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PubMed2004

Comparative study of enamel matrix derivative with or without GTR in the treatment of class II furcation lesions in dogs.

Chronic Class II furcation lesions were created in four dogs. After 21 days, group I remained as a control, group 2 was treated with membranes and enamel matrix derivative (EMD), and group 3 received EMD alone. Healing in group 1 was characterized by a long junctional epithelium and discrete bone formation; group 2 showed reduced bone formation; and group 3 showed significant bone regeneration (area of new bone = 67.36%+/-3.93%; distance from furcation roof to bone crest = 0.57+/-0.15 mm). The EMD led to significant regeneration of the furcation lesions, and the association with membranes was detrimental.

Animals↗
PubMed2006

Radiographic assessment of dental health in middle-aged men following sudden cardiac death.

Poor oral health has been suggested to be a risk factor for myocardial infarction. To study if dental pathology might predispose to pre-hospital sudden cardiac death, and using a sum index of panoramic tomography findings, we compared the oral health of middle-aged (33-69 yrs) male victims (Helsinki Sudden Death Study) of sudden cardiac death (n = 117) with that of controls, who died of non-cardiac diseases (n = 63) or suffered unnatural sudden death (n = 120). The mean number of teeth was 15.2, and 17.4% of the men were edentulous. Frequent age-associated findings in dentate victims were fillings (79.9%), horizontal bone loss (72.1%), periapical lesions (45.6%), residual roots (38.2%), and vertical pockets (30.9%). In multivariate analysis with coronary heart disease risk factors and number of teeth as covariates, poor oral health was associated (p = 0.053) with the risk of sudden cardiac death along with age, smoking, and body mass index. This association was especially strong (p = 0.009) among victims < 50 yrs.

Adult↗
PubMed1995

Radiographic detectability of periodontal diseases. A comparison of perapical radiography with detailed zonography.

OBJECTIVE: To compare the diagnostic accuracy of conventional periapical radiography with detailed zonography using the Scanora system for the detection of periodontal disease. METHODS: We selected for comparison 311 periodontal sites in 165 patients. Five observers independently assessed the periapical radiographs and detailed zonograms for marginal widening of periodontal ligament space, crestal erosion, vertical bone loss, furcation involvement and calculus. RESULTS: ROC analysis revealed no significant differences between the two imaging techniques for either overall or lesion-specific interpretation of periodontal pathology. The sensitivity of periapical radiography was 79%, and of detailed zonography 91% (multiview) and 89% (stereoscopic). Specificities were 82%, 77% and 83%, respectively. CONCLUSION: Detailed zonography performs as well as periapical radiography in the detection of periodontal disease.

Adult↗
PubMedDate not supplied

Management of molar teeth with periodontal disease.

Over the years patients' attitudes towards maintaining a functional and aesthetic masticatory apparatus have improved, and their expectations of delivery of care by the dental professional have risen. With the advance of new techniques and materials, the periodontist can now offer an ever-expanding range of treatments in the management of molar teeth with periodontal disease. This paper considers such treatment in relation to the levels of disease present and within the overall context of adult restorative dental healthcare.

Adult↗
PubMed2005

Use of radiographs in the diagnosis of periodontal disease.

UNLABELLED: Radiographs are commonly used in the diagnosis of periodontal diseases. They can be used to assess bone loss and the pattern of loss as well as in the identification of other periodontally relevant features, such as overhanging restoration margins, calculus deposits and furcation lesions. Horizontal and vertical bitewings, panoramic radiographs and periapicals can be used for periodontal assessment. Referral (selection) criteria based on clinical signs can assist the decision of the radiographs to use. All exposures must be made in accordance with the Ionizing Radiation (Medical Examination) Regulations 2000 and each exposure justified. CLINICAL RELEVANCE: Following a clinical examination, optimum selection of radiographs can assist in the assessment of patients with periodontal diseases.

Alveolar Bone Loss↗
PubMed2006

An audit of the quality and content of periodontal referrals and the effect of implementing referral criteria.

AIMS: This audit aimed to assess the effect of implementing referral criteria on the quality and content of referral letters sent by general dental practitioners (GDPs) to the periodontal department of a teaching hospital. METHODS: Retrospective data were collected from a total of 450 referrals made in: (i) 1997, prior to any changes; (ii) 2000/2001, after referral guidelines were implemented; and (iii) 2004/2005, after referral criteria were redefined and circulated via Primary Care Trusts. A standardised data-collection form was used to record the information that was provided in the referral letters. This information was also compared to the findings at initial hospital consultations. RESULTS: There was a small improvement in the administrative details provided in the referral communications in 2000/2001 and 2004/2005. Medical history was often incomplete and was mentioned in 31-34% of referral letters. Use of the Basic Periodontal Examination (BPE) score increased from 17% (1997) to 57% (2004/2005). The information on clinical details otherwise increased in 2000/2001 with a tendency to decrease in 2004/2005. There was little agreement between the clinical details in the referral communications and the findings at consultation in the periodontal department. CONCLUSIONS: Following implementation of referral criteria, there was an increase in the clinical details provided in referral letters. However, the validity of the information provided by the GDPs was often questionable. The number of referrals that provided medical history details remained unchanged. Use of a pro forma was not associated with an improvement in the quality of referrals in this audit.

Communication↗
PubMed1994

Guided tissue regeneration: an adjunct to endodontic surgery.

Membrane barriers used in conjunction with periodontal surgery have promoted regeneration of lost marginal attachment. Membrane barriers also may be indicated during surgical endodontics, in selected cases, where primary apical lesions are complicated by the loss of marginal attachment. The indications for using guided tissue regeneration in endodontic surgery are discussed and two cases are presented.

Adult↗
PubMed1997

Accidental orthodontic elastic band-induced periodontitis: orthodontic and laser treatment.

The periodontal effects of elastic bands in the subgingiva have been reported since 1870. Case reports illustrate the treatment of elasticband-induced periodontitis in two children with a combination of laser treatment, antibiotics, splinting and orthodontics. Follow-up evaluations show reattachment, maturation of the apical portion of the roots, improved radiographic bone levels and minimal sulcus depth, mobility and recession. Continued orthodontic and periodontic care is planned.

Accidents↗
PubMed1997

The effectiveness of periodontal treatment as measured by tooth loss.

In a retrospective study, the authors evaluated the effectiveness of periodontal treatment in preventing tooth loss in patients with moderate to advanced periodontitis. Patients had received maintenance therapy for an average of 12.5 years. Of the 2,899 teeth present after active treatment, 152 were lost to periodontal disease and 68 were lost to other causes during maintenance therapy. The authors evaluated causes and patterns of tooth loss after surgical vs. nonsurgical treatment. Surgery did not significantly improve tooth retention in the high-risk patients. This study and other retrospective studies suggest that tooth loss may be related more to the type of periodontal disease present than to the treatment rendered.

Adult↗
PubMed1997

A review of root resective therapy as a treatment option for maxillary molars.

Restorative treatment planning is often confounded when periodontal attachment loss, caries or tooth fracture involves the furcation area of the tri-rooted maxillary molars. Although such involvement invariably diminishes the long-term prognosis of the affected teeth, extraction is not always an option. Root resective therapy, which removes the involved root plus its associated crown portion (trisection), is one of several treatment modalities that can be used in such cases. This article reviews the indications and contraindications for root resective therapy, describes the techniques of surgical trisection and presents a case in which combined resective, endodontic and prosthetic management resulted in a successful outcome.

Adult↗
PubMed2002

The mandibular molar class III furcation invasion: a review of treatment options and a case report of tunneling.

BACKGROUND: The predictable management of a mandibular molar that has lost all of its interradicular periodontal support-in other words, that has experienced a Class III furcation invasion, or FI-often is a frustrating and disappointing process for both clinician and patient. The strategic value of retaining such a periodontally involved tooth must be determined by both the patient and dentist before a treatment option is selected. In this article, the authors present and describe various therapeutic plans available for Class III FIs in mandibular molars, discussing the advantages and disadvantages of each approach. They focus particularly on a surgical technique called "tunneling," which is performed to débride the remaining soft and hard tissues in the furcal area; this, in turn, allows access for effective oral hygiene and maintenance. CASE DESCRIPTION: The authors report on the 23-year result of a case involving tunneling. The procedure facilitated the retention of a mandibular molar with a Class III FI in a manner acceptable to both the patient and the clinician. CLINICAL IMPLICATIONS: Tunneling, in a properly selected patient who is motivated to perform careful oral hygiene, can result in comfortable, functional, healthy retention of the affected tooth, with a minimal commitment of time and financial outlay.

Debridement↗
PubMed2002

The nonsurgical treatment of patients with periodontal disease: results after five years.

BACKGROUND: In a previous study involving patients seen at the dental clinic of the Detroit Receiving Hospital, the authors found that 87 percent of teeth initially recommended for surgery or extraction were spared those treatments by a combination of debridement and short-term usage of antimicrobial agents. The objective of the present study was to determine how long the surgery-sparing benefits of less invasive treatment would persist. METHODS: Ninety of these patients were scheduled for maintenance therapy at three-month intervals over a five-year period. They were evaluated periodically for surgical needs by a clinician who was not aware of the nonsurgical periodontal treatment the patient had received. RESULTS: The initial treatment benefits were sustained, as the number of teeth needing periodontal surgery or extraction was 0.06 teeth per patient after 1.1 year, 0.22 after 2.3 years, 0.51 after 3.6 years and 0.86 after 5.1 years. CONCLUSIONS: A noninvasive treatment regimen for an anaerobic infection in teeth seriously compromised by periodontal disease resulted in a reduced need for surgery or tooth extraction for at least five years after completion of the initial treatment.

Age Factors↗
PubMedDate not supplied

Biometric analysis of the maxillary permanent molar teeth and its relation to furcation involvement.

A high rate of root exposure and consequently the exposure of the furcation area is usually observed in multirooted teeth. In maxillary molar teeth, this fact may endanger the three existent furcations (buccal, mesial and distal), causing serious problems. In this research, distance measures from the buccal furcation to the mesial (F1M) and distal (F1D) surfaces of the mesio-buccal and disto-buccal roots; from the mesial furcation to the buccal (F2B) and palatal (F2P) surfaces of the mesio-buccal and palatal roots and from the distal furcation to the buccal (F3B) and palatal (F3P) surfaces of the disto-buccal and palatal roots, respectively were established. One hundred maxillary first molar teeth were used, 50 of the right and 50 of the left side. Reference marks and demarcations were determined on the furcations and also on the root surfaces involved in the measures. We concluded that these measurements are important because they may effectivelly contribute to diagnosis, prevention and treatment of periodontal problems.

Furcation Defects↗
PubMed1993

The clinical effectiveness of open versus closed scaling and root planing on multi-rooted teeth.

Scaling and root planing are the most common techniques utilized to achieve a biologically-acceptable root surface. Thorough root debridement is a demanding task, with residual deposits of plaque and calculus a not uncommon finding after instrumentation. This study evaluated the effectiveness of scaling and root planing via a closed versus an open flap approach. Sixty multi-rooted teeth were assigned to one of three groups: untreated controls, closed scaling/root planing, and open flap scaling/root planing. Following debridement, teeth were extracted, immersed in methylene blue, and examined for the percent surface area having stainable residual deposits. The mean percent stained surface area covered by residual plaque and calculus was 54.3% in the closed root planing group compared to 33.0% in the open flap root planing group. The untreated control teeth had 91.0% of the root surface covered with stainable deposits. Within-group comparisons showed no significant difference in the percent stained residual plaque and calculus in shallow areas of the pocket (< or = 3 mm apical to the gingival margin) compared to deeper areas (> 3 mm subgingival). Examination of furcation regions demonstrated heavy residual stainable deposits for both treatment methods, with no significant differences between techniques. There was no correlation between the time spent in root debridement and the percent residual deposit area. The results demonstrate that hand instrumentation alone is inadequate for thorough debridement of furcations and suggest that new approaches are needed to provide a root surface which is compatible with formation of new periodontal attachment. High frequency ultrasonic instruments, rotary burs, and chemical agents may assist in debridement of such surfaces.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Guided tissue regeneration using calcium phosphate implants together with 4 different membranes. A study on furcations in dogs.

Four different membranes were used in conjunction with porous calcium phosphate granules to treat grade II furcations in lower molars of 6 dogs. Six months later block sections were used to measure the amount of regeneration and inflammation. The 4 membranes (polycarbonate, silicone rubber, polytetrafluoroethylene, and polycaprolactone) all gave similar improvements in bone fill ranging from 1.74 +/- 0.44 mm to 2.02 +/- 0.38 mm while control areas had only 0.34 +/- 0.12 mm. The amount of new attachment ranged from 2.32 +/- 0.62 mm to 2.58 +/- 0.62 mm for the membranes and was 0.26 +/- 0.11 mm for controls. There were increased numbers of chronic inflammatory cells seen with the polycarbonate and polycaprolactone group compared to controls and the other 2 membranes.

Animals↗
PubMed1993

Survival characteristics of periodontally-involved teeth: a 40-year study.

Four hundred and fifty-five teeth that were judged clinically to have a questionable prognosis were observed over a 40-year span in 166 patients in a private practice. Therapy initially was debridement with oral hygiene instruction, followed by flap curettage procedures and preventive maintenance recall therapy. An assessment of compliance based on oral hygiene and recall attendance was also performed. A total of 55 (12%) teeth were lost with an average survival rate of 8.8 years prior to extraction. No teeth were lost during the first 2 years of observation. The majority of extracted teeth were maxillary second molars (38.2%), followed by maxillary first molars (25.5%), and mandibular second molars (16.4%). Tooth loss patterns appeared to be bilaterally symmetrical, with 51% of teeth lost in the right quadrants and 49% lost in the left quadrants. Indications for extraction were primarily periodontal abscesses. Teeth that were considered to have a very questionable prognosis have been retained for many years after therapy, supportive treatment, and patient compliance with recall attendance.

Adult↗
PubMed1994

The influence of molar furcation involvement and mobility on future clinical periodontal attachment loss.

The purpose of this study was to determine the influence of furcation involvement (FI) and mobility (MO) on change in probing periodontal attachment level (AL) on molar teeth. Twenty-four patients were selected from The University of Michigan longitudinal periodontal clinical trial. The patients who met the entry criteria received a baseline examination and were treated by periodontal scaling and root planing followed by different periodontal surgical approaches in a split-mouth design. Patients were placed on a 3-month interval for maintenance prophylaxis and had yearly periodontal scorings for a period of 8 years. The scorings included determination of AL, FI, MO, and tooth loss (TL). Data for molar teeth from three different time periods (at entry (A) and at 1 (B) and 8 (C) years) were analyzed. The results demonstrated that teeth with FI were 2.54 times more likely to be lost when compared to teeth without FI during the maintenance period. By using paired t test approach to the probing attachment level data, molars with FI had significantly more loss between times B and C but not between A and B or A and C. Teeth with increased MO demonstrated significantly more AL between times A and C and B and C. When the interaction between MO and FI was analyzed, teeth with both FI and MO had significantly more attachment loss during the maintenance period (B to C). No statistically significant difference was found among the three different therapeutic approaches (pocket elimination, curettage, and modified Widman flap) during any of the time periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A clinical study of an electronic constant force periodontal probe.

Automated probing systems have been developed to provide a more precise method of evaluating periodontal pocket depths and attachment levels. The purpose of this study was to assess the clinical performance (reproducibility, time, and comfort) of a new electronic probe (E.P.) compared to the UNC 15 conventional probe (C.P.). Paired measurements 2 hours apart were performed by one examiner on 20 patients with moderate to advanced localized or generalized adult periodontitis. Both the E.P. and C.P. were used on each patient in a random manner. Overall reproducibility (+/- 1.5 mm) was: E.P. 94% (n = 1181); C.P. 96.5% (n = 1254); E.P./C.P. used interchangeably 82.4% (n = 830). In assessing the reproducibility of bleeding on probing, using the Wilcoxon matched pairs signed ranks test, only the mid-facial surface, when using the C.P. exhibited differences between measurements (P < 0.017). Paired t test revealed E.P. took significantly longer per exam (4 minutes, 46 seconds). Comfort levels, evaluated with a visual analog scale, were not significantly different between probes as shown by the Mann Whitney U test. The data suggest that, in general, there was no major significant difference in reproducibility measurements between the E.P. and the C.P. The E.P. took more time. Comfort levels were similar for both probes.

Adult↗