Periodontal tissue repair after sealing of the gap in vertical root fracture.

The aim of this study was to determine whether sealing of fracture gap using adhesive resin through the root canal can prevent inflammation of periodontal tissue, and resealing the incompletely sealed fracture gap from outside can resolve such inflammation in experimentally created vertical root fractures. Vertical root fractures were created in incisor of beagles. In the experimental group, the fracture gap was sealed through the root canal with adhesive resin. After 5 weeks, sites with the clinical attachment level ≥4 mm were further divided randomly into the poor-replanting group and the poor-untreated group. In the poor-replanting group, the tooth was extracted and replanted after resealing the fracture gap with adhesive resin from the outer surface. Sites with clinical attachment level ≤3 mm after 5 weeks were considered as the satisfactory group. The poor-untreated group and the satisfactory group were subjected to no further treatment. The clinical attachment level was evaluated at baseline and after 2, 5, and 9 weeks. After 9 weeks, histological measurements were made to determine the length of the epithelial downgrowth and the area of alveolar bone resorption. The clinical attachment level and the area of bone resorption were significantly smaller in the poor-replanting group and the satisfactory group than in the poor-untreated group (p < 0.05). The results indicate the possibility that periodontal inflammation along the fracture line can be prevented and improved if the fracture gap is sealed.

Immunolocalization of sclerostin synthesized by osteocytes in relation to bone remodeling in the interradicular septa of ovariectomized rats.

This study aimed at elucidating whether estrogen deficiency would affect the synthesis of an osteocyte-derived factor, sclerostin, in the mesial region of alveolar bone. Eight 9-week-old Wistar female rats were ovariectomized (OVX) and eight other rats were Sham-operated (Sham). After 4 weeks, the interradicular septa of mandibular first molar were embedded in paraffin and then histochemically examined. Sclerostin-positive osteocytes were located in the superficial layer of the mesial region of Sham bones, whereas the OVX mesial region showed less sclerostin-reactive osteocytes. There was no significant difference in the distribution of estrogen receptor α and terminal deoxynucleotidyl transferase-mediated deoxyuridinetriphosphate nick end-labeling -positive cells in the groups studied. The Sham mesial region featured many osteoclasts, and OVX specimens showed numerous osteoclasts in association with intense immunolabeling of the receptor activator of the nuclear factor kB ligand. Contrary to the observations in Sham specimens, a complex meshwork of cement lines was seen in the OVX mesial region, accompanied by an irregularly distributed osteocytic lacunar-canalicular system. In conclusion, estrogen deficiency appears to inhibit osteocyte-derived sclerostin synthesis in the mesial region of the interradicular septum, in a process that seems to be mediated by accelerated bone remodeling rather than by direct effects on osteocytes.

A large-scale observational study to investigate the current status of diabetic complications and their prevention in Japan (JDCP study 6): baseline dental and oral findings.

Japan Diabetes Complication and Prevention prospective (JDCP) study was conducted to examine the association between glycemic control and oral conditions in a large database of Japanese patients with diabetes. It included a total of 6099 patients with diabetes (range, 40-75 years) who had been treated as outpatients between 2007 and 2009. The mean number of present teeth at baseline was 19.8 and women with type 2 diabetes had fewer teeth than men with type 2 diabetes. Within the previous year, 17% of all patients had lost teeth. At baseline, 32% had experienced gingival swelling, 69% had brushed more than twice a day, 37% had used interdental cleaning aids, and 43% had undergone regular dental checkups. Multiple logistic regression analysis indicated that type 1 patients with HbA1c ≥ 7.0% were at higher risk of having fewer than 20 teeth (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.25-4.78), and type 2 patients with HbA1c ≥ 8.0% also were at high risk of having fewer than 20 teeth (OR 1.16; 95% CI 1.00-1.34), after adjustment for nine possible confounding factors. In conclusion, patients with diabetes were found to be at high risk of tooth loss, and the poorer the glycemic control, the higher the risk of tooth loss in these patients.

Association between self-efficacy and loss to follow-up in long-term periodontal treatment.

AIM: To examine whether or not oral health care-specific self-efficacy can predict loss to follow-up for long-term periodontal treatment. METHODS: Our prospective cohort study enrolled 144 patients with chronic periodontitis. Patient self-efficacy was assessed on the initial visit using the self-efficacy scale for self-care (SESS). Participants were then followed for 30 months from the onset of periodontal treatment. The loss to follow-up is the main outcome variable. Multiple logistic regression analysis was conducted to examine the association between self-efficacy for self-care and loss to follow-up for periodontal treatment. Gender, age, number of teeth, probing depth, plaque control record (PCR) value, PCR improvement rate, general self-efficacy scale score, and SESS score were used as the independent variables, and loss to follow-up as a dependent variable. RESULTS: A total of 67 patients were lost to follow-up over the course of the study. Compared with the high-scoring SESS group (60-75), the odds ratio of loss to follow-up for the middle- (54-59) and low-scoring groups (15-53) were 1.05 [95% confidence interval (CI): 0.36-3.07] and 4.56 (95% CI: 1.11-18.74), respectively. CONCLUSION: Assessment of oral health care-specific self-efficacy may be useful in predicting loss to follow-up in long-term periodontal treatment.

Development of the self-efficacy scale for maternal oral care.

PURPOSE: This study's purpose was to develop a task-specific self-efficacy scale for maternal oral care (SESMO) with reliability and validity. METHODS: A draft scale consisting of 36 items was designed and tested on 119 mothers at a dental clinic. Item analysis was performed to improve its accuracy by reducing the number of items. Internal consistency and test and retest stability were investigated. Concurrent validity was tested by examining associations of the SESMO score with the: general self-efficacy scale (GSES) score; number of decayed teeth; and frequency of tooth-brushing for children. Construct validity was examined by comparing the SESMO scores between mothers of children with caries at initial visit (Group 1) and those continuing regular dental checkups (Group 2). RESULTS: The item analysis selected 16 items for the SESMO. Alpha coefficient of the SESMO was 0.82. Significant correlation was observed between tests and retests (r=0.74). There were significant associations between the SESMO score and GSES score (r=0.39); number of decayed teeth (r=-0.33); and frequency of brushing children's teeth (r=0.66). Group 2 had a significantly higher SESMO score than Group 1 (P<.001). CONCLUSIONS: The SESMO showed high reliability and validity. This scale might endure with research applications in pediatric dental practice.

Influence of residual bone on recombinant human bone morphogenetic protein-2-induced periodontal regeneration in experimental periodontitis in dogs.

BACKGROUND: Previous studies reported that bone morphogenetic protein (BMP)-2 induced periodontal regeneration in animals. However, the effects of local host factors on bone formation when using recombinant human (rh)BMP-2 are unknown. The purpose of this study was to evaluate local conditions in recipient sites that affected periodontal regeneration following BMP implantation in experimentally induced horizontal defects in dogs. METHODS: Experimental periodontitis was induced in the maxillary and mandibular premolars of six male beagles. The recipient sites were divided into four quadrants (maxillary buccal, maxillary palatal, mandibular buccal, and mandibular lingual sites). A polymer-coated gelatin sponge (PGS; 3 x 3 x 2 mm) was impregnated with 7.2 mul rhBMP-2 solution. The recipient sites in each quadrant were treated with physiologic saline/PGS and rhBMP-2/PGS (rhBMP-2 at 7.2 mug/7.2 mul). The dogs were sacrificed 12 weeks post-surgery, and healing was evaluated histologically. RESULTS: Bone formation and connective tissue attachment were observed following rhBMP-2/PGS implantation. In the four recipient sites of the BMP-treated group, significant positive correlations were found between the width of residual bone and the height and area of regenerated bone (r = 0.791; r = 0.828; P <0.0001). The height of regenerated bone was also significantly correlated to the area (r = 0.891; P <0.0001). CONCLUSIONS: The width of residual bone was one of the clinical host factors that affected bone regeneration following BMP implantation. However, it did not affect connective tissue attachment, cementum regeneration, and downgrowth of junctional epithelium.

Systematic cognitive behavioral approach for oral hygiene instruction: a short-term study.

OBJECTIVE: Determine whether a six-step behavioral cognitive method is more effective than traditional oral hygiene instruction. METHODS: Thirty-eight patients with chronic periodontitis were randomly assigned to two groups. The control group was given traditional oral hygiene instruction for 20 min. The intervention group received counseling by Farquhar's six-step method for 10 min after traditional oral hygiene instruction. In both groups, oral hygiene instruction was given once a week, and performed three times in total for 3 weeks. Clinical characteristics, deposition of dental plaque, frequency and duration of brushing, frequency of interdental cleaning and scores based on scale of "self-efficacy for brushing of the teeth" were compared in both groups. RESULTS: There were no differences between the two groups in clinical, demographic, behavioral and self-efficacy characteristics at the baseline examination. However after the third visit, the intervention group had a significantly higher self-efficacy, lower plaque index, longer brushing duration and higher frequency of inter-dental cleaning than those of the control group. Multiple regression analysis showed significant association of toothbrushing duration with self-efficacy for brushing of the teeth (p<0.001). CONCLUSION: The six-step method might be more effective for enhancing self-efficacy and behavioral change of oral hygiene than traditional oral hygiene instruction alone. PRACTICE IMPLICATIONS: Dentists and dental hygienists can use the six-step method for effective oral hygiene instruction.

Oral health care-specific self-efficacy assessment predicts patient completion of periodontal treatment: a pilot cohort study.

BACKGROUND: Whether patients complete periodontal treatment is an important matter of concern. Self-efficacy is the confidence of an individual that determines "how well he/she can take the actions necessary for producing certain results" and is a variable that forecasts behavior. This study examined whether oral health care-specific self-efficacy can predict patient completion of periodontal treatment. METHODS: A total of 140 subjects with mild to moderate chronic periodontitis (64 females and 76 males; 19 to 86 years of age; mean age: 51.7 +/- 15.7 years) participated in this study. Their self-efficacy was assessed using the self-efficacy scale for self-care (SESS) and the general self-efficacy scale (GSES) scores at the initial visit. SESS consists of three subscales: self-efficacy for dentist consultations, brushing of the teeth, and dietary habits. The subjects were classified into three groups: group 1 = 87 subjects who stayed in periodontal treatment and fulfilled maintenance criteria; group 2 = 17 subjects who stayed in periodontal treatment but did not fulfill criteria; and group 3 = 36 subjects who dropped out of periodontal treatment. Clinical and demographic characteristics and scores of GSES, SESS, and their subscales were compared among the three groups using the chi(2) and non-parametric multiple comparison tests. RESULTS: The mean age of the subjects in groups 1 and 2 was significantly greater than the mean age of the subjects in group 3. Groups 1 and 2 exhibited significantly deeper probing depths and higher scores for SESS and its subscale, self-efficacy for dentist consultations, than did group 3. CONCLUSION: Assessment of oral health care-specific self-efficacy is effective for the prediction of patient completion of periodontal treatment.

Hybrid layer seals the cementum/4-META/MMA-TBB resin interface.

Although 4-META/MMA-TBB resin has adhesive properties to dentin, and has been clinically used for the bonding treatment of vertically fractured roots and apicoectomy, there has not been any investigation on the adhesion of 4-META/MMA-TBB resin to cementum. The purpose of this in vitro study was to evaluate the bonding and the sealing ability of 4-META/MMA-TBB resin to cementum. Bovine root cementum and dentin surfaces were treated with a citric acid and ferric chloride solution, and the 4-META/MMA-TBB resin was applied on the treated surfaces before testing. The microtensile bond strength and the leakage levels obtained for the cementum were almost equal to those for the dentin. In SEM and TEM observations, a hybrid layer approximately 2-3 microm in thickness was observed at the interface between the resin and the cementum. It is concluded that 4-META/MMA-TBB resin adhered to cementum via a hybrid layer on cementum, as previously reported for dentin.

Effects of dose of recombinant human BMP-2 on bone formation at palatal sites in young and old rats.

This study was designed to examine the effects of dose of recombinant human BMP-2 (rhBMP-2) on bone formation at palatal sites in 10-week-old (10w) and 70-week-old (70w) rats, when combined with a polylactate-polyglycolate copolymer/gelatine sponge (PGS). New bone formation was observed at six weeks after implantation. In the 10w rats, thickness of new bone (TNB) increased as the dosage increased from 0 microg to 4 microg, and decreased significantly as the dosage increased from 8 microg to 24 microg. In contrast, in the 70w rats, TNB increased as the dosage increased from 0 microg to 16 microg, and did not significantly change as the dosage increased from 16 microg to 24 microg. These results suggest that the most effective dosage of rhBMP-2 for induction of bone formation varies according to age.

Site-level progression of periodontal disease during a follow-up period.

Periodontal disease is assessed and its progression is determined via observations on a site-by-site basis. Periodontal data are complex and structured in multiple levels; thus, applying a summary statistical approach (i.e., the mean) for site-level evaluations results in loss of information. Previous studies have shown the availability of mixed effects modeling. However, clinically beneficial information on the progression of periodontal disease during the follow-up period is not available. We conducted a multicenter prospective cohort study. Using mixed effects modeling, we analyzed 18,834 sites distributed on 3,139 teeth in 124 patients, and data were collected 5 times over a 24-month follow-up period. The change in the clinical attachment level (CAL) was used as the outcome variable. The CAL at baseline was an important determinant of the CAL changes, which varied widely according to the tooth surface. The salivary levels of periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, were affected by CAL progression. "Linear"- and "burst"-type patterns of CAL progression occurred simultaneously within the same patient. More than half of the teeth that presented burst-type progression sites also presented linear-type progression sites, and most of the progressions were of the linear type. Maxillary premolars and anterior teeth tended to show burst-type progression. The parameters identified in this study may guide practitioners in determining the type and extent of treatment needed at the site and patient levels. In addition, these results show that prior hypotheses concerning "burst" and "linear" theories are not valid.

Graphene oxide scaffold accelerates cellular proliferative response and alveolar bone healing of tooth extraction socket.

Graphene oxide (GO) consisting of a carbon monolayer has been widely investigated for tissue engineering platforms because of its unique properties. For this study, we fabricated a GO-applied scaffold and assessed the cellular and tissue behaviors in the scaffold. A preclinical test was conducted to ascertain whether the GO scaffold promoted bone induction in dog tooth extraction sockets. For this study, GO scaffolds were prepared by coating the surface of a collagen sponge scaffold with 0.1 and 1 µg/mL GO dispersion. Scaffolds were characterized using scanning electron microscopy (SEM), physical testing, cell seeding, and rat subcutaneous implant testing. Then a GO scaffold was implanted into a dog tooth extraction socket. Histological observations were made at 2 weeks postsurgery. SEM observations show that GO attached to the surface of collagen scaffold struts. The GO scaffold exhibited an interconnected structure resembling that of control subjects. GO application improved the physical strength, enzyme resistance, and adsorption of calcium and proteins. Cytocompatibility tests showed that GO application significantly increased osteoblastic MC3T3-E1 cell proliferation. In addition, an assessment of rat subcutaneous tissue response revealed that implantation of 1 µg/mL GO scaffold stimulated cellular ingrowth behavior, suggesting that the GO scaffold exhibited good biocompatibility. The tissue ingrowth area and DNA contents of 1 µg/mL GO scaffold were, respectively, approximately 2.5-fold and 1.4-fold greater than those of the control. Particularly, the infiltration of ED2-positive (M2) macrophages and blood vessels were prominent in the GO scaffold. Dog bone-formation tests showed that 1 µg/mL GO scaffold implantation enhanced bone formation. New bone formation following GO scaffold implantation was enhanced fivefold compared to that in control subjects. These results suggest that GO was biocompatible and had high bone-formation capability for the scaffold. The GO scaffold is expected to be beneficial for bone tissue engineering therapy.

A Novel Regenerative Technique Combining Bone Morphogenetic Protein-2 With Fibroblast Growth Factor-2 for Circumferential Defects in Dog Incisors.

BACKGROUND: Periodontal regeneration of incisors is necessary for esthetic recovery. A novel regenerative method combining bone morphogenetic protein (BMP)-2 and fibroblast growth factor (FGF)-2 was developed. The purpose of this study is to evaluate periodontal healing, including root coverage, in circumferential defects of incisors. METHODS: Fifty incisors in five beagles were used. After circumferential defects were surgically created, each group, consisting of ten recipient sites, received: 1) a double layer with FGF-2 (2 µg)/collagen as inner layer and BMP-2 (4 µg)/collagen as outer layer (FB-DL group); 2) collagen impregnated with both FGF-2 (2 µg) and BMP-2 (4 µg) (FB-M group); 3) BMP-2 (4 µg)/collagen (B group); 4) FGF-2 (4 µg)/collagen (F group); or 5) collagen (C group). Dogs were sacrificed 8 weeks post-surgery, and healing was evaluated histologically. RESULTS: The three groups treated with BMP-2 showed enhanced new bone formation compared with control and F groups (P < 0.05). Furthermore, connective tissue attachment with cementum regeneration in the FB-DL group was significantly greater than in FB-M and B groups (P <0.05). Ankylosis in the FB-DL group was significantly less than in FB-M and B groups (P <0.05). Gingival recession was inhibited significantly better in FB-DL and FB-M groups compared with control and B groups. CONCLUSION: These data support development of a double-layer method combining BMP-2 and FGF-2 as a therapeutic approach to periodontal regeneration at incisors with horizontal circumferential defects.

Randomized Placebo-Controlled and Controlled Non-Inferiority Phase III Trials Comparing Trafermin, a Recombinant Human Fibroblast Growth Factor 2, and Enamel Matrix Derivative in Periodontal Regeneration in Intrabony Defects.

We investigated the efficacy, safety, and clinical significance of trafermin, a recombinant human fibroblast growth factor (rhFGF)-2, for periodontal regeneration in intrabony defects in Phase III trials. Study A, a multicenter, randomized, double-blind, placebo-controlled study, was conducted at 24 centers. Patients with periodontitis with 4-mm and 3-mm or deeper probing pocket depth and intrabony defects, respectively, were included. A total of 328 patients were randomly assigned (2:1) to receive 0.3% rhFGF-2 or placebo, and 323 patients received the assigned investigational drug during flap surgery. One of the co-primary endpoints, the percentage of bone fill at 36 weeks after drug administration, was significantly greater in the rhFGF-2 group at 37.131% (95% confidence interval [CI], 32.7502 to 41.5123; n = 208) than it was in the placebo group at 21.579% (95% CI, 16.3571 to 26.8011; n = 100; p < 0.001). The other endpoint, the clinical attachment level regained at 36 weeks, was not significantly different between groups. Study B, a multicenter, randomized, blinded (patients and evaluators of radiographs), and active-controlled study was conducted at 15 centers to clarify the clinical significance of rhFGF-2. Patients with 6-mm and 4-mm or deeper probing pocket depth and intrabony defects, respectively, were included. A total of 274 patients were randomly assigned (5:5:2) to receive rhFGF-2, enamel matrix derivative (EMD), or flap surgery alone. A total of 267 patients received the assigned treatment during flap surgery. The primary endpoint, the linear alveolar bone growth at 36 weeks, was 1.927 mm (95% CI, 1.6615 to 2.1920; n = 108) in the rhFGF-2 group and 1.359 mm (95% CI, 1.0683 to 1.6495; n = 109) in the EMD group, showing non-inferiority (a prespecified margin of 0.3 mm) and superiority of rhFGF-2 to EMD. Safety problems were not identified in either study. Therefore, trafermin is an effective and safe treatment for periodontal regeneration in intrabony defect, and its efficacy was superior in rhFGF-2 compared to EMD treatments.

Risk analysis of failure of root canal treatment for teeth with inaccessible apical constriction.

OBJECTIVE: The risk of failure of root canal therapy was assessed in teeth with inaccessible apical constriction and factors influencing treatment outcome in these teeth were analyzed. METHODS: From the same 57 patients, one tooth with inaccessible apical constriction (n=57) and one tooth with adequate accessibility (n=57) were included in this retrospective investigation. Cox regression analysis was used to analyze factors that may have influenced the outcome one or more years after obturation. These factors included inaccessibility, systemic disease, canal curvature, preoperative periradicular lesion, widening of periodontal ligament space, patient gender and age, size of master apical file, preoperative pulp vitality, years of operator experience and obturation length. RESULTS: Inaccessible apical constriction was a significant factor related to outcome (odds ratio, 5.301). Preoperative presence of periradicular lesion significantly influenced the outcome in cases with inaccessibility (odds ratio, 4.448). CONCLUSION: Inaccessibility increases the risk of root canal therapy failure particularly in teeth with preoperative periradicular lesion.

Favorable healing following space creation in rhBMP-2-induced periodontal regeneration of horizontal circumferential defects in dogs with experimental periodontitis.

BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) is believed to be capable of inducing periodontal regeneration. However, the risk of aberrant healing events, such as root resorption and ankylosis, has been reported. We hypothesized that implantation of BMP-containing carriers directly on the root planed surface may be the cause of unfavorable healing. The purpose of this study was to evaluate the influence of a 1 mm spacer membrane, which separated the rhBMP-2 in polymer-coated gelatin sponge (PGS) and the root surface, on periodontal regeneration of experimentally induced horizontal defects in dogs. METHODS: Horizontal circumferential periodontal defects were surgically created, and experimental periodontitis was induced in 72 maxillary and mandibular premolars of four male beagle dogs. The recipient sites of each quadrant received: 1) rhBMP-2/PGS (B group) (rhBMP-2 at 1.0 mg/ml, total implant volume/ site approximately 7.2 microl) (n = 24); 2) rhBMP-2/PGS with a spacer membrane (PB group) (n = 24); and 3) physiological saline (PS)/PGS as a control (P group) (n = 24). One quadrant was left untreated. Dogs were sacrificed at 12 weeks post-surgery, and healing was evaluated histologically. RESULTS: Both groups treated with rhBMP-2/PGS demonstrated enhanced new bone formation and connective tissue attachment with cementum regeneration when compared to the control group. Sites treated with rhBMP-2/PGS showed a greater degree of bone formation than sites treated with rhBMP-2/PGS and spacer membrane, although the latter sites showed no ankylosis. CONCLUSIONS: Implantation of rhBMP-2/PGS enhances bone formation and connective tissue attachment in horizontal circumferential defects. In addition, the use of a spacer membrane reduces the degree of bone formation, but minimizes ankylosis.

Accessibility of an ultrasonic furcation tip to furcation areas of mandibular first and second molars.

The purpose of this study was to compare an ultrasonic furcation tip with an ultrasonic conventional tip and a hand scaler on accessibility to furcation areas of mandibular first and second molars. The study was conducted on 360 artificial molars that were replicated from 30 mandibular first molars and 30 second molars with silicone impression material and resin. The furcation areas of each molar were coated with red nail colour for artificial calculus. The root areas from the cement-enamel junction apically were covered with silicone rubber simulating gingival tissue. Then the models were instrumented on the buccal or lingual aspects by an experienced operator with each of the following instruments: an ultrasonic furcation tip, an ultrasonic conventional tip and a hand scaler. After instrumentation the percentage of the furcation area with residual artificial calculus was assessed using a computerised imaging system. Results showed that when the horizontal pocket depth was less than 2mm, all three instruments showed good accessibility. When the horizontal pocket depth was more than 2mm, the ultrasonic conventional tip and the hand scaler showed less removal of artificial calculus than the ultrasonic furcation tip (P < 0.01). Efficiency of the ultrasonic furcation tip was fairly satisfactory for the horizontal pocket up to the ridge of the furcation roof.

Effects of debridement with an ultrasonic furcation tip in degree II furcation involvement of mandibular molars.

The purpose of this study was to evaluate the clinical effects of closed debridement with an ultrasonic furcation tip in degree II furcation involvement of mandibular molars. Fifteen patients with degree II furcation involvement in mandibular first and/ or second molars participated in the study. All patients were given oral hygiene instruction. Plaque score, probing depth, probing attachment level and bleeding on probing were recorded at baseline, 1, 4, 8 and 12 weeks. Following a baseline examination, a single episode of supra- and subgingival debridement was provided using an ultrasonic furcation tip in the test group, and an ultrasonic conventional tip and hand scalers under local anesthesia in the control group. At baseline, the mean horizontal probing depth in the test group was 6.35 mm and in the control group 6.06 mm. These values decreased to 4.88 mm and 5.29 mm respectively after 12 weeks. There were horizontal probing attachment gains of 1.29 mm in the test group and 0.59 mm in the control group after 12 weeks (P < 0.01). The bleeding scores were 1.0 in the test group and 0.88 in control group at baseline. These scores were improved to 0.12 in the test group and 0.59 in the control group after 12 weeks (P < 0.01). The results suggest that ultrasonic debridement with a furcation tip has a significantly better potential in treating degree II furcation involvement of mandibular molars.

Effect of lifestyle on periodontal disease status in diabetic patients.

Lifestyle and socioeconomic status have been associated with the disease status of diabetic patients. However, there have been few reports on the relationship between these factors and the periodontal condition of diabetics. We assessed the association between disease status and lifestyle of diabetic patients and clinical features of advanced periodontitis such as deep probing depths and severe alveolar bone loss. Fifty-seven diabetic patients were examined in this study. Clinical assessment of probing pocket depth and radiographic alveolar bone loss was performed. Data regarding diabetic status and lifestyle of the diabetic patients were also recorded and statistically analysed by logistic regression. Drinking habits and high values of hemoglobin A1c (HbA1c) (>9.0%) were significantly associated with deep probing depth. The odds ratios (OR) of these factors were 7.72 (95% confidence interval (CI), 1.80 to 33.19), and 6.10 (95% CI = 1.23 to 30.25), respectively. Presence of complications such as retinopathy (OR = 8.86, 95% CI, 1.99 to 39.40), irascible behaviour (OR = 8.40, 95% CI = 1.33 to 53.17) and high value of HbA1c (OR = 4.94, 95% CI = 1.14 to 21.46) were significantly related to mean advanced alveolar bone loss. Only the high value of HbA1c (OR = 3.53, 95% CI = 1.06 to 11.73) was detected as a significant factor related to advanced periodontitis, characterised by more than 50% mean alveolar bone loss, or two or more teeth with probing depth greater than 6 mm. In conclusion, drinking habit and irascible behaviour are correlated with the periodontal disease condition of diabetic patients, in addition to a high value of HbA1c (>9.0%). Lifestyle and psychosocial stress may affect the periodontal disease status of diabetic patients.

Durability of adhesion between 4-META/MMA-TBB resin and cementum.

4-META/MMA-TBB resin has shown good biocompatibility and remarkable adhesion to dentin. It seems to be suitable for use in periodontal tissues for retrograde root sealing and treatment of vertically fractured roots. For an adhesive resin to be useful clinically, it must bond not only to the dentin but also to the cementum. The purpose of this study was to evaluate the long-term adhesion durability of 4-META/MMA-TBB resin to cementum kept in water at 37 degrees C. Bovine root cementum and dentin surfaces were treated with 10-3 solution before 4-META/MMA-TBB resin was applied on treated surfaces. The micro-tensile bond strength (microTBS) decreased during the first two months; dye leakage value increased during the first four months and stabilized thereafter. No significant differences in adhesion durability were recognized between the dentin and cementum.