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PubMed2000

Parameter on occlusal traumatism in patients with chronic periodontitis. American Academy of Periodontology.

The American Academy of Periodontology has developed the following parameter on occlusal traumatism in patients with chronic periodontitis. Occlusal therapy is an integral part of periodontal therapy. Patients should be informed about the occlusal problem, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. Failure to treat occlusal traumatism appropriately in patients with chronic periodontitis may result in progressive loss of bone and an adverse change in prognosis, and could result in tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

Chronic Disease↗
PubMed2002

Making sense of the epithelial barrier: what molecular biology and genetics tell us about the functions of oral mucosal and epidermal tissues.

The epidermis of skin and the oral mucosa are highly specialized stratified epithelia that function to protect the body from physical and chemical damage, infection, dehydration, and heat loss. To maintain this critical barrier, epithelial tissues undergo constant renewal and repair. Epithelial cells (keratinocytes) undergo a program of terminal differentiation, expressing a set of structural proteins, keratins, which assemble into filaments and function to maintain cell and tissue integrity. Two types of cell adhesion structures, desmosomes and hemidesmosomes, function to glue keratinocytes to one another and to the basement membrane, and connect the keratin cytoskeleton to the cell surface. Keratinizing epithelia such as the epidermis and oral gingiva that have to withstand severe physical and chemical forces produce a toughened structure, the cornified cell envelope. This envelope is a major component of the epithelial barrier at the tissue surface. This article summarizes our current understanding of the structure and function of these different cellular components and discusses various genetic and acquired diseases that alter tissue integrity and barrier function. We also highlight recent work demonstrating how loss or attenuation of certain proteases can lead to early onset periodontitis and tooth loss as well as other epithelial abnormalities.

Autoimmune Diseases↗
PubMed1986

Periodontal status in relation to age of dentate middle aged women. A 12 year longitudinal and a cross-sectional population study.

The periodontal status was studied by means of orthopantomography in one prospective and one cross-sectional cohort study of representative samples of dentate middle aged women living in Gothenburg. The proximal bone height was assessed by measurements on the roentgenographs by aid of a five degree scale. Since loss of teeth in middleaged persons often is due to periodontal disease, also tooth loss was registered. The prospective study: Eight hundred and sixty-two women belonging to age strata 38, 46, 50, 54 and 60 years and born on certain dates were examined in 1968 and were re-examined in 1980. The average number of teeth lost during the 12 year observation period varied from 1.7 to 3.3 in the different age strata and the average alveolar bone height had been reduced in all age groups. About 83 per cent of the participants had a mean bone height of the same magnitude at both occasions, while about 5 per cent showed a considerable progression of bone loss. The percentage of individuals showing greater bone loss was the lowest among those who were 50 years old at the first examination. The progression of bone loss during the observation period did not seem to be related to the initial periodontal status. The cross-sectional cohort study included four samples, viz. 38 and 50 years old women from each of the 1968 and 1980 examinations. Some improvement of the dental state had occurred from 1968 to 1980 as evidenced from the number of remaining teeth. The 38 year old women had on an average 2.1 teeth more in 1980 compared to participants of the same age 12 years earlier. In 50 year old women the corresponding figure was 2.5 teeth. The percentage of 38 year old women with greater than or equal to 22 remaining teeth had increased from about 73 to 90 per cent in the 1968 and 1980 cohorts respectively. The corresponding figures for 50 year old women were 48 per cent in 1968 and 67 per cent in 1980. Also the periodontal state was somewhat better in the 1980 cohorts: More than 65 per cent of the women in the 38 year cohort had only slight bone loss in 1980 compared to 49 per cent in the 1968 one. In the 50 year old cohort 32 per cent of the women showed only a slight bone loss in 1980 compared to 23 per cent in 1968.

Adult↗
PubMed1982

Development of deciduous and permanent dentition in Tarsius and its phylogenetic significance.

The earliest stages of development and differentiation of deciduous and permanent teeth were studied in prenatal and perinatal tarsiers. Both deciduous and successional teeth develop at loci for I1, I2, C, P2-4. Relationships among the dental lamina, enamel organs, and successional lamina were used to determine tooth homologies. During the second half of prenatal life, dP2 and dI2 undergo abnormal development. Their dentin becomes fragmented, and these teeth are shed or resorbed without eruption during the perinatal period. Our study provides evidence of an intermediate phase in evolutionary tooth loss. These findings do not corroborate recent hypotheses of primate phylogeny based mainly on tooth eruption patterns.

Animals↗
PubMed2000

Parameter on chronic periodontitis with slight to moderate loss of periodontal support. American Academy of Periodontology.

The American Academy of Periodontology has developed the following parameter on the treatment of chronic periodontitis with slight to moderate loss of periodontal supporting tissues. Patients should be informed of the disease process, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. Failure to appropriately treat chronic periodontitis can result in progressive loss of periodontal supporting tissues, an adverse change in prognosis, and could result in tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

Chronic Disease↗
PubMed2000

Parameter on chronic periodontitis with advanced loss of periodontal support. American Academy of Periodontology.

The American Academy of Periodontology has developed the following parameter on the treatment of chronic periodontitis with advanced loss of periodontal supporting tissues. Patients should be informed of the disease process, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. Failure to appropriately treat chronic periodontitis can result in progressive loss of periodontal supporting tissues, an adverse change in prognosis, and could result in tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

Chronic Disease↗
PubMed2000

Parameter on acute periodontal diseases. American Academy of Periodontology.

The American Academy of Periodontology has developed the following parameter on the treatment of acute periodontal diseases. Patients should be informed about the disease process, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. Failure to treat acute periodontal diseases appropriately can result in progressive loss of periodontal supporting tissues, an adverse change in prognosis, and could result in tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy.

Acute Disease↗
PubMedDate not supplied

Use of natural teeth in an interim partial denture.

A clinical case is presented in which the patient's natural teeth were used in an interim partial denture. The patient accepted this treatment despite his reluctance to have the periodontally hopeless anterior teeth extracted. This technique may be used when the patient is emotionally unprepared for tooth loss, when the teeth to be replaced are highly characterized, or when no suitable denture tooth is available.

Adult↗
PubMed1990

[Measurement of supra-eruption of the human first upper molar in the absence of an opposing tooth].

The situation and configuration of the occlusal plane can be modified by the process of supra-eruption, which can be split up into: active eruption (the tooth leaves its socket) and periodontal growth. In order to dissociate and better by understand them, supra eruption of the first upper molar was observed in the absence of the first lower molar. Three groups of subjects were selected, the first group, our reference group (n = 50), consisted of subjects with complete healthy dental arches for which we could determine the extent of the gingival margin and the crown height. The second group of subjects (n = 50) differed from the former by the presence of a supra-erupted first upper molar. This allowed us to evaluate the migration of the gingival margin and the crown height increase in terms of the length of time the antagonist tooth was missing. The analysis of these 2 values shows that in the early years after the tooth loss, supra-eruption is due mainly to periodontal growth. It is only later that tooth movement beyond the occlusal plane is due principally to active eruption. The third group was made up of subjects showing pathological conditions of the periodontium. We observed an apical migration of the gingival margin and in increase in crown height, resulting from a periodontal regression (passive eruption) and a rapid active eruption.

Adult↗
PubMed1996

Cemental tear: a risk factor in periodontal attachment loss.

The objective of this retrospective study was to evaluate the influence of cemental tear as a risk factor in periodontal attachment loss. Seventeen extracted, single-rooted teeth showing loss of attachment and having one cemental tear surface and one opposite intact surface were examined. The teeth were stained in 0.1% toluidine blue to visualize attached periodontal ligament remnants and examined in a light microscope under incident light. On each tooth, loss of attachment was measured along the long axis of the root from the cemento-enamel junction to the most coronal level of the periodontal ligament on intact as well as on defect surfaces. Cemental tear surfaces demonstrated a significantly greater loss of attachment than opposite intact surfaces (P < 0.0001). In one specimen, the cemental tear fragment was partially attached to the root after the extraction procedure. This specimen was processed for light microscopy to determine the location of the cemental tear fracture. Histological examination clearly revealed that the split between the root and the fragment had occurred along the cemento-dentinal border. The results indicate that cemental tear should be considered as a possible etiologic entity in localized rapid periodontal breakdown.

Dental Cementum↗
PubMed1996

Effects of in vitro cellular aging on alkaline phosphatase, cathepsin activities and collagen secretion of human periodontal ligament derived cells.

It is believed that the degree of periodontal tissue breakdown and tooth loss increase with age. In periodontal tissues which are gingiva, periodontal ligament (PL), alveolar bone and tooth cementum, the PL which is soft connective tissue, lies between the tooth cementum and alveolar bone, having the primary function of tooth support, and maintaining the homeostasis of supporting tissues, as well as providing the healing process. We therefore investigated the effects of in vitro cellular aging on alkaline phosphatase (ALP), cathepsin activities and collagen secretion from human PL cells obtained from 18-23 year-old patients' teeth. ALP, cathepsin activities and collagen secretion may play important roles in the remodeling and maintaining of periodontal tissues. To investigate the life span of PL cells, the cells were sequentially subcultivated. The maximum population doubling level of the PL cells in the present experiment was 22-25 passages. Investigating some important biological activities of the PL cells at different passage levels (6-7, 30% of life span to 17-20, 75% of life span), ALP activity and collagen secretion were found to have significantly decreased while cathepsin B and L activities significantly increased with cellular aging. Since these biological activities in human PL cells tend to be more catabolic with increase in cellular aging, the increase in periodontal breakdown with age may be partly related to the catabolic changes of the PL cells themselves.

Adolescent↗
PubMed1989

A 10-year retrospective study of periodontal disease progression.

The purpose of this study was to record the rate of periodontal disease progression over a 10-year period with respect to individual subject, age and tooth type. 283 subjects, who had undergone a full-mouth radiographic examination in 1974-76 and at that time were 25-70 years old, were randomly selected from a larger patient sample for a new radiographic examination in 1985-86. 201 subjects (71%) agreed to participate. For each respondent, tooth loss over the 10-year period was calculated. The radiographic bone height at the mesial and distal aspect of all teeth was assessed by measuring the distance between the cemento-enamel junction and the bone crest. Difference in periodontal bone height between the 2 examinations was calculated for each tooth site. The results revealed that the mean number of teeth lost over the 10-year period was 3.8 (SD 4.6). Tooth mortality, expressed as a % of the no. of teeth present at the initial examination, increased with age and varied between 2.9%-28.5%. In all age groups, molars had the highest and canines the lowest rate of tooth mortality. The frequency of subjects with loss of greater than 10 teeth was highest for the initially 45-year old individuals (20%). 7 individuals (3%) had become edentulous. The mean annual reduction of alveolar bone height varied between 0.07-0.14 mm in the age groups 25-65 years. The initially 70-year old subjects showed a statistically significant higher annual rate of bone loss (0.28 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Pediatric dental rehabilitation procedures in the OR.

Children with significant baby bottle tooth decay and children who are challenged by significant physical and emotional limitations are candidates for dental rehabilitaion procedures with general anesthesia. Rehabilitation of children's primary teeth is important to prevent pain, infection, and tooth loss. To provide skilled care for children undergoing dental rehabilitation procedures, perioperative nurses must understand normal dentition, tooth anatomy, and caries prevention and formation and be able to meet children's developmental and emotional needs. Perioperative nurses also must collaborate with dentists to maintain appropriate supply inventories that are unique to dental rehabilitation procedures.

Adolescent↗
PubMed2000

Parameter on aggressive periodontitis. American Academy of Periodontology.

The American Academy of Periodontology has developed the following parameter on the treatment of aggressive periodontitis. Patients should be informed of the disease process, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. Failure to treat aggressive periodontitis appropriately can result in progressive and often rapid loss of periodontal supporting tissues. This may have an adverse effect upon prognosis and could result in tooth loss. Given this information, patients (or their parents or guardians, as appropriate) should then be able to make informed decisions regarding their periodontal therapy.

Aggregatibacter actinomycetemcomitans↗
PubMed1994

Modeling the relationship between clinical, microbiologic, and immunologic parameters and alveolar bone levels in an elderly population.

A cross-sectional periodontal study of 74 subjects aged 65 to 75 years was performed. Clinical data were collected and related to microbiological and immunological data. A statistical model (step-wise multiple regression) of factors related to bone loss was created initially using clinical data only; then by adding either the microbiologic or immunologic data; and then by using clinical, microbiologic, and immunologic data together. When only clinical data were considered, three factors were found to have significant positive correlations with bone loss. Tooth mobility accounted for 17% of the variability in the alveolar bone level measurements, probing depth for 12%(r2), and plaque index for 3%, for a total of 32% of the variability explained by these clinical factors. Tooth mobility and probing depth were clinical factors which remained significant in the model when the microbiological data were also considered. As percentages of the total cultivable microbiota, E. corrodens (r2 = 14%) and black-pigmenting Prevotella intermedia (r2 = 4%) correlated positively with alveolar bone loss. The addition of the microbiologic data only increased the r2 to 33%. When immunological data were considered with the clinical data, pocket depth and tooth mobility were the clinical parameters which remained in the model. IgG antibody levels to P. gingivalis W83 and/or 381 (r2 = 24%) A. actinomycetemcomitans 627 (r2 = 2%) were the significant immunologic measures having a positive correlation with bone loss. Anti-F. nucleatum levels had a significant negative correlation. A total of 50% of the variability in alveolar bone level was accounted for in the model by the addition of specific serum antibody levels to subgingival plaque microorganisms. When clinical, microbiological, and immunological measurements were all considered together, antibody to P. gingivalis W83 and/or 381 (r2 = 42%), percentage of B-lymphocytes (r2 = 3%), probing depth (r2 = 4%), anti-E. corrodens levels (r2 = 2%), and anti-P. gingivalis 33277 levels (r2 = 4%) all had significant positive correlation with loss of alveolar bone. The number of enteric bacteria, anti-F. nucleatum levels, and anti-P. intermedia levels each had a significant negative correlation with alveolar bone heights. The r2 for this model was 75%. These results indicated that antibody levels to subgingival plaque microorganisms and tooth mobility were the best predictors of bone loss in the elderly patients tested in this study.

Age Factors↗
PubMed2000

Immediate functional loading of Brånemark single tooth implants. An 18 months' clinical pilot follow-up study.

A clinical and radiographical study was performed to evaluate the treatment outcome of single tooth replacements with artificial crowns retained to implants installed according to a 1-stage surgical procedure and immediate loading (Experimental Group = EG) in comparison to the original 2-stage concept (Control Group = CG). The EG comprised 14 patients (= 14 implants) and the CG comprised 8 patients (= 8 implants), all with single tooth losses anterior to the molars. Beyond the non-smoking criterion the following criteria were adopted: i) the amount of bone had to allow for installation of a fixture with a minimum length of 13 mm and Ø = 3.75 mm, ii) the jaw relationship had to allow for bilateral occlusal stability, iii) the patients should be judged to be non-bruxers, and iv) the patients had to be available for the follow-up and maintenance programme. In the EG a temporary crown was connected to the implant within 24 h following fixture installation. Six months later this crown was replaced with a permanent one. In the CG the surgical and prosthetic treatment followed the standard protocol. Out of the 14 fixtures in the EG 2 were lost up to 5 months in function and were subsequently removed. All remaining 12 implants were stable at every subsequent follow-up examination. No fixture losses were recorded in the CG and all implants in this group were stable at the follow-ups. At the 6-month observation interval all the participating 20 patients were radiographically examined, an examination that was repeated at the 18-month follow-up. The analysis of the radiographs from the EG as well as from the CG disclosed that during the 12-month observation period the mean change of bone support was about 0.1 mm. Further studies, designed as controlled multicenter ones, have to be performed before the results of this pilot study can be recommended for more general use.

Adult↗
PubMed2003

Immediate occlusal loading of single lower molars using Brånemark System Wide-Platform TiUnite implants: an interim report of a prospective open-ended clinical multicenter study.

BACKGROUND: First and second molars in the lower jaw are the most commonly missing teeth. As in other jaw regions with tooth loss, implant therapy is an attractive concept. Owing to the wide dimension of the molar teeth, wide implants seem to be a natural choice. However, wide implants in posterior mandibular regions sometimes present a problem. As an oxidized surface seems to facilitate implant integration and to result in a stronger fixation to bone, it was hypothesized that this surface would improve the performance of wide implants in posterior mandibles. As high initial stability most often is achieved in this region, it was hypothesized that the load per se is not a problem. PURPOSE: The purpose of the present study is to evaluate immediate loading of Brånemark System TiUnite Wide-Platform implants (Nobel Biocare AB, Gothenburg, Sweden) supporting single molar crowns in the lower jaw. MATERIALS AND METHODS: The study includes 44 patients treated in three separate private dental offices between March 2001 and June 2002. A total of 50 implants were placed, and all implants have passed the 6-month follow-up; 24 have been followed up for 1 year. All implants were provided with provisional crowns in centric occlusion at the time of surgery. RESULTS: No implant has been lost. Marginal bone levels were found in accordance with normal biologic width requirements. Resonance frequency analysis showed high and consistent implant stability. No biomechanical problems were found associated with the use of wide implants, and the potential physiologic problem in dense mandibular bone was eliminated. CONCLUSION: Although limited by being a short-term study, the result encourages immediate loading of single Brånemark System TiUnite Wide-Platform implants placed in the molar regions in the lower jaw.

Adult↗
PubMed2003

Diagnosis, therapy, and prevention of the cracked tooth syndrome.

Many morphologic, physical, and iatrogenic factors, such as deep grooves, pronounced intraoral temperature fluctuation, poor cavity preparation design, and wrong selection of restorative materials, may predispose posterior teeth to an incomplete fracture. The resulting cracked tooth syndrome is frequently associated with bizarre symptoms that may complicate diagnosis and can persist for many years. Epidemiologic data reveal that splits or fractures are the third most common cause of tooth loss in industrialized countries, primarily affecting maxillary molars and premolars and mandibular molars. This finding indicates that the cracked tooth syndrome is of high clinical importance. Thus, at-risk teeth should be reinforced early, for instance by castings with cusp coverage or by internal splinting with adhesive ceramic restorations.

Bicuspid↗