Clinical Management of Intra-Pulp Canal Broken Endodontic Files in Primary Teeth: Literature Review / Manejo clínico de las limas endodónticas fracturadas dentro del conducto pulpar en dientes primarios: Revisión de la literatura

ABSTRACT: Fracture of an endodontic file inside a primary root canal is a rare but critical complication during the pulpectomy treatment, because the mechanical obstruction impedes the optimal cleaning and obturation of the pulp canal, compromising seriously the clinical outcome. This accidental event is mainly associated with over-use and excessive torque of intracanal files. Most clinicians opt to proceed with the extraction of the affected tooth followed by a space maintainer placement. Other practitioners attempt the non-surgical retrieval of the separated fragment through available proven techniques in permanent teeth; however, these methods may involve significant damage to the tooth and surround tissues. On the other hand, preservation of the metallic fragment might affect the treatment prognosis and interfere with the physiological root resorption.

RESUMEN: La fractura de una lima endodóntica dentro de un conducto radicular primario es una complicación rara aunque critica durante el tratamiento de pulpectomía, debido a que la obstrucción mecánica impide la limpieza y obturación óptimas del conducto pulpar, comprometiendo seriamente el resultado clínico. Este evento accidental está principalmente asociado con el sobreuso y torque excesivo de las limas dentro del conducto. La mayoría de los clínicos optan por realizar la extracción del diente afectado, seguido por la colocación de un mantenedor de espacio. Otros practicantes intentan la remoción no quirúrgica del fragmento separado a través de técnicas disponibles probadas en dientes permanentes; sin embargo, estos métodos pueden causar daños significativos al diente y tejidos circundantes. Por otra parte, la preservación del fragmento metálico puede afectar el pronóstico del tratamiento e interferir con el proceso de reabsorción radicular fisiológico.

Avaliação da padronização das sondas periodontais do tipo Williams e OMS de diferentes marcas / Evaluation of standardization of Williams and WHO periodontal probes of different brands / Evaluación de la estandarización de sondas periodontales Williams y OMS de diferentes marcas

Objetivos: O estabelecimento do diagnóstico clínico periodontal tem como base a avaliação de parâmetros clínicos por meio da sondagem periodontal, sendo através desses resultados que o Cirurgião Dentista fará a melhor escolha de tratamento. Porém, possíveis erros encontrados na padronização das sondas periodontais podem levar a um plano de tratamento inadequado e/ou ineficiente. O presente estudo teve como objetivo avaliar a padronização de seis sondas periodontais do tipo Williams e seis sondas do tipo OMS de diferentes marcas comerciais. Materiais e Métodos: Com o auxílio de um paquímetro digital e de uma balança digital de alta precisão, foi avaliado o peso da sonda, o diâmetro do cabo, o diâmetro da ponta ativa/esfera, e distância das marcações. Além disso, foi feito uma comparação dos preços de cada sonda, para que fosse possível se avaliar o custo/benefício de cada sonda periodontal. Resultados: Os resultados demonstraram que as sondas das seis marcas comerciais avaliadas, tanto das sondas do tipo OMS quanto do tipo Williams apresentaram algum tipo de distorção em relação às medidas consideradas ideais pela OMS (Organização Mundial da Saúde). Conclusão: As sondas da marca Hu-Friedy, tanto do tipo OMS quanto Williams, apresentaram melhores marcações milimetradas entre todas as marcas avaliadas(AU)

Objectives: The establishment of the periodontal clinical diagnosis is based on the evaluation of clinical parameters throughperiodontal probing, and through these results the dentist will make the best treatment choice. However, possible errors found inthe standardization of periodontal probes may lead to an inadequate and/or inefficient treatment plan. The aim of the present study was to evaluate the standardization of six Williams-type periodontal probes and six WHO-type probes of different trademarks. Materials and Methods: With the aid of a digital caliper and a high precision digital scale, the weight of the probe, the cable diameter, the active tip/sphere diameter, and the distance of the markings were evaluated. In addition, a price comparison of each probe was made, so that the cost/benefit of each periodontal probe could be evaluated. Results: The results showed that the probes of the six evaluated trademarks of both the WHO and Williams probes presented some kind of distortion in relation to the measures considered ideal by the WHO (World Health Organization). Conclusion: The Hu-Friedy probes,both WHO and Williams, had better millimeter markings among all evaluated brands(AU)

Objetivos: El establecimiento del diagnóstico clínico periodontal se basa en la evaluación de parámetros clínicos mediante sondaje periodontal, y es a través de estos resultados que el odontólogo tomará la mejor opción de tratamiento. Sin embargo, los posibles errores encontrados en la estandarización de las sondas periodontales pueden dar lugar a un plan de tratamiento inadecuado y/o ineficaz. El presente estudio tuvo como objetivo evaluar la estandarización de seis sondas periodontales tipo Williams y seis sondas tipo OMS de diferentes marcas comerciales. Materiales y Métodos: Con la ayuda de un calibre digital y una balanza digital de alta precisión, se evaluó el peso de la sonda, el diámetro del cable, el diámetro de la punta / esferaactiva y la distancia de las marcas. Además, se realizó una comparación de los precios de cada sonda, de manera que se pudo evaluar el costo/beneficio de cada sonda periodontal. Resultados: Los resultados mostraron que las sondas de las seis marcas comerciales evaluadas, tanto del tipoOMS como del tipo Williams, presentaron algún tipo de distorsión en relación a las medidas consideradas ideales por la OMS (Organización Mundial de la Salud). Conclusión: Las sondas de la marca Hu-Friedy, tanto del tipo OMS como Williams, presentaron mejores marcas en milímetros entre todas las marcas evaluadas(AU)

Analysis of the characteristics of periodontal curettes used for scaling the roof of the furcation by manual versus digital method / Análise das características de curetas periodontais utilizadas para raspagem em teto de furca pelo método manual versus digital

Abstract Introduction The treatment of periodontal disease in multiradicular teeth with furcation involvement is a challenge for dentists, with unpredictable results. Objective To evaluate the characteristics of the active tip of periodontal curettes used for scaling the furcation roof, comparing the manual versus digital method. Material and method Forty-two Pádua Lima (PL) curettes of the Millennium® brand (n = 6 for each model) were evaluated: PL 1-2, PL 3-4, PL 5-6, PLW 1-2, PLW 3-4, PLW 5 -6, and PLF. The following were measured: total length of the coronary face (CTc, millimeters, mm), total length of the lateral face (CTl, mm), width of the coronary face (Lc, mm), and width of the lateral face (Ll, mm). The measurements were performed in duplicate. Result The results showed that weight varied among the curettes (p <0.05), however the handle diameter was similar for all instruments (p> 0.05). Considering that seven different types of curettes were evaluated, the parameters of CTl and Ll showed a statistical difference for all evaluated curettes (7: 7 ratio), with higher values ​​for the caliper method compared to the software (p <0.05). There was a statistically significant difference between assessment methods for CTc and Lc measurements (p <0.05), showing that there was a coincidence of values ​​in the proportion of 4:7 for measurements of CTc and 5:7 for Lc. Conclusion The comparison between methods generally resulted in lower values ​​and greater variation for the digital method, thus favoring the use of the manual method to measure the active tip of periodontal curettes.

Resumo Introdução O tratamento da doença periodontal em dentes multirradiculares com envolvimento de furca tem sido um desafio para os cirurgiões-dentistas, com resultados imprevisíveis. Objetivo Avaliar as características da ponta ativa de curetas periodontais utilizadas para raspagem do teto de furca, comparando o método manual versus digital. Material e método Foram avaliadas 42 curetas de Pádua Lima (PL) da marca Millennium® (n=6 para cada modelo): PL 1-2, PL 3-4, PL 5-6, PLW 1-2, PLW 3-4, PLW 5-6 e PLF. Foram mensurados: comprimento total da face coronária (CTc, milímetros, mm), comprimento total da face lateral (CTl, mm), largura da face coronária (Lc, mm) e largura da face lateral (Ll, mm). As mensurações foram em duplicata. Resultado Os resultados mostraram que o peso variou entre as curetas (p<0,05), porém o diâmetro do cabo foi semelhante para todos os instrumentos (p>0,05). Considerando que foram avaliados sete tipos de curetas diferentes, os parâmetros de CTl e Ll se mostraram com diferença estatística para todas as curetas avaliadas (proporção 7:7), com valores maiores para o método do paquímetro em comparação ao software (p<0,05). Houve diferença estatisticamente significativa entre métodos de avaliação para as medidas de CTc e de Lc (p<0,05), mostrando que houve uma coincidência de valores na proporção de 4:7 para as mensurações de CTc e de 5:7 para Lc. Conclusão A comparação entre métodos resultou, em geral, menores valores e maior variação para o método digital, favorecendo, dessa forma, o uso do método manual para a mensuração da ponta ativa de curetas periodontais.

Quantitative measurements of aerosols from air-polishing and ultrasonic devices: (How) can we protect ourselves?

AIM: To assess the distribution and deposition of aerosols during simulated periodontal therapy. METHODS: A manikin with simulated fluorescein salivation was treated by four experienced dentists applying two different periodontal treatment options, i.e. air-polishing with an airflow device or ultrasonic scaling in the upper and lower anterior front for 5 minutes, respectively. Aerosol deposition was quantitatively measured on 21 pre-defined locations with varying distances to the manikins mouth in triplicates using absorbent filter papers. RESULTS: The selected periodontal interventions resulted in different contamination levels around the patient's mouth. The highest contamination could be measured on probes on the patient's chest and forehead but also on the practitioner's glove. With increasing distance to the working site contamination of the probes decreased with both devices. Air-polishing led to greater contamination than ultrasonic. CONCLUSION: Both devices showed contamination of the nearby structures, less contamination was detected when using the ultrasonic. Affirming the value of wearing protective equipment we support the need for universal barrier precautions and effective routine infection control in dental practice.

Correlation between clinical parameters of crown and gingival morphology of anterior teeth and periodontal biotypes.

BACKGROUND: In this study, we conducted a quantitative analysis of the clinical parameters of crown and gingival morphology (CGM) of the maxillary anterior teeth (MAT). We also analyzed the correlation of these parameters with periodontal biotype (PB), with a view to providing objective standards for PB diagnosis. METHODS: The three-dimensional (3D) maxillary digital models of 56 individuals were obtained using an intra-oral scanner. The following parameters were measured with the SpaceClaim software: gingival angle (GA), papilla width (PW), papilla height (PH), crown length (CL), crown width (CW), crown width/crown length ratio (CW/CL), bucco-lingual width of the crown (BLW), contact surface width (CSW), and contact surface height/crown length ratio (CS/CL). The PB were determined based on the transparency of the periodontal probe through the gingival sulcus. Independent factors influencing PB were analyzed by logistic regression, and the optimal cutoff values for the independent influencing factors were analyzed using receiver operating characteristic curves (ROC curves). RESULTS: There was no significant difference in the parameters of CGM of the MAT at the left and right sides. The thick biotype accounted for 69.6%, and the parameters of GA, PW, PH, CW, CW/CL and CS/CL were significantly correlated with PB (P ≤ 0.2). GA (odds ratio (OR) = 1.206) and PW (OR = 5.048) were identified as independent predictive factors of PB, with areas under the ROC curve (AUC) of 0.807 and 0.881, respectively, and optimal cutoff values of 95.95° and 10.01 mm, respectively. CONCLUSION: The CGMs of the MAT at the left and right side are symmetrical. The thin biotype accounts for a small proportion, and GA and PW are independent influencing factors of PB. GA of 95.95° and PW of 10.01 mm are the optimal cutoff values for categorization of individuals as thick biotype. This indicates that when the GA and PW of the right maxillary central incisor are G ≥ 95.95° and ≥ 10.01 mm, respectively, there is a higher probability that these individuals will be categorized as thick biotype.

Instrument Selection and Application Used to Probe Dental Implants.

PURPOSE: The purpose of this study is to survey clinicians' choice of peri-implant instrument selection and the application used to probe dental implants as well as to evaluate peri-implant probing force and pressure applied as compared to that reported in current literature. MATERIALS AND METHODS: 48 clinicians (16 periodontists/periodontal residents, 16 restorative dentists and 16 hygienists) participated in the study. A questionnaire to determine the frequency and method of probing dental implants was provided and subject to the Chi-square test. Each participant was given a choice of three periodontal probes (Marquis, UNC15, Plastic) to use on the typodont and probing force was recorded blindly. Probing force and pressure data were analyzed with ANOVA among subject groups as well as probe types per site; where statistical differences (p < .05) were detected, Tukey's posthoc test was applied. RESULTS: The questionnaire resulted in a variety of answers although the majority demonstrated an agreement on probing implants in everyday practice. There was no significant difference among provider groups in regard to instrument selection, probing forces and pressure in both maxilla and mandible although the mean probing forces and pressures in all provider groups were higher than the suggested value reported in the literature. CONCLUSION: This study indicates that there are variations among clinical provider groups with regard to peri-implant probe instrument type used and forces applied, though these are not statistically significant. Probe tip diameter should be considered to avoid BOP false positives when probing dental implants especially as the forces generally used by the clinicians may be higher than advised.

Measurement properties of gingival biotype evaluation methods.

BACKGROUND: There are numerous methods to measure the dimensions of the gingival tissue, but few have compared the effectiveness of one method over another. OBJECTIVE: This study aimed to describe a new method and to estimate the validity of gingival biotype assessment with the aid of computed tomography scanning (CTS). MATERIALS AND METHODS: In each patient different methods of evaluation of the gingival thickness were used: transparency of periodontal probe, transgingival, photography, and a new method of CTS). Intrarater and interrater reliability considering the categorical classification of the gingival biotype were estimated with Cohen's kappa coefficient, intraclass correlation coefficient (ICC), and ANOVA (P < .05). The criterion validity of the CTS was determined using the transgingival method as the reference standard. Sensitivity and specificity values were computed along with theirs 95% CI. RESULTS: Twelve patients were subjected to assessment of their gingival thickness. The highest agreement was found between transgingival and CTS (86.1%). The comparison between the categorical classifications of CTS and the transgingival method (reference standard) showed high specificity (94.92%) and low sensitivity (53.85%) for definition of a thin biotype. CONCLUSION: The new method of CTS assessment to classify gingival tissue thickness can be considered reliable and clinically useful to diagnose thick biotype.

Effects of Instrument Handle Design on Dental Hygienists' Forearm Muscle Activity During Scaling.

Purpose: The purpose of this study was to determine the effects of 4 different commercially available instrument handle designs (A. 16 grams and 12.7 mm diameter, B. 23 grams and 11.1 mm diameter, C. 21 grams and 7.9 mm diameter and D. 18 grams and 6.35 mm diameter) on the muscle activity of four forearm muscles during a simulated scaling experience.Methods: A convenience sample of 27 (n=27) dental hygienists used a Columbia 13/14 curet with four different instrument handles to scale artificial calculus from typodont teeth. Each participant's muscle activity was measured using surface electromyography (sEMG).Results: Similar muscle activity was generated when scaling with instruments at 16, 18, and 21 grams with varying diameter handles. Instrument B generated significantly more muscle activity when compared to each of the other instrument handle designs (p=0.001, p=0.002, p=0.039). The lower left quadrant displayed significantly less muscle activity during scaling than the upper and lower right quadrants (p=0.026, p=0.000), although no significant interaction effect was found with instruments within quadrants. Most participants (62.96%) preferred instrument A, which was rated more comfortable based on weight when compared to the other instruments tested.Conclusions: Instrument handle design has an effect on forearm muscle activity when scaling in a simulated environment. The heaviest instrument with a relatively large diameter (B 11.1 mm and 23 g) generated significantly more overall mean muscle activity compared to the other three instruments. Similar amounts of muscle activity were produced by instruments weighing between 16 and 21 g. Participants' instrument preferences were more affected by handle diameter than weight. Results support the need for further research to determine the impact of these findings on muscle load related to risk of musculoskeletal disorders in a real-world setting.

Lasers and the treatment of periodontitis: the essence and the noise.

The dental literature contains 25 years of accumulated reports and clinical studies addressing the utility of lasers in the treatment of periodontitis, both as a monotherapy or as an adjunct to surgical and nonsurgical therapy. Yet, the evidence from the 118 human clinical studies cited in this narrative review remains conflicted and insufficient to suggest that integration of a laser in a periodontal treatment protocol will provide antimicrobial and healing outcomes superior to those achieved by traditional therapy. When viewed as a collective body of evidence, it becomes apparent that a majority of the studies are underpowered and exhibit significant heterogeneity in design. Furthermore, the collected studies report a varied choice of parameters, even within the same wavelength of laser. There is little uniformity between studies in the reporting of measured clinical parameters. Most studies reported 3- and/or 6-month post-treatment results; however, the range of time intervals includes studies reporting results from 1 week to up to 1-12 months or longer. Lastly, many studies were considered at risk for bias as a result of a lack of examiner masking and/or calibration. There is great need for well-designed, highly controlled multicenter clinical trials that are adequately powered in terms of subject enrollment, that use similar protocols in terms of laser parameters and that report measureable outcomes in a uniform manner. Without such studies, the questions surrounding the use of lasers in the treatment of periodontal disease will persist.

[Diagnossis and treatment of complicated anterior teeth esthetic defects by combination of whole-process digital esthetic rehabilitation with periodontic surgery].

OBJECTIVE: To explore a new method of whole-process digital esthetic prosthodontic rehabilitation combined with periodontic surgery for complicated anterior teeth esthetic defects accompanied by soft tissue morphology, to provide an alternative choice for solving this problem under the guidance of three-dimensional (3D) printing digital dental model and surgical guide, thus completing periodontic surgery and digital esthetic rehabilitation of anterior teeth. METHODS: In this study, 12 patients with complicated esthetic problems accompanied by soft tissue morphology in their anterior teeth were included. The dentition and facial images were obtained by intra-oral scanning and three-dimensional (3D) facial scanning and then calibrated. Two esthetic designs and prosthodontic outcome predictions were created by computer aided design /computer aided manufacturing (CAD/CAM) software combined with digital photography, including consideration of white esthetics and comprehensive consideration of pink-white esthetics. The predictive design of prostheses and the facial appearances of the two designs were evaluated by the patients. If the patients chose the design of comprehensive consideration of pink-white esthetics, they would choose whether they would receive periodontic surgery before esthetic rehabilitation. The dentition design cast of those who chose periodontic surgery would be 3D printed for the guide of periodontic surgery accordingly. RESULTS: In light of the two digital designs based on intra-oral scanning, facing scanning and digital photography, the satisfaction rate of the patients was significantly higher for the comprehensive consideration of pink-white esthetic design (P<0.05) and more patients tended to choose priodontic surgery before esthetic rehabilitation. The 3D printed digital dental model and surgical guide provided significant instructions for periodontic surgery, and achieved success transfer from digital design to clinical application. The prostheses were fabricated by CAD/CAM, thus realizing the whole-process digital esthetic rehabilitation. CONCLUSION: The new method for esthetic rehabilitation of complicated anterior teeth esthetic defects accompanied by soft tissue morphology, including patient-involved digital esthetic analysis, design, esthetic outcome prediction, 3D printing surgical guide for periodontic surgery and digital fabrication is a practical technology. This method is useful for improvement of clinical communication efficiency between doctor-patient, doctor-technician and doctors from different departments, and is conducive to multidisciplinary treatment of this complicated anterior teeth esthetic problem.

Efectos del raspaje y alisado radicular a boca completa con azitromicina sobre los niveles de proteina C reactiva ultra sensible, parametros clínicos y microbiológicos periodontales. Ensayo clinico aleatorizado / High sensitive- C reactive protein, periodontal parameters and periodontal microbiota after scaling-root planning plus Azithromycin as treatment of Chronic Periodontitis: A Randomized Clinical Trial

Objetivo: El propósito de este ensayo clínico controlado aleatorizado simple ciego fue determinar el efecto del raspaje y alisado radicular en una sesión adjunto a azitromicina oral, sobre los niveles de proteína C reactiva ultra sensible y otros biomarcadores sanguíneos, parámetros clínicos y microbiológicos periodontales en pacientes con periodontitis crónica tres meses después del tratamiento. Materiales y Métodos: 49 sujetos con periodontitis crónica participaron en el estudio y fueron asignados aleatoriamente en dos grupos de 27 pacientes, el grupo intervención recibió raspaje y alisado ra- dicular adjunto a azitromicina (RAR+Azi) 500 mg/día por cinco días, y el grupo con- trol recibió raspaje y alisado radicular más placebo (RAR+Pb), ambos tratamiento en sesión única. Los grupos de periodontitis recibieron un examen periodontal a boca completa, análisis de sangre y cultivos microbiológicos al inicio del estudio y tres meses después del tratamiento. Se incluyó un grupo referencia de 25 pacientes perio- dontalmente sanos tomando muestras sólo al inicio. La variable principal de desenlace fue la variación de la proteína C reactiva ultra sensible. Las variables de resultado secundarias fueron la variación de triglice - ridos, colesterol de alta densidad (HDL), colesterol de baja densidad (LDL), glucosa en ayunas, profundidad al sondaje (PS) y composición microbiana. Resultados: La terapia RAR+Azi no redujo significativamente los niveles plas - máticos de hsPCR, sin embargo, se observó una tendencia positiva (4,33 a 2,99 mg/L). Este grupo obtuvo también una mayor re- ducción en PS, índice arterial y frecuencia de detección de Porphyromonas gingivalis y Prevotela intermedia en comparación con el grupo RAR+Pb (p<0.05). Los otros pa- rámetros sanguíneos no cambiaron signifi - cativamente. En contraste, el grupo control aumentó los niveles de hsPCR después de la terapia y en algunos casos se detectó un aumento de PS. Conclusiones: La terapia de RAR+Azi ofrece a corto plazo beneficios clínicos y microbiológicos comparado a RAR solo. No se encontraron diferencias significati - vas en los niveles de hsPCR. Es necesario realizar estudios con mayor tiempo de seguimiento para confirmar o rechazar la hipótesis que el tratamiento periodontal solo o con antibióticos generan efectos en los niveles de hsPCR y otros marcadores de riesgo cardiovascular...(AU)

Objective: This single blind randomized clinical trial (RCT) determined the effect of scaling and root planning plus azithromycin (SRP+Azi) in serum C reactive protein levels and other blood biomarkers, clinical periodontal parameters and subgingival microbial composition three months after periodontal therapy. Materials and Methods: Forty-nine chronic periodontitis patients participated in the study and were randomly assigned Recibido para publicación: Octubre 09 de 2016 Aceptado para publicación: Diciembre 07 de 2016 Correspondencia: JE, Soto, Universidad del Valle jesotofranco@gmail.com R E V I S T A ESTOMATOLOGIA Artículo original La Revista Estomatología usa la licencia Creative Commons de Atribución ­ No comercial ­ Sin Derivar 4.0 Internacional; de tal forma que los textos de la revista pueden ser descargados en ver - sión PDF siempre que sea reconocida la autoría y el texto no tenga modificaciones de ningún tipo. Volumen 24 Nº 2 2016 15 to a test group of 27 patients received one session of scaling and root planning plus oral azithromycin 500 mg daily for five days (SRP+Azi) while, 27 patients in the control group received the same single session of scaling and root planning plus placebo (SRP+Pb). A group of 25 subjects presenting periodontal health-gingivitis were included as a comparison group and in them was determined clinical periodontal parameters, blood parameters and micro - biota at baseline. Periodontitis groups recei - ved a full mouth periodontal examination, blood test and microbiological cultures at baseline, and three months after therapy. Primary outcome variable was the variation in serum high sensitive C- reactive protein (hs-CRP). Secondary outcome variables were variation of triglycerides, High density Cholesterol (HDL), low density Cholesterol (LDL), fasting glucose, pocket depth and microbial composition. Results: Therapy with SRP+Azi do not significantly reduce the plasmatic levels of hs-CRP however, a positive trend was noti - ce (4,33 to 2,99 mg/l). This group obtained also greater reduction of pocket depth (PD), artery index and P. gingivalis and P inter - media detection frequency when compared to the SRP-placebo group (p<0.05). Other blood biochemistry parameters did not changed significantly in the test group. In contrast, the control group increased the hs- CRP levels after therapy and in some cases a increase of pocket depth was detected. Conclusions: Combined SRP+Azi therapy in chronic periodontitis did not reduced hs- CRP serum level significantly after three months. However, this group reduced signi - ficantly their probing pocket depth, reduced P. gingivalis and P intermedia frequency and increased clinical attachment gain.

Modal damping factor detected with an impulse-forced vibration method provides additional information on osseointegration during dental implant healing.

PURPOSE: To evaluate whether resonance frequency (RF) analysis combined with modal damping factor (MDF) analysis provides additional information on dental implant healing status. MATERIALS AND METHODS: In in vitro tests, epoxy resin was used to simulate the implant healing process. The RF and MDF values of the implants were measured during the entire polymerization process. Implant stability quotient (ISQ) and Periotest values (PTVs) from Ostell and Periotest devices were used to validate the apparatus. In in vivo experiments, vibrational analysis was performed on 17 dental implants in 12 patients. The RF and MDF values of the tested implants were recorded during the first 10 weeks after surgery. The effects of jaw types and primary stability on MDF healing curves were analyzed. RESULTS: In the in vitro model, the RF values obtained from the apparatus used in this study were similar to those obtained from the Osstell device. Unlike the Periotest healing curve, the MDF curve showed a 1.8-fold increase during the early phase. In clinical experiments, the mean RF values were unchanged during the first 2 weeks and increased continuously until 6 weeks. The corresponding mean MDF value decreased over time and reached 0.045 ± 0.011 at 10 weeks, which is approximately 50% lower than the initial value. Although the RF values of the implants with higher initial frequency remained unchanged during the healing period, the MDF values decreased significantly. CONCLUSION: Analysis of RF combined with MDF provides additional information on dental implant healing status. MDF analysis can detect changes in the implant/bone complex during the healing period even in implants with higher RF values.

Efficacy of the ND:YAG laser therapy on EBV and HSV1 contamination in periodontal pockets.

AIM: The aim of this retrospective multicenter study was to verify the efficacy of Nd:YAG laser in the treatment of periodontal pockets infected by Epstein-Barr Virus (EBV) and Herpes Simplex Virus 1 (HSV1). METHODS: Subgingival plaque samples of 291 Italian periodontal patients were analyzed by Real Time PCR to evaluate the frequency of both viruses before and after Nd:YAG laser-assisted periodontal treatment. RESULTS: Before treatment, EBV and HSV1 were observed in 29.9% and in 3.8% of periodontal patients respectively, while co-infection with both viruses was detected in 1.7% of cases. Periodontal Nd:YAG laser treatment ("Periodontal Biological Laser-Assisted Therapy", PERIOBLAST) produced statistical significant benefits, especially in EBV periodontal infection: 78.2% of EBV positive patients became EBV-negative following treatment. CONCLUSIONS: Results of this preliminary study highlight that EBV is found in periodontal pockets more frequently than HSV1, supporting the theory of the potential role of EBV in the onset and progression of periodontal disease. Moreover, our data showed that Nd:YAG laser-assisted periodontal treatment (Perioblast) is also effective in case of viral infection, validating evidences that it represents a successful alternative approach to traditional periodontal protocols.

Influence of Periodontal Biotype on Root Surface Exposure During Orthodontic Treatment: A Preliminary Study.

The aim of this study was to investigate the role of periodontal biotype in the development of gingival recession in patients who have undergone orthodontic treatment. A total of 60 mandibular incisors were analyzed. The qualitative assessment of periodontal biotype was performed with the use of a new biotype probe. A strong correlation was found between thin biotype and proinclination in terms of recession depth and keratinized tissue width. Patients with thin periodontal biotype are more prone to gingival margin instability, irrespective of the type of orthodontic movements. Thin periodontal biotype and proinclination orthodontic movement were related to loss of keratinized tissue width.

Periodontal Biotype: Gingival Thickness as It Relates to Probe Visibility and Buccal Plate Thickness.

BACKGROUND: Probe visibility is the clinical gold standard to discriminate thick from thin biotype but is prone to subjective interpretation. The primary objective of this study is to determine at what objective gingival thickness the probe becomes invisible through the tissue. A secondary objective is to compare mean buccal plate thickness between thick and thin biotypes as determined by probe visibility. METHODS: Maxillary anterior teeth (n = 306) were studied in 56 human patients. Biotype was determined by probe visibility through the tissue. Gingival thickness was measured via transgingival sounding. Buccal plate thickness was measured (n = 66 teeth) by cone beam computed tomography. For the primary objective, the gingival thickness that best corresponded with probe invisibility was selected using the receiver operating characteristic and area under the curve (AUC) with the highest combination of sensitivity and specificity. For the secondary objective, mean buccal plate thickness was compared between sites in which the probe was visible and when it was not (Student t test, α= 0.05). RESULTS: The gingival thickness that most closely corresponded with probe invisibility was >0.8 mm (0.666 AUC, 67.7% sensitivity, 65.4% specificity). When the probe was visible, mean gingival thickness was 0.17 mm less (P <0.001) compared to the "thick" counterparts. When the probe was visible, mean buccal plate thickness tended to be smaller by 0.212 mm (P = 0.08), but the difference was not statistically significant. CONCLUSIONS: The study failed to identify a gingival thickness threshold that can discriminate reliably between sites in which the probe was visible (i.e., thin biotype) and those in which it was not (i.e., thick biotype). Probe visibility was associated with thinner measurements of gingival thickness and showed a tendency to be associated with a thinner buccal plate.

Standards for reporting chronic periodontitis prevalence and severity in epidemiologic studies: Proposed standards from the Joint EU/USA Periodontal Epidemiology Working Group.

Periodontal diseases are common and their prevalence varies in different populations. However, prevalence estimates are influenced by the methodology used, including measurement techniques, case definitions, and periodontal examination protocols, as well as differences in oral health status. As a consequence, comparisons between populations are severely hampered and inferences regarding the global variation in prevalence can hardly be drawn. To overcome these limitations, the authors suggest standardized principles for the reporting of the prevalence and severity of periodontal diseases in future epidemiological studies. These principles include the comprehensive reporting of the study design, the recording protocol, and specific subject-related and oral data. Further, a range of periodontal data should be reported in the total population and within specific age groups. Periodontal data include the prevalence and extent of clinical attachment loss (CAL) and probing depth (PD) on site and tooth level according to specific thresholds, mean CAL/PD, the CDC/AAP case definition, and bleeding on probing. Consistent implementation of these standards in future studies will ensure improved reporting quality, permit meaningful comparisons of the prevalence of periodontal diseases across populations, and provide better insights into the determinants of such variation.

Furcation Measurements: Realities and Limitations.

Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy. For the efficient clinical management of furcation defects, it is necessary to have a reliable diagnostic tool that can accurately measure and quantify the furcation defect. This article addresses the various diagnostic methods available and assesses their limitations. Further, it also highlights some new frontiers in the field of furcation diagnosis and measurements.

Correlation between clinical and radiographic findings on the occurrence of furcation involvement in patients with periodontitis.

UNLABELLED: Aim : The aim of the present study was to determine the occurrence of furcation involvement in the molars of patients with chronic periodontitis and correlate clinical and radiographic findings. MATERIALS AND METHODS: Seventy subjects aged 35-69 years enrolled for treatment at a periodontics specialization program in Pernambuco, Brazil (EAP-SCDP-ABO/PE) participated in the study, comprising a total of 350 molars examined. The clinical diagnosis of furcation involvement was performed with a horizontal Nabers probe, whereas the radiographic examination was performed with periapical and bite-wing radiographs. The images were analyzed with an X-ray viewer at 3× magnification. The Chi-square test was used, with the level of significance set at 5%. RESULTS: A total of 64.5% individuals presented with furcation involvement, 43.1% of whom had degree II furcation. A significant association (P = 0.0060) was found between tooth type and frequency of furcation involvement. The first lower and upper molars were affected in 64.5 and 58.5% of cases, respectively. Adequate agreement (0.65) was observed between the clinical and radiographic findings. CONCLUSION: Taking into consideration the method employed and the results obtained, it may be concluded that the clinical and radiographic examinations performed are effective tools for diagnosing furcation involvement in teeth affected with periodontal disease.

Periodontal probing: a review.

Periodontal probes are the main instruments that are used to assess the status of the periodontium, either for screening purposes or to evaluate periodontal changes throughout the treatment process. With increased knowledge and understanding of periodontal disease, the probes have evolved from a unidimensional manual shape into a more sophisticated computerised instrument. This is due to the need to increase the accuracy and reproducibility of readings and to improve efficiency (time, effort, money). Each probe has characteristic features that makes it unique and, in some cases, specific and limited to use. The aim of this paper is to present a brief introduction to periodontal disease and the methodology of measuring it, followed by probing limitations. The paper will also discuss the methodology of reducing probing error, examiner calibration and probing reproducibility.

Minimal intervention dentistry II: part 6. Microscope and microsurgical techniques in periodontics.

Different aspects of treatment for periodontal diseases or gingival problems require rigorous diagnostics. Magnification tools and microsurgical instruments, combined with minimally invasive techniques can provide the best solutions in such cases. Relevance of treatments, duration of healing, reduction of pain and post-operative scarring have the potential to be improved for patients through such techniques. This article presents an overview of the use of microscopy in periodontics, still in the early stages of development.