Clinical Decision Making for Primary Peri-Implantitis Prevention: Practical Applications.

FOCUSED CLINICAL QUESTION: When planning dental implant therapy, what risk-reduction strategies allow practitioners to select patients, sites, and restorative plans that decrease the incidence of peri-implant disease? SUMMARY: With a marked increase in the number of patients receiving dental implants to treat partial or complete edentulism, it follows that the prevalence of peri-implant mucositis and peri-implantitis have increased. Risks associated with implant therapies may vary based upon underlying local, environmental, surgical, patient, prosthetic, and fixture-related factors. Furthermore, an emphasis on preventative measures and maintenance should be undertaken to avoid development and progression of peri-implant diseases. Thorough risk assessment, proper treatment planning, and early diagnosis and intervention are critical in the absence of definitive data of long-term success of treatments for peri-implant condition. Given the difficulty in intervention once peri-implantitis is established, identification of risk factors and development of treatment plans to address those factors before dental implant therapy is critical to the long-term health and success of dental implants. CONCLUSIONS: A patient-centered, evidence based approach to dental implant treatment planning to reduce the risk for peri-implantitis should be undertaken. Systematic diagnosis of disease state(s) and evaluation of the etiologic and modifying risk factors for peri-implant diseases can yield more optimal outcomes to reduce peri-implantitis rates.

Bring the past to the future: adapting stereoscope images for use in the Oculus Go.

The purpose of this project was to explore methods for adapting images originally created for the analog stereoscope to use in contemporary virtual reality headsets. The Alabama Museum of the Health Sciences holds in its collections a set of medical images for the stereoscope published by Dr. S.I. Rainforth in 1910. We scanned 3 stereoscope cards from the collection at a resolution of 1200 dots per inch, then adapted the images for use in virtual reality using Adobe Photoshop and Unity. We successfully created a working application for the Oculus Go that displays the images stereoscopically in the headset. The current application allows only static display of the images. Our next steps in developing this project will be to add additional images from the collection to the virtual reality application, optimize parameters related to image display, and develop scripting that would allow users to dynamically select images from the collection. More information on this project is available on the Alabama Museum of the Health Sciences Virtual Exhibits website, and a short video demonstration is available on Vimeo.

Treatment of Recession Defects With Mucosal Access and Use of Soft Tissue Allograft: A Case Report of a Simplified Protocol.

INTRODUCTION: Esthetic and functional root coverage procedures using a variety of techniques and materials allow for predictable outcomes in Miller Class I and II defects, but may be accompanied by high levels of postoperative discomfort and lengthy intrasurgical time. Current techniques may also require a steep practitioner learning curve, cumbersome intrasurgical steps, and their use in challenging clinical situations, e.g. multiple adjacent recession defects, limited vestibular depth, and anatomical limitations can prove difficult. This report introduces the side access mucosal releasing incision (SAMRI) technique as an innovative and simplified method to perform mucosal-access root coverage procedures. CASE PRESENTATION: A 42-year-old female presents with 3 to 4 mm of gingival recession at #9-11 and opts for treatment with a vestibular approach and acellular dermal matrix graft to avoid a secondary surgical site. CONCLUSION: SAMRI procedure allows for optimal root coverage and esthetic results while limiting intrasurgical time and postoperative patient morbidity.

Toss the Floss? Evidence-Based Oral Hygiene Recommendations for the Periodontal Patient in the Age of "Flossgate".

FOCUSED CLINICAL QUESTION: What are the key considerations for effective delivery of oral hygiene home care to best manage or prevent periodontal diseases? BACKGROUND: Plaque control is critical for the management of periodontal diseases, but not all patients demonstrate the same risk for disease progression and challenges differ based upon clinical findings. This report seeks to present evidence-based oral hygiene recommendations for a variety of common periodontal diseases. SUMMARY: Accurate diagnosis, risk assessment, and individualized delivery of oral hygiene instruction is necessary to ensure that patients can provide adequate home care to promote health and maintain the benefits of periodontal therapy. CONCLUSIONS: Oral hygiene techniques and recommendations should vary based upon patients' clinical presentation and risk assessment. Utilization of evidence-based strategies to deliver personalized care will allow for optimal wellness for patients.

Clinical effectiveness of orthodontic treatment on smile esthetics: a systematic review.

Objectives: The aim of this systematic review is to identify how different types of orthodontic interventions affect the esthetics of the smile, any time after orthodontic treatment. Materials and methods: A systematic search of the literature was carried out using 5 electronic databases (PubMed, Embase, The Cochrane Library, Scopus, Dentistry and Oral Sciences Source) that included articles until October 2017. Randomized and non-randomized controlled clinical trials, case-control observational studies, and cohort and cross-sectional studies with validated data collection and/or follow-up periods reporting on orthodontic interventions that changed the smile any time after orthodontic treatment were part of the study protocol. Only studies that were published in the English language and those that had human patients of any age and gender who underwent orthodontic treatment were included. Results: A total of 814 articles were found and 9 of them were included (7 cohort and 2 cross-sectional studies). Among the selected articles, 8 stated the type of orthodontic intervention used during treatment and 1 did not specify the intervention. Eight articles were judged of moderate risk and 1 had high risk of bias. Conclusion: Orthodontic treatment affects the esthetics of the smile in three dimensions. There was slight evidence that extractions do not affect the smile width and buccal corridors area. Evidence on palatal expansion was controversial. The remaining existing data evidence that investigated smile esthetics after orthodontic treatment was uncertain. Therefore, more validated, evidence-based studies are needed.

Commentary: Targeting Underlying Biologic Mechanisms in Selecting Adjunctive Therapies to Improve Periodontal Treatment in Smokers: A Commentary.

Despite well-established evidence that cigarette smoking is the largest modifiable risk factor for periodontal disease and has many deleterious health effects, treatment of periodontal disease in smokers remains a challenge of periodontal therapy. A recent meta-analysis revealed that adjunctive use of local delivery of antimicrobials, but not systemic antibiotic usage, with non-surgical periodontal therapy resulted in improvement in clinical periodontal parameters. Further evaluation of the current literature reveals that host modulation therapy may also result in clinical benefit in smokers. These findings may be tied to the underlying pathophysiology of periodontal disease progression in smokers and suggest that focused therapies that target known mechanisms of action are critical to the success of proposed treatments.