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Fixed prosthodontics and periodontal health.
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The effect of interdental continuous loop wire splinting and intermaxillary fixation on the marginal gingiva.
To study the influence of interdental loop-wire splinting and intermaxillary fixation on the marginal gingiva, 30 patients were evaluated clinically using different periodontal parameters, at 5 examination times. It was shown that despite a standardized oral hygiene regime including the use of a mouthrinse, gingival inflammation occurred for the duration of the splinting period. Factors other than the presence of limited plaque, such as gingival trauma due to splint application and subsequent mechanical irritation should be considered as possible aetiological factors. All investigated marginal gingival changes had totally reversed 2 weeks following loop-wire splint removal, apart from tooth mobility which did not re-attain pre-operative levels, the difference, however, being statistically insignificant.
The periodontal ligament of teeth connected to osseointegrated implants. An experimental study in the beagle dog.
The aim of the present investigation was to analyze the periodontal tissues at immobilized teeth connected to osseointegrated implants. 10, 1-year old beagle dogs, were used. Bilaterally, the mandibular 2nd (2P2) and 3rd premolars (3P3) and 1st molars (1M1) were extracted. 2 titanium fixtures were installed in the edentulous segment of the right side of the mandible, one about 10 mm mesial and the other about 10 mm distal to 4P (test tooth). 3 months later, abutment connection was performed and healing allowed for one month. The dogs were randomly divided into 2 groups of 5 each, group A and group B. In group A, a fixed gold splint, rigidly connecting the tooth and the 2 implants, was installed on day 0 and 4P was hereby immobilized. The controlateral 4th premolar (P4) served as the non-splinted control tooth. Plaque control measures continued until the end of the experiment (day 180). In group B, plaque control measures were abandoned 1 month after abutment connection and a 4- month period of experimental periodontal tissue breakdown was initiated. This was accomplished by placing cotton floss ligatures submarginally around 4P and P4. At the end of this 4-month period, the ligatures were removed, and an apically positioned flap procedure was performed. Healing was allowed for another 2 months. Plaque control measures were re-established and continued throughout the experiment. A given day was termed day 0 and 4P was rigidly connected to the adjacent implants in the manner described for group A.(ABSTRACT TRUNCATED AT 250 WORDS)
Complete replacement resorption after replantation of maxillary incisors: report of case.
This article describes the treatment of a 17-year-old patient with complete root resorption of the maxillary permanent central and lateral incisors following avulsion and replantation seven years ago. The most important factor influencing the prognosis of replanted teeth is the status of the periodontal ligament (PDL). As a result of replantation, the PDL cells necrosed and tooth replacement resorption occurred. The main factors, which affected the resorption after replantation and survival of PDL cells, could be summarize as; dry extraoral time greater than 30 minutes, the kept tooth in a dry environment, touching the cementum surface, and splint treatment for a prolonged time. Since complete root resorption was found in our case, these factors probably also occurred.
Prosthetics, periodontal therapy and conservative dentistry in the eighteenth century: archeological findings from Grand Sacconex, Geneva, Switzerland.
There are only few archaeological findings on therapeutic measures dating to the early times of scientific dentistry. The remains of two burials from the mid-eighteenth century permit the assessment of the spectrum of dental treatments of that time. Bridges, ivory dentures, gold ligatures for splinting as well as various metal fillings demonstrate the state-of-the-art of contemporary practical dentistry. A presentation of the findings should be of interest not only for the history of dentistry but can also supplement the written records of that time.
Osseous surgery--how much need we compromise?
It is essential that the execution and results of osseous surgery be carefully analyzed. Perhaps the two most compelling reasons are (1) that we should understand the effects on tooth mobility and their implications for complex restorative dentistry, and (2) to facilitate the accurate assessment of postoperative "success," bearing in mind not only improvement of the environment, but also increased chances of survival for the operated teeth. We have discussed the effects of osseous surgery on tooth mobility. In the light of recent information, a more accurate assessment of the need for splinting can be made. There has always been some controversy about osseous recontouring. Of late, there has been a particular resurgence of scepticism as to the efficacy of osseous resective procedures compared with more conservative forms of therapy. Scientific investigation demands the doubting mind and the analytical approach in order to establish the truth or fallacy of current ideas. This approach is essential to the continued existence of periodontics as a clinical science. These investigations should be based on a full understanding of the therapeutic measures being investigated, as it is misleading to assess the results of a procedure when that procedure is either not used to its full advantage or inappropriately used. It is hoped that these comments will be helpful in deciding whether definitive osseous correction in a given case is desirable or possible, in terms of both bone removal and permanent splinting. The author also hopes that this article has served to enhance the possibilities of more complete osseous correction when indicated, in order to achieve minimal pocket depths, and to permit proper comparison with other modes of periodontal therapy. It is, however, crucial to realize that whatever modality of therapy utilized, it is merely one phase in the treatment spectrum. Maintaining a stable state for the patient over many years is the ultimate goal, beside which any given technical procedure pales in significance. Periodontal therapy is an ongoing process in which patient recall plays a central role.
Non-crown and bridge stabilization of severely mobile, periodontally involved teeth. A 25-year perspective.
It is the author's belief, after analyzing forces and stresses on the periodontium for more than 30 years, that stabilization of severely mobile teeth can retain teeth, if in health, almost indefinitely. Because these teeth are retained using restorative materials, recurrent caries is a problem that needs to be treated. Tooth loss resulting from caries can occur. In the author's 26 years of using extracoronal adhesive resins for splinting, the technology of adhesive bonding and restorative resins have been improved. Earlier shortcomings of the physical properties of these materials never dissuaded the author from recommending splinting. When the cases were presented to the patient and the referring dentist, the types of the current materials used to splint teeth were immaterial. Realizing that improvements in adhesives and resins would be developed, the near-hopeless teeth were retained. Because the elderly population is the fastest-growing segment of the population, caries control is more of a concern than it was 50 or more years ago. Because teeth are being retained longer in this cohort, and because caries has a greater potential to exist, supportive periodontal therapy and recalls and caries examination become more important.
Mechanical stabilization in the mandibular anterior segment.
Teeth in the mandibular anterior region of the mouth, affected by years of periodontal disease and resultant bone loss, frequently require treatment for the patient to be able to chew comfortably and effectively. Often patients choose to keep compromised teeth, despite being presented with treatment options involving a fixed or removable prosthesis. In these situations, mechanical stabilization becomes necessary. Current treatment possibilities include bonding with resin composite or placement of a bonded metal mesh splint, a cast metal resin-bonded retainer, or a fiber-reinforced resin composite splint. Coupled with good oral hygiene practices, these mechanical stabilization techniques can provide increased oral comfort and improved function, especially for geriatric dental patients.
The biomechanics of force distribution in implant-supported prostheses.
Force distribution with natural teeth depends on micromovement induced by the periodontal ligament. The location and cusp inclination of the tooth qualitatively alter the force pattern. Osseointegrated implants do not have micromovement associated with force distribution. Force distribution to the osseointegrated implant interface is completely different than with natural teeth. Alterations in tooth location and cusp inclination are suggested to limit implant overload. Force distribution in splinted natural teeth and osseointegrated prostheses are compared. The mechanism of interface force distribution and the consequences of poor interface fit are interrelated. The differential mobility of splinted natural teeth affects diagnosis and treatment. However, combining natural teeth with an osseointegrated prosthesis requires new design principles.
Polyethylene ribbon and fixed orthodontic retention and porcelain veneers: solving an esthetic dilemma.
The patient, a 58-year-old woman, had started orthodontic treatment to correct spacing between the maxillary anterior teeth 6 year prior to presentation with a chief complaint of tooth discoloration and spacing. The treatment had consisted of the use of a removable appliance to retract the maxillary anterior teeth. The patient continued to wear the appliance sporadically. When she presented, the maxillary incisors were in primary occlusal trauma with Grade 2 mobility. The patient discontinued wearing the appliance. The periodontal condition was addressed with initial therapy. As part of the treatment plan to stabilize the maxillary anterior teeth and provide the patient with an esthetic result, it was decided to do a limited occlusal adjustment of the maxillary anterior teeth to control fremitus, and to place a fixed, composite resin, polyethylene ribbon-reinforced splint, using a facial approach. The esthetic restoration of these teeth was accomplished with bonded porcelain veneers.
Growth of dental plaque on hydroxyapatite splints. A method of studying early plaque morphology.
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Diagnosis and classification of the periodontal diseases.
A classification for gingivitis and periodontitis has been proposed based on clinical observations and immunologic parameters (summarized in Table 10). Overlapping clinical situations and exceptions to the rule certainly exist and pose challenges to clinicians during diagnosis, prognosis, and treatment planning. The clinical significance of making the diagnosis of either rapidly progressive periodontitis, juvenile, or prepubertal forms of periodontitis compared with adult periodontitis must be considered. A diagnosis of early-onset disease may (1) modify the periodontal treatment plan and may include the use of systemic antibiotics (for example, tetracyclines) or antiplaque agents (for example, sanguinarine, chlorhexidine); (2) modify the prosthetic treatment plan and require longer periods of monitoring before extensive replacement or splinting is initiated; (3) increase the frequency of periodontal recall appointments (at least four to six times during the first year or two following peridontal therapy); (4) implicate a genetic basis for the disease with the possibility of peridontal involvement of other family members; (5) influence decisions on prognosis; and (6) alert the clinician for potential future rapid periodontal breakdown. Future studies will further define and characterize all forms of periodontal diseases. Clinical, microbial, and immunologic information may permit inclusion of the relatively rare forms of periodontitis such as ANUG periodontitis and refractory periodontitis. Understanding the underlying biologic mechanisms of the pathogenesis of the periodontal diseases, coupled with clinical observations, will permit improved clinical investigations that ultimately will improve therapeutic approaches.
Repair processes in the cervical region of replanted and transplanted teeth in monkeys.
The repair processes in the cervical region of replanted teeth where the periodontal ligament was injured by either extensive drying or removal was studied. These repair processes were related to various clinical factors, such as splinting, traumatic occlusion and exactness of repositioning. Permanent incisors were extracted, root filled extraorally and allotted to the following experimental groups: (1) PDL injured by drying, no splinting; (2) PDL injured by drying, splinting for 2 weeks; (3) PDL injured by drying, replanted tooth in traumatic occlusion; (4) PDL injured by drying, no splinting, non-exact repositioning of the replanted tooth; (5) PDL removed, no splinting. The animals were sacrificed 8 weeks after replantation and the replanted teeth examined histometrically. The different groups demonstrated area with normal periodontal ligament extending from 0.4 to 1 mm apically from the crestal margin, where the greatest extent was found in teeth with non-exact repositioning. The possible role of the gingiva in these repair processes is discussed.
Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report.
Periodontal disease can lead to migration of anterior teeth with the presence of infrabony defects. This creates the opportunity for treating such patients with a combined orthodontic-periodontic treatment. In the presented clinical case, an adult periodontal patient with extrusion of the maxillary central incisors and an infrabony defect on their lingual aspects was treated. During the surgical procedure, the bone defects were augmented with a combination of porous bovine bone mineral (Bio-Oss) and a fibrin-fibronectin sealing system (Tissucol). Ten days after surgery, the active orthodontic treatment started, and the teeth were intruded and realigned, moving the roots into the defects. After 6 months, the orthodontic appliances were removed and the teeth were retained by means of a resin-bonded splint. At this time, reduction in probing pocket depth and gingival recession was detected. Twelve months after the initial surgery, a reentry procedure was performed, showing complete filling of the predisposing defects with the presence of bone-like hard tissue. These clinical results suggest that teeth can be successfully moved and intruded into bone defects previously augmented with bovine bone substitute and fibrin glue. During the orthodontic treatment, this combined augmentation material was able to be replaced by bone-like hard tissue. At the end of the therapy, an improvement in esthetics and periodontal health status was registered.
Maxillary distal-extension removable partial denture abutments with reduced periodontal support.
An in vitro study that used photoelastic models compared stress distribution characteristics of three maxillary, bilateral, distal-extension removable partial denture designs when the abutments were subjected to a progressive loss of periodontal support. One design used I-bar retention, a second design used a semiprecision, spring-loaded plunger attachment, and a third design used the ERA attachment. Both attachment designs were tested with and without splinted abutments. The ERA design was also tested with and without supporting rests and included light and heavy retention elements. Periodontal support loss up to 35%, a 60/40 crown-to-root ratio, resulted in increased stress concentrations. The ERA design with supporting rests, light retention elements, and splinted abutments compared very favorably with the I-bar retained design on nonsplinted abutments.
Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root.
Healing and long-term prognosis of 94 cervical root fractures were evaluated. The teeth were divided into two groups according to type of fracture: transverse fractures limited to the cervical third of the root (51 incisors) and oblique fractures involving both the cervical and middle parts of the root (43 incisors). Neither the frequency nor the type of fracture healing differed significantly between the two groups. In the material as a whole, healing of the fracture with hard tissue formation was observed in 17 teeth (18%), and healing with interposition of periodontal ligament (PDL) and, in some cases, hard tissue between the fragments in 62 teeth (66%). Fifteen teeth (16%) showed no healing and a radiolucency adjacent to the fracture. Statistical analyses revealed that incomplete root formation and a positive sensibility test at the time of injury were significantly related to both healing and hard tissue repair. The same applied to concussion or subluxation compared with dislocation of coronal fragment, as well as optimal compared with suboptimal reposition of displaced coronal fragments. The type and duration of splinting (or no splinting) appeared to be of no significance for frequency or type of healing of cervical root fractures. During the observation time (mean = 75 months), 19 (44%) of the teeth with transverse fractures and 3 (8%) of those with oblique fractures were lost after healing. In conclusion, fractures in the cervical part of the root had a healing potential and the predictive parameters identified for fractures in other parts of the root seemed to be valid for the healing of cervical root fractures. Transverse fractures appeared to have a significantly poorer long-term prognosis compared to oblique fractures, apparently due to a marked post-treatment mobility, which often led to new luxation caused by even minor impacts.
Epithelial rests' function in replantation: is splinting necessary in replantation?
The problem of resorption during replantation in relationship to the epithelial rests and a lack of splinting was studied. Ten mongrel dogs were used. Two dogs served as control subjects, while eight had their mandibular incisors intentionally replanted and studied histologically. It was observed that where rests of Malassez were present we did not see resorption, and the lack of splinting did not result in resorption or loss of teeth. It appears we can stain epithelial rests of Malassez with immunofluorescent antibodies and use this technique for further study of this tissue.