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At least 1,117 records · Page 62Linked to original sources
PubMed1979

Posterior maxillary osteotomies: an aid for a difficult prosthodontic problem.

Patients who have supereruption of posterior dentoalveolar segments provide an interesting challenge to the dentisr. The severe problems require a team approach to achieve the best results. Factors influencing the treatment include the periodontal status of the involved teeth as well as the concern of the patient. The posterior maxillary osteotomy provides the chance to maintain the vital functional teeth in an otherwise difficult situation. It must be emphasized that the patient must wear an opposing splint or prosthesis following surgery to prevent relapse. This conservative approach maintains the teeth and their vitality and anatomically repositions the supererupted segment to an improved functional position.

Adult↗
PubMed1986

Influence of occlusal interferences on the periodontium in patients treated with fixed prosthesis.

Gingival bleeding, pocket depth, and tooth mobility were recorded, and occlusal analyses were made on 147 subjects treated with fixed prostheses placed 4 years earlier. The percent of gingival bleeding was greater in teeth with interferences than in those without interferences. A slight increase in pocket depth was found in connection with interferences. However, the difference was statistically significant only in the group with no preprosthetic treatment. No differences in tooth mobility were found between teeth with and those without interferences, possibly partly because of the splinting influence of the fixed partial dentures on the mobile teeth.

Crowns↗
PubMed1981

The effect of excessive occlusal trauma upon periodontal healing after replantation of mature permanent incisors in monkeys.

The effect of excessive occlusal force upon periodontal healing after replantation of mature permanent incisors was studied in green Vervet monkeys. The extra-alveolar period before replantation was 120 min. Prior to replantation, the teeth were root filled with gutta percha. The material consisted of four groups. In the two control groups, either no splinting or splinting for 2 weeks was used. In the first experimental group, a stainless steel crown was cemented on the antagonist of the replanted tooth, thus elevating the bite 1--2 mm. In the second experimental group, an orthodontic band was cemented onto the replanted tooth, also elevating the bite slightly. All bite elevations were removed after 6 weeks. The animals were sacrificed 8 weeks after replantation and the replanted teeth were examined histometrically. Replacement resorption (ankylosis) was found with the same frequency and extent in all groups. However, a significant difference was found in the pattern of replacement resorption activity among the experimental groups. Thus, active replacement resorption was more common in the groups with no splinting or traumatic occlusion as compared to the splinted group. Furthermore, linear replacement resorption, a process which apparently removes established ankylosis areas, was significantly more frequent in the non-splinted groups than in the other groups. It is concluded that excessive occlusal forces cannot prevent or eliminate ankylosis in replanted teeth after prolonged extra-alveolar dry storage.

Animals↗
PubMed2001

Inter-abutment and peri-abutment mucosal enlargement with mandibular implant overdentures.

A variety of terms have been used to describe changes in the oral mucosa around abutments underneath fixed and removable implant prostheses such as mucosal inflammation, peri-implant mucosal hyperplasia, gingival hyperplasia, hyperplastic tissue, mucosal proliferation, proliferative gingivitis and peri-implant mucositis. Although such terms have become part of the evidence-based literature, there is no histological evidence to support the descriptive terminology used by authors. The use of the alternative term mucosal enlargement for clinical observations underneath mandibular implant overdentures is proposed. Prospective and retrospective reports have failed to use similar criteria to measure periodontal parameters in relation to these mucosal changes, both in keratinized or non-keratinized tissues. Therapeutic remedies for mucosal enlargement are dictated by authors' opinions on the possible aetiology. This literature review, coupled with clinical observations during a 5-year prospective study, prompts this proposal of the term mucosal enlargement underneath splinted and unsplinted mandibular implant overdentures.

Dental Abutments↗
PubMed1982

Relationship between alveolar bone measured by 125I absorptiometry with analysis of standardized radiographs: 2. Bjorn technique.

THE BJORN TECHNIQUE is widely used in periodontal studies as a standardized measure of alveolar bone. Recent studies have demonstrated the feasibility of using 125I absorptiometry to measure bone mass. The purpose of this study was to compare 125I absorptiometry with the Bjorn technique in detecting small sequential losses of alveolary bone. Four periodontal-like defects of incrementally increasing size were produced in alveolar bone in the posterior segment of the maxilla of a human skull. An attempt was made to sequentially reduce the amount of bone in 10% increments until no bone remained, a through and through defect. The bone remaining at each step was measured using 125I absorptiometry. At each site the 125I absorptiometry measurements were made at the same location by fixing the photon source to a prefabricated precision-made occlusal splint. This site was just beneath the crest and midway between the borders of two adjacent teeth. Bone loss was also determined by the Bjorn technique. Standardized intraoral films were taken using a custom-fitted acrylic clutch, and bone measurements were made from the root apex to coronal height of the lamina dura. A comparison of the data indicates that: (1) in early bone loss, less than 30%, the Bjorn technique underestimates the amount of loss, and (2) in advanced bone loss, more than 60% the Bjorn technique overestimates it.

Absorption↗
PubMed2004

Healing of 400 intra-alveolar root fractures. 1. Effect of pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation.

This retrospective study consisted of 400 root-fractured, splinted or non-splinted incisors in young individuals aged 7-17 years (mean = 11.5 +/- 2.7 SD) who were treated in the period 1959-1995 at the Department of Pediatric Dentistry, Eastman Dental Institute, Stockholm. Four hundred of these root fractures were diagnosed at the time of injury; and 344 teeth were splinted with either cap-splints, orthodontic appliances, bonded metal wires, proximal bonding with composite resin or bonding with a Kevlar or glass fiber splint. In 56 teeth, no splinting was carried out for various reasons. In the present study, only pre-injury and injury factors were analyzed. In a second study, treatment variables will be analyzed. The average observation period was 3.1 years +/- 2.6 SD. The clinical and radiographic findings showed that 120 teeth out of 400 teeth (30%) had healed by hard tissue fusion of the fragments. Interposition of periodontal ligament (PDL) and bone between fragments was found in 22 teeth (5%), whereas interposition of PDL alone was found in 170 teeth (43%). Finally, non-healing, with pulp necrosis and inflammatory changes between fragments, was seen in 88 teeth (22%). In a univariate and multivariate stratified analysis, a series of clinical factors were analyzed for their relation to the healing outcome with respect to pulp healing vs. pulp necrosis and type of healing (hard tissue vs. interposition of bone and/or PDL or pulp necrosis). Young age, immature root formation and positive pulp sensibility at the time of injury were found to be significantly and positively related to both pulpal healing and hard tissue repair of the fracture. The same applied to concussion or subluxation (i.e. no displacement) of the coronal fragment compared to extrusion or lateral luxation (i.e. displacement). Furthermore, no mobility vs. mobility of the coronal fragment. Healing was progressively worsened with increased millimeter diastasis between fragments. Sex was a significant factor, as girls showed more frequent hard tissue healing than boys. This relationship could possibly be explained by the fact that girls experienced trauma at an earlier age (i.e. with more immature root formation) and their traumas were of a less severe nature. Thus, the pre-injury or injury factors which had the greatest influence upon healing (i.e. whether hard tissue fusion or pulp necrosis) were: age, stage of root development (i.e. the size of the pulpal lumen at the fracture site) and mobility of the coronal fragment, dislocation of the coronal fragment and diastasis between fragments (i.e. rupture or stretching of the pulp at the fracture site).

Adolescent↗
PubMed1994

Biomechanical considerations when combining tooth-supported and implant-supported prostheses.

The force distribution of multiple tooth-supported and implant-supported prostheses is completely different. A direct correlation exists between the degree of flexion at the site of loading and the amount of force distribution to other members of the prosthesis. Micromovement produced by the periodontal fibers facilitates force distribution to all the root surfaces of the natural tooth abutments. The rigidity of the implant/abutment/prosthesis configuration concentrates the force at the crestal bone at the site of loading with limited distribution to the remaining implants. Differential mobility concentrates the force distribution to the bone support of the most rigid members of splinted natural teeth or to the implants when they are united with natural teeth in a combined prosthesis. Implants always support the natural teeth and never the other way around. Therefore a nonrigid attachment is recommended between a tooth-supported prosthesis and an implant-supported prosthesis when they are combined. However, when implants are interspersed with natural teeth in the same prosthesis, the restoration will be implant borne. This requires special force distribution analysis to prevent implant overload.

Alveolar Process↗
PubMed2002

Non-surgical periodontal therapy with adjunctive topical doxycycline: a double-blind randomized controlled multicenter study.

AIM: Evaluation of the clinical effect of topical application of doxycycline adjunctive to non-surgical periodontal therapy. METHODS: A total of 111 patients suffering from untreated or recurrent moderate to severe periodontitis at 3 different centers (Heidelberg, Frankfurt, Nijmegen) were treated in this double-blind split-mouth study. In each patient, 3 different treatment modalities were assigned randomly to 3 test teeth: scaling and root planing alone (SRP), SRP with subgingival vehicle control (VEH), and SRP with subgingival application of a newly developed biodegradable 15% doxycycline gel (DOXI). At baseline, clinical parameters were measured at all single rooted teeth using a reference splint: PlI, PPD, relative attachment level (RAL-V), GI. 3 strata were generated according to baseline PPD: (i) 5-6 mm, (ii) 7-8 mm, (iii) > or =9 mm. Not more than 50% active smokers were allowed to each stratum. 3 and 6 months after therapy re-examination was performed by examiners blinded to baseline data and test sites. The statistical comparison of RAL-V gain and PPD reduction between the treatments was based on a repeated measures ANOVA with correction according to Huynh & Feldt. The comparison of SRP versus DOXI was considered as the main study question. RESULTS: 110 patients finished the 3 months and 108 the 6 months examination. The study did not show adverse effects of VEH or DOXI except for one singular inflammation that occurred 2 months after application of the doxycycline gel. DOXI provided statistically significantly more favorable PPD reduction (SRP: -2.4+/-1.4 mm, VEH: -2.7+/-1.6 mm, DOXI: -3.1+/-1.2 mm; SRP versus DOXI p=0.0001, VEH versus DOXI p=0.0066) and RAL-V gain (SRP: 1.6+/-1.9 mm, VEH: 1.6+/-2.2 mm, DOXI: 2.0+/-1.7 mm; SRP versus DOXI p=0.027, VEH versus DOXI p=0.038) than SRP and VEH after 6 months. CONCLUSIONS: Adjunctive topical subgingival application of a biodegradable 15% doxycycline gel was safe and provided more favorable RAL-V gain and PPD reduction than SRP alone and VEH. Thus, by use of topical doxycycline the threshold for surgical periodontal therapy might be moved toward deeper pockets.

Administration, Topical↗
PubMed1998

Methods to improve a periodontally involved terminal abutment of a cantilever fixed partial denture--a finite element stress analysis.

The two-dimensional plane stress finite element stress analysis was used to evaluate the stress of mandibular posterior cantilevers for compromised periodontal involved distal terminal abutments. Some commonly practiced methods to alleviate the stress from mastication of the cantilever FPDs were also evaluated. From the analysis the following was concluded: (1) The most distal terminal abutment of a cantilever FPD generally experienced a high stress concentration. (2) The cantilever FPDs require at least two abutments. Optimum stress reduction occurred with a splinting of three abutments. To increase the number of abutments to more than three, would not result in a proportional and meaningful reduction of stress in the periodontium. (3) To alter the bridge material with more rigid material or to have a longer marginal preparation of the terminal abutment are ineffective for better stress distribution.

Alveolar Process↗
PubMed1988

Management of Class III furcally involved abutments for fixed prosthodontic restorations.

Class III furca-involved molars provide formidable challenges, but the literature suggests that such teeth can be successfully treated. Under specific circumstances described in this article, reasonable longevity may be expected when advanced furcal involvement of abutments has been treated with (1) open-flap root debridement, (2) root separation with metal furcal replacement, (3) root resection as a conventional FPD or splint abutment, or (4) root resection as a vertical stop for a fixed cantilever prosthesis. Well-controlled maintenance therapy is essential for success.

Bone Resorption↗
PubMed1995

Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing.

400 avulsed and replanted permanent teeth were examined for periodontal ligament (PDL) healing, using standardized radiographic and clinical examination procedures (i.e. percussion test and mobility test). The effect of various clinical factors was examined, such as age and sex of the patient, type of tooth replanted, presence of crown fracture or bone fracture, stage of root development (including apical diameter and length of the pulp), type and length of extra-alveolar storage, clinical contamination of the root surface, type of root surface cleansing procedure, type and length of splinting period and antibiotic therapy. Surface resorption was generally diagnosed after 12 months; while inflammatory resorption and replacement resorption (ankylosis) were usually observed after 1 month and 1-2 months respectively. Most resorptive processes were diagnosed within the first 2-3 years. However, although rarely, even after 5 and 10 years new resorptive processes could be diagnosed. A univariate statistical analysis of 272 teeth revealed 9 factors significantly related to PDL healing. A subsequent multivariate analysis revealed that the following 4 factors had the strongest impact upon PDL healing, in descending order of significance: Stage of root development; length of the dry extra-alveolar storage period; immediate replantation and length of the wet period (saliva or saline storage). Nonphysiological storage, such as homemade saline and sterilizing solutions (chloramine and alcohol) always led to root resorption. Storage in tap water for more than 20 minutes usually led to root resorption. The common denominator for all these factors related to PDL healing appears to be survival of the PDL cells along the root surface. Based on these findings, immediate replantation is recommended irrespective of stage of root development.

Analysis of Variance↗
PubMed1992

[Results after short- and long-term observations of bone transplantation to vertical, marginal bone defects].

The effect of autologue bone transplantation to 26 vertical, marginal bone defects has been investigated on a long-term scale ranging from 2 to 26 years. The operation technique included excision of gingival pocket epithelium, removal of granulation tissue, and cleansing of the root surface with scalers. The bone cavities were filled preferably with cancellous bone chips, usually from the patients' upper third molar region. After suturing, the area was covered with a wound paste for 12-14 days. Loosened teeth were splinted for at least 2 months. In 25 of 26 teeth (96%) a bone regeneration was observed radiographically. The maximum healing of 22 cases occurred 2-12 months (median 6 months) postoperatively (Table 1). The maximum healing was maintained for more than half of the teeth (56%) at the last control, median 16 years (range 2-26 years), and none of these teeth were extracted of periodontal causes. They might therefore be expected to function for still a long time. Eight teeth (32%) showed more or less recurrence when controlled 5 to 15 years (median 10 years) after operation and 6 of the 8 teeth with recurrence were extracted. Three teeth (12%) developed root resorption and were extracted 6, 10 and 14 years postoperatively. As most of the complications occurred after extended observation periods, this factor has to be taken into account when prognosis of periodontal treatment procedure is considered.

Adult↗
PubMed1995

A comparison of the effects of EMLA cream and topical 5% lidocaine on discomfort during gingival probing.

This investigation compared the use of a 5% eutectic mixture of local anesthetics (EMLA) cream to a "standard" intraoral topical anesthetic (5% lidocaine) as a means of anesthetizing the gingival sulcus in a double-blind, split-mouth study with human volunteers. A 5-min application of EMLA in a customized intraoral splint resulted in a significant increase in the depth of probing of the gingival sulcus without discomfort compared to a similar application of 5% lidocaine. Following application of EMLA, the pain-free probing depth measured at three sites in the upper premolar region increased by a mean total of 2.8 mm compared to an increase of 1.9 mm with lidocaine. This study suggests EMLA may be advantageous in providing periodontal anesthesia where manipulation of the gingiva is necessary.

Administration, Topical↗
PubMed2002

Porous-surfaced dental implants in the partially edentulous maxilla: assessment for subclinical mobility.

Fifty patients received 151 short, porous-surfaced implants in the partially edentulous maxilla. Periotest values (PTV) were recorded at baseline and after 6 months and 1 and 2 years. For this, prostheses were removed and a standard abutment attached and tightened (20-Ncm force) to each implant. Data analysis indicated significant relationships between time in function vs PTV and implant diameter (3.5, 4.1, or 5.0 mm) vs PTV There was no relationship between PTV and implant length. PTVs were more favorable in the posterior than anterior maxilla, and better PTVs were obtained with nonsplinted as opposed to splinted implants.

Alloys↗
PubMed1998

Immediate loading of root-form implants: two case reports 3 years after loading.

This study examines a protocol for achieving successful osseointegration in immediately loaded implants. With an atraumatic surgical technique and an acceptable biomaterial for implant placement, in certain cases adequate splinting of implants may sufficiently shield the bone-implant interface from functional overload and prevent micromovement from exceeding the allowable limits for successful osseointegration. Two successful cases are presented in which titanium root-form implants were immediately loaded for the support of fixed restorations in the maxilla and the mandible. The authors conclude that for a distinct patient population, immediate loading of multiple, splinted implants may prove to be a valuable adjunct to therapy.

Aged↗
PubMed1995

Use of the carbon dioxide laser in retarding epithelial migration: a pilot histological human study utilizing case reports.

Predictable regeneration of tooth-supporting tissues lost to periodontal disease is the aim of periodontal therapy. Often the result of conventional treatment is healing with a long junctional epithelium along the root surface and little regeneration of the complete attachment apparatus. The purpose of this pilot study was to evaluate whether de-epithelialization with a CO2 laser at the time of flap surgery and at 10-day intervals over the first 30 days of healing has the potential to enhance the formation of a connective tissue attachment. Six mandibular incisors in two patients were selected for the study. Each patient received oral hygiene instruction and initial therapy prior to surgery. The teeth were splinted together, open flap debridement was performed on all teeth, a notch was placed on the roots at the height of the crest of the alveolar bone, and the flaps were sutured in place. The test side received controlled de-epithelialization of the outer (oral) gingiva with the carbon dioxide laser, and the inner gingival flap. The de-epithelialization was repeated on the test side at 10, 20, and 30 days postsurgically. Controls received open debridement only. Block sections were taken at 90 days and processed for histologic analysis. The results showed that for both patients, junctional epithelium (JE) was formed on both test and control teeth. In all control teeth, the JE extended the entire length of the root to the base of the reference notch.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

The efficacy of a single pocket irrigation on subgingival microbial vitality.

The object of this study was to monitor the proportion of vital bacteria (microbial vitality: VF in %) present in subgingival dental plaque following one single subgingival irrigation with saline (S), chlorhexidine (CHX) or povidone iodine (I2), but without any subgingival instrumentation. Its effect on the main composition of the microflora was also assessed. Seventeen patients with adult periodontitis took part in this investigation. In each patient four initially untreated pockets (pocket depth 5-11 mm) associated with bleeding were selected for the standardised pocket irrigation and plaque sampling at baseline (0 h) and after the following 1 h, 24 h, 7 days and 31 days. The subgingival irrigation was only performed once (0 h). One pocket per quadrant was irrigated using 0.9% prereduced S, 0.2% CHX or 0.05% I2 (Iso-Betadine Buccale). The remaining untreated pocket without any irrigation served as an additional control (C). Using an acrylic splint as a guide, paperpoints were inserted into the pocket precisely at the same site to collect subgingival plaque. The bleeding on sampling (BOS) was thereafter noted. The proportions of bacterial morphotypes were examined by darkfield microscopy. VF was evaluated using a vital fluorescence staining. The undisturbed subgingival dental plaque was composed of 86% (median value) vital bacteria. The sampling procedure alone and the saline irrigation led to a decrease in the number of spirochetes but had no influence on the vitality of the flora. Large variations in VF could be observed in the short-term (1 h, 24 h) irrigation effect of CHX and I2. The reduction of VF was still significant after 7 days (VF(CHX) 30-80%, VF(I2) 35-80%) but persisted up to 31 days only after I2 irrigation (VF(I2) 12-90%). The findings indicated that all single subgingival irrigations resulted in a temporary change of the subgingival microflora while povidone iodine produced the longest lasting antimicrobial effect. Any clinical advantage of this situation should be further investigated.

Adult↗
PubMed1975

Clinical observations following root amputation in maxillary molar teeth.

Thirty-four maxillary molar teeth were evaluated from 11 to 84 months after root amputation. The most consistent finding was that although 24 were neither splinted nor supported in any way, only three developed mobility. Two of these were used as abutments for partial dentures. One other tooth was extracted due to recurrent lateral abscesses and subsequent involvement of the mesial furca.

Apicoectomy↗