Early orthodontic treatment after periodontal surgery: a randomized controlled trial / Le traitement orthodontique précoce après la chirurgie parodontale : essai clinique randomisé et contrôlé.

Introduction: The pathological teeth migrations require correct multidisciplinary treatment which consists of periodontal surgery associated with early or late orthodontic treatment. The aim of this study was to know which of the two orthodontic treatments would have a better periodontal response. Material and Method: Two parameters, radiological (the height of the alveolar bone) and clinical (the depth of the periodontal pocket), were used to meet the objective of this work. Eighteen patients received early orthodontic treatment (straight wire appliance) after periodontal flap debridement surgery and eighteen others late orthodontic treatment (straight wire appliance). Results: The results showed the absence of significant difference between the two early and late orthodontic treatments after periodontal flap debridement surgery. Conclusion: Orthodontic treatment can be started early seven to ten days after periodontal surgery.

Introduction: Les migrations dentaires pathologiques exigent un traitement pluridisciplinaire correct qui consiste en une chirurgie parodontale associée à un traitement orthodontique précoce ou tardif. Le but de cette étude était de connaître lequel des deux traitements orthodontiques aurait une meilleure réponse parodontale. Matériel et méthode: Deux paramètres, radiologique (la hauteur du défaut osseux) et clinique (la profondeur de la poche parodontale), ont été utilisés afin de répondre à l'objectif de ce travail. Dix-huit patients ont reçu, après la chirurgie parodontale par un lambeau d'assainissement, un traitement orthodontique précoce (technique d'arc droit) et dix-huit autres un traitement orthodontique tardif (technique d'arc droit). Résultats: Les résultats ont montré l'absence de différence significative entre les deux traitements orthodontiques, précoce et tardif, après la chirurgie parodontale par un lambeau d'assainissement. Conclusion: Le traitement orthodontique peut débuter précocement dès sept à dix jours après la chirurgie parodontale.

Palatal soft tissue thickness around dental implants and natural teeth in health and disease: A cross sectional study.

BACKGROUND: Previous studies focused on the influence of buccal mucosa thickness on peri-implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri-implantitis sites. Therefore, we hypothesize that thick palatal peri-implant mucosa may be associated with deeper pockets and disease severity. PURPOSE: To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease. METHODS: Adult, non-smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri-implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t-test; as well as between peri-implantitis and non-peri-implantitis sites (among patients). RESULTS: Sixty patients were included. Thirty-four implants were diagnosed with peri-implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p = 0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p = 0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p = 0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri-implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p = 0.001). Palatal thickness at peri-implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p = 0.000. Implant sites with palatal mucosa >4 mm (n = 32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n = 28) (4.48 ± 1.18, p = 0.018). CONCLUSION: Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri-implantitis.

Association between Smokeless Tobacco Use and Risk of Periodontitis in Asian Countries: A Systematic Review and Meta-Analysis.

BACKGROUND: Individual studies conducted in Asian countries have reported higher risk of periodontitis among smokeless tobacco (SLT) users in comparison to non-users. Therefore, a systematic review was conducted to summarize the available evidence on this topic. METHODS: Prominent electronic databases were searched using pre-decided MeSH terms and keywords. Screening of titles and abstracts, full text reading, quality assessment and data extraction was done by two investigators independently. The Newcastle-Ottawa scale was used for risk of bias assessment of eligible studies. Meta-analysis was performed for four periodontal outcomes (periodontal pocket depth, loss of attachment, clinical attachment level and gingival recession). A sensitivity analysis was also performed. RESULTS: Of the 546 citations, 367 were screened for eligibility. Finally, 89 studies were shortlisted for full text reading, of which, 36 were found eligible for qualitative analysis. Most of the studies were conducted in India (n=22), were of cross-sectional design (n=33), utilized purposive sampling and 24 studies were included for meta-analysis (n=28) and done on hospital-based population (n=26). Only 13 (37.1%) studies achieved a score of more than 50% (5/10 stars) on quality assessment scale. SLT users had higher odds of greater periodontal pocket depth greater than 4 mm (OR=3.64), gingival recession (OR=1.71) and loss of attachment 4-5 mm (OR=2.83) and mean difference of 1.7 mm for Clinical Attachment Level compared to non-users. CONCLUSION: The studies included in this review suggests that SLT users have poorer periodontal health in comparison to non-users. But most of this evidence comes from cross-sectional studies. Longitudinal studies with rigorous methodology are required to support this elucidation. Registration: This systematic review protocol has been registered in PROSPERO (CRD42019122964).

Bone and soft tissue outcomes, risk factors, and complications of implant-supported prostheses: 5-Years RCT with different abutment types and loading protocols.

BACKGROUND: Data on risk factors and complications after long-term implant treatment is limited. The aims were to evaluate the role of various fixation modes and to analyze complications and risks that affect long-term use of implant-supported partial fixed dental prostheses. MATERIALS AND METHODS: Fifty partially edentulous subjects received three Brånemark TiUnite™ implants. Superstructures were attached directly at implant level (IL) or via abutments: machined surface (AM) and an oxidized surface (AOX, TiUnite™). Implants were immediately loaded (test) or unloaded for 3 months (control). Examinations occurred over a 5-year period. RESULTS: Forty-four subjects were re-examined after 5 years. Cumulative survival rates in test and control groups were 93.9% and 97.0%, respectively. Marginal bone loss (MBL; Mean [SEM]) was significantly lower at superstructures connected to AM (1.61 [0.25] mm) than at sites with no abutment IL (2.14 [0.17] mm). Peri-implantitis occurred in 9.1% of subjects and in 4.0% of implants. Multiple linear regression indicated that increased probing pocket depth (PPD), periodontal disease experience, deteriorating health, and light smoking (≤10 cigarettes/day) predict greater MBL, whereas increased buccal soft tissue thickness and higher ISQ predict lower MBL. CONCLUSIONS: The results show that MBL was influenced by the connection type. A machined abutment, instead of connecting the superstructure directly at the implant level, was beneficial. The following factors influenced MBL: PPD, periodontal disease experience, deteriorating health, light smoking, buccal soft tissue thickness, and ISQ. The results on peri-implantitis underscore the need for long-term maintenance care. Further, the abutment material surface properties constitute additional target for strategies to minimize MBL.

Periodontal status of tooth adjacent to implant with peri-implantitis.

OBJECTIVES: To evaluate the relationship between peri-implantitis and the periodontal health of the adjacent tooth, the periodontal status of the teeth adjacent and contralateral to the implants with and without peri-implantitis. METHODS: Fifty-three subjects with existing dental implants and chronic periodontitis were examined in this cross-sectional study. Seventy implants were categorized into peri-implantitis (n = 42) and healthy/mucositis (n = 28) groups. The periodontal and peri-implant status, including probing depth (PD), clinical attachment level (CAL), and gingival recession (GR) were measured at 6 sites around the implants and the teeth adjacent and contralateral to those implants. In total 560 sites of the 70 teeth/implant sets, the association between the periodontal status at the near and away sites of the teeth (according to implant) and the implant status (without/with peri-implantitis) was examined. RESULTS: A significantly different mean PD (5.01 ±â€¯1.69, 4.42 ±â€¯1.8, 3.55 ±â€¯0.88, and 3.71 ±â€¯1.07 mm, p < 0.001) and CAL (6.02 ±â€¯2.36, 4.89 ±â€¯2.04, 4.35 ±â€¯1.11, and 4.35 ±â€¯1.5 mm, p < 0.001) were noted at the near sites of the teeth adjacent to the implants with peri-implantitis when compared with the away sites of adjacent and contralateral teeth and the near sites of contralateral teeth. With generalized estimating equation (GEE), the presence of peri-implantitis (ß â€¯= 1.041 mm, confidence interval = 0.646-1.435, and p < 0.001; ß â€¯= 0.857 mm, confidence interval = 0.279-1.434, and p < 0.004) and tooth location (ß â€¯= 0.65 mm, confidence interval = 0.4-0.9, and p < 0.001; ß â€¯= 0.682 mm, confidence interval = 0.34-1.024, and p < 0.001) were significantly associated with the values of the PD and CAL of the teeth. Moreover, the factor of examining sites (i.e. near and away sites of the tooth) was significantly associated with CAL (ß = 0.304 mm, confidence interval = 0.019-0.588, and p = 0.036) and GR (ß = 0.136 mm, confidence interval = 0.02-0.252, and p = 0.022). CONCLUSION: The existence of peri-implantitis, the tooth location, and the examining site are significantly associated with the periodontal measurements of the remaining teeth. CLINICAL SIGNIFICANCE: Peri-implant health is related to the periodontal health of the natural teeth close to the dental implant.

Discomfort/pain due to periodontal and peri-implant probing: Implant type and age.

AIM: There is evidence that patients experience more discomfort/pain after peri-implant probing than periodontal probing. However, there are several plausible factors to additionally influence this observation: e.g., implant type, age, smoking. Thus, this study was designed to compare discomfort/pain after periodontal and peri-implant probing in different implant types. METHODS: Two dentists recruited and examined 80 patients, each of them exhibiting a dental implant with a contralateral natural tooth. Only two types of implants were included. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether implant or tooth were measured first was randomly assigned. Immediately after probing patients scored discomfort/pain using a visual analogue scale (VAS). RESULTS: Eighty patients (median; lower/upper quartile: age 57; 47.5/65.5 years; 40 females, 11 smokers) were examined. With the exception of PPD and PAL at the deepest site as well as mean PPD (p < .05) clinical parameters (PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 9.0; 5.0/17.0) caused significantly (p = .038) more discomfort/pain than periodontal probing (5.5; 2.0/13.5). This was confirmed by repeated measures analysis of variance adjusting for several factors (p = .011). CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing.

[Consequences of impacted wisdom teeth extraction on the periodontal environment of second molars. A pilot study]. / Conséquences de l'avulsion des dents de sagesse incluses sur l'environnement parodontal des deuxièmes molaires. Une étude pilote.

INTRODUCTION: Wisdom teeth extraction is a common procedure, generally considered as safe by patients. However, complications are possible, especially periodontal ones. The aim of this study was to evaluate the frequency and the consequences of periodontal complications at the level the 2nd molars after extraction of the wisdom teeth. MATERIAL AND METHODS: A single-center retrospective observational multi-operator study was conducted at the university hospital of Besançon - France. The files of all the adult patients who underwent extraction of four impacted wisdom teeth by mean of a standardized surgical technique between November 2012 and November 2014 and who could be followed 1 year postoperatively at least and that precisely mentioned the periodontal status of the surgical sites were included. Postoperative complications, gingival and plaque indexes according to Loë and Silness, periodontal attachment level and periodontal second molar probing were recorded. The main judgment criterion was the occurrence of a periodontal complication in the second molar areas. RESULTS: The files of 20 patients (15 women - 5 men), operated on by five different surgeons, met the inclusion criteria. Two patients suffered from dry socket at one of the avulsion sites. No patient had a gingival or plaque index greater than 2. No gingival recession or periodontal pocket over 4mm was found. DISCUSSION: Extraction of impacted third molars in young healthy adults didn't have any impact on the second molars periodontal environment in our study. Literature suggests that surgical technique greatly influences the occurrence and the extent of periodontal sequelae.

Peri-implant bleeding on probing: a cross-sectional multilevel analysis of associated factors.

OBJECTIVES: The objective was to evaluate the association between peri-implant bleeding on probing (BoP) and probing depth. Other factors regarding patients, implants, and sites were taken into consideration. MATERIAL AND METHODS: Consecutive adult patients with ≥1 dental implant were eligible. Two calibrated operators examined the patients. BoP was the outcome variable. The effects of patient, implant and site factors on BoP were assessed using a 3-level logistic model. RESULTS: Fifty-two patients for a total of 92 implants and 552 sites were included in the analysis. The BoP was observed in 217 sites (39%). The odds ratio increased by 1.81 (95% CI from 1.47 to 2.23; P < 0.0001) for each 1 mm increment in probing pocket depth. A significant higher risk was observed also for interproximal vs. approximal surfaces (OR = 1.55; 95% CI from 1.02 to 2.36; P = 0.0402). CONCLUSIONS: Peri-implant bleeding was associated with site-specific factors.

[The relationship of molecular genetic markers with clinical signs and risk factors of periodontitis]. / Vzaimosvyaz' molekulyarno-geneticheskikh markerov s klinicheskimi priznakami i faktorami riska razvitiya parodontita.

The study revealed positive correlation between bleeding on probing and teeth loss risk with periodontal hypercolonization by Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola. Pathological tooth mobility was associated with hypercolonization by P. intermedia and Tannerella forsythensis. Expression of IL8, TNF-α, MMP8 and MMP9 genes was also assessed in patient groups divided according to the depth of periodontal pockets and-the severity of chronic periodontitis revealing IL8 as positive diagnostic marker.

Chronic periodontitis and smoking. Prevalence and dose-response relationship.

OBJECTIVES: To determine the prevalence and dose-response relationship of chronic periodontitis among smokers in Pakistan. METHODS:   This is a cross-sectional study among participants seeking dental care in Karachi Medical and Dental College, Karachi, Pakistan. A total of 443 participants with a mean age of 44.3 (±6.5) participated in the study from April 2011 to December 2011. Males comprised 64.7%, and females comprised 35.2%. Participants were interviewed on social demographics and oral habits. Participants with shallow pockets (3.5-5.5 mm) and deep pockets (greater than 5.5 mm) were considered suffering from chronic periodontitis. The characteristics of participants were assessed using frequency distribution for categorical variables and mean (standard deviation) for continuous variables.  RESULTS: Among 443 participants, smokers were distributed as 55.1% and non-smokers as 44.9%. Smoking was found to be significantly related to young adults (p less than 0.007), male gender (p less than 0.001), and lower education level (p less than 0.01). Overall prevalence of chronic periodontitis among smokers was estimated at 81.6%. Heavy smoking was found to have significantly high prevalence (p less than 0.001) and severity (p less than 0.001) of periodontitis as compared with moderate and light smokers. The multivariate unadjusted model depicted 3.5 times higher risk of chronic periodontitis among smokers (p less than 0.001). CONCLUSION: Chronic periodontitis had a high prevalence among smokers. Heavy smoking was found to have a higher risk for having periodontitis.

Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Inflammatory collateral cyst associated with a palatoradicular groove: report of a case and discussion of nomenclature.

The aims of this article are to present a case demonstrating the connection between palatoradicular grooves and inflammatory collateral cysts and to discuss the related nomenclature. Radiographs in a 21-year-old man revealed a radiolucent, unilocular, well-defined area near the vital maxillary right lateral incisor and canine. Palatal swelling was present, and a 6-mm-deep periodontal pocket was found at the palatal surface of the right lateral incisor. The differential diagnoses were keratocystic odontogenic tumor, developmental lateral periodontal cyst, and inflammatory lateral periodontal cyst. The area was explored surgically, and the lesion was excised. Surgical exploration revealed a palatoradicular groove, which was scaled and planed with the aid of manual curettes with the intention of creating a flat surface to promote insertion of the periodontal fibers. Histopathologic analysis revealed that the lesion was an inflammatory cyst. The presence of a palatoradicular groove can put the periodontium at risk because a resulting lack of fiber insertion makes oral hygiene difficult. This established inflammatory process can initiate development of an inflammatory collateral cyst that may be misdiagnosed, hindering successful management. In this case, bone grafting and placement of a resorbable membrane were used to promote bone formation and subsequent sealing of the periodontal space.

Metabolic Syndrome and Periodontal Disease Progression in Men.

Metabolic syndrome, a cluster of 3 or more risk factors for cardiovascular disease, is associated with periodontal disease, but few studies have been prospective in design. This study's aim was to determine whether metabolic syndrome predicts tooth loss and worsening of periodontal disease in a cohort of 760 men in the Department of Veterans Affairs Dental Longitudinal Study and Normative Aging Study who were followed up to 33 y from 1981 to 2013. Systolic and diastolic blood pressures were measured with a standard mercury sphygmomanometer. Waist circumference was measured in units of 0.1 cm following a normal expiration. Fasting blood samples were measured in duplicate for glucose, triglyceride, and high-density lipoprotein. Calibrated periodontists served as dental examiners. Periodontal outcome events on each tooth were defined as progression to predefined threshold levels of probing pocket depth (≥5 mm), clinical attachment loss (≥5 mm), mobility (≥0.5 mm), and alveolar bone loss (≥40% of the distance from the cementoenamel junction to the root apex, on radiographs). Hazards ratios (95% confidence intervals) of tooth loss or a periodontitis event were estimated from tooth-level extended Cox proportional hazards regression models that accounted for clustering of teeth within individuals and used time-dependent status of metabolic syndrome. Covariates included age, education, smoking status, plaque level, and initial level of the appropriate periodontal disease measure. Metabolic syndrome as defined by the International Diabetes Federation increased the hazards of tooth loss (1.39; 1.08 to 1.79), pocket depth ≥5 mm (1.37; 1.14 to 1.65), clinical attachment loss ≥5 mm (1.19; 1.00 to 1.41), alveolar bone loss ≥40% (1.25; 1.00 to 1.56), and tooth mobility ≥0.5 mm (1.43; 1.07 to 1.89). The number of positive metabolic syndrome conditions was also associated with each of these outcomes. These findings suggest that the metabolic disturbances that comprise the metabolic syndrome may play a role in the development or worsening of periodontitis.

Evaluation of corticotomy-facilitated orthodontics and piezocision in rapid canine retraction.

INTRODUCTION: The purpose of this study was to evaluate the efficiency of corticotomy-facilitated orthodontics and piezocision in rapid canine retraction. METHODS: The sample consisted of 20 patients (15-25 years old) with Class II Division 1 malocclusions. The suggested treatment plan was extraction of the maxillary first premolars with subsequent canine retraction. The sample was divided into 2 equal groups. In the first group, 1 side of the maxillary arch was randomly chosen for treatment with corticotomy, and in the second group, piezocision treatment was used. The contralateral sides of both groups served as the controls. Cuts and perforations were performed with a piezotome, and canine retraction was initiated bilaterally in both groups with closed-coil nickel-titanium springs that applied 150 g of force on each side. The following variables were examined over a 3-month follow-up period: rate of canine crown tip, molar anchorage loss, canine rotation, canine inclination, canine root resorption, plaque index, gingival index, probing depth, attachment level, and gingival recession. The rate of canine crown tip was assessed every 2 weeks after the start of canine retraction at 6 time points. RESULTS: The rates of canine crown tip were greater in the experimental sides than in the control sides in both groups. Corticotomies produced greater rates of canine movement than did piezocision at 4 time points. Canine root resorption was greater in the control sides. The remaining studied variables exhibited no differences between the control and the experimental sides. CONCLUSIONS: Corticotomy-facilitated orthodontics and piezocision are efficient treatment modalities for accelerating canine retraction.

Erosive esophageal reflux vs. non erosive esophageal reflux: oral findings in 71 patients.

BACKGROUND: The purpose of this clinical study was to assess the prevalence of acidic oral mucosal lesions and periodontal conditions in patients suffering from erosive esophageal reflux disease (ERD) compared with non erosive esophageal reflux disease (NERD) patients, both treated with long term proton pump inhibitors (PPI). METHODS: Seventy-one patients with diagnosed GERD were studied: i.e. 29 ERD and 42 NERD patients. Thorough visual examination of the oral mucosa and a periodontal evaluation was performed. The primary outcome was defined as a statistically significant difference, between the two groups, in the presence of acidic lesions of the oral mucosa and specific periodontal parameters. RESULTS: This study failed to demonstrate statistically significant differences between ERD and NERD patients with respect to the prevalence of oral mucosal lesions. However, significantly more ERD patients suffered from severe periodontitis (CAL ≥ 5 mm) as compared to NERD patients. Accordingly, it may be assumed that PPI-use had no adverse effects on the prevalence of acidic oral mucosal lesions and on periodontal destruction. CONCLUSIONS: Within the limitations of this study it may be concluded that ERD and NERD patients need separate evaluation with respect to periodontal destruction. Moreover, long term PPI medication had no adverse clinical impact on acidic oral mucosal lesions and periodontal destruction. Further studies are necessary to elucidate the role of reflux in the periodontal destruction of ERD individuals.

Clinical evaluation of the oral health status in vascular-type dementia patients. A case-control study.

AIM: The aim of this study was to evaluate the oral health status in patients with vascular dementia (VaD). Moreover, the association of the disease severity and the patients' cognitive and functional impairment with the oral findings have been recorded. METHODS: The study was directed on the study group (86 VaD patients) and the control group (82 healthy volunteers of the same age) from the IRCSS Neurolesi Bonino-Pulejo in Messina, Italy. Cognitive status was evaluated with the MMSE scoring system. Oral parameters, such as decaying, missing, filled teeth (DMFT) index, plaque index (PI), periodontal probing depth (PPD) and bleeding on probing (BOP) were evaluated in all patients. Denture condition and denture-induced stomatitis were also analysed. The frequency of untreated caries, periodontal diseases and missing teeth of the Study Group was significantly higher than in Control Group. RESULTS: Particularly, VaD patients presented higher number of decayed teeth and deeper periodontal pockets. Decreased cognitive functions in VaD patients have been demonstrated to result in a decline of denture care and increased denture-related mucosal lesions. CONCLUSION: These results underlined that clinicians should direct high attention to oral hygiene of patients with VaD in order to prevent the evolution of those pathologic dental and periodontal conditions, especially in patients with decreased cognitive functions.

Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery?

PURPOSE: To assess the influence of the surgical removal of partially impacted third molars (3Ms) and compare the effects of a 3-cornered laterally rotated flap (LRF) with primary closure (flap 1) and an envelope flap with secondary closure (flap 2) on the short-term periodontal status of the adjacent second molars (2Ms). We also assessed the postoperative complications after removal of the partially impacted 3M. MATERIALS AND METHODS: A split mouth, randomized clinical study was designed. The study sample included patients with bilateral partially impacted 3Ms. The primary predictor variable was the type of flap design (flaps 1 and 2). The primary outcome variable was periodontal status (gingival recession [GR], probing depth [PD], plaque index [PI], and gingival index) of the 2Ms measured preoperatively and 90 days postoperatively. The secondary outcome variables were postoperative complications, including pain, facial swelling, alveolitis, and local wound infection. The other variables included gender, position of the 3Ms, and surgical difficulty. We performed descriptive, comparative, correlation, and multivariate analyses. RESULTS: The sample included 28 patients aged 18 to 28 years. The GR, PD, and PI values with the flap 2 design were greater than those with the flap 1 design (P < .05). Facial swelling with the flap 1 design was significantly greater than with the flap 2 design on the second postoperative day (P < .05). The pain levels with the flap 1 design were significantly greater than those with the flap 2 design on the first and second postoperative days (P < .05). According to the multivariate regression analyses, flap design was closely related to the periodontal status of the 2Ms and postoperative discomfort. CONCLUSION: The results of the present clinical study have shown that the flap design in partially impacted 3M surgery considerably influences the early periodontal health of the 2Ms and postoperative discomfort. However, although the 3-cornered LRF design might cause more pain and swelling, it could be the method of choice for partially impacted 3M surgery because of the early periodontal healing.

Grafting after sinus lift with anorganic bovine bone alone compared with 50:50 anorganic bovine bone and autologous bone: results of a pilot randomised trial at one year.

Our aim was to compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone grafts compared with those augmented with mixed 50:50 bovine and autologous bone grafts. Twenty sinuses with 1-4mm of residual crestal height below the maxillary sinuses were randomised into two groups according to a parallel group design (n=10 in each). Sinuses were grafted using a lateral approach. In one group the grafts were 50:50 anorganic bovine bone and autologous bone and in the other anorganic bovine bone alone. After 7 months, 32 implants had been inserted. Outcome measures were survival of implants, complications, marginal changes in the height of the bone, and soft tissue variables (pocket probing depth and bleeding on probing). Probabilities of less than 0.05 were accepted as significant. No patient failed to complete the trial and no implant had failed at 1 year. There were some minor complications. After 12 months, the mean (SD) marginal bone loss (mm) was 1.06 (0.61) in the 50:50 group and 1.19 (0.53) in the anorganic bovine group. The mean (SD) values for pocket probing depth (mm) and bleeding on probing (score) were 2.49 (0.38) and 1.59 (0.82) in the 50:50 group and 2.31 (0.64) and 1.36 (0.87) in the anorganic bovine group (neither difference was significant). The present data are consistent with the hypothesis that the outcome of implants inserted in sinuses grafted with either material is comparable.

Evaluation of treatment outcome after impacted mandibular third molar surgery with the use of autologous platelet-rich fibrin: a randomized controlled clinical study.

PURPOSE: To assess the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus, periodontal healing on the distal aspect of the second molar, and progress of bone regeneration in mandibular third molar extraction sockets. MATERIALS AND METHODS: Over a 2-year period, 31 patients (mean age, 26.1 yr) who required surgical extraction of a single impacted third molar and met the inclusion criteria were recruited. After surgical extraction of the third molar, only primary closure was performed in the control group, whereas PRF was placed in the socket followed by primary closure in the case group (16 patients). The outcome variables were pain, swelling, maximum mouth opening, periodontal pocket depth, and bone formation, with a follow-up period of 3 months. Quantitative data are presented as mean. Statistical significance was inferred at a P value less than .05. RESULTS: Pain (P = .017), swelling (P = .022), and interincisal distance (P = .040) were less in the case group compared with the control group on the first postoperative day. Periodontal pocket depth decreased at 3 months postoperatively in the case (P < .001) and control (P = .014) groups, and this decrease was statistically significant. Bone density scores at 3 months postoperatively were higher in the case group than in the control group, but this difference was not statistically important. CONCLUSIONS: The application of PRF lessens the severity of immediate postoperative sequelae, decreases preoperative pocket depth, and hastens bone formation.

[Association between periodontal pockets and health-related behaviors of workers].

OBJECTIVE: Periodontal disease is a chronic disease caused by bacterial infection, and frequently develops in adulthood. As the disease is closely related to lifestyle, it is important to clarify its relationship with health-related behaviors to provide effective health instructions targeting its prevention. In this study, we focused on periodontal pockets with advanced periodontal disease to clarify the health-related behaviors associated with the presence or absence of periodontal pockets. METHODS: The subjects were 3,142 employees (male: N=2,429, female: N=713; 42.4 ± 10.5 years, Range 20-59 years) of one company, which had provided all employees with an oral health program in 2002. Participants with a Community Periodontal Index code of ≤2 and ≥3 were classified as those without and with periodontal pockets, respectively. To clarify the health-related behaviors associated with the presence or absence of periodontal pockets, we conducted multivariate logistic regression analysis, with presence/absence of periodontal pockets as the dependent variable, and items of health-related behavior investigated in 2002 as independent variables, and calculated the odds ratios (OR) and 95% confidence intervals (95%CI) adjusted for sex, age group and occupation. RESULTS: The factor most strongly correlated with the presence of periodontal pockets was non-use of dental floss (OR=1.95 (95%CI: 1.57-2.41)), followed by smoking (OR=1.71 (95%CI: 1.44-2.03)), and tooth-brushing habits (≤once a day: OR=1.33 (95%CI: 1.10-1.61)). CONCLUSIONS: Our results suggest that, to promote oral health program at the worksite, it is important to provide health education and instructions to encourage the use of dental floss, a daily tooth-brushing habit, and smoking cessation.