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PubMed2002

Current concepts of periodontal regeneration. A review of the literature.

The purpose of this article is to provide a review of the various regenerative therapies and materials in use today, along with treatment and patient variables that may affect outcome predictability. Future direction in this ever-changing field is also discussed. Techniques currently in use are reviewed and evaluated. They include open flap debridement, the use of bone grafts and bone substitutes, guided tissue regeneration, combination techniques, root surface treatment and the use of biologics. Clinical and histological human studies employing the above-mentioned treatments are discussed. The advantages and disadvantages of each treatment modality are discussed, along with patient and local factors that have been shown to affect success rates.

Absorbable Implants↗
PubMed2000

Regenerative periodontal therapy.

Regenerative periodontal therapy comprises procedures which are specially designed to restore parts of the tooth supporting apparatus which have been lost due to periodontitis. A procedure must fulfill certain criteria to be considered a therapy which encourages regeneration. This paper discusses a variety of surgical approaches including root surface conditioning, the placement of bone garfts or bone substitute implants and the use of organic or synthetic barrier membranes (GTR). Evidence is presented that regenerative surgery utilising the GTR principle fulfills all the criteria required of a surgical procedure to be considered a procedure leading to periodontal regeneration.

Animals↗
PubMed2002

Effects of debridement with an ultrasonic furcation tip in degree II furcation involvement of mandibular molars.

The purpose of this study was to evaluate the clinical effects of closed debridement with an ultrasonic furcation tip in degree II furcation involvement of mandibular molars. Fifteen patients with degree II furcation involvement in mandibular first and/ or second molars participated in the study. All patients were given oral hygiene instruction. Plaque score, probing depth, probing attachment level and bleeding on probing were recorded at baseline, 1, 4, 8 and 12 weeks. Following a baseline examination, a single episode of supra- and subgingival debridement was provided using an ultrasonic furcation tip in the test group, and an ultrasonic conventional tip and hand scalers under local anesthesia in the control group. At baseline, the mean horizontal probing depth in the test group was 6.35 mm and in the control group 6.06 mm. These values decreased to 4.88 mm and 5.29 mm respectively after 12 weeks. There were horizontal probing attachment gains of 1.29 mm in the test group and 0.59 mm in the control group after 12 weeks (P < 0.01). The bleeding scores were 1.0 in the test group and 0.88 in control group at baseline. These scores were improved to 0.12 in the test group and 0.59 in the control group after 12 weeks (P < 0.01). The results suggest that ultrasonic debridement with a furcation tip has a significantly better potential in treating degree II furcation involvement of mandibular molars.

Adult↗
PubMed2003

Prevalence of cervical enamel projection and its correlation with furcation involvement in eskimos dry skulls.

The objectives of this study were to investigate the prevalence of cervical enamel projection (CEP) in molars of Eskimo dry skulls and to study the correlation of CEP with furcation involvement (FI). The material consisted of 834 upper and lower first and second permanent molars from 133 Eskimo dry skulls. CEPs were investigated from the buccal aspect of the tooth and classified according to a system modified from Masters & Hoskins (12). FI was measured horizontally from the buccal aspect into the furcation with a graduated probe to the nearest mm. Any measurement > or = 2 mm was considered to have positive FI. The result showed a presence of 72% of CEPs among the examined molars. Grade III was found in 53%, Grade II in 9% and Grade I in 11% of the 834 molars. Lower molars had a higher prevalence of CEPs (78%) than upper molars (67%). With the individual skull used as the unit for analysis, a statistically significant correlation of CEP with FI was found in upper right 2nd molar, upper left 1st molar, lower left 1st and 2nd molars and lower right 1st molar. These results may be of clinical importance since the impact of CEPs to periodontal treatment of FIs has been discussed.

Chi-Square Distribution↗
PubMed2002

A clinician's 3-year experience with perioscopy.

A medical endoscope has been modified for assisting the clinician in subgingival scaling and root planing. The dental endoscope provides real-time indirect visualization of the root surface for aiding the removal of root deposits and biofilm. When the majority of biofilm and visible calculus is removed from the root surface in a periodontal pocket, the pocket will most often close, resulting in a shallow sulcus. Many lesions on single-rooted teeth can be treated successfully with this technique, resulting in a significant reduction in probable pocket depth and a gain in the calibrated attachment level. Other sites, such as furcations and maxillary first bicuspids, may demonstrate significant improvement but not complete resolution of these parameters. Perioscopy is scaling and root planing aided by indirect vision with an endoscope. This technique can offer many patients an alternative to periodontal surgery in carefully selected sites. This article describes the clinical rationale for perioscopy, defines those sites that most predictably will respond to this mode of therapy, and offers some guidelines on integrating this technology into the dental practice. The observations and recommendations in this article are based on the author's 3-year experience with the dental endoscope in his periodontal practice, the experience of other periodontists and dental hygienists, and published reports.

Biofilms↗
PubMed2002

Longitudinal periodontal treatment outcomes in private practice.

The majority of studies evaluating the efficacy of periodontal therapy have been conducted in university-based clinical trials under ideal and well-controlled conditions, where time (and cost) effectiveness was not an overriding factor. In Australia, where the larger proportion of dental treatment is provided by the private sector, there are no clinical studies which provide information on the efficacy of periodontal treatment in general or specialist private practice. The overall purpose of this study was to evaluate the efficacy of periodontal therapy in a specialist private practice over an initial period of 5.3 years in a group of 100 patients, and subsequently on the remaining 70 patients followed over a period 13.5 years. Hence the total observation period extended over nearly two decades. Using frequency distributions of site data, and statistical inferences based on the patient as the experimental unit, the results indicated an overall improvement and subsequent stability in clinical attachment in all categories of Initial Probing Depths, for both single- and multi-rooted teeth, for teeth treated with root planing alone and those that required adjunctive surgical intervention, and for younger and older patients. It was also noted that very few teeth were lost over the extended observation period. These positive results were achieved in a most favourable time in the initial phase of treatment (1.5-2.0 hours) as compared with the protracted time frame (5-8 hours) recorded in university-based clinical trials. Similarly, professional maintenance therapy took an average of around two appointments per year (1 hour) compared with an average of 3-4 hours per year in the university-based studies. The results therefore proved not only satisfactory from the standpoint of clinical parameters measured but also on the basis of time efficiency.

Adult↗
PubMed2003

Implication of cervical enamel projection to furcation involvement in molars. A pilot clinical study.

The aim of this study was to investigate the correlation of cervical enamel projection (CEP) with furcation involvement (FI) and compare the healing response of molars with or without CEP after surgery. A total of 30 patients contributing 78 maxillary and mandibular first or second molars were included. Plaque Index (PII), Gingival Index (GI), probing pocket depth (PPD) and probing attachment level (PAL) were measured before surgery and 1 and 3 or 6 months postoperatively. During surgery, CEPs were identified and classified with a modified grading system from Masters & Hoskins (24). FI was measured horizontally from the buccal aspect into the furcation with a graduated probe to the nearest mm. Any measurement > or = 1 mm was considered as FI. CEPs were found in 33 molars (42%). Grade III CEPs were found in 14 teeth, Grade IIIb in 4 teeth, Grade II in 1 tooth and Grade I in 14 teeth. The results showed no significant correlation of CEP with FI. Nor was CEP significantly affecting the PPD and PAL 3 or 6 months after surgery. However, FI was a significant factor in the further loss of PAL after surgery. Further studies, involving larger sample size may be necessary in order to give more conclusive results.

Adult↗
PubMed2003

[Histological evaluation on repair of furcation perforation in dogs using mineral trioxide aggregate].

OBJECTIVE: To investigate histological response to immediate repair of different sizes of furcation perforation using MTA, Dycal and GIC. METHODS: Forty-two posterior teeth in three adult beagle dogs were randomly divided into two groups, small perforation group and large perforation group. Each group was then divided into three sub-groups which were repaired with MTA, Dycal and GIC respectively. The dogs were sacrificed 4 months later, and the specimens processed and examined under the light microscope. Inflammation, epithelial proliferation, and formation of hard tissue over the material were evaluated. RESULTS: In teeth repaired with MTA, five cases were free of inflammation, and the other nine cases were associated with slight or moderate inflammation. There was formation of cementum with cementoblast cells around it in four cases. In the group of Dycal, all specimens had moderate or severe inflammation. The deposition of irregular calcified tissues as well as a large quantity of inflamed cells were found in two cases of small perforation. Six cases presented epithelial proliferation. In the group of GIC, moderate or severe inflammation was seen in all cases except for one case of large perforation with fibrous tissues and sparse inflammatory cells around the material. Four cases presented epithelial proliferation. There was some relation between epithelial proliferation and size of perforation. CONCLUSION: MTA is superior to GIC and Dycal for immediate repairing furcation perforation in dogs owing to its less irritation to surrounding tissues and its ability to induce the formation of hard tissues.

Aluminum Compounds↗
PubMed2003

A histomorphometric study of osteocytic lacunae in interradicular bone with periodontal disease.

Previous studies report on the differences in volume of osteocytic lacunae that are associated to different local and systemic bone pathologies. Alterations have also been reported in rats with periodontal disease. The aim of the present study was to assess the histomorphometric pattern of osteocytic lacunae of the interradicular septum in human molars with periodontal disease (PD). We took samples of the interradicular septum of 31 molars with indication of extraction of male and female patients, 18-55 years old, who attend the Department of Surgery II of the Faculty of Dentistry, National University of Cordoba and private centers. Clinical records were prepared for each patient. The corresponding radiographs were taken for all the patients. We studied 11 samples of molars with slight PD and 12 control molars free from PD. Ten samples of healthy bone corticals of vestibular or lingual tables obtained from histopathology archives were also assessed. Following extraction with atraumatic pincers, the interradicular septum was removed. The samples were fixed in buffered formaline, decalcified in EDTA and embedded in paraffin. Ten micrometer sections were stained with H&E and Masson's trichromic technique. The sections were analyzed by light microscopy. A minimum of 50 lacunae were selected at random in each sample for histomorphometric evaluation. Semi-automatic evaluation of the area and diameters of the lacunae was performed employing an image analyzer and the PRO IMAGE PLUS software. The data showed that the volume of osteocytic lacunae of interradicular bone is larger than that of the cortical bone of the vestibular or lingual tables. The latter are more ribbon-shaped and their minor diameter is smaller. No differences were found between the osteocytic lacunae of the interradicular bone of healthy molars and that of molars with slight periodontal disease. Given that the experimental data evidenced volume changes in osteocytic lacunae of severe, inflammatory periodontal lesions, it would be interesting to examine the volume changes in osteocytic lacunae in patients with varying degrees of periodontal disease to examine the role of osteocytes in the development and progression of periodontal disease.

Adolescent↗
PubMed2004

Fixed restoration of sectioned mandibular molar teeth.

A mandibular molar tooth may have its furcation area or one of its roots severely affected by periodontal disease or caries. Multiple factors must be favorable to restore health to such a compromised tooth. Adequate bone support for stabilization of the individual roots and coronal segments must be available after periodontal therapy. Root morphology and separation space must allow for ease of preparation and cleaning between the sectioned roots. Endodontic therapy should be uncomplicated and provide an excellent prognosis for long-term success. All caries must be removed and adequate tooth structure must remain after root and crown sectioning. Appropriate resistance and retention form must be achievable after tooth preparation of a sectioned mandibular molar. If these conditions can be met and the patient wants to keep the tooth, fixed restoration of a sectioned molar tooth is a viable treatment alternative to extraction and replacement with a removable partial denture or a dental implant. This article has described factors and procedures that should be considered for successful fixed prosthodontic treatment of sectioned multirooted mandibular molar teeth. The authors recommend an interdisciplinary diagnostic and treatment planning approach before performing endodontics, providing periodontal therapy, and restoring bicuspidized or hemisectioned multirooted teeth.

Crowns↗
PubMed2005

Topographic study of root trunk type on Chinese molars with Class III furcation involvements: molar type and furcation site.

This study investigated the relationship between root trunk length and prognosis for molars with furcation involvement. Molars with furcation involvement were obtained from 169 patients affected with periodontitis. The test group consisted of 174 hopeless molars screened from a total of 441 molars with Class III involvement; the remaining 267 molars formed the control group. Both arches showed a significantly higher missing rate for teeth with a long root trunk length (type C) in second molars (41.3% and 32.4% in the maxilla and mandible, respectively), with a high degree of Class III furcation involvement for the test group (extracted hopeless or poor prognosis), compared to first molars (9.9% and 0.9% in the maxilla and mandible, respectively). Both arches had a significantly higher prevalence of long root trunk lengths in the second molars compared to first molars, irrespective of furcation site. Although first molars had an early and higher prevalence of Class III furcation involvement than second molars, the latter reached a significantly higher missing rate. Molars with longer root trunk lengths had a higher risk for poor prognosis than shorter root trunks when teeth were affected by Class III furcation involvement. For extracted furcation-involved maxillary second molars that failed to respond to periodontal therapy, long root trunk length (C) accounted for the greatest prevalence at the mesial furcation site (41.8%), followed by the distal (33.0%) and buccal sites (25.2%); the greatest prevalence of root trunk length C was found at the lingual (47.9%) and buccal furcation sites (45.1%) of mandibular second molars. When a molar with root trunk type C has a Class III involvement, the prognosis is poor; for the disease to reach that level, greater amounts of attachment must be destroyed.

Adult↗
PubMed2005

Effects of application of platelet releasate in periodontal regeneration therapy.

The alpha granules of platelets contain various growth factors, which display in vitro and in vivo activities known to be important in wound healing. Biologically active proteins from platelets include platelet-derived growth factor, transforming growth factor-beta, and insulin-like growth factor, as well as other less well-described angiogenic and differentiated protein factors. The purpose of this study was to evaluate histologically and histometrically the new tissue formation on furcation treatment with platelet-derived factor releasate (PR) in beagle dogs. Class II furcations were created in the mandibular premolars of eight adult male beagle dogs. Periodontal regenerative treatments were then performed using collagen sponge graft material with and without the topical application of PR. PR was prepared fresh from blood drawn from dogs before treatments. A histologic evaluation of the effect on new tissue formation was then performed by comparing periodontal tissue regeneration of sites treated with and without PR. Four and 12 weeks after the flap operations, histologic sections were processed and histologically analyzed. The evaluated parameters were bone, cementum and connective tissue attachment regeneration, length of epithelium, resorption, and ankylosis. Histologically evaluated, the regeneration of new cementum was greater at the collagen sponge with PR sites compared to the control sites throughout the entire research period (P < .01). Four and 12 weeks after the flap operations, the amount of new bone in the sites treated with PR was greater than that in the control group (P < .05). These results suggest that collagen sponge graft material with PR promotes new attachment on the periodontal tissue regeneration treatments.

Animals↗