous teeth revealed lack of cementum, lacunae in the cementum and lack of fibrillar insertion on the middle part of the root. Skin lesions, mainly situated on face, were observed. Treatment was by extraction of mobile deciduous teeth combined with 3-week courses of metronidazole. Clinical and microbiological follow-up was continued over a 7-year period. No periodontal lesions have been detected since eruption of the permanent teeth. The present subgingival and lingual microflora (December 1995) is composed of bacteria associated with periodontal health. However, the future appearance of a hitherto undetected systemic disease is still possible.

Aggregatibacter actinomycetemcomitans↗

Relative influence of plaque control, scaling and root planing on occlusal sounds.

Nine periodontally affected subjects and eight healthy subjects were selected in order to examine the effect of initial periodontal treatment on occlusal sounds. Gingival Index, probing depth, tooth mobility and occlusal sound duration via an occlusal sound analyser were recorded at the baseline. The nine periodontal patients were then treated by plaque control, root planing with general scaling and were re-examined at 1 month and 3 months post-operatively. The following results were obtained: (i) The normal duration of an occlusal sound is less than 10 ms. (ii) Occlusal sounds of periodontal patients were of longer duration compared with values in healthy subjects, but decreased and approached the normal value after treatment.

Adult↗

Diagnosis of periodontitis by physical measurement: interpretation from episodic disease hypothesis.

Physical measurements including the evaluation of probing depth, bleeding on probing, tooth mobility, and inflammation form the basis for most periodontal diagnostics in use today. The interpretation of these observations and the methods available for their measurement, however, have begun to change significantly. The episodic disease activity concept has done much to implement these changes. Observation of episodic attachment loss has been correlated with parallel radiographic changes, alteration in levels of probable pathogens, and changes in inflammatory mediator levels. The failure of pocket depth, suppuration, and bleeding on probing to predict episodic attachment loss has been given plausible explanations and enhanced meanings. Although attachment loss by a continuous process cannot be excluded in some disease conditions, the hypothesis of periodontal disease progression by episodic activity supplements and expands understanding of the disease process. Interest in periodontal diagnostics has accelerated in the last decade. As a parallel development, the technology of small computers has decreased in cost and increased in sophistication. The combination of these factors has created an environment for the development of intelligent diagnostic systems. Four commercially available systems and two systems under development are described. The systems, which measure pocket depth, pocket depth or attachment level, tooth mobility, and pocket temperature, all utilize computer processing of measurements. The result is to provide a simplified and more meaningful presentation of diagnostic information. As intelligent diagnostic systems prove themselves, some of these instruments are likely to become common to dental practice. The promise of more accurate identification of areas of the mouth that are diseased can increase both the efficiency and effectiveness of periodontal therapy.

Humans↗

Reperfusion of autotransplanted teeth--comparison of clinical measurements by means of dental magnetic resonance imaging.

OBJECTIVE: Dental magnetic resonance imaging (dMRI) with administration of contrast material is one method of assessing pulpal perfusion. The purpose of this study was to evaluate the level of contrast enhancement displayed by means of dMRI after transplantation of teeth and to compare these findings with the results of tooth mobility, pocket depth, cold, and electrical tests. STUDY DESIGN: Twenty-three teeth with either complete root formation or incomplete root formation (IRF) were investigated by using dMRI and were clinically examined at intervals of 2, 4, 8, and 12 weeks, as well as 6 months and 12 months after transplantation. RESULTS: An analysis of the enhancement in the dental images revealed a significant difference between teeth with IRF and teeth with complete root formation. In addition, the time to occurrence of a positive reaction to the cold test was significantly longer for teeth with IRF. CONCLUSIONS: The findings of this study indicate that transplanted IRF teeth are associated with reperfusion seen by means of dMRI as well as with delayed occurrence of a positive cold test.

Adolescent↗

A retrospective clinical evaluation of two-unit cantilevered resin-bonded fixed partial dentures.

BACKGROUND: The authors conducted a study to examine the clinical performance of two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) that were inserted at The Prince Philip Dental Hospital, University of Hong Kong. METHODS: The authors recalled patients who had received two-unit cantilevered RBFPDs at least 24 months before the recall examination. The authors recorded the following data: patient's sex and age, operator's experience, prosthesis cementation date, endodontic treatment if performed, bone support, tooth mobility, the presence of shim-stock contacts on the abutment or pontic in intercuspal position, and the presence of aproximal axial contacts adjacent to the prosthesis. They also recorded the date of any debonding with subsequent treatment. They asked the patients qualitative questions about their prostheses. RESULTS: A total of 269 prostheses were placed in 214 patients and had a mean service life of 51.7 months +/- 19.5 months standard deviation, with a range of 13.2 to 141.6 months. Of 14 failed prostheses, 12 debonded, resulting in a success rate of 94.8 percent and clinical retention rate of 95.5 percent. No discernable rotation or drifting of the abutments was apparent in any of the prostheses. Overall patient satisfaction with RBFPDs was good, with an average assessment score of 8.5. CONCLUSIONS: The authors observed a 95.5 percent clinical retention rate of 269 two-unit RBFPDs, with no apparent drifting of the abutments. Longer-term follow-up studies are required. CLINICAL IMPLICATIONS: Two-unit RBFPDs are conservative and clinically retentive prostheses in the short to medium term.

Adolescent↗

[Case report of periodontal disease with periodic neutropenia].

A case of periodic neutropenia with specific symptoms of gingiva and alveolar bone loss in primary dentition is reported. The patient was a boy, and it was followed between the ages of 3- and 9 years-old. At the period of neutropenia he was suffered from recurrent redness, swelling and bleeding of the gingiva, and also with cold-like symptoms with fever. Although the cause of these symptoms was not definite at first, even in medical exploration, we could diagnose this disease as periodic neutropenia by the process of dental therapy. By alveolar bone resorption, pocket formation and severe tooth mobility, the patient had lost more than half of his primary teeth at the end of 2 years after the initial examination. However throughout this period we motivated and instructed the patient and his mother how to brush his teeth. His oral hygiene was improved in the mixed and permanent dentition stages. Then there was no evidence of bone resorption around the teeth of the permanent dentition stage, but recurrent gingival symptoms are continuing now. The specific feature of this case is found in the gingival findings. There was no ulceration of the oral mucosa, but a bright red jelly-like appearance was found periodically in the area of the marginal and attached gingiva. The junction between the reddened attached gingiva and the alveolar mucosa was well-defined. The serial examination of peripheral blood in this case revealed the cycle of neutropenia as 16 to 21 days. During this examination, and at the almost time of neutropenia of this patient, hyperplasia of monocytes and lymphocytes occurred. In this situation there was no clinical signs except for gingival redness. However at other times, generally marked signs were recurrent. This may have occurred due to the lack of both neutrophils and monocytes. From the above results we think that periodic neutropenia may be diagnosed first in the dental clinic by the distinctive redness in the gingival area as one specific sign of this disease. We also think that plaque control procedures may retain the teeth.

Alveolar Bone Loss↗

Bone loss in the oral cavity.

Bone loss in the oral cavity may occur due to many causes, including infection, systemic or local alterations in the host response, or multifactorial causes. The purpose of this article is to review our present understanding of the major causes of oral bone loss in adults, with special emphasis on two major oral diseases: periodontitis and residual ridge resorption. Periodontitis is characterized by resorption of the alveolar bone as well as loss of the soft tissue attachment to the tooth. Progressive periodontitis will result in continued alveolar bone loss and may result in tooth mobility, abscesses, and ultimately tooth loss. Although the reported prevalence may vary according to the epidemiologic study design, the 1985 National Survey of Oral Health of United States Adults indicated that 94% of female senior citizens examined demonstrated at least one site with at least 2 mm loss of attachment. Resorption of alveolar bone that occurs following tooth extraction is termed residual ridge resorption. In many cases, the denture will loosen because of the inability of the resorbed ridge to stabilize the prosthesis. In the most severe cases, the denture may impinge on the exposed mandibular nerve, resulting in pain or total inability to tolerate the prostheses. Although clear statistics on the prevalence of residual ridge resorption are not available, this boss loss may result in the need for new dentures to replace ill-fitting prostheses.

Adult↗

DENTAL PULP HEMOGRAM.

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Blood Cell Count↗

Predicting tooth loss during a population-based study: role of attachment level in the presence of other dental conditions.

BACKGROUND: Our objectives were to quantify: 1) the association between incident tooth loss and prior periodontal attachment level; and 2) the contribution to tooth loss made by non-periodontal conditions in increasingly periodontally involved teeth. METHODS: The Florida Dental Care Study was a prospective cohort study of persons who at baseline had at least 1 tooth and were 45 years or older. In-person interviews and clinical examinations were conducted at baseline, and at 24 and 48 months, with telephone interviews at 6-month intervals in between. A regression model was used to simultaneously quantify tooth-specific predictors of tooth loss, with person-level factors taken into account. RESULTS: Of the 687 persons who participated for a 48-month clinical examination, 36% lost 1 or more teeth during follow-up, and 5.0% of all teeth were lost. Attachment level up to 2 years before tooth loss was strongly predictive of incident tooth loss, with increases in risk for each millimeter in attachment loss. Certain other tooth-specific conditions (tooth mobility, bulk restoration fracture, decayed surfaces, filled surfaces, tooth type and arch location, root fragment) were strongly and independently associated with increased risk for tooth loss, while others were not (prosthetic crown coverage, cusp fracture, root surface defect). Propensity to choose extraction over other treatment alternatives, as reported by participants at baseline, was also strongly predictive of tooth loss. CONCLUSIONS: Increasingly severe attachment level was consistently associated with an increased risk for tooth loss in this sociodemographically diverse sample, with or without other tooth-specific conditions taken into account.

Aged↗