Enamel Pearls Implications on Periodontal Disease.

Dental anatomy is quite complex and diverse factors must be taken into account in its analysis. Teeth with anatomical variations present an increase in the rate of severity periodontal tissue destruction and therefore a higher risk of developing periodontal disease. In this context, this paper reviews the literature regarding enamel pearls and their implications in the development of severe localized periodontal disease as well as in the prognosis of periodontal therapy. Radiographic examination of a patient complaining of pain in the right side of the mandible revealed the presence of a radiopaque structure around the cervical region of lower right first premolar. Periodontal examination revealed extensive bone loss since probing depths ranged from 7.0 mm to 9.0 mm and additionally intense bleeding and suppuration. Surgical exploration detected the presence of an enamel pearl, which was removed. Assessment of the remaining supporting tissues led to the extraction of tooth 44. Local factors such as enamel pearls can lead to inadequate removal of the subgingival biofilm, thus favoring the establishment and progression of periodontal diseases.

A mixed-model study assessing orthodontic tooth extrusion for the reestablishment of biologic width. A systematic review and exploratory randomized trial.

This study assessed the use of orthodontic extrusion (OE) for biologic width reestablishment (BWR) and compared two protocols for BWR: periodontal flap surgery (FS) performed either before (FS + OE) or after (OE + FS) extrusion. Databases were screened up to March 2013 for studies on OE, and outcomes from 13 patients treated by OE + FS or FS + OE were assessed. The results of the literature showed that OE + fiberotomy led to a greater amount of root extrusion than OE alone. The clinical/radiographic assessment demonstrated no significant differences between groups (P > .05). Within groups, there was an improvement in the keratinized tissue (P = .034) and in probing depth (P = .025) for OE + FS.

Análise crítica de estudos sobre biomateriais à base de fosfato de cálcio e HA, utilizados como enxertos ósseos em animais / Critical analysis of biomaterials, used as bone grafts, in animals studies

O objetivo desta revisão foi abordar o comportamento de diferentes biomateriais à base de fosfato de cálcio e/ou HA, utilizados como enxerto para reparo ósseo, bem como as respostas teciduais obtidas em modelos experimentais animais. A comparação direta entre estudos realizados em condições experimentais diversas é de difícil análise pelas variáveis envolvidas (métodos cirúrgicos, modelos experimentais, sítios de implantação e espécies). Dependendo do sítio de implantação, a arquitetura óssea difere em relação aos ossos cortical e medular, o que pode gerar diferentes tipos de estresse biomecânico e diferentes taxas de formação e remodelação ósseas. As características físico-químicas dos diferentes biomateriais influenciam consideravelmente na capacidade de estimulação da neoformação óssea. Os estudos analisados comprovam a atividade osteocondutiva das cerâmicas de fosfato de cálcio em vários sítios e modelos animais. Em relação às cerâmicas de fosfato de cálcio bifásico (BCP), suas características físico-químicas influenciam diretamente o grau de formação óssea e de sua estabilidade, estando relacionados à dissolução das fases de tricálcio fosfato e hidroxiapatita. Diversos estudos apontam para a utilização promissora do BCP como substituto ósseo e como uma alternativa viável aos enxertos de osso autógeno.

The aim of this review is to highlight the behavior of different calcium phosphate/HA-related biomaterials used as graftings for bone repair, as well as their tissue responses in experimental animal models. The direct comparison among varied experimental conditions is complicated due to the existing variables (surgical methods, experimental models, implantation sites, and selected species). Depending on the local site composition (cortical/marrow bone), different biomechanical patterns arise along with bone formation/remodeling outcomes. The physicochemical characteristics of available biomaterials significantly influence on the ability to form the new bone tissue. The presented studies corroborate the osteoconductive performance of calcium phosphate ceramics in several sites and animal models. Regarding the biphasic calcium phosphate ceramics (BCP), its physical and chemical properties influence on the bone formation degree and stability, being these related to the HA and tricalcium phosphate crystal dissolution rates. Also, several studies point out to the successful use of BCP as bone substitute and a viable alternative to the autogenous bone grafts.