Clinical comparison of instrumentation systems for periodontal debridement: A randomized clinical trial.

OBJECTIVE: To compare clinical efficacy, chairside time and post-treatment hypersensitivity of four instruments used for subgingival periodontal debridement. MATERIALS & METHODS: Seventeen patients with stage II and III periodontitis were enrolled in this randomized clinical trial using a split-mouth design. Quadrants were randomly divided into four treatment groups: Group A: Gracey curettes-Hu-Friedy® ; Group B: piezoelectric ultrasonic (Satelec® ) with No.1S insert; Group C: diamond burs 40 µm (Intensiv Perioset® ); and Group D: piezosurgery ultrasonic (Mectron® ) with PP1 insert. Clinical outcomes, chairside time and hypersensitivity were assessed at 1, 2, 4 and 8 weeks after treatment. The primary outcome variable was improvement in clinical attachment level. RESULTS: At 8 weeks post-treatment, Gracey curettes, piezoelectric ultrasonic (Satelec® ) and piezosurgery ultrasonic (Mectron® ) were statistically more effective than diamond burs in increasing attachment level and reducing probing pocket depth. Comparison of piezoelectric ultrasonic (Satelec® ) and piezosurgery ultrasonic (Mectron® ) with the other instruments showed a statistical difference (p < 0.001) in chairside time. Regarding post-treatment hypersensitivity, no statistical differences were observed in any of the groups. CONCLUSIONS: Gracey curettes, piezoelectric ultrasonic (Satelec® ) and piezosurgery ultrasonic (Mectron® ) were clinically more effective than diamond burs 40 µm. The ultrasonic instruments showed a significant reduction in chairside time.

Vancomycin and tobramycin impregnated mineralized allograft for the surgical regenerative treatment of peri-implantitis: a 1-year follow-up case series.

OBJECTIVES: To assess the clinical and radiographic outcomes of the regenerative treatment of peri-implantitis using a vancomycin and tobramycin impregnated allograft (VTA) after a 12-month period. MATERIAL AND METHODS: Thirteen consecutive patients who required a regenerative treatment of peri-implantitis were recruited. For the 17 implant sites, a flap was raised, and after mechanical and chemical implant decontamination, a vancomycin and tobramycin impregnated allograft was placed in the defect and then covered with a collagen membrane. Soft tissues were sutured allowing a non-submerged healing. Clinical and radiographic variables were evaluated at baseline and at 12 months after treatment. RESULTS: No signs of continuous bone loss were observed and no implant was lost, yielding a 100% survival rate. All patient's clinical examination at 12 months revealed peri-implant health showing absence of suppuration and a statistically significant reduction in terms of bleeding on probing scores (70.6%, P = 0.001). Initial probing pocket depth (7.88 ± 1.22 mm) was significantly reduced at 12 months healing, a mean reduction of 4.23 ± 1.47 mm (P = 0.001) was achieved. The mean radiological infrabony defect at baseline reached 4.33 ± 1.62 mm, and was significantly reduced up to 0.56 ± 0.88 mm, which represents an 86.99 ± 18.2% bone fill from the original infrabony defect. CONCLUSIONS: Within the limits of the study, the application of VTA with a collagen membrane yielded positive outcomes in terms of radiographic bone fill, pocket depth reduction, and attachment gain after a 12-month period. Thus, VTA plus a collagen membrane seem to be suitable for the regenerative treatment of peri-implantitis. CLINICAL RELEVANCE: The use of locally delivered antibiotic together with the bone graft may reduce the undesirable effects related to the systemic administration and the risk of resistances. In the light of the results obtained, these grafting materials might offer new treatment strategies in the surgical regenerative treatment of peri-implantitis.

Social disparities in breast and cervical cancer preventive practices.

Knowledge of factors related to the use of preventive practices is essential in order to build strategies to decrease cancer incidence and mortality. The aim of this study is to describe the characteristics of women who periodically use cervical smear and mammography. This is a cross-sectional study based on the 2001 Balearic Health Survey, using a stratified sample of non-institutionalized population resident in the Balearic Islands. The study included 560 women, aged 20 years or over. The variables studied were age, marital status, social class, education, place of residence and birth, self-perceived health status, satisfaction with health services, job status and type of medical coverage. A multivariate analysis was performed using logistic regression models. Thirty-five per cent had regular mammography (72% between 50 and 64 years) and 54% had cervical smears. The probability of having undergone mammography is higher in women between the ages of 50 and 64 years [odds ratio (OR)=11.74; interval confidence (IC): 5.89-23.39] and in those with additional medical coverage (OR=1.97; IC: 1.19-3.27) and much lower in single women (OR=0.22; IC: 0.10-0.49). The probability of having undergone a Pap test increases according to educational level (OR=2.25; IC: 0.98-5.18 for women in the higher level) and social class (OR=1.98; IC: 0.91-4.28 for social class I) and decreases in women older than 65 years (OR=0.15; IC: 0.07-0.35) and in single women (OR=0.29; IC: 0.16-0.50). Age and marital status are factors related to both practices. Socio-economic status remains associated with cervical smear use, while having an additional medical coverage increases the probability of regular mammography.