Susceptibility of different mouse strains to peri-implantitis.

BACKGROUND AND OBJECTIVE: Peri-implantitis (PI) is an inflammatory condition that affects the tissues surrounding dental implants. Although the pathogenesis of PI is not fully understood, evidence suggests that the etiology is multifactorial and may include a genetic component. The aim of this study was to investigate the role of genetics in the development of peri-implantitis. MATERIAL AND METHODS: Four-week-old C57BL/6J, C3H/HeJ and A/J male mice had their left maxillary molars extracted. Implants were placed in the healed extraction sockets. Upon osseointegration, ligatures were placed around the implant head for 1 or 4 weeks to induce PI. Micro-computed tomography scanning was used to measure volumetric bone loss. Histological analyses were also performed to evaluate collagen organization and the presence of neutrophils and osteoclasts. RESULTS: Radiographically, comparing the ligature-treated mice, C57BL/6J displayed the greatest amount of bone loss, followed by C3H/HeJ and A/J mice at 1 and 4 weeks. Histologically, at 1 week, C57BL/6J mice presented with the highest numbers of neutrophils and osteoclasts. At 4 weeks, C57BL/6J mice presented with the most active bone remodeling compared with the other two strains. CONCLUSION: There were significant differences in the severity of peri-implantitis among the different mouse strains, suggesting that the genetic framework can affect implant survival and success. Future work is needed to dissect the genetic contribution to the development of peri-implantitis.

Heritability of periodontal bone loss in mice.

BACKGROUND: Periodontitis is an inflammatory disease of the periodontal tissues that compromises tooth support and can lead to tooth loss. Although bacterial biofilm is central in disease pathogenesis, the host response plays an important role in the progression and severity of periodontitis. Indeed, clinical genetic studies indicate that periodontitis is 50% heritable. In this study, we hypothesized that lipopolysaccharide (LPS) injections lead to a strain-dependent periodontal bone loss pattern. MATERIAL AND METHODS: We utilized five inbred mouse strains that derive the recombinant strains of the hybrid mouse diversity panel. Mice received Porphyromonas gingivalis-LPS injections for 6 wk. RESULTS AND CONCLUSION: Micro-computed tomography analysis demonstrated a statistically significant strain-dependent bone loss. The most susceptible strain, C57BL/6J, had a fivefold higher LPS-induced bone loss compared to the most resistant strain, A/J. More importantly, periodontal bone loss revealed 49% heritability, which closely mimics periodontitis heritability for patients. To evaluate further the functional differences that underlie periodontal bone loss, osteoclast numbers of C57BL/6J and A/J mice were measured in vivo and in vitro. In vitro analysis of osteoclastogenic potential showed a higher number of osteoclasts in C57BL/6J compared to A/J mice. In vivo LPS injections statistically significantly increased osteoclast numbers in both groups. Importantly, the number of osteoclasts was higher in C57BL/6J vs. A/J mice. These data support a significant role of the genetic framework in LPS-induced periodontal bone loss and the feasibility of utilizing the hybrid mouse diversity panel to determine the genetic factors that affect periodontal bone loss. Expanding these studies will contribute in predicting patients genetically predisposed to periodontitis and in identifying the biological basis of disease susceptibility.

Ligature-induced peri-implantitis in mice.

BACKGROUND AND OBJECTIVE: Peri-implantitis has a prevalence of 11-47%, involves destruction of peri-implant bone and may lead to implant loss. A detailed understanding of the pathogenesis of peri-implantitis is lacking. The objective of this study was to develop a murine model of experimental peri-implantitis. MATERIAL AND METHODS: Machined, smooth-surface, screw-shaped titanium implants were placed in the healed alveolar bone of the left maxillary molars of C57BL/6J male mice, 8 wk after tooth extraction. Peri-implantitis was induced by securing silk ligatures around the head of the implant fixtures. Implant survival and peri-implant bone levels were analyzed by micro-computed tomography (micro-CT) scans and histology, 12 wk after ligature placement. RESULTS: Implant survival was 60% (six of 10) for implants with ligatures and 100% (eight of eight) for controls. Micro-CT revealed significantly greater bone loss around the implants that received ligatures and that survived, compared with controls. The radiographic findings were confirmed via histology and toluidine blue staining. CONCLUSION: This study describes a murine model of experimental peri-implantitis around screw-shaped titanium implants placed in the edentulous alveolar bone. This model should be a useful tool to dissect pathogenic mechanisms of peri-implantitis and evaluate potential treatment interventions.

Platelet-rich fibrin and bovine porous bone mineral vs. platelet-rich fibrin in the treatment of intrabony periodontal defects.

BACKGROUND AND OBJECTIVE: Bovine porous bone mineral (BPBM) is a xenograft that has been successfully utilized in periodontal regeneration. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to be used as regenerative treatment for periodontal defects. The purpose of this study was to examine the suitability of autologous PRF as regenerative treatment for periodontal intrabony defects in humans and to examine the ability of BPBM to augment the regenerative effects exerted by PRF. MATERIAL AND METHODS: Using a split-mouth design, 17 paired intrabony defects were randomly treated either with PRF or with PRF-BPBM combination. Re-entry surgeries were performed at 6 mo. Primary study outcomes were changes in pocket depth, attachment level and defect fill. RESULTS: Preoperative pocket depths, attachment levels and transoperative bone measurements were similar for the PRF and PRF-BPBM groups. Postsurgical measurements revealed a significantly greater reduction in pocket depth in the PRF-BPBM group (4.47±0.78 mm on buccal and 4.29±0.82 mm on lingual sites) when compared with the PRF group (3.35±0.68 mm on buccal and 3.24±0.73 mm on lingual sites). The PRF-BPBM group presented with significantly greater attachment gain (3.82±0.78 mm on buccal and 3.71±0.75 mm on lingual sites) than the PRF group (2.24±0.73 mm on buccal and 2.12±0.68 mm on lingual sites). Defect fill was also greater in the PRF-BPBM group (4.06±0.87 mm on buccal and 3.94±0.73 mm on lingual sites) than in the PRF group (2.21±0.68 mm on buccal and 2.06±0.64 mm on lingual sites). CONCLUSION: The results of this study indicate that PRF can improve clinical parameters associated with human intrabony periodontal defects, and BPBM has the ability to augment the effects of PRF in reducing pocket depth, improving clinical attachment levels and promoting defect fill.

Prostanoids induce egr1 gene expression in cementoblastic OCCM cells.

BACKGROUND AND OBJECTIVE: Prostanoids that activate protein kinase C signaling are potent anabolic stimulators of cementoblastic OCCM cells. Using cDNA subtractive hybridization, we identified early growth response gene-1 (egr1) as a prostanoid-induced gene. Egr1, a zinc-finger transcription factor expressed during tooth development, regulates cell growth and differentiation. We hypothesize that Egr1 may mediate part of the prostanoid-induced anabolic effect in cementoblasts. Our objective was to characterize prostanoid-induced egr1 gene expression in OCCM cells. MATERIAL AND METHODS: Total RNA and proteins were assayed by northern blot and western immunoblot assays. RESULTS: Prostaglandin E2-, prostaglandin F2alpha- and fluprostenol-induced egr1 mRNA levels peaked at 0.5 h and returned to baseline by 4 h. Prostaglandin F2alpha and fluprostenol more potently induced egr1 compared with prostaglandin E2. The phorbol ester, phorbol 12-myristate 13-acetate, which activates protein kinase C signaling, induced egr1 mRNA levels 66-fold over the control, whereas forskolin (a cAMP-protein kinase A activator) and ionomycin (a calcium activator) had no effect. Protein kinase C inhibition significantly inhibited prostaglandin E2-, prostaglandin F2alpha- and fluprostenol-induced egr1 mRNA levels. Finally, prostanoids maximally induced Egr1 protein at 1 h. CONCLUSION: egr1 is a primary response gene induced by prostaglandin E2, prostaglandin F2alpha and fluprostenol in OCCM cells through protein kinase C signaling, suggesting that Egr1 may be a key mediator of anabolic responses in cementoblasts. Cementum is vital for periodontal organ maintenance and regeneration. Periodontal ligament fibers (Sharpey's fibers) insert into bone and cementum, thereby supporting the tooth in the alveolus (1). If the periodontal organ is lost, its regeneration requires cementoblast differentiation in order to form new cementum for periodontal ligament fiber insertion. Early attempts to regenerate cementum have proven difficult and rarely generate sufficient tissue (2). A better understanding of the molecular and cellular regulators that promote cementoblast differentiation is critical for developing targeted periodontal regeneration.

Prostaglandins E(2) and F(2alpha) enhance differentiation of cementoblastic cells.

BACKGROUND: The prostaglandins (PG) E(2) and PGF(2alpha) are important cytokines in periodontal physiology and pathology. PGE(2) and PGF(2alpha) alter cell function by binding and activating the plasmamembrane G-protein-coupled PG receptors. In this study, we examined the PGE(2) and PGF(2alpha) effects on the immortalized cementoblastic OCCM cells. METHODS: Confluent OCCM cells were treated with PGE(2), PGF(2alpha), specific activators/inhibitors of the EP prostanoid receptors, a specific activator of the FP prostanoid receptor, and direct activators/inhibitors of the protein kinase C (PKC) signaling pathway. Mineral nodule formation was assessed by the von Kossa stain. RESULTS: PGE(2) and PGF(2alpha) significantly increased mineralization of OCCM cells. The EP1 and EP3 PG receptor activators 16,16-dimethyl-prostaglandin E(2) and sulprostone, also increased mineralization. In contrast, specific activators of the EP2 or the EP2/EP3/EP4 receptors did not have any effect. Fluprostenol, a specific activator of the FP receptor, significantly increased mineralization of OCCM cells. FP and EP (1 or 3) receptors signal through activation of the protein kinase C (PKC) pathway. Indeed, phorbol 12-myristate 13-acetate (PMA), a direct activator of the PKC pathway, significantly increase OCCM mineralization, while pre-treatment of OCCM cells with the PKC inhibitor GF109203x (bisindolylmaleimide) significantly decreased mineralization. CONCLUSION: We conclude that PGE(2) and PGF(2alpha) exert an anabolic effect on OCCM mineralization through activation of PKC signaling.

Prostaglandins E2 and F2α Enhance Differentiation of Cementoblastic Cells.

BACKGROUND: The prostaglandins (PG) E2 and PGF2α are important cytokines in periodontal physiology and pathology. PGE2 and PGF2α alter cell function by binding and activating the plasmamembrane G-protein-coupled PG receptors. In this study, we examined the PGE2 and PGF2α effects on the immortalized cementoblastic OCCM cells. METHODS: Confluent OCCM cells were treated with PGE2 , PGF2α , specific activators/inhibitors of the EP prostanoid receptors, a specific activator of the FP prostanoid receptor, and direct activators/inhibitors of the protein kinase C (PKC) signaling pathway. Mineral nodule formation was assessed by the von Kossa stain. RESULTS: PGE2 and PGF2α significantly increased mineralization of OCCM cells. The EP1 and EP3 PG receptor activators 16,16-dimethyl-prostaglandin E2 and sulprostone, also increased mineralization. In contrast, specific activators of the EP2 or the EP2/EP3/EP4 receptors did not have any effect. Fluprostenol, a specific activator of the FP receptor, significantly increased mineralization of OCCM cells. FP and EP (1 or 3) receptors signal through activation of the protein kinase C (PKC) pathway. Indeed, phorbol 12-myristate 13-acetate (PMA), a direct activator of the PKC pathway, significantly increase OCCM mineralization, while pre-treatment of OCCM cells with the PKC inhibitor GF109203× (bisindolylmaleimide) significantly decreased mineralization. CONCLUSION: We conclude that PGE2 and PGF2α exert an anabolic effect on OCCM mineralization through activation of PKC signaling. J Periodontol 2005;76:303-309.

The significance of prior mechanical therapy for changes of periodontal status achieved by local delivery of a doxycyclinehyclate containing gel.

AIM: The purpose of this retrospective analysis was to examine what effect, if any, the time elapsed between an individual's last episode of scaling and root planing and subsequent treatment with a sustained-release doxycycline hyclate gel (DH) alone or scaling and root planing alone (SRP) would have upon adult periodontitis. METHODS: A total of 207 subjects were included in the DH group and 210 patients in the SRP group. Periodontitis was defined as those sites which presented with pocket depths > or =5 mm and exhibited bleeding upon probing. In both DH and SRP groups, 3 sub-groups of subjects were identified according to their last episode of scaling and root planing prior to the study baseline: within 2 to 6 months, >6 but < or =12 months, and one or more times in their life but not within the last 12 months. Each study site was treated twice over a 9-month study period, once at baseline and again at 4 months. Data from the study sites at 4, 6, and 9 months were then evaluated for changes in probing depth, clinical attachment level, and bleeding upon probing. RESULTS: At the 9-month evaluation, all sub-groups in the DH and SRP treatment arms presented with improvement in the measured clinical parameters, as compared to baseline. No significant differences were observed in the measured periodontal indices among the study sites between the three sub-groups for either treatment. CONCLUSIONS: It is concluded that the time interval since the last episode of scaling and root planing had no observable effect on the results achieved when treating periodontitis sites with locally delivered doxycycline hyclate alone or scaling and root planing alone. The treatment of periodontitis sites with locally delivered doxycycline hyclate resulted in clinical improvement comparable to scaling and root planing irrespective of the patient's prophylaxis frequency.

The effectiveness of enamel matrix proteins used in combination with bovine porous bone mineral in the treatment of intrabony defects in humans.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of enamel matrix proteins (EMPs) used in combination with bovine porous bone mineral (BPBM), compared to open flap debridement (OFD) in the treatment of intrabony defects in humans. MATERIAL AND METHODS: Using a split-mouth design, 24 paired intrabony defects were surgically treated and re-entered 6 months later. Experimental sites were treated with EMPs and grafted with BPBM. Control sites were treated with an OFD. The primary outcomes evaluated in the study were changes in pocket depth, clinical attachment level and defect bone fill. RESULTS: Preoperative pocket depths, attachment levels and intra-operative bone measurements were similar for control and experimental sites. 6-month post surgical measurements revealed a significantly greater reduction in pocket depth (differences of 2.35+/-0.86 mm on buccal and 2.28+/-0.90 mm on lingual measurements) and more gain in clinical attachment (differences of 2.04+/-0.28 mm on buccal and 1.99+/-0.26 mm on lingual measurements) in the experimental sites. Surgical reentry of the defects revealed a significantly greater amount of defect fill in favor of the experimental sites (differences of 2.85+/-0.28 mm on buccal and 2.67+/-0.33 mm on lingual measurements). CONCLUSIONS: The results of this study suggest that combining EMPs and BPBM as a regenerative technique for intraosseous defects results in statistically and clinically significant more favorable results than OFD. The nature of the attachment between the newly regenerated tissue and the root surfaces needs to be evaluated histologically to confirm the presence of new attachment.

The use of bovine porous bone mineral in combination with enamel matrix proteins or with an autologous fibrinogen/fibronectin system in the treatment of intrabony periodontal defects in humans.

BACKGROUND: Enamel matrix derivative (EMD) and autologous fibrinogen/fibronectin system (AFFS) are agents that have been shown to be effective in periodontal regeneration. Their use in combination with graft materials, however, has not been extensively examined. The purpose of this study was to compare the clinical effectiveness of bovine porous bone mineral (BPBM) used in combination with an EMD or in combination with AFFS as regenerative treatments for periodontal intrabony defects in humans. METHODS: Twenty-three paired intrabony defects were surgically treated using a split mouth design. Defects were treated with BPBM either combined with EMD (BPBM/EMD) or with AFFS (BPBM/AFFS). The clinical parameters evaluated included changes in attachment level, probing depth, and defect fill as revealed by re-entry surgeries at 6 months. RESULTS: Preoperative probing depths, attachment levels, and transoperative bone measurements were similar for the 2 treatment groups. Postsurgical measurements taken at 6 months revealed that both treatment modalities resulted in clinically and statistically significant improvements in probing depth resolution, clinical attachment gain, and defect fill as compared to baseline. Both therapy modalities improved clinical parameters as compared to baseline, but the differences found between the groups were not statistically significant. CONCLUSIONS: The results of this study indicate that EMD and AFFS used in combination with BPBM have similar effects in promoting probing depth reduction, clinical attachment gain, and defect fill when employed as regenerative therapy for intraosseous lesions in humans. A study involving a larger sample size is necessary to statistically confirm the equivalence between the 2 treatment modalities.

Combination use of bovine porous bone mineral, enamel matrix proteins, and a bioabsorbable membrane in intrabony periodontal defects in humans.

BACKGROUND: The purpose of this study was to evaluate the effectiveness of a combination of enamel matrix proteins (EMP), bovine porous bone mineral (BPBM), and a bioabsorbable membrane for guided tissue regeneration (GTR) as regenerative therapy for intrabony defects in humans and compare it to an open flap debridement (OFD) technique. METHODS: Using a split-mouth design, 18 pairs of intrabony defects were treated and surgically reentered 6 months after the initial surgery. Experimental sites were treated with EMP, grafted with BPBM, and received a collagen/polylactic acid membrane for GTR. Control sites were treated with OFD. The primary outcomes evaluated in the study included probing depth resolution, clinical attachment gain, and bony defect fill. RESULTS: Preoperative probing depths, attachment levels, and intraoperative bone measurements were similar for the experimental and control groups. Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the experimental group (4.95+/-1.52 mm on buccal sites and 4.74+/-1.47 mm on lingual sites) when compared to the control group (2.83+/-0.83 mm on buccal sites and 2.90+/-0.91 mm on lingual sites). The experimental sites also presented with significantly more attachment gain (3.89+/-1.16 mm on buccal sites and 3.78+/-1.14 mm on lingual sites) than the control sites (1.52+/-0.83 mm on buccal sites and 1.48+/-0.78 mm on lingual sites). Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of the experimental group (4.76+/-1.36 mm on buccal sites and 4.81+/-1.37 mm on lingual sites) as compared to the control group (1.78+/-0.92 mm on buccal sites and 1.67+/-0.90 mm on lingual sites). CONCLUSIONS: The results of this study indicate that a combination technique including BPBM, EMP, and GTR results in better clinical resolution of intrabony defects than treatment with OFD. Differences observed were both statistically and clinically significant. The exact role of each of the 3 technique components in achieving the clinical improvement observed in this study remains to be determined.

Soft tissue root coverage as treatment for cervical abrasion and caries.

Root exposure caused by gingival recession may result in cervical abrasion, root caries, root sensitivity, and compromised esthetics. Although cervical root lesions can be treated with Class V restorations, there may be advantages in treating them with soft tissue grafts for root coverage since they restore the dento-gingival unit to its prerecession condition. The rationale for root coverage with soft tissue grafts is reviewed and two cases are presented of successful root coverage procedures in which gingival recession associated with cervical abrasion and caries was present.

Influence of bioactive glass on changes in alveolar process dimensions after exodontia.

BACKGROUND: Preservation of the alveolar process after tooth extraction is desirable because it facilitates placement of endosseous implants and minimizes adverse esthetic results associated with fixed partial dentures. The purpose of this study was to evaluate the clinical effectiveness of bioactive glass used as a graft material combined with calcium sulfate used in the form of a mechanical barrier in preserving alveolar ridges after tooth extraction. METHODS: Sixteen patients who required extraction of 2 anterior teeth or bicuspids participated in the study (split mouth design). After tooth extraction and elevation of a buccal full-thickness flap, experimental sockets were filled with bioactive glass, which in turn was covered with a layer of calcium sulfate. Control sites did not receive any graft or calcium sulfate. Titanium pins served as fixed reference points for measurements. No attempt was made to advance the flap to cover the socket areas on control or experimental sites (open socket approach). Reentry surgeries were performed at 6 months. RESULTS: Reentry surgeries showed that experimental sites presented with (1) significantly more internal socket bone fill (6.43 +/- 2.78 mm vs 4.00 +/- 2.33 mm on control sites), (2) less (although not statistically significantly less) resorption of alveolar bone height (0.38 +/- 3.18 mm vs 1.00 +/- 2. 25 mm on control sites), and (3) similar degree of horizontal resorption of the alveolar bony ridge as compared with controls (3. 48 +/- 2.68 mm vs 3.06 +/- 2.41 mm on control sites). CONCLUSIONS: This study suggests that treatment of extraction sockets with a combination of bioactive glass and calcium sulfate is of some benefit in preserving alveolar ridge dimensions after tooth extraction.

A comparison between enamel matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony periodontal defects in humans.

BACKGROUND: It has been shown that clinical improvement of intrabony periodontal defects can be achieved with the use of enamel matrix proteins (EMPs) or by grafting with bovine porous bone mineral (BPBM). There is no report on the potential synergistic effect of EMPs and BPBM in periodontal regenerative therapy. The purpose of this study was to compare the clinical effectiveness of EMPs used alone or in combination with BPBM in the treatment of periodontal intrabony defects in humans. METHODS: Twenty-one paired intrabony defects were surgically treated using a split-mouth design. Intrabony defects were treated either with enamel matrix proteins (EMP group) or with enamel matrix proteins combined with bovine porous bone mineral (EMP/BPBM group). Re-entry surgeries were performed at 6 months. RESULTS: Preoperative probing depths, attachment levels, and transoperative bone measurements were similar for the EMP and EMP/BPBM groups. Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the EMP/BPBM group (3.43 +/- 1.32 mm on buccal sites and 3.36 +/- 1.35 mm on lingual sites) when compared to the EMP group (1.91 +/- 1.42 mm on buccal sites and 1.85 +/- 1.38 mm on lingual sites). The EMP/BPBM group also presented with significantly more attachment gain (3.13 +/- 1.41 mm on buccal sites and 3.11 +/- 1.39 mm on lingual sites) than the EMP group (1.72 +/- 1.33 mm on buccal sites and 1.75 +/- 1.37 mm on lingual sites). Surgical re-entry of the treated defects revealed a significantly greater amount of defect fill in favor of the EMP/BPBM group (3.82 +/- 1.43 mm on buccal sites and 3.74 +/- 1.38 mm on lingual sites) as compared to the EMP group (1.33 +/1.17 mm on buccal sites and 1.41 +/- 1.19 mm on lingual sites). CONCLUSIONS: The results of this study indicate that BPBM has the ability to augment the effects of EMPs in reducing probing depth, improving clinical attachment levels, and promoting defect fill when compared to presurgical levels.

A controlled re-entry study on the effectiveness of bovine porous bone mineral used in combination with a collagen membrane of porcine origin in the treatment of intrabony defects in humans.

AIM: The purpose of this study was to evaluate the clinical effectiveness of a bovine porous bone mineral used in combination with a porcine derived collagen membrane as a barrier in promoting periodontal regeneration in intrabony defects in humans. MATERIAL AND METHODS: The study employed a split-mouth design. 22 paired intrabony defects were treated and surgically re-entered 6 months after treatment. Experimental sites were grafted with bovine porous bone mineral and received a collagen membrane for guided tissue regeneration. Control sites were treated with an open flap debridement. RESULTS: Preoperative pocket depths, attachment levels and trans-operative bone measurements were similar for control and experimental sites. Post surgical measurements revealed a significantly greater reduction in pocket depth (differences of 1.89 +/- 0.31 mm on buccal 0.88 +/- 0.27 mm on lingual measurements) and more gain in clinical attachment (differences of 1.51 +/- 0.33 mm on buccal and 1.50 +/- 0.35 mm on lingual measurements) in experimental sites. Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of experimental sites (differences of 2.67 +/- 0.91 mm on buccal and 2.54 +/- 0.87 mm on lingual measurements). CONCLUSIONS: The results of this study indicate that clinical resolution of intrabony defects can be achieved using a combination of bovine porous bone mineral and an absorbable, porcine derived collagen membrane when employing a technique based on the principles of guided tissue regeneration. The nature of the attachment between the newly regenerated tissue and the root surfaces needs to be evaluated histologically to confirm the presence of new attachment.

Laboratory interproximal access efficacy of two toothbrushes with cross-angulated bristling.

Interproximal access efficacy (IAE) has been evaluated in a laboratory method using pressure-sensitive paper placed around simulated anterior and posterior teeth, using horizontal or vertical brushing motions. The two toothbrushes evaluated in this study were the Oral-B Cross Action Medium 40 and the Dr. Best X-Activ Mittel. Twenty-four tests on each toothbrush design were conducted, and results were statistically analyzed using ANOVA. In all of the individual evaluations, using either vertical or horizontal brushing motions on either anterior or posterior simulated teeth, the Dr. Best X-Activ Mittel toothbrush was significantly (p < 0.001) more effective than the Oral-B Cross Action Medium 40 in achieving IAE. When individual IAE data from the vertical, horizontal, anterior and posterior assessments were combined to assess overall IAE, the Dr. Best X-Activ Mittel toothbrush had a significantly (p < 0.001) higher mean value than the Oral-B Cross Action Medium 40 mean value.

A comparative pilot study of the effects of a dentifrice containing green tea bioflavonoids, sanguinarine or triclosan on oral bacterial biofilm formation.

The aim of the present study was to evaluate the effect of a green tea bioflavonoid/zinc ascorbate-containing dentifrice (Natural Antioxidant Toothpaste) on bacterial plaque biofilm accumulation. Plaque biofilms were formed and observed on saliva-conditioned synthetic hydroxyapatite disks (HA) over 4 days. Two test treatments were performed daily over a 4-day experimental period for a total of 8 treatments. Four test dentifrices were evaluated: a 0.1% bioflavonoid/0.2% zinc ascorbate; a non-active control test dentifrice; a 0.075% sanguinarine/2.0% zinc chloride dentifrice; and a 0.3% triclosan dentifrice. The repeated treatment of the HA with the green tea bioflavonoid/zinc ascorbate, the sanguinarine/zinc chloride, or the triclosan dentifrice resulted in significant reductions in total viable plaque biomass when compared to a non-active placebo control dentifrice.

Aesthetic management of extractions for implant site development: delayed versus staged implant placement.

Resorption of the dentoalveolar bone and collapse of the gingival ridge following tooth loss often results in aesthetic compromise and inadequate bone for "prosthetically driven" implant placement. Preventing alveolar bone resorption with a conservative procedure at the time of extraction can enhance aesthetics and reduce the duration and extent of treatment required for implant placement. This article describes the aesthetic management of extraction sites using a conservative bone grafting procedure at the time of extraction for implant site development. The case presented demonstrates staged and delayed implant placement techniques.