Oral manifestations of histiocytosis X.
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Alveolar Process↗
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A laser instrument for measuring tooth movements.
An improved apparatus has been constructed which is based upon the laser reflexion method and is used in a highly accurate direct technique of measuring tooth movement without contact. The possibility of making clinical investigations of tooth movements with the equipment has been investigated by testing its various components. The most critical part of the system is the repositioning of the patient, which has been done with an accuracy of +/- 20 micron. The reflected pattern used during 3 months of experiments was the same. The instrument can be used for measurements down to 50 micron.
Adult↗
The behavior of angular bony defects following reduction of inflammation.
This study was designed to quantitate the changes in experimental angular bony defects and the surrounding tissues following the removal of irritants associated with marginal periodontitis. Plaque retentive ligatures were placed around the mandibular second bicuspids in each of four squirrel monkeys. Ten weeks later the ligatures were removed and mechanical cleaning was implemented. At the same time, ligatures were placed on the contralateral (control) bicuspids. After 10 weeks the monkeys were sacrificed and the tissues prepared for analysis. The control tissues represented the state of the periodontium immediately prior to ligature removal and the implementation of 10 weeks of mechanical cleaning. Histometric analyses revealed a reduction from 68 to 14% in the inflammatory cell infiltrate present in the supracrestal connective tissue following ligature removal and plaque control. Concomitant with this decrease was a 50% increase (P < 0.01) in the amount of bone present in the coronal periodontium. There was bone repair at the crest and along the angular defect but there was not a total regeneration of the lesion. These tissue changes were accompanied by a reduction in tooth mobility and a reformation of the gingival architecture although there was no new attachment. It appears that there is a potential for bone repair in these angular defects without an alteration in the connective tissue attachment level.
Alveolar Process↗
The relationship of palato-gingival grooves to localized periodontal disease.
The purpose of this investigation was to determine the prevalence of the palato-gingival groove in maxillary incisor teeth and the health status of the lingual periodontal tissues adjacent to maxillary incisor teeth with and without the grooves. A total of 531 individuals aged 17 to 35 years were examined for the presence or absence of palato-gingival grooves in their maxillary incisor teeth. A Plaque Index (PII), Gingival Index (GI), and Periodontal Disease Index (PDI) were recorded for the lingual aspect of the four maxillary incisors. Tooth mobility was also recorded. The prevalence of the palato-gingival grooves in the 531 individuals examined was 8.5%. Of the 2,099 maxillary incisor teeth examined, 2.33% had a palato-gingival groove. Most of the palato-gingival grooves (93.8%) were in maxillary lateral incisor teeth. Statistical analyses revealed no differences in groove prevalence on the basis of sex or race. Results of the study also indicate that the palato-gingival groove is associated with poorer periodontal health as measured by the GI and PDI and more plaque accumulation as measured with the PII.
Adolescent↗
Effect of retention of gingival sulcular epithelium on attachment and pocket depth after periodontal surgery.
Both the modified Widman flap and the intrasulcular incision technique produced significant and similar reductions in pocket depth and increases in attachment. Loss of attachment occurred where the initial pocket depth was less than 3 mm. Both techniques resulted in significant and similar increases in gingival recession. Neither technique affected tooth mobility or plaque scores to a clinically important degree. Historically, the necessity for removal of the sulcular epithelium in the course of periodontal therapy is a widely accepted tenet. This study fails to clinically validate this concept.
Adult↗
The use of a porous hydroxylapatite implant in periodontal defects. I. Clinical results after six months.
Twenty-five patients with advanced periodontal destruction were used in the study. Following initial therapy, two angular interproximal defects were selected in each patient. During flap surgery a porous hydroxylapatite implant shaped to fit the periodontal defect was placed in one defect, the other defect was used as nonimplanted control. The material used for implantation was a hydroxylapatite replicate of coral from the genus Porites, with a pore size of 190 to 220 micron. Clinical parameters were measured prior to flap surgery for each of the defects. An occlusal acrylic stent was used to give a stable reference point for pocket depth, attachment level and gingival margin height measurements. Also gingival fluid, gingival inflammation, plaque index and tooth mobility were recorded. Periapical radiographs using a standardized positioning device were also taken. At the time of surgery, the depth of the osseous defect and the height of the alveolar crest were recorded. After 6 months the clinical measurements were repeated and a re-entry surgery was carried out in 15 selected sites. Results showed that the porous implant produced statistically significant reduction in pocket depth, in the depth of osseous lesion, and a statistically significant gain in attachment level, as compared to control areas.
Adult↗
Treatment of a patient with Papillon-Lefèvre syndrome. A case report.
A vital root submersion procedure was performed in a rare case of Papillon-Lefèvre syndrome (PLS). Although the etiology and pathogenesis are obscure, possible host genetic defects and known or unknown periodontal pathogens may play important roles in the progression of PLS. Since this patient did not respond to conventional periodontal therapy, a submersion procedure was employed to maintain the alveolar ridge and resulted in controlling the progression of the patient's severe periodontitis. The following is a report of the treatment and the rationale for therapy.
Alveoloplasty↗
Effects of penicillin and erythromycin on the clinical parameters of the periodontium.
The clinical effects of systemic penicillin and erythromycin on the periodontium were investigated. There are only a few studies of the effects of these antibiotics on clinical periodontal parameters. Of the 72 subjects in the study, 24 belonged to the penicillin group, 21 to the erythromycin group and 27 to the control group. Plaque and gingival indices, tooth mobility, and probing depths of gingival pockets were recorded before the drug treatment. Radiographs were taken. Both antibiotics decreased plaque, and erythromycin also decreased gingivitis. In the penicillin group 10 of the 24 patients developed abscesses during the study, and the studied clinical parameters worsened. These patients had more severe periodontitis initially than the persons with no acute reaction. The clinical changes had returned to the baseline level by 12 weeks after the antibiotic treatments. There were no significant or lasting effects of antibiotic treatment alone in patients with overt periodontitis.
Adult↗
Occurrence of periodontitis in an urban adolescent population.
The presence of periodontitis in 307 black, Hispanic, and Asian students age 12 to 15 years was evaluated by calibrated examiners in a Los Angeles inner city junior high school. The periodontal status of maxillary and mandibular incisors and permanent first molars was evaluated using the Plaque Index, probing depth, attachment loss, bleeding on probing, tooth mobility, presence of calculus, and caries. Thirty-nine (12.7%) of 307 students had 5 mm or deeper probing depths and associated attachment loss of at least 2 mm and were considered to have periodontitis (PD). The PD group had significantly more bleeding, calculus, and missing teeth than the non-PD group, but both groups had moderate to severe plaque accumulation. The distribution and severity of disease increased with age. Deeper probing depths were associated with the molar teeth and six (15.4%) of the 39 subjects in the PD group had furcation involvement. Clinical screening alone was not sufficient to determine if the periodontitis seen was localized juvenile periodontitis; however, the program detected a high occurrence of periodontitis in this population group.
Adolescent↗
Comparative clinical study of porous hydroxyapatite and decalcified freeze-dried bone in human periodontal defects.
Interproximal bony defects were treated with either porous hydroxyapatite (PHA) or decalcified freeze-dried bone allograft (DFDB) implants at two different clinical centers. Twelve paired defects in 12 patients were treated at each center. Six months post-surgically the defects were measured to assess changes from the presurgical status. No statistically significant differences were found between the groups in changes in gingival fluid, bleeding index, plaque index, or tooth mobility. The porous hydroxyapatite implant produced greater reduction in pocket depth (P = 0.03) and more gain in clinical attachment level (P = 0.001) and defect fill (P = 0.001) when compared with DFDB grafted sites. This study indicates that more clinical resolution of interproximal periodontal defects in humans can be obtained with the use of PHA than with the use of DFDB.
Adult↗
Doxycycline-tricalcium phosphate composite graft facilitates osseous healing in advanced periodontal furcation defects.
The purpose of this study was to compare the effectiveness of a tricalcium phosphate, plaster of paris, and doxycycline composite graft to surgical debridement alone in the treatment of Class II and Class III furcation defects. Fifteen patients with adult periodontitis and at least two mandibular molars with Class II or III furcation defects were selected. A total of 40 sites were treated: 26 were Class II defects and 14 were Class III. Following initial therapy one site was randomly selected to receive the composite graft while the remaining site served as the surgically debrided control. Osseous healing was evaluated by direct measurements from an acrylic stent at the time of graft surgery and at the 6-month reentry. Following surgery each patient was placed on doxycycline 100mg/day for 10 days. The absence of clinical inflammation and infection during the healing process provided additional substantiation of the biocompatibility of the grafting materials. Results after 6 months indicated that sites treated with the composite graft had improved defect fill, defect resolution, probing depths, and clinical attachment levels when compared to the surgically debrided controls. Defect fill was 3.7 times greater in grafted sites and these sites were 4.0 times more likely to have 50% or greater defect fill. The effect of grafting was more pronounced in Class III defects where horizontal defect fill and gain of clinical attachment was achieved only in grafted sites. The plaster of paris functioned well as a binder, preventing particle scatter and facilitating graft retention. Additionally the plaster served as a vehicle to carry and retain the doxycycline at the treated site. These short-term results point to the potential of a composite graft containing tricalcium phosphate, plaster of paris, and doxycycline in promoting healing of furcation lesions.
Adult↗
Squamous odontogenic tumor: diagnosis and management.
The squamous odontogenic tumor (SOT) is a rare, benign, locally infiltrative neoplasm of the jaws that appears to originate from the rests of Malassez. It has been confused with other pathologic entities such as ameloblastomas, carcinomas, and fibromas and clinically may resemble localized periodontal disease. The tumor is often asymptomatic, although it can present with symptoms of pain and tooth mobility. A characteristic radiographic appearance is that of a triangular-shaped or semi-circular lucency associated with the roots of erupted teeth. Histologically, the tumor is characterized by the formation of variably sized nests and cords of uniform, benign-appearing, squamous epithelium with occasional vacuolization and keratinization. Treatment of SOT by conservative surgical excision is normally curative with rare episodes of recurrence reported. Since the clinical presentation of SOT may mimic more common pathologic entities, this case report reinforces the need for careful histologic evaluation of all lesions found in the periodontium.
Adult↗
Prevalence and severity of periodontal disease at mandibular molar teeth in smokers with regular oral hygiene habits.
BACKGROUND: Smoking appears to be detrimental to health because it has been associated with several diseases including cancer and cardiovascular diseases. Smoking also appears to be a major environmental factor associated with periodontal disease progression. The objective of this study was to evaluate the prevalence and severity of periodontal destruction as influenced by smoking in a Thai population. METHODS: Gingival health and periodontal conditions at mandibular molar furcation sites in 120 Thai dental patients (60 smokers and 60 never-smokers, age range 31 to 60 years) with generally high oral hygiene standards and regular dental care habits were evaluated. RESULTS: Smokers exhibited more frequent and severe mandibular molar periodontal destruction than never-smokers. The prevalence and severity of gingival recession, periodontal pocket formation, clinical attachment loss, furcation involvement, and tooth mobility were significantly increased in smokers compared to never-smokers. Seventy-three percent of the smokers exhibited furcation involvement in contrast to only 20% of the never-smokers. CONCLUSIONS: The results of this study suggest that smoking appears to be a major environmental factor associated with accelerated periodontal destruction in adult smokers with generally high oral hygiene standards and regular dental care habits in a Thai population.
Adult↗
Oral health impacts on daily living related to four different treatment protocols for chronic periodontitis.
BACKGROUND: The aims of this study were to evaluate the oral health impacts perceived by patients submitted to different treatments of chronic periodontitis and their association with clinical parameters. METHODS: Sixty patients were assigned to one of the following therapeutic groups: control, treated with full-mouth scaling and root planing (SRP); test 1, treated with SRP and 400 mg systemically administered metronidazole (MET) three times per day for 10 days; test 2, treated with SRP and professional supragingival plaque removal (PP) every week for 3 months; and test 3, treated with SRP and MET plus PP. Clinical periodontal measurements and data regarding patients' oral health impacts (perceived impacts on bleeding gums, gingival recession, sensitivity to cold, packing foods, aesthetics, bad breath, and tooth mobility) were collected at baseline and 3 months after therapy. RESULTS: All groups presented significant improvement in oral health perceived impacts. There was no statistically significant difference in the improvement of oral health impacts among groups subjected to different treatments. The clinical data of percentage of deep probing depth, deep clinical attachment level, and bleeding on probing were found to be correlated significantly with oral health impacts. CONCLUSIONS: Periodontal treatment leads to a significant reduction of self-perceived impacts regardless of the non-surgical treatment protocol employed. Most of the clinical data were associated with oral health impacts.
Activities of Daily Living↗
Clinical, genetic, and biochemical findings in two siblings with Papillon-Lefèvre Syndrome.
BACKGROUND: Papillon-Lefèvre Syndrome (PLS) is an autosomal recessive disease characterized by palmoplantar hyperkeratosis and severe periodontitis affecting both primary and secondary dentitions. Cathepsin C (CTSC) gene mutations are etiologic for PLS. The resultant loss of CTSC function is responsible for the severe periodontal destruction seen clinically. METHODS: A 4-year-old female (case 1) and her 10-year-old sister (case 2) presented with palmoplantar skin lesions, tooth mobility, and advanced periodontitis. Based on clinical findings, the cases were diagnosed with PLS. Mutational screening of the CTSC gene was conducted for the cases, and their clinically unaffected parents and brother. Biochemical analysis was performed for CTSC, cathepsin G (CTSG), and elastase activity in neutrophils for all members of the nuclear family. The initial treatment included oral hygiene instruction, scaling and root planing, and systemic amoxicillin-metronidazole therapy. RESULTS: CTSC mutational screening identified a c.415G>A transition mutation. In the homozygous state, this mutation was associated with an almost complete loss of activity of CTSC, CTSG, and elastase. Although monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to stabilize the periodontal condition, case 1 lost all her primary teeth. In case 2, some of the permanent teeth could be maintained. CONCLUSIONS: This report describes two siblings with a cathepsin C gene mutation that is associated with the inactivity of cathepsin C and several neutrophil serine proteases. The failure of patients to respond to periodontal treatment is discussed in the context of these biological findings.
Adenine↗
[A consideration of determining the removal or retention of teeth in the patient with a few remained teeth].
The alveolar bone of edentulous ridge is resorbed after the teeth extraction and the subsequent denture insertion. For the periodontal structure, the stress transmitted along the longitudinal axis is favorable, but the horizontal stress is destructive. Under the overdenture application which the retained teeth have the reduced clinical crown, it is possible to prevent the alveolar bone resorption and to improve the involved teeth. However it is difficult for the inclined teeth to get the successful results. In a case, having a few remained teeth contained the embedded root stump and the overdenture being applicated, we obtained the suggestion as follows. 1. Also the embedded root stump is useful to prevent the alveolar bone resorption. 2. The top and direction of longitudinal axes of the inclined abutment teeth can be determined by means of surveying the least teeth movement when the stress was applied to the teeth by the fingers with dental pincette. 3. Also to the inclined abutment teeth, it is possible to transmit the stress along the longitudinal axes, when the overdenture has the contact with the short dome coping at the top and in the inferior area to the longitudinal axes inclined, and is relieved in the superior area to its axes.
Alveolar Bone Loss↗
[Clinical evaluation of hydroxyapatite implants in human periodontal osseous defects. Clinical observations over a one-year period following surgery].
The purpose of this study was to evaluate the effect of implants of granular hydroxyapatite (HAP). HAP was implanted into twenty-five vertical bone defects of twenty-one patients as bone graft material. Various clinical and radiographic examinations were performed postoperatively over a twelve month period. Redness and swelling of the gingiva, gingival bleeding, postoperative pain and increased tooth mobility developed transiently, but they all recovered in time. Open wounds and out-flow of HAP disappeared within the first month. After twelve months, mean probing depth decrease was 3.7 mm and clinical attachment gain was 2.5 mm. In all cases there was radiographic evidence of alveolar bone repair. These results suggest that HAP is clinically effective as a bone graft in periodontal therapy.
Alveolar Bone Loss↗
Light protection of fiber-reinforced strip using aluminum foil for the direct splinting technique.
The critical point of the clinical procedure of direct splinting is the placement of the fiber-reinforced strip, which has to be well adapted to tooth surfaces. This article describes the use of aluminum foil to cover and protect the fiber-reinforced strip from light polymerization during the direct splinting technique. The advantage of using aluminum foil is to prevent premature curing of the fiber-reinforced strip, which would necessitate repetition of the procedure. With this technique, the strip is gradually exposed and adapted to the lingual/palatal surfaces of the teeth and light cured, allowing for ample working time.
Acid Etching, Dental↗