Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment.

AIM: This retrospective longitudinal study assessed the risk of and prognostic factors for tooth loss in patients with generalized aggressive periodontitis (GAgP) after periodontal treatment in a university setting. METHODS: Fifty-seven patients (1,505 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after 17.4 ± 4.8 [range: 9-28] years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox-proportional-hazards shared-frailty model were applied. RESULTS: Overall, 98 and 134 teeth were lost during APT and SPT, respectively, with 0.14 ± 0.18 teeth being lost per patient and year. During SPT, three patients (5%) lost ≥10 teeth, 14 (25%) lost 4-9 teeth, 40 lost 0-3 (70%) teeth, respectively. One-third (n = 19) of all patients lost no teeth. Mean PPD of the teeth surviving SPT was stable from T1 (3.5 ± 1.1 mm) to T2 (3.4 ± 1.1 mm). Nearly, 84% of all survived teeth showed stable or improved bone level at T2. Risk of tooth loss was significantly increased in active smokers (HR[95% CI]: 4.94[1.91/12.75]), the upper dental arch (1.94[1,16/3.25]), with each mm of residual PPD (1.41[1.29/1.53]), teeth with furcation involvement (FI) (HR 4.00-4.44 for different degrees) and mobility (5.39 [2.06/14.1] for degree III). CONCLUSION: Within the provided conservative treatment regimen, GAgP patients lost only few teeth.

Congenitally missing maxillary lateral incisors: Long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion.

INTRODUCTION: The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD). METHODS: This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at 6 locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD. RESULTS: The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the 2 groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients. CONCLUSIONS: Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.

[An 18 month evaluation of MM-MTA pulpotomy on primary decayed molars]. / Evaluation sur 18 mois de la pulpotomie au MM-MTA sur des molaires temporaires cariées.

Pulpotomy is the most performed and controversial therapeutic in pediatric dentistry. Formocresol is known to have a toxic effect on living tissues, a mutagenic and carcinogenic potential with a systemic uptake of formocresol via pulpotomized teeth, other alternative products have been investigated. 40 molars were pulpotomized using Micro Mega Mineral Trioxide Aggregate (MM-MTA), which eliminates the need for the use of formocresol. The effects of this material were evaluated both clinically and radiographically. Post-operative control examinations were performed at 1, 6, 12, and 18 months trying to detect spontaneous or stimulated pain, pathological tooth mobility, abscesses or fistulas, internal or external pathological tooth resorption, periapical bone destruction, or canal obliteration. Pain was absent at 18 months post operatively. Thirty six molar treated with the MM-MTA didn't show any mobility or pain, one molar presented a pathological resorption and one molar presented an abscess without a fistula at 12 month. The observations were compared to others related to formocresol, ferric sulfate, MTA, and laser pulpotomies, using the Chi-square test x2. The abundance of positive result strongly demonstrate that the MM-MTA pulpotomy on carious temporary molars is a promising technique.

Clinical performance and satisfaction of removable prostheses with self-adjusting magnetic attachments.

STATEMENT OF PROBLEM: Conventional magnetic attachments have rigid assemblies and are unable to compensate for the movement of the prosthesis under function, which may result in the deepening of periodontal pockets and an increase in the mobility of abutment teeth. PURPOSE: The purpose of this study was to evaluate the clinical performance and satisfaction of participants with removable prostheses with self-adjusting magnetic attachments that allow vertical and rotational movement. MATERIAL AND METHODS: The clinical performance of 17 prostheses with 22 self-adjusting magnetic attachments in 16 participants was analyzed for a mean of 3.1 years. Periodontal indices, including probing pocket depth and tooth mobility, were measured at denture placement (baseline) and from 0.5 to 5 years after insertion. Control data were obtained from the remaining teeth, which were restored by resin or metal coping. Prosthetic parameters, including the reduction of retention in self-adjusting magnetic attachments, reline, or fracture of dentures, were also recorded. A visual analog scale questionnaire on participant satisfaction with stability, comfort, and cleaning of the prostheses was completed. The Wilcoxon signed rank test and 1-way analysis of variance (α=.05) were performed on data collected at the time of prostheses placement and final follow-up evaluation. RESULTS: No significant differences were found in terms of probing pocket depth and tooth mobility between the baseline and postinsertion data for self-adjusting magnetic attachments and control teeth. Retention in all prostheses was stable, without reduction. Higher visual analog scale scores for "easy cleaning" were noted. CONCLUSIONS: No significant difference between baseline and postinsertion was noted regarding the periodontal condition of self-adjusting magnetic attachments and control teeth with resin or metal coping materials.

Do dentists have better oral health compared to general population: a study on oral health status and oral health behavior in Kathmandu, Nepal.

BACKGROUND: Dentists are considered role models by the general population in regards to oral hygiene and oral health behavior. This study aimed to access the oral health status of dentists and laypersons, and compare the dentists' practice of preventive dentistry and oral self-care behaviors to that of the laypersons. METHODS: This cross-sectional study recruited 472 participants (195 dentists and 277 laypersons from the general population). Their oral health/hygiene behavior was assessed using a standardized close-ended multiple choice questionnaire. Oral examination was performed to assess caries using Decayed Missed Filled teeth (DMFT) index and periodontal status using Community Periodontal Index of Treatment Needs (CPITN). RESULTS: Ninety-six percent of dentists brushed their teeth at least once daily, using fluoridated toothpaste and 80.5% twice daily. Although 94% of laypersons brushed their teeth once daily, they seldom used fluoridated toothpaste. Ten percent of participants in each group were caries free. The mean number of teeth present in the oral cavity (27.4 versus 25.4), mean number of teeth with caries (1.8 versus 3.7) and fillings (2.5 versus 0.4) were significantly different (p < 0.0001) between dentists and laypersons, respectively. Regarding the periodontal status, 82% of dentists had CPITN score of 0 whereas 71% of laypersons had the highest score 3 (p = 0.007), and 81% of the laypersons reported tooth mobility compared to 1% of dentists (p < 0.0001). CONCLUSIONS: The participating dentists had better periodontal status and better self-reported oral health behaviors than the laypersons. Despite similar prevalence of caries in the two groups, the prevalence of decayed and unfilled teeth was lower among the dentists.

Glycohemoglobin levels with severity of periodontitis in non-diabetic population.

BACKGROUND: Periodontal disease is closely related to type 2 diabetes and is an important complication of diabetes. There are few studies about the relationship the glycohemoglobin levels with severity of periodontitis in non-diabetic population. We therefore planned this study to evaluate the glycohemoglobin levels with severity of periodontitis in non-diabetic population. METHODS: This study was conducted on 50 age and gender matched subjects in each of the three groups (according to the grades of mobility in periodontitis), a total of 150 non-diabetic periodontitis patients (Grade 1, Grade 2, and Grade 3 mobility) and 50 non-diabetic periodontitis patients with Grade 0 mobility (controls), in collaboration with the Department of Periodontics of Dental College and Department of Biochemistry, PGIMS, Rohtak, Haryana. After obtaining informed consent, fasting venous blood samples of all the non-diabetic periodontitis patients of all grades were collected aseptically for HbA1c, plasma glucose, and serum C-reactive protein (CRP) estimation. RESULTS: A total of 150 non-diabetic periodontitis patients (Grade 1, Grade 2, and Grade 3 mobility) and 50 age and gender matched controls participated in the study. There was no significant difference in fasting plasma glucose and postprandial plasma glucose in non-diabetic periodontitis patients with Grade 1, Grade 2, and Grade 3 mobility as compared to controls, non-diabetic periodontitis patients with Grade 1 mobility as compared to Grade 2, non-diabetic periodontitis patients with Grade 1 mobility as compared to Grade 3 and non-diabetic periodontitis patients with Grade 2 mobility as compared to Grade 3. Glycohemoglobin and serum C-reactive protein levels were significantly increased in non-diabetic periodontitis patients with Grade 1, Grade 2, and Grade 3 mobility as compared to controls, non-diabetic periodontitis patients with Grade 1 mobility as compared to Grade 3 and non-diabetic periodontitis patients with Grade 2 mobility as compared to Grade 3. The difference of serum C-reactive protein levels were significant. However, glycohemoglobin levels were non-significant between non-diabetic periodontitis patients with Grade 1 and Grade 2 mobility. CONCLUSIONS: The evidence of association between periodontitis and increased glycohemoglobin increases attention to the diagnosis and treatment of periodontitis, consequently improving the patient's oral health and prevention of occurrence in future diabetes. An understanding of these correlations is important to allow dental health care providers to inform patients with periodontitis of their increased risks and to counsel such patients to seek additional medical assessment or intervention as indicated.

Survival and success rates of autotransplanted premolars: a prospective study of the protocol for developing teeth.

INTRODUCTION: The aim of this prospective clinical trial was to examine the predictability of the protocol for premolar transplantation when applied by an inexperienced surgeon. Additional objectives were to examine the hard and soft tissues and to compare the findings with control premolars and also to record the patients' opinions of the treatment provided. METHODS: The sample comprised 23 consecutively transplanted developing premolars in 19 patients. Their mean age at surgery was 12 years 8 months (range, 9 years 10 months-17 years). The mean observation time was 35 months (range, 6-78 months). Plaque accumulation, pocket depth, gingival recession, mobility, and pulp sensitivity were recorded for the transplanted and the control teeth. Standardized radiographs were used to examine hard tissues and crown-to-root ratios. Questionnaires were used to register each patient's opinion about the treatment and its outcome. RESULTS: The survival rate was 100%, and the success rate was 91.3%. No significant differences were recorded between transplanted and control teeth. The patients' perceptions of the surgical management and the treatment outcome were favorable. CONCLUSIONS: The protocol for autotransplantation of developing premolars in growing patients was successfully adopted, regardless of lack of previous experience with this type of treatment.

Periodontal conditions in patients with Marfan syndrome - a multicenter case control study.

BACKGROUND: Marfan syndrome (MFS) is a disorder of the connective tissues. Alterations of the elastic fibers may manifest in different tissues especially in the skeletal, cardiovascular and ocular system. Oral manifestations like orthodontic or skeletal anomalies and fragility of the temporomandibular joint have been well described by various authors. However, no data are available regarding a possible periodontal involvement of MFS. Hence, the aim of the present study was to investigate for the first time if MFS may increase the susceptibility to periodontitis. METHODS: A comprehensive periodontal examination including documentation of probing pocket depth, gingival recession, clinical attachment level, and bleeding on probing was conducted in all patients. In addition, dental conditions were assessed by determining the Index for Decayed, Missing and Filled Teeth (DMFT) and a self-administered questionnaire was filled out by patients. For statistical analysis, the unpaired t-Test was applied (level of significance: p < 0.05). Both groups were matched concerning well known periodontal risk factors like age, gender and smoking habits. RESULTS: 82 participants, 51 patients with MFS (30 female and 21 male, mean age: 40.20 ± 15.35 years) and 31 sound controls (17 female and 14 male, mean age: 40.29 ± 13.94 years), were examined. All assessed periodontal and dental parameters were not significantly different between groups. CONCLUSIONS: Based on our data, patients with MFS did not reveal a higher prevalence of periodontitis compared to the control group. However, Marfan patients showed a tendency to more inflammation signs, which can be explained by the crowded teeth. Therefore, a regular professional cleaning of the teeth is recommendable (i.e., 6 months intervals) in order to reduce the bacterial biofilm in the oral cavity and thus resulting in a decreased risk of systemic diseases, specifically endocarditis.

Closure of the alveolar cleft by bone segment transport using an intraoral tooth-borne custom-made distraction device.

PURPOSE: The fact that bone transportation generates not only bone but also surrounding soft tissues makes it an ideal technique for tissue regeneration. This study evaluates bone segment transport using an intraoral tooth-borne distraction device for alveolar cleft closure. MATERIALS AND METHODS: Patients with an alveolar cleft were enrolled in the study. They were treated at the Al-Azhar University Hospital, Cairo, Egypt, between 2004 and 2007. Anterior transportation of the posterior dentoalveolar segment was performed by use of an intraoral tooth-borne custom-made distractor. Clinical evaluations included the following: preoperative and postoperative intraoral photographs, vitality testing of the teeth in the transport segment, cast analysis, and measurement of tooth mobility. Radiographic evaluations included occlusal films, orthopantomography, and computed tomography and 3D computed tomography for volumetric and densitometric evaluations of the distracted bone. RESULTS: After distraction was completed, the transported segments were positioned 1 to 4 mm superior to the occlusal plane. The radiographic evaluation showed residual triangular bone deficits that were closed through gingivoperiosteoplasty or bone grafting. Once the transported segments came in contact with the alveolar bone of the normal side, the intervening fibrous tissue at the docking site was removed, and docking-site surgery was then performed. The results obtained from both clinical examinations and radiographic imaging showed complete closure of the alveolar clefts. CONCLUSIONS: Maxillary alveolar bone transport offers an alternative technique in the latest treatment of the alveolar cleft.

Retrospective long-term evaluation of autotransplantation of premolars to the central incisor region.

AIM: This retrospective case-series study aimed to examine the long-term outcomes of autogenously transplanted premolars. METHODOLOGY: Twelve patients in whom donor premolars were used to replace maxillary central incisors lost by trauma were clinically and radiologically monitored. Standardized clinical and radiographic records were systematically obtained during the follow-up period of 14 years, to determine the influence of specific clinical criteria on the overall success rate of transplantation. RESULTS: The success rate of premolar autotransplantation in the maxillary central incisor area was 80% after 14 years follow-up. The highest success rate occurred in those teeth transplanted with two-thirds of full root development. Complete pulp obliteration was positively related to autotransplant viability, followed by root formation in the bony crypt. CONCLUSIONS: Autotransplantation of donor teeth, at the stage of ½ to ¾ of their expected root length, can provide a successful treatment solution for over 14 years.

Periodontal disease in gestational and type 1 diabetes mellitus pregnant women.

OBJECTIVE: The present study evaluated the relationship between periodontal disease and its clinical variables in Brazilian non-diabetic pregnant women (C), gestational diabetes mellitus (GDM), or type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS: A periodontal exam was performed in one hundred and sixty-one pregnant women (GDM:80; T1DM:31; C:50) by a single-blinded calibrated examiner who recorded plaque index (PI), gingival index (GI), bleeding index (BI), gingival margin location (GM), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and tooth mobility index (MI). The medical variables were age, pregestational body mass index (pre-BMI), fasting plasma glucose (FPG), and glycated hemoglobin (HbA(1c) ). RESULTS: The GI, GM, PD, CAL, BOP, and MI were significantly higher (P < 0.01) among GDM and T1DM than for C. The PI was higher in GDM and similar between C and T1DM. The Adjusted Final Model for medical variables to evaluate the effects of groups on periodontal parameters confirmed these results. CONCLUSIONS: The presence of periodontal disease was significantly higher in Brazilian diabetic pregnancies (GDM and T1DM) when compared to non-diabetic pregnant women (C). The degree of periodontal disease was similar between the GDM and T1DM groups. Age, pregestational BMI, and HbA(1c) were factors related to CAL development in these two types of diabetes mellitus.

Correlation of levels of interleukin-1ß in gingival crevicular fluid to the clinical parameters of chronic periodontitis.

BACKGROUND AND OBJECTIVES: IL-1ß is a potent stimulator of bone resorption and has been implicated in the pathogenesis of periodontal destruction. Therefore, this study was designed to compare the levels of IL-1ß of chronic periodontitis patients with the healthy subjects. Another objective of this study was to correlate IL-1ß levels with the clinical parameters of the periodontal disease progression. METHODS: For this study, total 60 subjects were chosen (30- healthy and 30-chronic periodontitis). Simplified oral hygiene index (OHI-S), gingival index (GI), periodontal disease index (PDI), probing depth (PD), tooth mobility, bleeding on probing (BOP) were recorded for all the subject. Gingival crevicular fluid (GCF) was collected and subjected for ELISA for estimation of IL-1ß. RESULTS: At the periodontal diseased sites, the IL-1ß levels increased at least 2-fold as compared with healthy subjects. This increase was highly significant (p = 0.0000). Within the test group, IL-1ß levels correlated positively and significantly with PDI, PD, BOP and tooth mobility. The correlations of IL-1ß with PD (p = 0.000) and IL-1ß with BOP (p = 0.0004) were highly significant. INTERPRETATION AND CONCLUSION: These data suggest that amount of GCF IL-1ß is closely associated with periodontal status. This relationship may be valuable in monitoring periodontal disease activity. CLINICAL SIGNIFICANCE: It could be stated from this study on IL- 1ß that there seem to be a strong correlation between periodontal tissue destruction and IL-1ß. Furthermore IL-1ß level could also differentiate between active and inactive periodontal lesions.

A comparative study of temporary splints: bonded polyethylene fiber reinforcement ribbon and stainless steel wire + composite resin splint in the treatment of chronic periodontitis.

UNLABELLED: The present clinical study was undertaken to determine the effects of splinting overunsplinted mobile teeth following periodontal surgery and compared the efficacy of two splinting materials, i.e. Ribbond ribbon + Composite with Stainless steel wire + Composite. MATERIALS AND METHODS: Total of 30 patients (20 experimental and 10 control) formed the study group. Entire study was extended over a period of 12 weeks for each patient and treatment plan was divided into 8 phases. Healing response was monitored and application, durability, biocompatibility of splint material was assessed. RESULTS: Splint had a promising and beneficial effects on anterior teeth exhibiting Grade I to Grade II degrees of mobility. Experimental group showed a greater reduction in tooth mobility compared to control group. There was no significant difference in plaque index and Ribbond Ribbon reinforced with composite resin was an excellent material for application, patient comfort, resistance to fracture, biocompatable and esthetic acceptability. CLINICAL SIGNIFICANCE: Splinting is recommended as an adjunct to periodontal surgery in the treatment of hypermobile teeth, especially in cases where patient discomfort is a prominent factor.

Long-term observation of autotransplanted teeth with complete root formation in orthodontic patients.

INTRODUCTION: The objective of this investigation was to examine the factors influencing the long-term prognosis of autotransplanted teeth with complete root formation. METHODS: Thirty-eight teeth, autotransplanted in 32 patients, were examined more than 6 years after transplantation. Periodontal health, condition of restoration, mobility, occlusal contact, level of gingival margin, and course of orthodontic movement were investigated clinically and with radiographs. RESULTS: More than 6 years after autotransplanation, 33 teeth survived in 27 patients. The survival rate was 86.8% (mean observation time, 9.2 years). Abnormal findings were observed in 9 teeth, so the success rate was 63.1%. An inadequate root filling tended to give rise to abnormal findings. CONCLUSIONS: The success of autotransplantation of a tooth with complete root formation is affected by the quality of root filling. When possible, clinicians should consider autotransplantation before root formation is complete.

Root coverage using acellular dermal matrix and comparing a coronally positioned tunnel with and without platelet-rich plasma: a pilot study in humans.

BACKGROUND: The primary aim of this randomized, controlled, blinded clinical pilot study was to compare the percentage of recession defect coverage obtained with a coronally positioned tunnel (CPT) plus an acellular dermal matrix allograft (ADM) to that of a CPT plus ADM and platelet-rich plasma (CPT/PRP) 4 months post-surgically. METHODS: Eighteen patients with Miller Class I or II recession >or=3 mm at one site were treated and followed for 4 months. Nine patients received a CPT plus ADM and were considered the positive control group. The test group consisted of nine patients treated with a CPT plus ADM and PRP. Patients were randomly selected by a coin toss to receive the test or positive control treatment. RESULTS: The mean recession at the initial examination for the CPT group was 3.6 +/- 1.0 mm, which was reduced to 1.0 +/- 1.0 mm at the 4-month examination for a gain of 2.6 +/- 1.5 mm or 70% defect coverage (P <0.05). The mean recession at the initial examination for the CPT/PRP group was 3.3 +/- 0.7 mm, which was reduced to 0.4 +/- 0.7 mm at the 4-month examination for a gain of 2.9 +/- 0.5 mm or 90% defect coverage (P <0.05). There were no statistically significant differences between the groups (P >0.05). CONCLUSIONS: The CPT plus ADM and PRP produced defect coverage of 90%, whereas the CPT with ADM produced only 70% defect coverage. This difference was not statistically significant, but it may be clinically significant.

A novel decision-making process for tooth retention or extraction.

BACKGROUND: Implant-supported restorations have become the most popular therapeutic option for professionals and patients for the treatment of total and partial edentulism. When implants are placed in an ideal position, with adequate prosthetic loading and proper maintenance, they can have success rates >90% over 15 years of function. Implants may be considered a better therapeutic alternative than performing more extensive conservative procedures in an attempt to save or maintain a compromised tooth. Inadequate indication for tooth extraction has resulted in the sacrifice of many sound savable teeth. This article presents a chart that can assist clinicians in making the right decision when they are deciding which route to take. METHODS: Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed. Book sources were also searched. Individual tooth- and patient-related features were thoroughly analyzed, particularly when determining if a tooth should be indicated for extraction. RESULTS: A color-based decision-making chart with six different levels, including several factors, was developed based upon available scientific literature. The rationale for including these factors is provided, and its interpretation is justified with literature support. CONCLUSION: The decision-making chart provided may serve as a reference guide for dentists when making the decision to save or extract a compromised tooth.

A report on the clinical and radiographic outcomes of 38 cases of apexification with mineral trioxide aggregate.

The aim of the study was to report on the clinical and radiographic assessment of 38 cases of apexification using MTA over a three year period. Thirty-eight cases of immaturely developed teeth requiring endodontic therapy were treated using MTA to achieve an apical barrier prior to obturation with gutta-percha. The teeth were clinically and radiographically assessed. The findings indicate that apexification using MTA is a predictable procedure. In particular, the number of visits and the total time taken to achieve an apical barrier was markedly less than conventional techniques using calcium hydroxide. The presence of a preoperative periapical radiolucency had no effect on the outcome. MTA shows promise as a viable alternative to calcium hydroxide to achieve root-end closure and using MTA, the number of visits to achieve a successful apical barrier may be markedly reduced. The presence of preoperative periapical radiolucencies did not affect the outcome or the treatment protocol.

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.

Mandibular disto-lingual root: a consideration in periodontal therapy.

BACKGROUND: Developmental and morphological abnormalities may contribute to the progression of localized periodontal disease. Although the presence of a disto-lingual root in the mandibular first molar is rare, its role in periodontal destruction has not been examined. The purpose of this study was to evaluate whether the presence of this root contributes to localized periodontal destruction. METHODS: The presence of the disto-lingual root was identified by examination of two periapical radiographs in each of 197 Taiwanese patients with 332 mandibular first molars. Regression analysis was used to evaluate the relationship between the presence of the root and probing depth, gingival recession, and periodontal attachment loss at the disto-buccal and disto-lingual sites of the molars. The adjusted variables included patient characteristics (age, gender, diagnosis, and general periodontal conditions), tooth (right and left location, tooth mobility, and periodontal category of the molar), and site (bleeding on probing and adjacent furcation involvement). RESULTS: A disto-lingual root was present in 26.9% of patients and in 21.7% of molars examined. A significant interaction between periodontal category and the presence of disto-lingual root on probing depth and attachment loss at disto-lingual but not disto-buccal sites was observed. Multivariable regression analysis showed a significantly higher probing depth and attachment loss at the disto-lingual site in molars with the disto-lingual root than in molars without the root in teeth classified as having advanced periodontitis. CONCLUSIONS: Greater probing depth and attachment loss occurred at disto-lingual sites of molars with the roots. The presence of a disto-lingual root may contribute to localized periodontal destruction.

A retrospective clinical evaluation of two-unit cantilevered resin-bonded fixed partial dentures.

BACKGROUND: The authors conducted a study to examine the clinical performance of two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) that were inserted at The Prince Philip Dental Hospital, University of Hong Kong. METHODS: The authors recalled patients who had received two-unit cantilevered RBFPDs at least 24 months before the recall examination. The authors recorded the following data: patient's sex and age, operator's experience, prosthesis cementation date, endodontic treatment if performed, bone support, tooth mobility, the presence of shim-stock contacts on the abutment or pontic in intercuspal position, and the presence of aproximal axial contacts adjacent to the prosthesis. They also recorded the date of any debonding with subsequent treatment. They asked the patients qualitative questions about their prostheses. RESULTS: A total of 269 prostheses were placed in 214 patients and had a mean service life of 51.7 months +/- 19.5 months standard deviation, with a range of 13.2 to 141.6 months. Of 14 failed prostheses, 12 debonded, resulting in a success rate of 94.8 percent and clinical retention rate of 95.5 percent. No discernable rotation or drifting of the abutments was apparent in any of the prostheses. Overall patient satisfaction with RBFPDs was good, with an average assessment score of 8.5. CONCLUSIONS: The authors observed a 95.5 percent clinical retention rate of 269 two-unit RBFPDs, with no apparent drifting of the abutments. Longer-term follow-up studies are required. CLINICAL IMPLICATIONS: Two-unit RBFPDs are conservative and clinically retentive prostheses in the short to medium term.