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PubMed2006

Clinical evaluation of tunneled molars: a retrospective study.

BACKGROUND: The main concern associated with the tunneling procedure is the development of root caries on the furcation area post-treatment. The objective of this study was to evaluate the periodontal conditions and the prevalence of root caries in tunneled molars. METHODS: The study sample comprised 30 tunneled teeth (mean tunneling age = 3.6 years) in 18 subjects who had received periodontal treatment and were enrolled in a maintenance program that included the application of fluoride to the exposed root surfaces. Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), decayed, missing, filled or sound teeth (DMFT) and demographic characteristics were assessed. Statistical analysis was performed using the Friedman and Mann-Whitney tests and multiple linear regression analyses. RESULTS: Four teeth (13.4%) showed active root caries inside the tunnels. Six (5.4%) of the 109 root surfaces facing the furcation region (inner surfaces) were affected by carious lesions, similar to the amount of root caries observed on the outer tunnel root surfaces, where 10 (5.3%) of the 189 surfaces studied were restored (p > 0.05). The interior of the tunnels had a higher percentage of sites with PD > or =6 mm then the exterior (p > 0.05). However, the plaque indexes and BOP scores were low for both the internal and external surfaces of the tunnels. Regression analysis indicated that the only positive association with the development of caries inside the tunnels was previous root caries experience (beta = -0.671; p = 0.01). CONCLUSION: The results show that tunneling is a suitable technique to treat periodontal furcation lesions in individuals following a regular maintenance program.

Adult↗
PubMed2006

Profiling gingival crevicular fluid from smoking and non-smoking chronic periodontitis patients.

BACKGROUND: Smoking is a major risk factor for the development and progression of chronic periodontitis (CP). Gingival crevicular fluid (GCF) derived from these patients contains many proteins that could serve as important diagnostic indicators. A protein chip technology called Surface Enhanced Laser Desorption/Ionization-Time of Flight-Mass Spectrometry (SELDI-TOF-MS) has recently been developed to facilitate protein profiling of complex biological mixtures. The hypothesis to be tested was SELDI-TOF-MS could distinguish between GCF of CP patients by smoking status and pocket depth. METHODS: GCF samples collected before treatment from sixteen CP patients (eight smokers and eight non-smokers) at both shallow and deep sites were evaluated by SELDI-TOF-MS. Spectral fingerprints were constructed for both cohorts and analyzed by a two-way ANOVA according to smoking status and pocket depth. Significance threshold was set at p < 0.05. Mean molecular weight (MW) peaks and intensities were also analyzed. RESULTS: The spectral fingerprints were significantly different between the two cohorts when analyzed by ANOVA according to smoking status (p < 0.0001) but not pocket depth (p = 0.9876). Also, the mean intensity of many individual MW peaks were determined to be significantly different between the two cohorts. Several peaks ranging in MW from 11-14 kDa were only detected in the GCF obtained from smokers. CONCLUSIONS: This study has demonstrated that profiling of GCF by SELDI-TOF-MS can distinguish between CP smokers and non-smokers. Moreover, over-expressed proteins in GCF from smokers may serve as biomarkers for this high risk patient population.

Biomarkers↗
PubMed2006

Galvanoforming for large-span fixed restorations in the treatment of periodontally compromised patients.

Large-span fixed restorations in the treatment of periodontally compromised patients are technically difficult to realize. Despite existing techniques of regenerative periodontal surgery and implant therapy aimed at preventing large spans by increasing the number of abutments, prosthetic complications do occur. The present article describes a method that introduces galvanic caps to conventional prosthetic technology, which facilitates clinical procedures and reduces complications by improving precision of fit.

Crowns↗
PubMed2006

[A periodontal furcation problem in a mandibular premolar].

For several days a patient suffered from difficult to diagnose mandibular oral pain. The patient complained of pain and swelling for which no obvious explanation could be found. Eventually the cause became clear, as a second premolar with a mesial and distal root was found to have been affected by periodontal inflammation at the root furcation.

Adult↗
PubMedDate not supplied

Surgical management of iatrogenic root perforation following endodontic therapy.

Endodontic mishaps still occur despite technological advancements in the field of dental instrumentation and materials. Iatrogenic root perforations during access preparation, canal instrumentation or preparation of post space are not uncommon, and instrument fractures during filing or reaming, as well as root fractures during condensation, are also encountered. Many of these mishaps are hard to avoid because of the extreme variability in root canal anatomy, canal calcification, abnormal root shapes and curvatures. They occur most often during access preparation, root cleaning, shaping and preparation of post space, or when attempting to bypass fractured instruments. Procedural errors impede endodontic therapy, thus increasing the risk of treatment failure, especially in teeth with necrotic pulps and periradicular lesions. Clinicians often have difficulty diagnosing and treating root perforations and the treatment of such mishaps is very difficult, especially in posterior teeth and in the area of the mandibular furcation. We report on a case of root perforation in a mandibular first molar that was successfully treated by surgery without the use of additional biomaterials.

Adult↗
PubMed1993

A national study of periodontal assessment by dental hygienists.

PURPOSE: Periodontal examination is one of the most frequently performed dental hygiene diagnostic services. This examination is the basis for effective dental hygiene treatment throughout long-term care. The purpose of this investigation was to examine how dental hygienists across the United States assess the periodontal status of three patient types: patients new to the practice, periodontally healthy recall patients, and periodontally unhealthy recall patients. METHODS: A two-stage cluster sampling method was used to select a random sample of dental hygienists from each of two states randomly selected from four regions of the United States. Questionnaires were mailed in 1989 to 2,618 dental hygienists. Individual responses were scored according to criteria derived from dental literature for conducting seven components of a comprehensive periodontal examination. Results were calculated and analyzed for each state and region, and across regions for each patient type. RESULTS: Responses were received from 1,429 subjects, resulting in a 57.5% response rate of deliverable questionnaires. Overall mean scores (possible 0-7) across all regions were 3.68-new patients, 3.22-healthy patients, and 2.67-unhealthy patients. Of the seven assessment components, three-gingival inflammation, furcation involvement, and radiographs-were performed according to the scoring criteria for all patient types by a majority of respondents. The criterion for periodontal pockets was met by a majority for new patients only. Three assessment component criteria were met by less than 40% of the sample for all patient types-attachment levels, mobility, and plaque control. Differences in the mean scores of certain states were found to be statistically significant. CONCLUSION: Specific dental hygiene standards are recommended for initial diagnostic and recall monitoring periodontal examinations. Additionally, dental hygiene administration and management of long-term preventive and supportive periodontal therapy programs should assist in improving effectiveness of care and further delineate the profession of dental hygiene.

Dental Care↗
PubMedDate not supplied

New subgingival restorative procedures with Geristore resin ionomer.

In an ongoing search for new and improved dental materials, researchers have developed restorative products which are improved versions of traditional formulations. This has been especially true in the area of glass ionomers. One such modification has been the development of a material, termed resin ionomer. This material is less technique sensitive and exhibits low oral solubility; it may be light activated and finished at the time of placement. This article presents the clinical application of such a material with emphasis on its use in subgingival and periodontal applications.

Composite Resins↗
PubMed1994

Principles and clinical applications of periodontal controlled drug delivery with tetracycline fibers.

Controlled drug delivery of antibiotics in the periodontal pocket is a scientifically tested clinical reality. Application of pharmacokinetic principles allows effective suppression of the pathogenic microflora, which, in turn, results in resolution of inflammatory signs. In the cases presented, tetracycline fibers were employed as a supplement to mechanical therapy and oral hygiene in a variety of clinical situations. Outcomes included depression of periodontal pathogens, reduction of bleeding on probing, decrease in probing pocket depths, and increase in probing attachment levels. A novel therapeutic approach based on root planing for debridement, local drug delivery for control of the pathogens, and oral hygiene for preventing recolonization is discussed.

Adult↗
PubMed1994

Survival rates of hemisected teeth: an attempt to compare them with survival rates of alloplastic implants.

Use of hemisection in an attempt to preserve multirooted teeth that have furcation involvement has increased in recent years. However, there are few long-term studies of the success of this treatment. Furthermore, it is difficult to compare results of different studies because of differences in the length of follow-up and the criteria for failure. Results of various studies were reduced to a common denominator to allow comparison. The compiled results of studies on hemisection revealed an average reported failure rate of 13.1%. This rate was compared with results of studies on implants; the failure rates of the two treatment alternatives are not substantially different. Thus, because hemisection is a relatively simple, inexpensive treatment with a good chance of success (given appropriate case selection), it should always be considered as an option before molar extraction.

Apicoectomy↗
PubMed1993

Root resection and root amputation.

Attachment loss in furcal areas is a challenge for the clinician. Root resection and root amputation techniques have been used to overcome the instrumentation problems that these areas pose. Recent reports indicate that this approach is effective and reliable but extremely technique-sensitive and expensive for endodontic and prosthetic involvement. A more conservative approach, such as scaling and root planing, is suggested only for shallow class II furcation. Guided tissue regeneration in deep class II and class III furcation seems to be unpredictable and the efficacy of this therapy in such areas is still questionable.

Apicoectomy↗
PubMed1995

Postoperative healing complications associated with Gore-Tex Periodontal Material. Part I. Incidence and characterization.

Guided tissue regeneration procedures with Gore-Tex Periodontal Material are associated with a unique set of postoperative healing characteristics. Five healing complications are described in this study examining 102 sites. The occurrence of pain and purulence were the most common. In purulent sites, the majority of bacteria cultured were Actinomyces and Streptococcus spp. Resistance to antibiotics was common. Prevention and treatment of the healing complications are discussed.

Actinomyces↗
PubMed1995

Orthodontic eruption of furca-involved molars.

Guided tissue regeneration techniques, which are used in the treatment of certain advanced Class II and Class II furca-involved teeth, have progressed from promising to predictable. However, furca-modification techniques remain important aspects of treatment. Tooth eruption, combined with standard furca-modification techniques, improves the prognosis for both the treated and the adjacent teeth. Continued eruption of periodontally involved molars improves the crown-to-root ratio and maintains the periodontium of the adjacent dentition. These same concepts can be used to treat restoratively compromised molars, many of which were considered hopeless and subsequently extracted. Passive eruption can be useful in treating cases that need less than 3 mm of tooth eruption; orthodontic-active eruption with fixed appliances is advised if more than 3 mm of eruption is desired. Slower eruption rates (2 mm per month) allow the periodontal ligament to repair and the alveolar bone to remodel between orthodontic adjustments (3 to 4 weeks between adjustments). Periodic periodontal maintenance is accomplished during orthodontic treatment. After a retention period (8 weeks), periodontal++ surgery should be performed to reestablish the tooth's biologic width. After surgical wound healing (6 to 8 weeks), the tooth should be restored.

Adolescent↗
PubMed1996

Bone grafting with a calcium sulfate barrier after root amputation.

Two cases are presented in which unfavorable anatomic factors after ro ot amputation were treated with demineralized freeze-dried bone allograft and a calcium sulfate barrier. The success of these cases demonstrates the potential advantage of this regeneration procedure when there is advanced furcation bone destruction after root removal.

Alveolar Bone Loss↗