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1.
Artículo en Inglés | MEDLINE | ID: mdl-33660930

RESUMEN

INTRODUCTION: How to best classify the Stage III and IV periodontitis cases that share common features of the most severe clinical attachment loss and the most severe radiographic bone loss? CASE PRESENTATION: Two patients presented features of generalized periodontitis, with severe probing depth and clinical attachment loss that would meet inclusion in both Stage III and IV. The cases retained all teeth but were further complicated by teeth drifting and secondary occlusal trauma. Appropriate disease classification required clinical judgement and led to the final classification of Stage III, Grade C for both cases. CONCLUSION: Patient-based clinical judgement, aiming for long-term preservation of natural dentition, drives the final assignment of staging when the case falls in the "gray zone" that focuses on major differences in Stage III and IV periodontitis.

2.
Artículo en Inglés | MEDLINE | ID: mdl-33382524

RESUMEN

INTRODUCTION: Guided bone augmentation often requires extensive releasing of the mucoperiosteal flap to achieve primary wound closure, an invasive procedure that can compromise the keratinized tissue volume and increase patient morbidity. Amnion-chorion membranes have been used to actively promote healing in chronic open-wound situations in the medical field, suggesting that they could be used in a similar manner in the oral cavity.The ability to use open-wound healing techniques for guided bone regeneration would allow clinicians to avoid invasive procedures that cause additional tissue trauma at the surgical site. CASE SERIES: Amnion-chorion membranes were applied over the bone grafting material augmenting localized horizontal ridge defects, and a gap between the flaps was left intentionally during healing. Minor flap releasing procedures were performed in these cases, which demonstrated uneventful soft tissue healing, good volume of bone regeneration and preserved keratinized tissue. CONCLUSIONS: Preliminary clinical outcomes suggested contained minor horizontal ridge defects may be treated satisfactorily in a controlled, open-wound healing manner that reduces surgical trauma, chair time, and patient morbidity.

3.
Artículo en Inglés | MEDLINE | ID: mdl-33037854

RESUMEN

FOCUSED CLINICAL QUESTION: What are the fundamental debates and questions related to the newly developed two-vector system for classification of periodontal diseases that have emerged as to how to accurately assign, stage, and grade periodontitis cases? The aim of the present manuscript is to demonstrate the essential thought processes that are needed in utilizing the new periodontitis classification system to diagnose two gray zone cases. SUMMARY: Clinical case 1 includes an 83-year-old male diagnosed with periodontitis and classified as Stage III Generalized Grade B periodontitis, while clinical case 2, a 73-year-old male was classified as presenting Stage IV Generalized Grade B periodontitis. Although clinical and radiographic evaluations revealed similarities between the cases, the thought process that includes clinical judgment is described to guide a more accurate diagnosis following the guidelines of the new classification system. CONCLUSION: The two cases demonstrated here offer an opportunity for clinicians to recognize the essential role of sound clinical judgment in certain cases when applying the new periodontal disease classification system and also clarify questions emerging from implementing this classification system.

4.
Int J Oral Maxillofac Implants ; 35(3): 631-638, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32406663

RESUMEN

Maxillary sinus augmentation is a procedure commonly performed in patients in need of posterior maxillary implants with limited vertical ridge height and sinus pneumatization. However, minimal information has been presented to evaluate the complexity of the sinus elevation procedure via a lateral window approach based on patient examination, including extraoral findings, anatomical factors, and the possible influence from the surgeon's experience. Therefore, this article presents a new scheme of maxillary sinus floor elevation difficulty score based on comprehensive patient- and surgical-related factors. The proposed scoring tool aims to aid surgeons in performing a comprehensive presurgical evaluation prior to the lateral wall sinus augmentation surgery and also enhance communication between clinicians and patients regarding the complexity of the case.


Asunto(s)
Seno Maxilar/cirugía , Elevación del Piso del Seno Maxilar , Implantación Dental Endoósea , Humanos , Maxilar/cirugía
5.
Artículo en Inglés | MEDLINE | ID: mdl-32233190

RESUMEN

Maxillary sinus augmentation is a procedure commonly performed in patients in need of maxillary posterior implants with loss of vertical ridge height and sinus pneumatization. Previous studies have identified some factors associated with sinus membrane perforation during lateral-wall sinus elevation procedures. Although membrane perforation does not directly link to future implant failure, it has been shown to have an association with postoperative complications. In order to promote more predictable results and reduce complications during the sinus elevation procedure, especially for the lateral window approach, articles published in peer-reviewed journals were reviewed to support the proposal of a new risk-evaluation system prior to the sinus surgery. This article reviews anatomical and patient-related factors that might affect the risk of perforation during the surgery and also aims to provide a risk assessment table to enable clinicians to analyze these factors prior to the lateral sinus augmentation surgery.


Asunto(s)
Seno Maxilar , Elevación del Piso del Seno Maxilar , Implantación Dental Endoósea , Humanos , Maxilar , Medición de Riesgo
6.
Artículo en Inglés | MEDLINE | ID: mdl-32231082

RESUMEN

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.


Asunto(s)
Implantes Dentales , Mucosa Bucal , Consenso , Egipto , Humanos
8.
J Periodontol ; 91(3): 299-310, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31670836

RESUMEN

BACKGROUND: Orthodontic treatment can greatly impact the periodontium, especially in dentitions with a thin periodontal phenotype. Orthodontic tooth movement can result into iatrogenic sequelae to these vulnerable anatomic conditions, such as development and exacerbation of bony dehiscence or fenestration defects, which can manifest loss of periodontal support and gingival recession (GR). This systematic review aimed to investigate whether periodontal phenotype modification therapy (PhMT) involving hard tissue augmentation (PhMT-b) or soft tissue augmentation (PhMT-s) has clinical benefits for patients undergoing orthodontic treatment. METHODS: An electronic search was performed in two major databases for journals published in English language from January 1975 to January 2019 and a hand search of printed journals was also performed to identify human clinical trials reporting clinical and radiographic outcomes of patients receiving orthodontic treatment with or without hard and soft tissue augmentation procedures. Data were extracted and organized into tables for qualitative assessment. RESULTS: Eight studies were identified evaluating the outcomes of PhMT in patients undergoing orthodontic therapy. Six studies evaluated patients receiving PhMT-b via corticotomy-assisted orthodontic therapy (CAOT) and simultaneous bone augmentation while the other two received PhMT-s before tooth movement. No studies investigated PhMT-b alone without CAOT and most studies focused on the mandibular anterior decompensation movements. There was high heterogeneity in the study design and inconsistency of the reported outcomes; therefore, a meta-analysis was not performed. Evidence at this moment supports CAOT with hard tissue augmentation accelerated tooth movement. However, only two studies provided direct comparison to support that CAOT with PhMT-b reduced the overall treatment time compared with conventional orthodontic treatment. No periodontal complications or evidence of severe root resorption were reported for both groups. Four studies provided radiographic assessment of the PhMT-b and demonstrated increased radiographic density or thicker facial bone after the treatment. Two studies reported an expanded tooth movement. One study reported an increase in keratinized tissue width post-CAOT plus PhMT-b, while another study with a 10-year follow-up showed a lower degree of relapse using the mandibular irregularity index when compared with conventional tooth movement alone. Two studies examined the effect of PhMT-s before orthodontic treatment. Unfortunately, no conclusions can be drawn because of the limited number of studies with contradicting outcomes. CONCLUSIONS: Within the limited studies included in this systematic review, PhMT-b via particulate bone grafting together with CAOT may provide clinical benefits such as modifying periodontal phenotype, maintaining or enhancing facial bone thickness, accelerating tooth movement, expanding the scope of safe tooth movement for patients undergoing orthodontic tooth movement. The benefits of PhMT-s alone for orthodontic treatment remain undetermined due to limited studies available. However, PhMT-b appears promising and with many potential benefits for patients undergoing orthodontic tooth movement. There is a need for a higher quality of randomized controlled trials or case control studies with longer follow-up to investigate the effects of different grafting materials and surgical sites other than mandibular anterior region.


Asunto(s)
Recesión Gingival , Resorción Radicular , Trasplante Óseo , Humanos , Fenotipo , Técnicas de Movimiento Dental , Estados Unidos
9.
J Periodontol ; 91(2): 202-208, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31378924

RESUMEN

BACKGROUND: Tooth mobility assessment is subjective and current techniques require the translation of a continuous variable to a categorical variable based on the perception of the examiner. The aim of this study was to evaluate the reliability of a novel technique to assess tooth mobility. METHODS: Three experienced periodontists were asked to push tooth #16 into a buccal position to in a typodont model with different mobility (M1-M2). Tooth position was obtained using an intraoral scanner and files were compared in metrology software. Mobility was calculated at three reference points at the cervical (C), middle (M), and occlusal (O) regions of the buccal surface of the tooth to determine the linear deviation in the three axes (x, y, and z). Reliability was determined by intraclass-correlation coefficient, differences between M1 and M2 determined by t test, and the analysis of variance (ANOVA) was used to compare the data at the C-M-O regions. RESULTS: Excellent reliability was assessed by Cronbach alpha >0.9 on the x-y-z axes for both mobility tested, except for M1-C X (0.85), M1-M Y (0.89), and M2-M Z (0.89). The correlation between the examiners demonstrated excellent (˃0.90) or good (0.75˃ x ˂0.90) consistency, except for M1-C Y (0.73; examiner 1 to 2) and M1-M X (0.69; examiners 1 to 3). Significant changes were detected in all axes at the three reference points comparing M1 and M2, and a similar proportional change was observed between O-M-C reference points for M1 and M2. CONCLUSION: A novel technique to assess tooth mobility based on intraoral scanner measurements provided reliable data in an in vitro experiment.


Asunto(s)
Movilidad Dentaria , Diente , Análisis de Varianza , Humanos , Reproducibilidad de los Resultados
10.
Artículo en Inglés | MEDLINE | ID: mdl-30304074

RESUMEN

Since periodontal plastic surgery's recent emergence and continuous, extensive development, various treatment modalities and materials have been developed alongside it to help clinicians pursue optimal esthetics and long-term stability around natural teeth and dental implants. To achieve satisfying and predictable long-term outcomes, promote more predictable results, and reduce complications following periodontal plastic surgery procedures, the authors reviewed articles published in peer-reviewed journals to better understand the biologic principles and potential of the soft tissue grafting materials and techniques being applied. That information was used to support a new classification system. This system aims to give clinicians guidance when selecting the most appropriate grafting materials and techniques for periodontal plastic surgery, using the graft materials' two most important features to guide the consideration/decision process: the source of blood supply and whether the grafts contain vital cells.


Asunto(s)
Periodoncio/cirugía , Cirugía Plástica/métodos , Estética Dental , Humanos
11.
Tissue Eng Part A ; 24(21-22): 1672-1679, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29921173

RESUMEN

BACKGROUND: Dental implants are an important option for replacement of missing teeth. A major clinical challenge is how best to accelerate bone regeneration and reduce the healing time for functional restoration after implant placement. A sclerostin-neutralizing antibody (Scl-Ab) has been shown to enhance alveolar bone formation and fracture repair. The aim of this study was to investigate the effects of systemic administration of Scl-Ab on dental implant osseointegration and bone regeneration in an experimental alveolar ridge tooth extraction model. MATERIALS AND METHODS: To investigate the effects of Scl-Ab on bone regeneration and dental implant osseointegration, an experimental alveolar bone osteotomy rat model was adopted. One month after extraction of maxillary right first molars, osteotomy defects were created at the coronal aspect of each of the extraction sites, and 1 × 2-mm custom titanium implants were installed into the osteotomies. Coincident with implant placement, Scl-Ab was administered subcutaneously at a dose of 25 mg/kg twice weekly for 10-28 days and compared with a vehicle control. Animals were sacrificed 10, 14, and 28 days after surgery, and maxillae were harvested and analyzed by microcomputed tomography (microCT), histology, and histomorphometry. RESULTS: microCT analysis demonstrated that the maxillary bone volume fraction was approximately 2- to 2.5-fold greater in Scl-Ab-treated animals compared with vehicle alone at days 14 and 28. Consistent with those findings, two-dimensional bone fill percentages within the coronal osteotomy sites were highest in Scl-Ab treatment groups at 28 days. In addition, bone-implant contact at 28 days was approximately twofold greater in the Scl-Ab group compared with the vehicle control. CONCLUSIONS: These results indicate that systemic Scl-Ab administration enhances osseointegration and bone regeneration around dental implants. This approach offers potential as a treatment modality for patients with low bone mass or bone defects to achieve more predictable bone regeneration at alveolar bone defects and to enhance dental implant osseointegration.


Asunto(s)
Anticuerpos Neutralizantes/farmacología , Proteínas Morfogenéticas Óseas/antagonistas & inhibidores , Regeneración Ósea/efectos de los fármacos , Implantes Dentales , Maxilar/metabolismo , Animales , Proteínas Morfogenéticas Óseas/metabolismo , Marcadores Genéticos , Masculino , Maxilar/diagnóstico por imagen , Maxilar/lesiones , Ratas , Ratas Sprague-Dawley , Microtomografía por Rayos X
12.
Compend Contin Educ Dent ; 39(4): 218-223; quiz 224, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29600869

RESUMEN

Periodontitis affects nearly half of the adult population in the United States and leads to periodontium destruction, tooth loss, and tooth mobility. Novel bioengineering has become an area of interest in dentistry, as various approaches aim to regenerate attachment apparatus around diseased teeth with the use of barriers, scaffolds, bone grafts, or biologics. This article emphasizes recent findings in the fields of stem cell/gene therapy, 3-dimensional printing, and innovative scaffold designs for future applications in clinical care.


Asunto(s)
Regeneración Tisular Guiada Periodontal/métodos , Bioingeniería , Trasplante Óseo , Regeneración Tisular Guiada Periodontal/tendencias , Humanos , Impresión Tridimensional
13.
J Oral Maxillofac Res ; 7(3): e13, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27833738

RESUMEN

OBJECTIVES: The purpose of this paper was to systematically evaluate the effectiveness of non-surgical therapy for the treatment of peri-implant diseases including both, mucositis and peri-implantitis lesions. MATERIAL AND METHODS: An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE from 2011 to 2016. Human studies reporting non-surgical treatment of peri-implant mucositis and peri-implantitis with more than 10 implants and at least 6 months follow up published in English language were evaluated. A systematic review was performed to evaluate the effectiveness of the different methods of decontamination employed in the included investigations. Risk of bias assessment was elaborated for included investigations. RESULTS: Twenty-five articles were identified of which 14 were further evaluated and included in the analysis. Due to significant heterogeneity in between included studies, a meta-analysis could not be performed. Instead, a systematic descriptive review was performed. Included investigations reported the used of different methods for implant decontamination, including self-performed cleaning techniques, and professionally delivered treatment such as laser, photodynamic therapy, supra-/sub-mucosal mechanical debridement, and air-abrasive devices. Follow-up periods ranged from 6 to 60 months. CONCLUSIONS: Non-surgical treatment for peri-implant mucositis seems to be effective while modest and not-predictable outcomes are expected for peri-implantitis lesions. Limitations include different peri-implant diseases definitions, treatment approaches, as well as different implant designs/surfaces and defect characteristics.

14.
J Oral Maxillofac Res ; 7(3): e16, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27833741

RESUMEN

INTRODUCTION: The task of Group 3 was to review and update the existing data concerning non-surgical, surgical non-regenerative and surgical regenerative treatment of peri-implantitis. Special interest was paid to the preventive and supporting therapy in case of peri-implantitis. MATERIAL AND METHODS: The main areas of interest were as follows: effect of smoking and history of periodontitis, prosthetic treatment mistakes, excess cement, overloading, general diseases influence on peri-implantitis development. The systematic review and/or meta-analysis were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was searched and reported using the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. The method of preparation of systematic reviews of the literature based on comprehensive search strategies was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic review and/or meta-analysis is presented in Preface chapter. RESULTS: The results and conclusions of the review process are presented in the respective papers. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.

15.
J Periodontol ; 87(6): 742-8, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26891246

RESUMEN

BACKGROUND: Stimulus-responsive devices have emerged as a novel approach for local drug delivery. This study investigates the feasibility of a novel chitosan-based, pH-responsive hydrogel loaded with N-phenacylthiazolium bromide (PTB), which cleaves the crosslinks of advanced glycation end products on the extracellular matrix. METHODS: A chitosan-based hydrogel loaded with PTB was fabricated, and the in vitro release profile was evaluated within pH 5.5 to 7.4. BALB/cJ mice and Sprague-Dawley rats were used to evaluate the effects during the induction and recovery phases of periodontitis, respectively, and animals in each phase were divided into four groups: 1) no periodontitis induction; 2) ligature-induced experimental periodontitis (group PR); 3) experimental periodontitis plus hydrogel without PTB (group PH); and 4) experimental periodontitis plus hydrogel with PTB (group PP). The therapeutic effects were evaluated by microcomputed tomographic imaging of periodontal bone level (PBL) loss and histomorphometry for inflammatory cell infiltration and collagen density. RESULTS: PTB was released faster at pH 5.5 to 6.5 and consistently slower at pH 7.4. In the induction phase, PBL and inflammatory cell infiltration were significantly reduced in group PP relative to group PR, and the loss of collagen matrix was significantly reduced relative to that observed in group PH. In the recovery phase, PBL and inflammatory cell infiltration were significantly reduced, and significantly greater collagen deposition was noted in group PP relative to groups PR and PH at 4 and 14 days after silk removal. CONCLUSION: Chitosan-based, pH-responsive hydrogels loaded with PTB can retard the initiation of and facilitate the recovery from experimental periodontitis.


Asunto(s)
Pérdida de Hueso Alveolar , Hidrogel de Polietilenoglicol-Dimetacrilato/uso terapéutico , Periodontitis/terapia , Animales , Ratas , Ratas Sprague-Dawley , Tiazoles
16.
J Periodontol ; 86(1): 36-43, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25272981

RESUMEN

BACKGROUND: The study evaluates the osteogenic properties and biocompatibility of growth factor-rich demineralized bone matrix (GDBM) by comparing with cancellous mineralized bone matrix (CMBM) and anorganic bovine bone matrix (ABBM). METHODS: Thirty-six Sprague-Dawley rats were used (n = 6/group/time point). To assess biocompatibility and osteoinductivity, the respective bone matrices were randomly placed in subcutaneous pouches for 7 and 28 days and evaluated by histology and osteopontin expression. Osteoconductivity was assessed by randomly implanting respective bone matrices in osteotomies on femurs for 14 and 28 days and evaluated by microcomputed tomography and histology. RESULTS: Neither acute inflammation nor mineralized tissue was noted in any of the subcutaneous specimens, whereas expression of osteopontin was more prominent in the GDBM group. Among the femoral specimens, the greatest relative bone volume (bone volume [BV] divided by trabecular volume [TV]) and trabecular thickness was noted in the ABBM group at both time points, whereas less BV/TV was noted in GDBM group at day 14. Residual matrix particles were noted in all examined groups at both time points, without significant differences regarding defect fill between groups. The GDBM group presented similar levels of newly formed bone compartment and marrow space to those of the ABBM group. CONCLUSIONS: GDBM demonstrated acceptable biocompatibility and osteogenic potential comparable to ABBM in vivo. Further investigations in a more clinically relevant model are warranted.


Asunto(s)
Matriz Ósea/trasplante , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Osteogénesis/efectos de los fármacos , Animales , Materiales Biocompatibles/uso terapéutico , Densidad Ósea/efectos de los fármacos , Enfermedades Óseas/cirugía , Médula Ósea/efectos de los fármacos , Matriz Ósea/patología , Bovinos , Fémur/cirugía , Células Gigantes/patología , Procesamiento de Imagen Asistido por Computador/métodos , Tamaño de los Órganos , Osteoblastos/efectos de los fármacos , Osteopontina/análisis , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Tejido Subcutáneo/cirugía , Microtomografía por Rayos X/métodos
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