Early Diagnosis and Treatment of Mandibular Second Premolar Impaction: A Case Report.

Odontogenesis, the process of tooth formation, is complex and susceptible to disruptions that can result in dental anomalies such as tooth impaction. The mandibular second premolar, though less commonly impacted than wisdom teeth, presents a unique challenge in pediatric dentistry due to its intricate etiology and the need for timely intervention. This case report aims to highlight the significance of early diagnosis and conservative management strategies in treating mandibular second premolar impaction. The case involves a pediatric patient with impacted mandibular second premolars. Initial treatment included the use of a lower removable appliance with an expansion screw to alleviate crowding, followed by a fixed space maintainer and a Haas rapid palatal expander. These interventions created the necessary space for the premolars to erupt. Self-ligating brackets were later applied, reducing friction and improving periodontal health. The patient underwent two CBCT examinations to monitor progress, which confirmed the successful eruption and alignment of the impacted premolars without the need for surgical exposure. This case underscores the effectiveness of early diagnosis and minimally invasive treatment in managing mandibular second premolar impaction. The tailored approach facilitated the natural eruption of the teeth, highlighting the importance of individualized treatment plans. Future research should focus on optimizing these conservative strategies to enhance patient outcomes in similar cases.

Prevalence and Patterns of Positional Dental Anomalies in First Permanent Molars: Insights from a Study in Oradea, Romania.

Tooth position anomalies, influenced by both genetic and environmental factors, can significantly impact oral health and play a critical role in establishing proper occlusion. The aim of this study was to identify the most prevalent tooth position anomalies in first permanent molars among Romanian patients and to evaluate additional variables as well. This retrospective study utilized digital study models to identify all existing tooth position anomalies. The study included patients aged 12 to 40 years with complete permanent dentition. Axial changes (buccal tilting, oral tilting, mesial tilting, and distal tilting) as well as rotational changes (mesio-buccal rotation and disto-buccal rotation) were investigated. After applying the exclusion criteria, 103 patients remained in the study. Our findings revealed a notable prevalence of positional anomalies, with disto-buccal rotations being most common in upper molars (tooth 1.6-22.3%, tooth 2.6-31.1%) and oral tilting predominating in lower molars (tooth 3.6-6.8%, tooth 4.6-14.6%). Interestingly, neither gender nor malocclusion type significantly influenced the occurrence of tooth position anomalies. Symmetrical patterns in positional changes were observed, with patients having tooth position anomalies at 1.6 significantly more frequently associated with anomalies at 2.6. Similarly, anomalies at 3.6 were significantly more frequently associated with anomalies at 4.6. Additionally, for molars 2.6 and 3.6 on the left side, the differences were statistically significant, with patients having anomalies at 2.6 significantly more frequently associated with anomalies at 3.6. This pattern was not observed for the molars situated on the right side of the dental arches. While this study provides insights into positional anomalies in first permanent molars among the Romanian population, its retrospective design and focus on a specific demographic may limit generalizability. In conclusion, the study underscores the significant prevalence of positional anomalies in first permanent molars among adolescents and adults in Oradea, Romania. Early detection and targeted interventions are crucial to address these anomalies and improve orthodontic outcomes. Comprehensive assessment and treatment planning are essential to achieve optimal dental harmony and function. Further research is needed to elucidate the underlying factors contributing to these positional changes and their long-term impact on oral health and occlusal stability.

Impact of Prosthetic Material and Restoration Type on Peri-Implant Bone Resorption: A Retrospective Analysis in a Romanian Sample.

Background/Objectives: This research investigates the nuanced factors influencing peri-implant bone resorption in implant-supported fixed prostheses, with a focus on age, gender, implant location, time since prosthetic loading, and material characteristics. Methods: Records from a dental clinic in Oradea, Romania, between 1 January 2017 and 1 January 2023, were scrutinized and were selected by means of purposive sampling. All records were analyzed between 1 May 2023 and 15 June 2023. A total of 160 implants were included, and the prosthetic restorations were either metal-ceramic or zirconia. Implants from a single manufacturer were used, and a standardized loading protocol was followed. The study examined variables such as age, gender, implant location, prosthetic material, and time since prosthetic loading. Results: A total of 160 implants were included, with 78 applied to female patients (48.8%) and 82 to male patients (51.2%). The age range of the patients undergoing dental implant procedures was 30 to 79 years. Implants were distributed between the mandible (51.2%) and maxilla (48.8%), with 49.4% placed in the posterior dental arches and 50.6% in the anterior dental arches. The majority of patients received metal-ceramic prosthetic reconstructions (76.9%). Statistical analysis revealed significant differences in resorption patterns between zirconia and metal-ceramic restorations (p < 0.001), with zirconia restorations exhibiting higher resorption in the mesial-vertical and distal-vertical planes compared to metal-ceramic restorations. Age-related factors showed a significant association with distal-vertical resorption (p = 0.017), with patients aged 60-69 years exhibiting higher resorption values compared to those aged 40-49 years. Gender differences were observed in mesial-horizontal resorption (p = 0.036), with male patients displaying higher resorption values compared to female patients. Implant location and time elapsed since implant loading did not show significant associations with resorption patterns. Conclusions: The study provides insights into the multifactorial nature of peri-implant resorption. Age, gender, and material characteristics contribute to variations, informing personalized treatment approaches. The findings facilitate a comprehensive understanding for clinicians, enhancing treatment planning and post-operative care.

The Relationship between Dietary Habits and Periodontal Pathogens in a Sample of Romanian Children and Adolescents: A Cross-Sectional Study.

The role of diet in shaping oral microbiota and its potential contribution to the development of periodontal pathogens cannot be understated. This study aimed to explore the correlation between dietary habits and the prevalence of 11 periodontal pathogens among children and adolescents in Oradea, Romania. The identification of these pathogens was performed using the micro-IDent test kit, capable of detecting 11 specific periodontal pathogens. Bacterial sampling was conducted from the crevicular fluid in the morning, prior to brushing, followed by the completion of a brief questionnaire by parents. The questionnaire captured various aspects of the children's eating habits, including meal frequency, consumption of sweets, and hydration levels. The collected samples were dispatched to the laboratory for analysis, which provided insights into the abundance of microorganisms. The study encompassed 60 participants aged between 2 and 18 years, with the majority reported by their parents to have regulated meal timings, frequent sugar intake, and adequate hydration. The findings revealed significant associations between certain dietary factors and the presence of specific periodontal pathogens. Notably, the absence of breastfeeding was linked with the detection of Tannerella forsythia and Campylobacter rectus. Furthermore, frequent consumption of sweets corresponded with the presence of Capnocytophaga spp., which was particularly observed in individuals consuming sweets 2-3 times a day. Insufficient age-appropriate hydration showed an association with the prevalence of T. forsythia, Peptostreptococcus micros, and Capnocytophaga spp. In this sample, it became evident that eating habits and diet influenced the presence of several periodontal pathogens. The lack of breastfeeding was predominantly associated with positive results for T. forsythia and C. rectus, while inadequate hydration correlated more frequently with the presence of T. forsythia and P. micros. Moreover, frequent consumption of sweets was linked to the presence of Capnocytophaga spp.

The Relationship between Age, Gender, BMI, Diet, Salivary pH and Periodontal Pathogenic Bacteria in Children and Adolescents: A Cross-Sectional Study.

The oral microbiome can be influenced by many factors and its dysbiosis can have negative effects on oral and general health. The purpose of this study was to analyze the intensity of 11 periodontal pathogenic microorganisms identified in the oral cavity of a sample of children and adolescents from Oradea, Romania and to investigate the association of some variables (age, gender, body mass index, diet, and salivary pH) with the identified microorganisms. The cross-sectional study was conducted on a group of clinically healthy patients under the age of 18 years from Oradea, Romania. For the analysis of the periodontal pathogens, the micro-IDent kit was used, which determines 11 bacterial markers for periodontitis and peri-implantitis. The kit is based on the polymerase chain reaction (PCR). Bacterial sampling was carried out according to the manufacturer's instructions. A total of 60 children (23 male, 37 female) were included in this study, and were divided into three different age categories. No statistically significant results were identified for gender. However statistically significant results were obtained for other variables. Positive results for Prevotella intermedia and Bacteroides forsythus were associated with ages between 13 and 18 years, while positive results for Capnocytophaga spp. were associated with ages between 2 and 5 years. Positive results for Prevotella intermedia, Bacteroides forsythus, Peptostreptococcus micros, Campylobacter rectus and Eikenella corodens were associated with an overweight BMI. Negative results for Prevotella intermedia and Eikenella corodens were associated with a natural diet in the first 6 months of life. Positive results for Fusobacterium nucleatum and Campylobacter rectus were associated with an acidic salivary pH. In this study, the identified periodontal pathogens were associated with age, body mass index, diet in the first 6 months of life, and salivary pH.

Patterns of Mandibular Fractures through Human Aggression: A 10-Year Cross-Sectional Cohort Retrospective Study.

The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and guide these patients. This retrospective study was conducted in 478 patients with mandibular fractures caused by interpersonal violence over 10 years in a university clinic. The most affected were male patients (95.19%), 20-29 years of age (46.86%), under the influence of alcohol (83.26%) and without education (43.9%). The majority of mandibular fractures were displaced (89.3%) and intraorally open (64.0%). The most frequent location was the mandibular angle (34.84%). The most frequent soft tissue lesions were hematomas (45.04%) and abrasions (34.71%), being associated frequently with closed (p = 0.945/p = 0.237), displaced (p = 0.001/p = 0.002), single angle fractures (p = 0.081/p = 0.222). Educating the population and fighting alcohol consumption would decrease the occurrence of mandibular fractures through aggression. Clinical diagnosis should be made, keeping in mind that the severity of associated soft tissue lesions is directly proportional to the pattern and number of underlying fracture lines.

Clinical Patterns and Treatment of Pediatric Facial Fractures: A 10-Year Retrospective Romanian Study.

Pediatric facial fractures have different clinical patterns and require different therapeutic approaches in comparison with those of facial fractures that occur among adults. The aim of this study was to describe the main clinical characteristics of pediatric facial fractures (such as fracture location, fracture pattern, treatment, complications and evolution) in a group of pediatric patients from NW Romania. This research was a retrospective study that was conducted for 10 years in a tertiary hospital for oral and maxillofacial surgery from NW Romania. A total of 142 pediatric patients were included in this study, with ages between 0 and 18 years. Mandibular (66.2%), midface (25.4%) and combined fractures (8.5%) were identified, and patients from the 13-18 years age group were more frequently affected by facial fractures (78.9%). Most of the diagnosed fractures among all three types of fractures were total fractures, and most mandibular (92.6%) and midface (80.6%) fractures were without displacement. Hematomas, lacerations and abrasions were identified as associated lesions. Patients with associated lesions were more frequently associated with combined fractures or midface fractures than mandibular fractures. The instituted treatment was, in general, orthopedic, for all three types of fractures (mandibular-86.2%; midface-91.7%; combined-66.7%). Most fractures, mandibular (96.8%), midface (100%) and combined (91.7%) fractures, had a favorable evolution. Most fractures did not present any complications at the follow-up. Pediatric facial fractures have unique patterns and must be treated with caution, considering the particularities of pediatric facial anatomy.

Oral Manifestations in Children Diagnosed with COVID-19: A Narrative Review.

The COVID-19 disease has many symptoms, including fever, dry cough, tachypnea, and shortness of breath, but other symptoms can accompany the disease. The disease can also have oral manifestations. The aim of this narrative review is to describe the oral manifestations of COVID-19 in children and adolescents by summarizing the current knowledge as it was described in various case reports and original articles. A review of the literature was carried out by searching the online databases PubMed, Web of Science and Scopus, between October 2022 and 12 November 2022. For this narrative review, 890 articles from three databases and manual search were screened. Saliva was discovered to be a potential screening tool for the infection with the SARS-CoV-2, although it is most reliable in the first few days of infection. Different alteration of the oral mucosa, such as ulcers, erosions and gingivitis were reported. Oral manifestations accompanied children with COVID-19-related multisystem inflammatory syndrome, Kawasaki disease, thrombocytopenic purpura and erythema multiforme. COVID-19 had an indirect effect on oral harmful habits by decreasing their frequency during the lockdown. Although they occur more rarely, oral manifestations can accompany COVID-19 disease in children and adolescents, and they can be an early sign of the disease.

Ectopic Eruption of First Permanent Molars in Children from North-Western Romania.

Ectopic eruption of first permanent molars can lead to complications if left untreated. The aim of this study was to determine the prevalence of the ectopic eruption of first permanent molars in a sample of children from North-Western Romania, and to identify the characteristic of this anomaly in the studied population. We included patients aged between 5 and 9 years, and patients who needed a radiological examination for the diagnosis and treatment of dental or dento-maxillary diseases. The following exclusion criteria were applied: unclear or poor-quality radiographs; radiographs that belonged to patients who benefited from an orthodontic treatment before the panoramic radiograph was taken; patients who were undergoing orthodontic treatment when the radiograph was taken; and patients with local or general diseases that could influence dento-facial growth and development. Three degrees of severity were selected (moderate, severe, and very severe). The sample consisted of 438 patients, and 61 patients were diagnosed with ectopic eruption of first permanent molars (13.92%). Out of the 1752 analyzed molars, 103 were affected (5.87%). Patients with a moderate degree of ectopy were more frequently boys (56%, n = 14), while patients with a severe degree of ectopy were more frequently girls (52.8%, n = 19). Patients with a moderate degree of ectopy had significantly more frequently a unilateral position (57.1%, n = 16), while patients with a very severe degree of ectopy had significantly more frequently a bilateral position (36.4%, n = 12). The ectopic eruption was diagnosed at the level of the upper-right first permanent molar in a percentage of 18.4% (n = 19), at the level of the upper-left first permanent molar in a percentage of 17.5% (n = 18), at the level of the lower-right first permanent molar in a percentage of 32% (n = 33), and at the level of the lower-left first permanent molar in a percentage of 32% (n = 33). Although not very frequent, the ectopic eruption of first permanent molars is an important anomaly that should be early diagnosed, monitored and treated.

The Etiology and Epidemiology of Pediatric Facial Fractures in North-Western Romania: A 10-Year Retrospective Study.

Pediatric facial fractures are not as common as facial fractures occurring in the adult population. Their therapeutic approach is different because they affect patients with active growth, and have an etiology and epidemiology that vary depending on different cultural, religious and demographic factors. This research aimed to identify the main factors involved in the etiology of pediatric facial fractures, as well as the epidemiology of pediatric facial fractures in a sample of children and adolescents from North-Western Romania. This 10-year retrospective study was performed in a tertiary center for oral and maxillofacial surgery in North-Western Romania. Medical files of patients that were admitted between 1 January 2002 and 31 December 2022 were analyzed. Pediatric patients aged 0 to 18 years were included in this study. The final sample consisted of 142 children and adolescents diagnosed with facial fractures, with this number representing 14.1% of all patients affected by facial fractures. Most frequently, fractures were identified in the 13-18 age group (78.9%, n = 112), which were more often associated with fractures caused by interpersonal violence than caused by road traffic accidents, falls or animal attacks. Boys were more affected (88%, n = 125), and were more frequently associated with fractures caused by interpersonal violence. The most frequently identified etiological factors included interpersonal violence (50%, n = 71), falls (18.3%, n = 26) and road traffic accidents (11.3%, n = 16). In terms of location, the mandible was the most affected facial bone structure (66.2%, n = 94), and patients with mandibular fractures were more frequently associated with fractures caused by interpersonal violence. The incidence of pediatric facial fractures should be lowered because they may interfere with the proper development of the facial skeleton. Establishing measures aimed at preventing interpersonal violence, as well as other causes involved in the etiology of facial fractures is imperative.

PATTERNS OF FACIAL FRACTURES AND ASSOCIATED SOFT TISSUE INJURIES: A RETROSPECTIVE STUDY ON 1007 PATIENTS.

Background: Knowing the severity of a pathology in a population helps to both establish a rapid diagnosis and to prepare medical staff to provide adequate and complete treatment. The aim of this study was to determine the patterns of maxillofacial fractures and their associated soft tissue injuries in order to identify the specific types of maxillofacial fractures with the highest incidence of associated soft tissue injuries. Methods: A 10-year retrospective evaluation of maxillofacial trauma was performed on 1007 patients. All 1007 patients were clinically and paraclinically confirmed to have facial skeletal injuries. Results: The highest incidence of maxillofacial fractures was found in the mandible (62.16%), the mandibular angle being the most frequently involved (28.84%). Most of the fractures were complete (97.82%), displaced (87.98%) and closed (86.30%). Hematoma was the most common associated soft tissue injury (44.79%). In mandibular trauma, the incidence of hematoma and laceration was the highest in angle and simultaneous multiple fracture lines (p=0.002). In the midface, hematoma was more frequently associated with non-comminuted zygomatic bone fractures (p=0.003), while laceration was associated with multiple underlying fracture lines (p=0.002). Conclusions: Patients presenting with hematomas will most frequently have an underlying single closed fracture line, while patients with lacerations will most frequently present underlying multiple and displaced fractures.

An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients.

BACKGROUND: Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention. METHODS: A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients' medical records. Statistical analysis was performed. A value of p < 0.05 was considered statistically significant. RESULTS: The incidence of maxillofacial fractures was high among patients in the 20-29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions (p = 0.001, p = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks (p = 0.001). CONCLUSIONS: Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20-29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population.

Interrelation between facial soft tissue lessions, underlying fracture patterns and treatment of zygomatic bone trauma: a 10 year retrospective study.

BACKGROUND: The pattern of zygomatic bone fractures varies in the literature, their features being frequently masked by the presence of associated soft tissue lesions. In this context the clinical diagnosis and the therapeutic indications can be difficult. The aim of this study was to evaluate the clinical features of zygomatic bone fractures and their interrelation with concomitant overlying soft tissue injuries, as well as to assess the type of treatment methods applied depending on the fracture pattern and the results achieved depending on the incidence rate of postoperative complications. We will use these results in order to improve the diagnosis and the establishment of correct treatment of this pathology. METHODS: A 10-year retrospective evaluation of midface fractures was performed in patients diagnosed and treated in a tertiary Clinic of Oral and Maxillofacial Surgery. Statistical analysis was performed with the MedCalc Statistical Software version 19.2 (MedCalc Software bvba, Ostend, Belgium; 53 https://www.medcalc.org ; 2020). Nominal data were expressed as frequency and percentage. The comparisons of the frequencies of a nominal variable among the categories of another nominal variable were made using the chi-square test. Multivariate logistic regressions were used in order to establish the independent association between variables and lacerations/excoriations. After using the Bonferroni correction for multiple comparisons, a value of p < 0.025 was considered statistically significant. RESULTS: The study included 242 patients with zygomatic bone fractures. The majority of the fractures were displaced n = 179 (73.9%), closed n = 179 (73.9%) and complete n = 219 (90.5%). Hematoma was the most frequent associated soft tissue lesion n = 102 (42.1%) regardless of the fracture pattern (p = 1.000). Complete zygomatic fracture (OR - 2.68; p = 0.035) and fractures with displacement (OR - 3.66; p = 0.012) were independently associated with the presence of laceration. Fractures with displacement (OR - 7.1; p = 0.003) were independently associated with the presence of excoriation. The most frequent type of treatment applied was Gillies reduction (61.9%), followed by ORIF (30.9%). The most frequent postoperative complication was malunion secondary to Gillies treatment (4,6%). CONCLUSIONS: Patients presenting lacerations and excoriations on clinical soft tissue examination will most frequently have an underlying complete, displaced or comminuted zygomatic fracture. In the case of displaced, open or comminuted fractures we achieved the best results secondary to ORIF treatment method, while in the case of non-displaced and closed fractures, the best results achieved were secondary to conservative treatment.

Epidemiological Analysis of Zygomatic Bone Fractures in North-Western Romanian Population: A 10-Year Retrospective Study.

BACKGROUND/AIM: Midface fractures represent a challenge for medical practitioners due to the severe esthetic and functional consequences. This study aimed to determine the causes and to provide a demographic analysis of zygomatic bone fractures in our geographical area, with a view to implementing the necessary prevention methods, training the medical staff for a certain type of patients and decreasing the required costs. PATIENTS AND METHODS: A retrospective statistical epidemiological analysis of 242 patients with zygomatic bone fractures over a 10-year period was performed. RESULTS: The most affected age group was 20-29 years (27.27%). The most affected were men (n=211, 87.19%) from urban areas (n=140, 57.85%), and without education (n=122, 50.41%). The most frequent cause was interpersonal violence (54.04%), followed by falls (17.36%) and road traffic accidents (16.53%). CONCLUSIONS: Interpersonal violence as a cause of zygomatic bone fractures is currently reaching epidemic proportions. Taking legal measures to prevent aggression is a public health emergency that would considerably decrease the incidence of these fractures in our population.

Clinical patterns and characteristics of midfacial fractures in western Romanian population: a 10-year retrospective study

BACKGROUND: The aim of this study was to identify the clinical pattern of midfacial fractures and concomitant associated injuries in our geographical area, as well as to correlate them in order to determine the type of fracture with the highest incidence of associated injuries. MATERIAL AND METHODS: A 10-year retrospective evaluation of midfacial fractures was performed in 379 patients. RESULTS: Zygomatic complex fractures had the highest incidence (n = 242, 50%). The majority of the fractures were complete (n = 561, 92.42%), closed (n = 473, 84.16%) and without displacement (n = 454, 80.78%) regardless of the location of the fracture line (p = 0.014). All patients had at least one associated soft tissue injury (n = 379, 100%). The most frequent associated injury was hematoma (n = 308, 73.51%). Hematomas were predominant in the case of single fractures, while lacerations and excoriations were prevalent in the case of multiple fractures (p = 0.000). CONCLUSIONS: Following trauma of the midface, patients with soft tissue hematomas will most probably have an underlying fracture with a single trajectory, while patients with lacerations will most probably have concomitant multiple bone fractures

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Ludwig's angina, a rare complication of mandibular fractures.

Traumas are a major problem worldwide. A considerable proportion of traumas are located in the cephalic extremity. Neglect of these disorders by patients or those responsible for patient management may result in particularly serious consequences. This paper presents the case of a 58-year-old male patient with an intraorally open mandibular fracture, which left untreated for 3 days, was complicated by Ludwig's angina. Following aggressive surgical treatment during which the mandibular fracture was manually reduced and immobilized with a metal splint fixed with circumdental wires and effective antibiotic therapy, the septic process was terminated and the patient's fracture and infected wound were healed. The correct and rapid treatment of open mandibular fractures is mandatory in order to avoid severe septic complications.

The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections.

Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.

One year results of a randomized controlled clinical study evaluating the effects of non-surgical periodontal therapy of chronic periodontitis in conjunction with three or seven days systemic administration of amoxicillin/metronidazole.

BACKGROUND: To evaluate the clinical outcomes 12 months after systemic administration of amoxicillin (AMX) and metronidazole (MET) adjunctive to subgingival debridement (SD) in patients with severe chronic periodontitis (sChP). MATERIAL AND METHODS: 102 patients with sChP were treated randomly as follows: SD within 2 consecutive days and placebo for 7 days (group A), SD+AMX+MET (both 500mg x3 times daily TID) for 3 days (group B), SD+AMX+MET (both 500mg x 3 TID) for 7 days (group C). At baseline, at 3-, 6-, and 12-months post-treatment probing pocket depth (PD), clinical attachment level (CAL), furcation involvement, bleeding on probing (BOP), full-mouth plaque score (FMPS) were determined. The reduction in the number of sites with PD≥6mm was defined as main outcome variable. RESULTS: 75 patients completed the study. At 12 months, all three treatment groups showed statistically significant improvements (p<0.001) of mean PD, CAL, BOP and number of sites with PD≥6mm compared to baseline. Mean residual PD were statistically significantly lower and CAL gain statistically significantly greater in the two antibiotic groups as compared to placebo. While PD reductions (p = 0.012) and CAL gain (p = 0.017) were statistically significantly higher in group C compared to group A, only the 3-day AB group showed statistically significantly fewer sites with PD≥6mm at 12 m (p = 0.003). The reduction in the number of sites with PD≥6 mm (primary outcome) showed no statistical significant differences between the 3 treatment groups. However, in both antibiotic groups significantly more patients compared to the placebo group reached a low risk for disease progression at 12 months (≤4 sites with PD≥5mm). CONCLUSION: At 12 months, both adjunctive antibiotic protocols resulted in statistically significantly greater clinical improvements compared to placebo.

Clinical evaluation of a porcine acellular dermal matrix for the treatment of multiple adjacent class I, II, and III gingival recessions using the modified coronally advanced tunnel technique.

OBJECTIVE: To evaluate the clinical efficacy of a new porcine acellular dermal matrix (PADM) for the treatment of Miller Class I, II, and III multiple gingival recessions using the modified coronally advanced tunnel technique (MCAT). METHOD AND MATERIALS: Twelve nonsmoking, systemically healthy patients presenting at least two adjacent Miller Class I, II, or III gingival recessions (GR), with a minimal depth of 2 mm, were treated consecutively with MCAT in conjunction with PADM. At baseline and 12 months postoperatively, complete root coverage (CRC, eg 100% root coverage), mean root coverage (RC), recession depth, recession width, attached gingiva (AG), keratinized tissue (KT), periodontal pocket depths (PD), and clinical attachment level (CAL) were evaluated. The main outcome variable was CRC. RESULTS: Postoperative healing was uneventful in all cases, without any matrix loss or exposure or infection. Statistically significant improvements (P < .0001) were observed 12 months postoperatively in 53 of the included 54 GR (98.15%). Twenty two recessions (40.74%) showed CRC while the mean RC measured 73.20 ±â€¯27.71%. Mean GR reduction was 2.06 ±â€¯1.18 mm while the gain of AG amounted to 0.84 ±â€¯0.73 mm and of KT to 0.69 ±â€¯0.51 mm, respectively. There were no statistically significant changes for PD at 12 months; CAL showed a significant decrease (P < .05) at 12 months from 3.77 ±â€¯1.28 mm to 2.30 ±â€¯1.02 mm. CONCLUSION: PADM in conjunction with MCAT may be successfully utilized for the treatment of Miller Class I, II, and III multiple adjacent GR.