An in vitro comparison of four antibacterial agents with and without nicotine and their effects on human gingival fibroblasts.

BACKGROUND: The purpose of the study was to compare anti-bacterial activity of 0.12% chlorhexidine (CHX), 10% povidone iodine (PVD), Vega oral care gel (VEGA), and antioxidant gel (AO) on Streptococcus mutans, Streptococcus sanguis, Fusobacterium nucleatum, and Porphyromonas gingivalis with and without nicotine and to evaluate their effects on human gingival fibroblasts (HGFs). METHODS: S. mutans, S. sanguis, P. gingivalis, and F. nucleatum were incubated with serial dilutions (1/4, 1/8, 1/16, 1/32, and 1/64) of anti-bacterial agents in media (with and without nicotine). Minimum inhibitory and minimum bactericidal concentrations (MIC/MBC) were measured, and confocal microscopy was performed.  HGFs were exposed to serial dilutions (1/10, 1/100, 1/1000, and 1/10,000) of antibacterial agents with media. Water-soluble tetrazolium-1 (WST-1) assay and lactate dehydrogenase (LDH) assay were used to assess proliferation and cytotoxicity towards HGFs. RESULTS: CHX and PVD significantly inhibited growth of all bacterial species (P < 0.0001) at all dilutions. AO and VEGA inhibited growth of all bacterial species up to only the 1/4 dilution. CHX and PVD decreased HGF proliferation at 1/10 and 1/100 dilution, whereas AO at all dilutions (P < 0.05). CHX and AO were cytotoxic at all dilutions (P < 0.05). VEGA was not cytotoxic to HGFs and did not affect HGF proliferation at any dilution (P > 0.05). An increased bacterial growth was seen for all species except P. gingivalis with addition of nicotine. CONCLUSION: CHX and PVD demonstrate superior antibacterial properties, but significantly reduce HGF proliferation. AO is bacteriostatic at lower dilutions but is highly toxic to HGFs. VEGA was bacteriostatic and demonstrated no detrimental effects on HGF's.

In vitro comparison of root surface roughness and bacterial adhesion following treatment with three different instruments.

BACKGROUND: A novel device, piezoelectric 11 Gracey curet tip, reportedly combines benefits of a piezoelectric device and manual curet. The primary objective of this study was to compare root surface roughness outcomes between traditional manual curets and piezoelectric devices, as compared with this novel device. The secondary aim was to assess the level of adhesion of Streptococcus mutans on the root surface after instrumentation. METHODS: The groups consisted of the following: 1) Gracey curet; 2) piezoelectric scaler; 3) piezoelectric 11 Gracey curet tip; and 4) untreated control. Root specimens were obtained from extracted human teeth and randomly assigned to each group. Surface roughness measurements (Ra and Rz) were taken with a profilometer before and after instrumentation. After instrumentation, root specimens were inoculated with S. mutans and biofilm was dislodged. Various dilutions of resuspended biofilm were incubated on blood agar plates and colony forming units (CFU) values were measured. RESULTS: The experimental device resulted in significantly lower Ra and Rz compared with other groups (P < 0.01), and the Gracey curet was significantly lower than the piezoelectric tip and untreated control (P < 0.05). The Gracey curet and experimental device tip had significantly lower CFU values compared with the control (P < 0.05). There were no significant CFU value differences between the Gracey curet and both the piezoelectric and experimental device tips. There were no significant CFU differences between piezoelectric tip and both experimental device and control. There was no correlation between Ra and CFU values for Gracey curet, piezoelectric tip, or the control. However, correlation between Ra values and CFU approached significance for the experimental device (correlation = 0.66, P = 0.05). CONCLUSIONS: Piezoelectric 11 Gracey curet tip is effective at resulting in a significantly smoother surface compared with traditional piezoelectric and hand instruments. CFU values with piezoelectric 11 Gracey curet tip were significantly lower than non-instrumented surfaces, but there were no significant differences compared with conventional methods.

Dental laser training and education in postgraduate periodontics programs in North America.

INTRODUCTION: The application of various lasers to treat periodontal and peri-implant diseases is gaining momentum. While laser-related dental research is ongoing, it is important to determine if current periodontal training programs are keeping pace with these new treatment modalities and actively incorporating them into their training. MATERIALS AND METHODS: An electronic survey was created to evaluate the extent to which lasers are currently being used in North American periodontal programs. A brief explanation of the study and a link to the 15-question survey was emailed to 61 periodontal program directors requesting participation in the survey. The data regarding the prevalence of laser training in all the programs, which types of laser devices are used, and which surgical procedures are performed were collected and analyzed. RESULTS: The response rate was 49.1% (n = 30). Among those responding to the survey, 76.7% (n = 23) of these programs reported providing clinical training in lasers, with the diode laser being the most frequently used (65.2%), followed by carbon dioxide (39.1%), neodymium-doped yttrium aluminum garnet (26.1%), and erbium:yttrium aluminum garnet lasers (26.1%). Two major reasons for not utilizing lasers as part of regular patient care were cost and lack of evidence to support laser efficacy. Three out of seven programs that do not currently use lasers plan to provide laser training in the future. Over half (56.7%) of program directors did not think that lasers would become the standard of periodontal/implant care within the next 10 years, while 20% of them believed that they would. CONCLUSIONS: Laser training and education in postgraduate periodontal programs is still limited, and the majority of periodontal residents are not exposed to many types of laser devices.

Management of Recurrent Gummy Smile After 7 Years: A Case Report.

Esthetic crown lengthening is a periodontal surgical procedure to correct excess gingival display (ie, "gummy smile"). The procedure may require soft-tissue excision only, osseous resection, or a combination of both. However, the long-term healing responses, such as soft-tissue relapse or recession and hard-tissue regrowth and resorption, have not been fully reported in the literature. This case report describes the management of a patient with esthetic concerns about a gummy smile. The patient stated that the maxillary anterior area had been previously treated with periodontal surgery 7 years earlier but the condition had slowly recurred over time. The authors highlight the possible reasons for the recurrence and the keys to successfully managing the case.

Effects on Ridge Dimensions, Bone Density, and Implant Primary Stability with Osseodensification Approach in Implant Osteotomy Preparation.

PURPOSE: To compare the amount of bone expansion, bone density change, and implant primary stability with an osseodensification technique to a conventional drilling protocol. MATERIALS AND METHODS: Twenty-four bovine rib segments (20 × 25 × 4 mm) with a 1-mm outer layer of cortical bone were randomly divided into two groups: an osseodensification group and a conventional drilling group. Each bone sample received one 4.1 × 10-mm implant. The density of the peri-implant bone before and after osteotomy was measured. After implant placement, primary stability was assessed. A laser surface scanner was used before and after implant placement to compare the dimension of crestal bone width and volumetric expansion. Histomorphometric analysis was performed to compare the bone-to-implant contact percentage (BIC%) of the two groups. RESULTS: The peripheral and apical bone mineral density around the implants was significantly increased, and a statistically significantly higher peripheral BIC% was found in the osseodensification group. A significant increase in volume and bone width after implant placement was found in both groups. However, there were no significant differences in volume and bone width change at all three locations and in implant stability between the osseodensification and conventional drilling protocols. CONCLUSION: Within the limitations of this study, the osseodensification protocol increased the bone mineral density and primary bone-to-implant contact. Also, this study suggests that implant placement by osseodensification or conventional drilling can increase ridge dimensions in narrow alveolar ridges.

Effect of Medical-Grade Polyurethane Sponges on Sinus Membrane Perforation With a Lateral Window Approach.

The most commonly reported complication during the sinus elevation surgical procedure is the perforation of the Schneiderian membrane. The aim of this retrospective study was to compare the rate of sinus membrane perforation during lateral window augmentation using either conventional sinus curettes or medical-grade polyurethane sponges. This retrospective study included patients who received a lateral window approach for sinus floor elevation. The sinus elevation procedures using medical-grade polyurethane sponges (test) or conventional curettes (control) were recorded and analyzed. All subjects' demographic data and preexisting conditions were evaluated. A total of 38 procedures met inclusion criteria, and those data were evaluated for analysis. There were no statistically significant differences in demographic data or preexisting conditions including age, sex, treatment location, presence and absence of septum, Schneiderian membrane thickness, and residual bone height between test and control groups. The membrane perforation rate was 7% in the test group and 43% in the control group; however, this difference did not reach statistical significance (P = .064). Within the limitations of this study, although there was no statistically significant reduction of sinus membrane perforation with the use of medical-grade polyurethane sponges, the decreased incidence of perforation might be of clinical significance.

Effects of platelet-rich fibrin on human gingival and periodontal ligament fibroblast proliferation from chronic periodontitis versus periodontally healthy subjects.

BACKGROUND: Platelet-rich fibrin (PRF), an autogenous blood concentrate, contains multiple growth factors and is used as an adjunct in the periodontal regeneration and implant site development procedures to stimulate wound healing. Patient-related factors such as chronic periodontitis may affect the quality of PRF. OBJECTIVES: This study aimed to investigate and compare PRF's effects from patients diagnosed with generalized moderate or severe chronic periodontitis to patients who presented with intact periodontium on human gingival fibroblast (HGF) and human periodontal ligament fibroblast (HPLF) proliferation. MATERIALS AND METHODS: A total of 33 ml of whole intravenous blood was collected from each subject and centrifuged at 2700 rpm for 12 min in three 10 ml tubes, and 3 ml of blood was used for Complete Blood Count analysis. Three PRF clots were compressed to produce the membranes and liquid exudate. PRF membrane and 10% liquid exudate were exposed to 20,000 HPLFs/well or 25,000 HGFs/well in triplets from each subject in a 48 cell well plate. After 72 h of incubation, the conditioned media were evaluated by Water Soluble Tetrazolium-1 assays to determine fibroblast proliferation. Controls included cells alone and media without cells. Complete blood counts were measured. RESULTS: Subjects in both groups were age and gender-matched (intact 46.7 ± 11.4 years and periodontitis 54.8 ± 10.4 years, p-value = 0.1344). Body Mass Index and White Blood Corpuscles in the periodontitis group was significantly higher than the intact group (p = 0.0176 and p = 0.0038) whereas no differences were seen for Red Blood Corpuscles (p = 0.2020), Hemoglobin (p = 0.2290) and Platelets (p = 4,094). There were no significant differences in the HGF and HPLF proliferation with PRF exudates and membranes between intact periodontium and periodontitis groups (all p > 0.05). However, PRF exudates in both groups induced significant more cell proliferation when compared to PRF membranes. CONCLUSIONS: PRF exudates induced significant proliferation of fibroblasts and can play a vital role in wound healing. The current study concluded that PRF membranes, in combination with PRF exudates, can be utilized for their therapeutic and wound healing potential, not affected by the periodontal condition of the patient.

Alveolar Ridge Augmentation Around Exposed Mandibular Dental Implant With Histomorphometric Analysis.

INTRODUCTION: Alveolar ridge augmentation either before or during implant placement is a predictable procedure under certain conditions. A major complication during the healing phase is incision line opening and membrane exposure, which may result in reduced bone gain and reduced implant survival. This case report describes alveolar bone regeneration around three dental implants despite membrane exposure that developed during healing post-surgically. CASE PRESENTATION: A 72-year-old female presented requesting dental implants to replace tooth numbers 18, 19, and 20. A cone-beam computed tomography (CBCT) scan showed loss of horizontal and vertical ridge dimensions. All implants were placed with a variable degree of implant thread exposure on their buccal surfaces, ranging from 3 to 4.5 mm. Simultaneous bone grafting was performed using freeze dried bone allograft and deproteinized bovine bone mineral that was covered by a d-PTFE membrane that was secured with tacking screws. Primary closure was obtained, and flaps were sutured. Three weeks post-surgically, membrane exposure occurred. Exposure was monitored and patient was instructed to follow strict oral hygiene instructions around the exposed membrane. Membrane exposure gradually increased without infection and was removed at 16 weeks. Membrane removal revealed dense fibrous tissues covering all implant surfaces. At the second stage surgery, new bone was seen covering all the implants coronal to the cover screws. A trephine core biopsy specimen revealed significant new bone formation and connective tissue around any residual grafted bone. CONCLUSION: d-PTFE membrane exposure does not necessarily lead to adverse healing outcomes for alveolar ridge augmentation if handled properly with close patient follow-up.

Amnion-Chorion Allograft Barrier Used on Root Surface for Regenerative Procedures: Case Report.

INTRODUCTION: Guided tissue regeneration (GTR) has been well documented with combination of bone graft substitutes and biologic modifiers to improve the outcomes of periodontal regenerative procedures. Amnion-chorion allograft membrane (ACM) is a placenta-derived resorbable allograft membrane which contains growth factors found in the placenta. The primary purpose of the barrier membranes for GTR was to exclude the epithelial down-growth along with the root surface, however, the ACM can be used as an additional biologic modifier because of the release of growth factors from the ACM after placement. The aim of this case report is to evaluate the efficacy and the application of ACM on the previously diseased root surface to treat periodontal intrabony defect. CASE PRESENTATION: A 60-year-old Caucasian male with deep and wide intrabony defect on mesial #19 was treated with a regenerative procedure with combination of application of ACM on the root surface and filling the intrabony defect with the corticocancellous freeze-dried bone allograft. The bone substitute was covered with another layer of ACM and primary closure was achieved. Wound healing process was uneventful, and the clinical and radiographic outcomes were favorable up to 18 months after the surgical procedure. CONCLUSION: This case report demonstrated that the application of ACM on the root surface with a combination of bone substitute might enhance to the radiographic bone fill and the clinical attachment level gain and minimize the risk of post-operative gingival recession.

Levels of growth factors from platelet-rich fibrin from chronic periodontitis versus periodontally healthy subjects: a pilot study.

OBJECTIVES: This study aimed to (1) compare the amounts of growth factors from platelet-rich fibrin (PRF) between chronic periodontitis and periodontally healthy subjects and (2) evaluate the relationships between the amounts of growth factors from PRF with complete blood counts (white blood cell (WBC) and platelet counts) and the serum concentrations of IL-1ß, IL-6, and tumor necrosis factor-α (TNF-α). MATERIALS AND METHODS: Venous blood was collected from chronic periodontitis (test) and periodontally healthy subjects (control). PRF and serum were collected from the centrifuged blood. Liquid exudates from the compression of PRF were collected. The compressed PRF membranes were incubated in saline, and eluted aliquots were collected at 1, 24, and 72 h, and the membranes were then digested with trypsin. Epidermal growth factor, insulin-like growth factor-1, platelet-derived growth factor-BB, transforming growth factor-ß1, and vascular endothelial growth factor in the exudates and eluents were quantified by ELISA. Serum was used for IL-1ß, IL-6, and TNF-α quantifications. Complete blood counts were measured. RESULTS: There were no significant differences in the amounts of growth factors from PRF exudates and membranes measured between groups (all p > 0.05). The test group had significantly higher WBC (p < 0.05). However, there was no significant correlation between the WBC and the amounts of the growth factors from PRF (all p > 0.05). CONCLUSIONS: PRF can be utilized as an autologous source of growth factors not affected by periodontal condition and WBC level. CLINICAL RELEVANCE: The amounts of growth factors from PRF were not affected by the periodontal condition of the patient.

Comparative evaluation of mandibular canal visibility on cross-sectional cone-beam CT images: a retrospective study.

OBJECTIVES: The purpose of this study was to determine the visibility of the mandibular canal (MC) in CBCT images and if the visibility of the MC is affected by gender, location and/or age. METHODS: CBCT images were evaluated for the visibility of the MC by a board-certified oral and maxillofacial radiologist, a board-certified periodontist and a periodontics resident. Representative slices were examined for the first premolar (PM(1)), second premolar (PM(2)), first molar (M(1)) and second molar (M(2)) sites by all examiners. The visibility of the MC was registered as either present or absent. RESULTS: 360 total CBCT cross-sectional images were examined, with the MC identified in 204 sites (56%). Age had a significant effect on MC visibility, but it differed by location: for PM(1), age 47-56 had lower visibility than age 65+ (p = 0.0377). Gender also had a significant effect on canal visibility, where females had lower visibility than males overall (p = 0.0178) and had the most pronounced difference for PM(1) (p = 0.0054). Location had a significant effect on visibility, but it differed by age and by gender: for age 65+, M(2) had lower visibility than PM(1) (p = 0.0411) and PM(2) (p = 0.0180), while for females, PM(1) had lower visibility than M(1) (p = 0.0123) and M(2) (p = 0.0419). CONCLUSIONS: The MC was visualized only in just over half of the CBCT images. Age, gender and location had significant effects on the visibility.

A prospective, multicenter study of bovine pericardium membrane with cancellous particulate allograft for localized alveolar ridge augmentation.

Resorption of the alveolar ridge may lead to ridge deformities that make dental implant placement difficult or impossible. Augmentation of the alveolar ridge may restore appropriate ridge form to allow implant placement. Forty-four patients with edentulous spaces completed this multicenter prospective trial to clinically and radiographically evaluate the efficacy of a bovine pericardium membrane and a particulate mineralized cancellous bone allograft in promoting lateral ridge augmentation. Overall, 38 of 44 patients (86.4%) were able to receive dental implants in the appropriate restoratively driven position 6 months after ridge augmentation. The mean gain in clinical ridge width after augmentation was 2.61 mm, while radiographically the mean gain in ridge width was 1.65 mm at a level 3 mm apical to the bony crest and 1.93 mm at a level 6 mm apical to the crest. On average, approximately 50% of the graft material added horizontally during surgery was displaced or resorbed during healing. Histomorphometric evaluation of cores taken from the augmented ridge at 6 months revealed that approximately 58% of the tissue volume was vital bone, with 12% residual allograft particles and 30% nonmineralized tissue.

Cervical enamel projections and associated pouch-like opening in mandibular furcations.

BACKGROUND: Cervical enamel projections (CEPs) have been listed among the tooth-associated risk factors that could lead to isolated furcation defects around molar teeth. This is more likely when Grade III CEPs are present. However, the histologic aspects of the CEP interface with regard to the presence or absence of cementum over the enamel projection within the furcation have not been well described. This study was initially undertaken to evaluate this relationship. METHODS: Thirty-five mandibular molars with Grade III CEPs were selected from a collection of extracted teeth and evaluated for the presence of cementum covering these areas by stereomicroscopy, light microscopy, and scanning electron microscopy (SEM). RESULTS: Sixteen of the 35 teeth (45.7%) with Grade III CEPs appeared completely covered by cementum. SEM evaluation showed the presence of a narrow pouch-like opening between cementum and enamel in 15 of 16 teeth (93.8%). Light microscopy evaluation confirmed the presence of the pouch along with some indication of residual degenerated mesenchymal tissue within the defects. SEM evaluation showed the presence of globular bodies in this pouch. CONCLUSIONS: This study reports on the presence of a pouch-like opening between the enamel and cementum in mandibular molars with Grade III CEPs. The clinical significance of these cementum pouches has yet to be determined but bacterial contamination of these pouch-like structures in areas of furcation periodontal breakdown may serve as a nidus for recolonization and disease recurrence or for the development of furcation caries if exposed to the oral cavity after surgical procedures.

A clinical and histomorphometric study of calcium sulfate compared with freeze-dried bone allograft for alveolar ridge preservation.

BACKGROUND: Many materials have been found to be effective in ridge preservation. The purpose of this study is to determine whether calcium sulfate (CS) is as effective as freeze-dried bone allograft (FDBA) in preserving postextraction ridge dimensions and to evaluate the amount of new bone formation and graft clearance through histologic analysis. METHODS: Thirty-one extraction sites were selected. Postextraction clinical measurements were made, and sites were divided randomly into the test group (CS) or the control group (FDBA). After graft placement, all individuals received the same postoperative treatment and instructions. Participants were recalled after 3 months, measurements were made, and sites were re-entered. Bone samples were harvested and analyzed with histologic methodology for new bone formation and remaining residual graft. RESULTS: Thirteen test and 15 control sites were evaluated. There was no significant change in vertical ridge height before or after surgery within the test and control groups (P = 0.57, P = 0.68, respectively). There was a significant decrease in bucco-lingual ridge width for both groups (P = 0.0003, P = 0.0075, respectively), but the difference between groups was not significant (P = 0.11). Histologic analysis revealed an average of 32% new bone formation with 2.5% graft remaining for the test group and 16.7% new bone formation with 21% graft remaining for the control. CONCLUSIONS: Results indicate that CS is as effective as FDBA in preserving postextraction ridge dimensions in non-molar extraction sites. There is greater clearance of CS with more new bone formation after ≈3 months compared with FDBA in these sites. This paper received the Maynard K. Hine Award for Excellence in Dental Research presented by the Indiana Section of the American Association for Dental Research and supported by Procter & Gamble.

Microbial contamination and the sterilization/disinfection of surgical guides used in the placement of endosteal implants.

PURPOSE: The purpose of this study was twofold: (1) to estimate the level of microbial contamination found on commercial guides (CG) and in-house laboratory guides (LG) prior to use, and (2) to evaluate the antimicrobial potential of disinfectants commonly used in dentistry to decontaminate heat-sensitive surgical guides. Ethylene oxide gas was used as the positive control; sterile water served as a negative control. MATERIALS AND METHODS: Evaluation of CGs and LGs for bacterial contamination occurred soon after their arrival in the laboratory. Some guides went directly into tubes of trypticase soy broth solution, vortexed and equally divided into two tubes. One tube went into an 80°C bath for 19 minutes, while the other stayed at room temperature. After plating, half of the samples underwent anaerobic incubation. All incubation was for 48 hours at 37°C. Other guides underwent water rinsing or disinfection by various methods for 5 or 15 minutes or ethylene oxide gas sterilization prior to sampling. RESULTS: Untreated CG specimens showed modest levels of bacterial contamination, with most colonies coming from liquid specimens not exposed to 80°C. LG specimens had more bacteria from both heat-treated and non-heat-treated aliquots. Chlorhexidine gluconate, diluted bleach, and water rinsing were not able to completely eliminate microorganisms on the specimens, but no viable microorganisms were present on specimens treated with gas sterilization or 70% ethanol for 15 minutes. CONCLUSION: CGs and LGs, on average, had different levels of bacterial contamination prior to disinfection. Water, chlorhexidine gluconate, and diluted bleach were not totally successful in decontaminating the surgical guides, but no growth was found after 15 minutes of immersion in 70% ethanol. Preferably, surgical guides should be submerged in 70% alcohol for a minimum of 15 minutes or undergo sterilization using ethylene oxide gas.

A survey of United States periodontists' knowledge, attitudes, and behaviors related to tobacco-cessation interventions.

BACKGROUND: Because of the clear causal relationship between smoking and periodontal disease, and the negative effect of smoking on wound healing, it is of great importance to evaluate the tobacco-cessation interventions provided by periodontal practices. The use of tobacco-cessation interventions in clinical practice can be measured by whether the practitioner uses any of the "5 A's" defined by the 2008 United States Public Health Services Clinical Practice Guideline. METHODS: Surveys were mailed to 1,000 active members of the American Academy of Periodontology. The surveys assessed the periodontists' demographic information, educational and professional background, knowledge and attitudes about tobacco cessation, and use of interventions in the daily practice of periodontics. RESULTS: Data were collected from 231 periodontists via a self-administered survey. Most (92%) believed that tobacco cessation is a responsibility of the dental profession. A pattern of declining levels of involvement was seen as the providers moved through the suggested "5 A's" for promoting tobacco cessation. Providers with formal tobacco-cessation training were more likely to perform interventions. The primary perceived barriers to providing tobacco-cessation interventions were low patient acceptance of treatment, lack of time, and lack of training. CONCLUSION: The findings of this study indicate that periodontists believe that tobacco-cessation interventions are a responsibility of the dental profession; however, because of several perceived barriers, reported rates of comprehensive tobacco interventions in periodontal practices are low.

Peripheral quantitative computer tomographic, histomorphometric, and removal torque analyses of two different non-coated implants in a rabbit model.

OBJECTIVE: The objectives of this study were (1) to investigate the bone-tissue response to zirconia and titanium implants at the implant-to-bone interface and at the periosteal level and (2) to quantitatively measure the mineral density of the peri-implant bone using peripheral quantitative computer tomography (pQCT). MATERIAL AND METHODS: Ten 3.5 mm × 6.6 mm screw-shaped threaded implants fabricated from titanium and zirconia were inserted into the mid-tibial diaphysis of five male New Zealand white rabbits. Calcein green was administered at 4 weeks post-implantation. The animals were sacrificed after 6 weeks and implants were retrieved and analyzed in terms of bone-to-implant contact (BIC), bone area (BA), mineralized surface (MS) percentage, inter-thread calcein labels, removal torque (RT) values, as well as pQCT measurements. FINDINGS: No statistically significant differences were detected between the zirconia and titanium implants in terms of BIC, RT, and pQCT. However, statistically significant higher BA and MS levels were found in the titanium group, while the higher amount of calcein labels occupying the threads were found in the zirconium group. Significant differences were also found in the quantity and the composition of bone at the bone-implant interfacial area vs. the region 1.5 mm away from the bone-implant interface, irrespective of the implant type. CONCLUSION: Zirconia implants demonstrated a lower bone remodeling activity in the periosteal region. The bone at the bone-implant interface shows a significantly lower cortical bone density, a higher trabecular density, and trabecular mineral content. Finally, zirconia and titanium implants showed similar bone-implant responses in terms of BIC and RT.

Periodontal-endodontic lesion of a three-rooted maxillary premolar: report of a case.

BACKGROUND: A 43-year-old African American male initially presented for a dental evaluation of a recurrent swelling on the buccal aspect of tooth #12. His medical history was unremarkable except for a 20-pack year history of smoking. He was eventually diagnosed as having a necrotic pulp #12, and received root canal treatment. The patient's problem was unresolved, and he was subsequently referred for a periodontal evaluation with a presumptive diagnosis of a periodontal abscess. METHODS: A flap was reflected from teeth #11 through #15. A buccal furcation invasion was discovered on #12. Shortly thereafter, three distinct roots with three grade III furcation invasions were located. The tooth was deemed untreatable, and was extracted. The thin buccal plate of the extraction socket was preserved using freeze-dried bone allograft to facilitate future prosthodontic replacement. RESULTS: Healing was uneventful. Periodontal open flap debridement surgery was provided for the remainder of the mouth, and the patient was placed on a 3-month recall program. CONCLUSIONS: Periodontitis associated with endodontic lesions are among the most daunting diagnostic and therapeutic challenges faced by periodontists. This is particularly true for maxillary premolars with multiple roots. The tooth in this case, once periodontally involved, had a very poor prognosis. The prognosis was further compromised by the pulpal involvement. Therapy consisted of extraction of the tooth to relieve the patient's discomfort and treating the adjacent teeth with periodontal open flap debridement surgery. A review of the literature pertinent to the diagnosis and management of periodontal-endodontic lesions is also presented.

Changes in gingival dimensions following connective tissue grafts for root coverage: comparison of two procedures.

BACKGROUND: The purpose of this study was to investigate the changes in gingival dimensions and root coverage using the same surgical procedure but varying the amount of the connective tissue graft left uncovered. METHODS: Twenty-five Class I or II recession defects in 20 healthy subjects were randomly assigned to test (exposed connective tissue group; E group) or control (fully covered connective tissue group; FC group) groups and treated with a connective tissue graft procedure. In the E group, 1 to 2 mm of the graft was left uncovered at the completion of the surgery, whereas the FC group had the graft completely covered by the flap. Clinical parameters assessed included probing depth, recession depth, clinical attachment level, width of keratinized tissue, mobility, and plaque score. RESULTS: At 12 weeks, the mean root coverage percentages for FC and E groups were 93% and 88%, respectively. The difference between the groups was not statistically significant (P=0.48). Complete root coverage was observed in 79% and 64% of the subjects in FC and E groups, respectively. There was greater increase in the width of keratinized tissue in the E group (1.5+/-1.1 mm) than the FC group (0.9+/-0.9 mm), although this difference did not reach statistical significance (P=0.16). There were no statistically significant differences between the groups for the changes in other parameters. CONCLUSIONS: Both procedures resulted in successful root coverage with an increase in the width of keratinized tissue. Leaving a portion of the graft exposed resulted in a greater increase of keratinized tissue, and complete coverage of the graft resulted in greater root coverage. However, these differences did not reach statistical significance.

The relationship between acute otitis media and the anatomic form of the hard palate.

PURPOSE: Acute otitis media (AOM) is a serious health concern for millions of children. This study was conducted to determine the relationship between AOM and the shape of the hard palate. METHODS: Intraoral examinations were performed on 175 pediatric dental patients ages 4-6. The palatal height was classified as high, medium or low. The accompanying parent completed a survey regarding their child's age, gender, overall health, history of AOM and presence of known risk factors for AOM. RESULTS: Eighty five percent of the total sample had a positive history for AOM, with 76% experiencing AOM prior to age 1. High palatal vault was a significant finding in children that experienced AOM before age 1 (odds ratio 3.49). Logistic regression analysis revealed that children with high palatal vaults underwent tube placement more often than the rest of the study population (odds ratio 2.49). CONCLUSIONS: Our study revealed a relationship between the presence of high palatal vaults and early, recurrent acute otitis media in young children. Recognition of high palatal vault in children suffering from AOM, in the presence of other known risk factors, may guide health care professionals to identify an otitis media prone patient and aid in prevention of recurrence.