Digitally guided root removal and simultaneous implant placement: A case study.

BACKGROUND: Encountering a retained root tip post-extraction and prior to implant placement is a possible clinical complication. There are numerous approaches for removing retained roots that may be traumatic or atraumatic. Regardless of the approach, careful treatment planning is important to minimize complications, reduce morbidity, and preserve bony structures. The aim of the current case study is to introduce a technique and digitally generated device used for identifying and atraumatically removing a retained root tip and simultaneously placing a stable dental implant. METHODS: A 63-year-old female with a history of myocardial infarction, hypertension, and acute pancreatitis presented for implant placement at site #5. Clinical examination revealed adequate interocclusal, mesiodistal, and buccolingual dimensions for implant placement. Radiographic examination using cone beam computed tomography revealed that retained root #5 interfered with implant placement. Digital planning was used to extract the root tip with minimal trauma to maintain adequate bone for simultaneous implant placement with good primary stability. RESULTS: The follow-ups at 1, 3, and 6 weeks and 4, 8, and 10 months revealed good bone preservation with an osseointegrated implant. CONCLUSIONS: Employment of digital planning to create a palatal window allowed excellent accuracy in removing the retained root while maintaining the bony foundation for a well osseointegrated dental implant. KEY POINTS: Pre-planning using cone beam computed tomography scan merged with an intraoral digital scan is necessary for precise location of a retained root and correct implant placement with excellent primary stability. A digitally planned 3D surgical guide is a useful method for extracting retained roots during implant placement to minimize bone damage. Digital planning provides a precise and minimally invasive implant surgery.

Management of vertical bony defect using novel xenogeneic/allogeneic bone graft: A case report.

BACKGROUND: Guided tissue regeneration (GTR) is a common treatment modality for correcting vertical or bony defects in furcations. Multiple materials are used in GTR with allografts and xenografts being the most widely used. Each material has distinctive properties affecting the regenerative potential. A new bone graft combination of xenogeneic/allogeneic may improve the outcome of GTR by providing space maintenance (Xenograft) and osteoinductive potential (Allograft). The aim of this case report is to evaluate the efficacy of the new combined xenogeneic/allogeneic material based on clinical and radiographic outcomes. METHODS: A 34-year-old healthy male presented with vertical bone loss interproximally between #'s 9 and 10. Clinical exam revealed 8 mm probing depth without mobility. The radiographic exam revealed a wide and deep vertical bony defect of 30%-50% bone loss. The defect was treated using a layering technique with xenogeneic/allogeneic bone graft and collagen membrane. RESULTS: The 6- and 12-month follow-ups revealed a significant reduction in probing depths and radiographic bone fill. CONCLUSIONS: GTR using a layering technique of xenogeneic/allogeneic bone graft and collagen membrane showed proper correction of a deep and wide vertical bony defect. The 12-month follow-up revealed healthy periodontium with normal probing depths and bone level.

Custom allogeneic block graft for ridge augmentation: Case series.

INTRODUCTION: Alveolar bone deficiency is a common postextraction sequela that adversely affects implant placement. Therefore, ridge augmentation is often required to obtain proper bone quantity and quality for restoratively driven implant placement. This case series describes the successful horizontal and vertical alveolar ridge augmentation using custom-fabricated allogeneic block bone grafts. CASE SERIES: Two healthy partially edentulous patients presented to private practice seeking dental implant treatment. Initial clinical examination and cone-beam computed tomography (CBCT) radiographic analysis showed moderate to large horizontal ridge defects. Treatment options were discussed for alveolar ridge augmentation and the patients elected to undergo the custom allogeneic block graft procedure to regenerate the atrophied alveolar ridges. The CBCT scan in conjunction with computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to fabricate customized allogeneic block grafts based on alveolar ridge topography. The custom allogeneic block graft allowed less surgical time and decreased postoperative morbidity. The grafted area was allowed 6 months of healing time. Follow-up radiographs showed the stability of the graft followed by dental implant placement. The dental implants were functionally loaded, and successful implant esthetics and function achieved. CONCLUSION: Custom allogeneic block grafts could provide a promising innovative method for optimal ridge augmentation. Why are these cases new information? Less invasive procedure as an alternative conventional two-stage block augmentation. More predictable outcome due to customized block graft. What are the keys to successful management of these cases? It is important determining the type of bone defect. Vertical and horizontal bone loss. Primary closure. What are the primary limitations to success in these cases? Limited data from prospective clinical trials documenting the effectiveness of custom allogeneic block grafts. Limited data are available to confirm accuracy of the CAD/CAM process. Passive flap closure is needed.

Supernumerary tooth autotransplantation to replace missing maxillary central incisor using three-dimensional replica: A 6-year follow-up.

INTRODUCTION: Tooth autotransplantation is a viable surgical treatment option for patients with missing permanent teeth. Premolars are generally used for autotransplantation but often require extensive modifications. This case report evaluates the use of supernumerary tooth as an alternative option for premolar autotransplantation. This report shows successful supernumerary tooth autotransplantation with 6-year follow-up. METHODS: A 13-year-old male with non-contributory medical history was referred for a missing maxillary left central incisor (#9) and presence of a supernumerary tooth. The clinical and radiographic examination revealed presence of supernumerary tooth with similar dimensions to a central incisor. The treatment plan included autotransplantation of the supernumerary tooth to replace the missing central incisor (short-term) and future implant replacement of the autotransplanted tooth when jaw growth ceases (long-term). The patient and parents consented to treatment. A 3-D tooth replica was constructed based on CBCT analyses. Site #9 was prepared using split ridge technique to create a socket to house the 3-D replica. Upon achieving proper socket form, the supernumerary tooth was extracted and autotransplanted in the prepared socket. The supernumerary tooth was splinted, and the bite opened posteriorly using composite to eliminate any occlusal interferences. RESULTS: The patient was followed up clinically and radiographically. The autotransplanted supernumerary tooth integrated well within the newly created socket and remained functional at the 6-year follow-up. CONCLUSIONS: The current case presents successful management of supernumerary tooth autotransplantation with 6-year follow-up. The results show stable periodontium with satisfactory functional and aesthetic results.

Effect of guided bone regeneration on immediately placed implants: Meta-analyses with at least 12 months follow-up after functional loading.

BACKGROUND: Immediate implant placement (IIP) into fresh extraction socket is a favorable treatment option. If successfully managed, it reduces the overall treatment time, and increases patient's satisfaction. Surgical and restorative factors affect IIP success rates. In this systematic review we evaluate the effect of guided bone regeneration (GBR) at the time of IIP on crestal bone level (CBL) changes after at least 12-months of functional loading. METHODS: Reviewers conducted an independent search of the National Center for Biotechnology Information PubMed, Medline, and the Cochrane Collaboration Library from 1966 to January 2017 following the inclusion criteria. A hand search of bibliographies of reviews and clinical trials related to IIP was also performed. This study looked into CBL changes around IIP primarily and further extracted the data to conduct three meta-analysis of "IIP using GBR versus IIP without GBR", "IIP using bone graft alone versus IIP using bone graft with membrane" and "IIP using GBR versus conventional implant placement" which were further subdivided to provide more detailed information for each. Four reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms. RESULTS: The electronic search identified 714 potential studies and the hand search retrieved 55 studies. Crestal bone level (CBL) changes were determined in three meta-analyses. The results revealed a mean difference in CBL changes of 0.175 ± 0.180 mm  in favor of IIP without GBR when compared with implant with GBR. However, IIP with bone graft and membrane showed better results when compared with IIP with bone graft alone [CBL changes of 0.532 ± 0.572 mm]. CBL preservation was noted in IIP with GBR versus conventional implant placement [CBL changes of - 0.001 ± 0.049 mm]. CONCLUSIONS: Meta-analyses showed minimal difference in CBL around IIP with bone graft versus without bone graft and with IIP with GBR compared with conventional implant placement. However, IIP with bone graft and membrane reported better CBL preservation compared with IIP with bone graft alone. Nonetheless, these results should be interpreted with caution because of moderate heterogeneity between studies.

Management of a Periodontal Patient With Dermatomyositis: A Case Report.

INTRODUCTION: Dermatomyositis is an uncommon inflammatory disease marked by muscle and joint weakness with skin rash. Dermatomyositis affects adults and children, with higher prevalence for females aged 40 to 60 years. Most common oral lesions include mucosal edema, erythema, and telangiectasia. CASE PRESENTATION: A 51-year-old white female with an unremarkable medical history presented for periodontal evaluation in 2010. She reported a 6-month history of gingival inflammation and skin irritation on her hands and a rash on the center of her chest and forehead. Other complaints included fatigue, hot flashes, decreased appetite, and weight loss. Periodontal examination revealed generalized acute marginal erythema, with localized slight incipient bone loss. Oral hygiene was deemed good to fair. Oral hygiene instructions were reviewed and a prescription for chlorhexidine gluconate was given. The patient was then referred to an allergist and dermatologist where a diagnosis of dermatomyositis was made. After the initial diagnosis, localized scaling and root planing was performed using local anesthetic. The patient was managed medically using prednisone, mycophenolate mofetil, and methotrexate and a 3-month periodontal maintenance recall interval. The patient remained stable over an 8-year period. CONCLUSIONS: Dermatomyositis is an uncommon inflammatory disease that requires medical and dental teams for proper diagnosis and management. Although the condition is chronic in nature with no definitive cure, signs, and symptoms can be managed with steroids and immunosuppressants to delay progression of the disease and improve quality of life for the patient.

Successful Management of Peri-Implantitis Using a Titanium Brush and a Doxycycline-Saline Slurry for Surface Detoxification With Guided Bone Regeneration: A 5-Year Follow-Up.

INTRODUCTION: The inflammation associated with peri-implantitis lesions can be difficult to manage and regeneration of lost bone is unpredictable. Unfortunately, opinions vary on the best method(s) for elimination of inflammation and restoration of residual osseous defects. This report describes the successful surgical management of a peri-implantitis lesion with reduction of inflammation and maintenance of nearly completely regenerated horizontal and vertical bone over 5 years. CASE PRESENTATION: A 55-year-old healthy, non-smoking, African-American female presented in 2013 with inflammation and >25% bone loss at implant site #18. Probing depths ranged from 6 to 13 mm with bleeding on probing (BOP). She was diagnosed with peri-implantitis. She reported a history of routine scaling every 6 months since implant and crown placement 3 years earlier (2010). Initial periodontal treatment consisted of non-surgical scaling and implant debridement. Deep pockets and BOP persisted at re-evaluation. Surgical treatment consisted of full thickness flap, soft tissue curettage with titanium curets, and detoxification of the implant surface with a doxycycline and sterile saline slurry using a titanium brush. Mineralized freeze-dried bone allograft and demineralized freeze-dried bone allograft in a 50:50 ratio was placed and covered with a resorbable collagen membrane. All postoperative visits were uneventful. Maximum probing depths around the treated implant at the 5+-year follow-up (2019) were 4 mm with no BOP and nearly complete bone fill. CONCLUSIONS: This case illustrates that it is possible to successfully eliminate clinical inflammation associated with peri-implantitis, regenerate bone, and maintain health for >5 years.

The effects of cannabis use on oral health.

Cannabis, also known as marijuana, is one of the most commonly used substances for medical and recreational purposes globally. With the trend of global legalization of medical use of cannabis and even the recreational use, the prevalence of recreational use of cannabis has increased markedly over the past few years. Correspondingly, the potential health concerns related to cannabis consumption have also increased. Therefore, it is necessary for oral healthcare providers to understand the effects of cannabis use on oral health. This review briefly summarizes the components of cannabis, biologic activities on tissues, and mechanisms of action in human cells and tissues. Oral tissue expression of cannabinoid receptors and the potential association of cannabis to oral diseases are also examined. The goals of this review are to (1) elaborate the basic biology and physiology of cannabis in human oral tissues, and (2) provide a better understanding the effects of its use and abuse on oral health. Due to insufficient information, more well-designed studies should be conducted. It is urgent to include cannabis usage into dental patient health records.

Stabilization Techniques for Soft Tissue Grafting Around Dental Implants: Case Report.

INTRODUCTION: Implants that lack keratinized tissue (KT) have been associated with increased plaque accumulation, gingival inflammation or hue of metal showing through the tissue. Free gingival grafts (FGGs) are a predictable treatment for minimal or lack of KT. FGGs can increase the zone of KT around teeth and implants alike. Despite predictability of FGGs, stabilizing the graft around implants can be challenging, but is critical for success. Little information is available regarding ways to stabilize FGGs around implants. Acrylic or composite stents are a viable option for obtaining graft stability and support during the healing process. CASE PRESENTATION: This case report highlights the practicality of using acrylic or composite stents for FGG stabilization with successful outcomes. Two patients presented with dental implants, with minimal or lack of KT requiring soft tissue augmentation. FGGs were harvested from the palate and fitted around implant carriers allowing stabilization and adequate suturing. Custom-made acrylic or composite stabilization stents were fabricated to fit around implant carriers, which were screwed into the implant platform, and hollowed out internally to provide space for the graft. Postoperative visits showed healthy, stable zones of KT in both cases. CONCLUSION: The customized acrylic or composite stents allowed stabilization of the FGGs with successful outcome.

Partly Deepithelialized Free Gingival Graft for Treatment of Lingual Recession.

INTRODUCTION: Gingival recession (GR) is an unhealthy root exposure that could result in sensitivity, abrasion, root caries and higher chance of plaque collection. The prevalence of GR is higher on the facial surfaces but could also affect the lingual tooth surfaces. Despite the etiology and location of GR, treatment is warranted to improve the long-term periodontal stability around the affected teeth. This case report describes the use of partly deepithelialized free gingival graft (PE-FGG) to augment lingual GR post orthodontic treatment. CASE PRESENTATION: The current report evaluates the results of PG-FGG to correct lingual recession in a 21-year-old female. The patient presented with 5 mm lingual recession on a previously orthodontically rotated tooth (#21). The recession was treated using a PE-FGG to increase keratinized gingiva (KG) and reduce root exposure. Follow-up at 24 months showed adequate root coverage and KG. CONCLUSION: The use of PE-FGG can be used to enhance KG for lingual recession with adequate root coverage.

Inactivating Mutation in IRF8 Promotes Osteoclast Transcriptional Programs and Increases Susceptibility to Tooth Root Resorption.

This is the first study to our knowledge to report a novel mutation in the interferon regulatory factor 8 gene (IRF8G388S ) associated with multiple idiopathic tooth root resorption, a form of periodontal disease. The IRF8G388S variant in the highly conserved C-terminal motif is predicted to alter the protein structure, likely impairing IRF8 function. Functional assays demonstrated that the IRF8G388S mutant promoted osteoclastogenesis and failed to inhibit NFATc1-dependent transcriptional activation when compared with IRF8WT control. Further, similar to subjects with heterozygous IRF8G388S mutation, Irf8+/- mice exhibited increased osteoclast activity in the mandibular alveolar bone surrounding molar teeth. Immunohistochemistry illustrated increased NFATc1 expression in the dentoalveolar region of Irf8-/- and Irf8+/- mice when compared with Irf8+/+ controls. Genomewide analyses revealed that IRF8 constitutively bound to regulatory regions of several thousand genes in osteoclast precursors, and genetic aberration of IRF8 significantly enhanced many osteoclast-specific transcripts. Collectively, this study delineates the critical role of IRF8 in defining osteoclast lineage and osteoclast transcriptional program, which may help in better understanding of various osteoclast-mediated disorders, including periodontal disease. © 2019 American Society for Bone and Mineral Research.

Successful Management of Early Peri-Implant Infection and Bone Loss Using a Multidisciplinary Treatment Approach.

INTRODUCTION: Peri-implant infections can occur any time postloading. Although management of peri-implant infections has been described extensively in the literature, no consensus exists on the best approach to its treatment. Infections and bone loss can also occur around implants prior to loading, leading to early implant loss. Little has been reported on the management of peri-implant infections occurring prior to loading. This report describes the identification as well as the surgical and restorative management of infection and bone loss around a preloaded dental implant. CASE PRESENTATION: A 52-year-old systemically healthy, non-smoking white female had severe inflammation with bleeding on probing and bone loss around implant #28 (Universal Numbering System) 7 weeks after placement and augmentation with autogenous and deproteinized bovine bone and a resorbable collagen membrane (RCM). Surgical exposure revealed a deep bony crater around the entire implant. The implant was cleaned for 4 to 5 minutes with a tetracycline and saline slurry. Guided bone regeneration was performed with demineralized freeze-dried bone allograft and an RCM. Azithromycin, ibuprofen 800 mg three times daily, and 0.12% chlorhexidine gluconate rinse were given post-surgery. Postoperative healing was uneventful. Nearly complete bone fill was noted at 1 year of observation when implants were permanently restored. A combination of screw- and cement-retained restorations were placed. Tissues remained healthy 5.5 years postloading with maximum 3-mm probing depth and no changes in bone levels. CONCLUSIONS: This case shows that it is possible to arrest early peri-implant infection, regenerate bone, and maintain health over 5.5 years postloading. Early detection and multidisciplinary care resulted in long-term success.

Soft Tissue Changes Around Immediately Placed Implants: A Systematic Review and Meta-Analyses With at Least 12 Months of Follow-Up After Functional Loading.

BACKGROUND: Immediate implant placement (IIP) is predictable but can lead to esthetic challenges, including midfacial recession (MFR) and papillary height (PH) loss. The aim of this systematic review is to examine the effect of IIP on MFR and PH after at least 12 months of functional loading. METHODS: Literature review of the Cochrane and MEDLINE electronic databases and hand search up to January 2016 identified eligible studies. Four reviewers independently assessed data quality and methodology. RESULTS: A total of 106 articles satisfied the inclusion criteria. Twelve studies qualified for three meta-analyses. MFR was slightly less in conventional implant placement (CIP) than in IIP, but the result was not statistically significant (mean difference [MD] -0.064 mm; P = 0.687). Similarly, there was better PH maintenance in CIPs, with statistical significance for distal PH (DPH) only (cumulative PH: MD -0.396, P = 0.010; DPH: MD -0.765, P <0.001; mesial PH [MPH]: MD -0.285, P = 0.256). MFR was slightly less in IIP with thick versus thin biotypes, but not statistically significantly different (MD -0.373, P = 0.243). Pooled data showed statistically significantly less MFR and better PH maintenance in IIP with thick biotype (MFR: MD -0.478, P <0.001; cumulative PH: MD -0.287, P <0.001; MPH: MD -0.288, P <0.001; DPH: MD -0.310, P <0.001). Non-significantly less MFR (MD 0.253, P = 0.384) and significantly better PH maintenance were found in IIP with immediate provisionalization versus conventional restoration (MD -0.519, P = 0.028). CONCLUSIONS: IIP in thick biotype and with immediate provisionalization had less MFR and better PH than IIP in thin biotype or with delayed restoration. However, these findings should be interpreted with caution due to high heterogeneity, which was calculated using comprehensive meta-analysis statistical software that took into account sample size and different treatment groups, and limited qualified studies.

A Familial Pattern of Multiple Idiopathic Cervical Root Resorption With a 30-Year Follow-Up.

BACKGROUND: Multiple idiopathic cervical root resorption (MICRR) is a rare entity distinct from pathologic root resorption that occurs as a result of several local and systemic factors. METHODS: This report describes a familial pattern of MICRR, including a recently identified case and a 30-year follow-up on previously described cases. RESULTS: The previously reported father (aged 95 years) and son (aged 64 years), and the recently affected daughter (aged 61 years) recounted non-contributory medical history. The resorptive lesions were asymptomatic, unassociated with any predisposing factors, and first identified during the fourth to sixth decades of life. All tooth types were affected, with posterior teeth being affected earlier and with greater frequency; however, distal root surfaces were never affected. The resorptive lesions were progressive in nature, with additional teeth becoming involved as the condition was followed over time. In many instances, surrounding alveolar bone extended into the existing resorptive defects, but without clinical evidence of ankylosis. Gingival tissues, periodontal probing, and tooth mobility were within normal limits. Microcomputed tomography of extracted teeth demonstrated that the lesions were more extensive than clinically evident and rarely invaded the pulp chamber. Histologically, many resorptive lesions were noted along the cementum surface, with evidence of isolated cemental repair. Management of MICRR focused on restoring damaged root surfaces and extracting teeth with extensive root resorption. CONCLUSIONS: MICRR is a challenging entity with unknown etiology and a lack of well-established preventive and management strategies. The familial pattern noted in this report necessitates future studies to investigate the role of genetic components in MICRR development.

Novel CBCT and optical scanner-based implant treatment planning using a stereolithographic surgical guide: a multipronged diagnostic approach.

This report describes the use of the combination of 2 technologies (Cone-beam computed tomography and Optical 3-dimensional scan) to maximize accuracy of implant placement in an area where previous implants failed and had to be removed. This report also stresses the increased efficiency of combining technologies to fabricate stereolithographic surgical guide which, when used intraoperatively, can improve precision of placement.

Crestal bone level changes around immediately placed implants: a systematic review and meta-analyses with at least 12 months' follow-up after functional loading.

BACKGROUND: Immediate implant placement (IIP) is a successful treatment and has the advantages of reducing time and increasing patient satisfaction. However, achieving predictable esthetic results with IIP presents a challenge because of naturally occurring bone loss postextraction. Therefore, the focused question of this systematic review is: What is the effect of IIP on crestal bone level (CBL) changes after at least 12 months of functional loading? METHODS: Extensive literature review of the Cochrane and MEDLINE electronic databases and a manual search up to November 2012 identified eligible studies. Two reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms. RESULTS: Electronic and manual searches identified 648 relevant publications. A total of 57 articles satisfied the inclusion criteria. Sixteen studies had test and control groups; therefore, meta-analyses could be performed. The results demonstrated better CBL preservation around IIP compared with implant placement in healed/native bone at 12 months [CBL difference of -0.242 (95% confidence interval [CI], -0.403 to -0.080; P = 0.003)]. Similarly, platform switching around IIP showed better results compared with non-platform switching (CBL difference of -0.770 [95% CI, -1.153 to -0.387; P <0.001]). There was no difference in mean CBL changes with regard to one-stage or two-stage IIP protocol (-0.017 [95% CI, -0.249 to 0.216; P = 0.85]) or the use of immediate or delayed immediate implant loading (0.002 [95% CI, -0.269 to 0.272; P = 0.99]). CONCLUSIONS: Meta-analyses showed less CBL loss around IIP compared with implant placement in healed bone. Platform-switched implants showed greater crestal bone preservation than non-platform-switched implants. There was no significant difference in CBL with one- versus two-stage placement or use of immediate versus delayed IIP loading. Although there were statistically significant differences favoring IIP, the small differences may not be clinically relevant. Although IIP showed favorable outcomes for CBL changes, these results should be interpreted with caution because of high heterogeneity among studies.

Essential oil mouthwash (EOMW) may be equivalent to chlorhexidine (CHX) for long-term control of gingival inflammation but CHX appears to perform better than EOMW in plaque control.

SELECTION CRITERIA: For inclusion in this systematic review, studies had to be randomized clinical trials (RCTs) or controlled trials in healthy human subjects comparing the effects of essential-oil mouthwash (EOMW) with chlorhexidine (CHX) on plaque and calculus accumulation, tooth staining, and gingival inflammation. Included studies could be either short-term (< 4 weeks' duration) or long-term (> 4 weeks' duration). Studies were required to include a specific formulation of EOMW (Listerine, Johnson and Johnson). They reportedly selected this standard formula of EOMW because it was representative of essential oil-based mouthwashes and because it has the American Dental Association seal of approval. Conversely, there were no restrictions on the concentration of CHX used in studies. The CHX concentration in studies varied from 0.1% to 0.2%. Studies could include no brushing (de novo model) or brushing in conjunction with EOMW or CHX. The authors identified 390 unique articles from electronic database searches. Twenty-five of these articles were selected for full review. Seven articles were excluded because they did not meet the inclusion criteria. Hand searching the reference list of selected manuscripts resulted in the addition of one article. The final systematic review included 19 articles, with a total of 826 subjects who completed all trials. The systematic review included short-term studies lasting less than 4 weeks and long-term studies of 4 or more weeks' duration. Six of these trials were included in the 7 separate meta-analyses performed, yielding a total of 315 participants. The age of subjects in the trials ranged from 16 to 62 years. The study by Axelsson and Lindhe was included twice in the metaanalysis of plaque index, gingival index, and stain index because CHX was used in 0.1% and 0.2% concentrations. The studies by Haffajee et al and Charles et al were each used in meta-analyses for both plaque index and gingival index. Three separate meta-analyses included assessments for plaque index, whereas 2 involved gingival index and 2 assessed tooth staining index. KEY STUDY FACTOR: The effects of EOMW or CHX used as a monotherapy (alone) or in conjunction with self-performed daily oral hygiene on periodontal health, was measured by assessments for plaque index or calculus index, staining index, gingival bleeding index, or gingival index. MAIN OUTCOME MEASURE: The primary outcomes of this systematic review and meta-analysis were differences in mean plaque index, calculus index, and tooth staining index, gingival index, and gingival bleeding after daily use of either chlorhexidine gluconate or essential oil mouthwash for < 4 or > 4 weeks. MAIN RESULTS: Nineteen randomized or controlled clinical trials were included in this systematic review. In 5 of the 7 studies of plaque index, CHX was found to be significantly better than EOMW at reducing plaque accumulation. Stain development was assessed in 5 long-term brushing trials. CHX was significantly associated with more staining than EOMW in the systematic review. The calculus index was significantly greater among CHX users versus EOMW users. Of the 5 studies that measured gingivitis levels, 4 provided statistical data that could be used in the systematic review. Two of these investigations showed significantly lower gingival inflammation with CHX. Bleeding indices were assessed in 5 short-term and 4 long-term studies. Only one of the short-term studies showed a significant difference, whereas 3 of 4 long-term studies showed no difference between CHX and EOMW. Meta-analyses were included for plaque index, gingival index, and tooth staining index. In 2 of 3 meta-analyses of plaque index trials, CHX was shown to be significantly more effective than EOMW at reducing plaque. One of the significant meta-analyses involved plaque regrowth over 4 days (< 4 weeks) of no oral hygiene measures. The overall weighted mean difference (WMD) for the plaque index (Turesky modification of the Quigley and Hein plaque index was 0.46 (95% confidence interval (CI) = 0.09, 0.84). The other meta-analysis was a comparison of 6-week and 6-month trials (> 4 weeks) in which either daily EOMW or CHX supplemented normal oral hygiene measures. This long-term study of plaque accumulation showed significantly less plaque with CHX than with EOMW. The WMD for the long-term plaque control studies was smaller than for the short-term studies (0.19; 95% CI = 0.08, 0.30). No significant differences were found in meta-analyses for gingival inflammation (gingival index) or stain accumulation (stain index). Significant heterogeneity was identified in 1 of 2 of the meta-analyses for both gingival index and stain index. CONCLUSIONS: The authors concluded that CHX was significantly better at reducing plaque accumulation than EOMW in short-and long-term studies. Staining and calculus accumulation were greater among CHX users compared to EOMW. CHX and EOMW were not different with respect to long-term control of gingival inflammation. They suggested that EOMW might be a reliable alternative to CHX for controlling gingival inflammation in cases where a dental professional deems that anti-inflammatory oral care is beneficial. However, they concluded that CHX remains the first choice when plaque control is the focus of therapy.

Essential oil mouthwash (EOMW) may be equivalent to chlorhexidine (CHX) for long-term control of gingival inflammation but CHX appears to perform better than EOMW in plaque control.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review. Van Leeuwen MPC, Slot DE, Van der Weijden GA. J Periodontol 2011 Feb;82(2):174-94. Epub 2010 Nov 2. REVIEWER: Anthony L. Neely, DDS, MDentSc, PhD. PURPOSE/QUESTION: To determine whether essential oil mouthwash is comparable to chlorhexidine gluconate with respect to reducing plaque and gingival inflammation and promoting calculus accumulation and extrinsic staining. SOURCE OF FUNDING: Some support came from the Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam. TYPE OF STUDY DESIGN: Systematic review with meta-analysis of data. LEVEL OF EVIDENCE: Level 1: Good-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence.

Treatment of Class II molar furcation involvement: meta-analyses of reentry results.

BACKGROUND: Predictable regeneration of lost periodontal tissues in furcations is difficult to achieve. This paper investigates the efficacy of different treatment modalities for Class II molar furcations. METHODS: Publications in English were searched using PubMed, Medline, and Cochrane Library databases combined with hand searching from January 1, 1966 to October 1, 2007. The search included randomized controlled human trials in molar Class II furcations with over 6 months of surgical reentry follow-up. Changes in vertical probing depths, vertical attachment levels, and vertical and horizontal bone levels were compared. RESULTS: The search identified 801 articles of which 34 of 108 randomized clinical trials met the criteria. Thirteen trials had test and control arms allowing three meta-analyses: 1) five comparing non-resorbable versus resorbable membranes, 2) five comparing non-resorbable membranes versus open flap debridement and 3) three comparing resorbable membranes versus open flap debridement. There was significant improvement for resorbable versus non-resorbable membranes mainly in vertical bone fill (0.77 ± 0.33 mm; [95% CI; 0.13, 1.41]). Non-resorbable membranes showed significant improvement in vertical probing reduction (0.75 ± 0.31 mm; [95% CI; 0.14, 1.35]), attachment gain (1.41 ± 0.46 mm; [95% CI; 0.50, 2.31]), horizontal bone fill (1.16 ± 0.29 mm; [95% CI; 0.59, 1.73]), and vertical bone fill (0.58 ± 0.11 mm; [95% CI; 0.35, 0.80]) over open flap debridement. Resorbable membranes showed significant improvement in vertical probing reduction (0.73 ± 0.16 mm; [95% CI; 0.42, 1.05]), attachment gain (0.88 ± 0.16 mm; [95% CI; 0.55, 1.20]), horizontal bone fill (0.98 ± 0.12 mm; [95% CI; 0.74, 1.21]) and vertical bone fill (0.78 ± 0.19 mm; [95% CI; 0.42, 1.15]) over open flap debridement. CONCLUSIONS: Guided tissue regeneration with the use of resorbable membranes was superior to non-resorbable membranes in vertical bone fill. Both types of membranes were more effective than open flap debridement in reducing vertical probing depths and gaining vertical attachment levels and in gaining vertical and horizontal bone.

The relationship between periodontal diagnosis and prognosis and the survival of prosthodontic abutments: a retrospective study.

OBJECTIVE: To examine the relationship between periodontal diagnosis and prognosis and survival of prosthodontic abutments over time. METHOD AND MATERIALS: The study consisted of 70 randomly selected patients with either fixed or removable partial dentures delivered by dental students. Age, gender, ethnicity, pertinent medical history, smoking status, procedure performed, abutment tooth number, year of prosthesis delivery, year of most recent periodontal examination, year of tooth loss, periodontal diagnosis and prognosis, date of prosthesis delivery, and most recent periodontal examination were extracted from dental charts. Statistical analyses included chi-square, Kaplan-Meier, and Cox proportional hazards models. RESULTS: A total of 16 of 226 abutment teeth (7.1%) were lost. A total of 88.6% of subjects lost no abutment teeth during the study, while 15.7% lost at least 1 tooth. Analysis showed a cumulative 13.8-year survival rate of 66.0% (SE = +/- 0.10). Tooth-specific periodontal prognosis was a significant predictor of tooth loss. The data showed a 3.05-fold increased risk for tooth loss with removable partial denture abutments compared to fixed partial denture abutments. Abutment teeth with an initial specific prognosis of "good" had a 9.3-fold lower risk of loss than teeth with any other specific prognosis. CONCLUSIONS: Teeth with a periodontal prognosis other than good and those used as removable partial denture abutments had an increased risk of tooth loss. Periodontal diagnosis, overall prognosis (prognosis for the entire dentition), gender, ethnicity, smoking status, and diabetes were not significantly associated with abutment tooth loss over time.