Periodontology, Implant Dentistry

二極體雷射又稱作軟組織雷射，因其擁有牙齦手術切割的能力，裝置尺寸小且費用相對較低，在部分臨床牙醫師之間已漸漸風行。軟組織雷射的防潮控制(moisture control)與止血(hemostasis)的能力，使臨床牙醫師切割牙齦組織、施行美觀性牙冠增長術(esthetic crown lengthening)、與降低牙齦溝(gingival troughing)等術式容易上手，讓臨床牙醫師們對於雷射手術技術的操作更容易熟悉。軟組織雷射在牙科領域中也漸漸被接受，他們有潛力在降低生物性副作用的情況下，完成贗復前牙齦處理。這篇文章強調了二極體雷射於上顎前牙的牙周-贗復技術中的使用。針對他們臨床優點的評估，討論其使用在美容牙科治療的好處。

RESUMEN Los tratamientos de implantes dentales se han convertido en un tratamiento cotidiano dentro de la práctica diaria, por lo que la presencia de defectos del reborde alveolar que se da por la reabsorción ósea ha conllevado al desarrollo de muchos procedimientos de aumento óseo con la intención de mejorar la cantidad y calidad del hueso, para así lograr un tratamiento de implantes dentales predecible. El objetivo de esta revisión de la literatura es la de presentar los principales procedimientos referidos al manejo de los defectos horizontales del reborde alveolar, que siempre representan un desafío para los clínicos. ABSTRACT Dental implant treatments have become a daily treatment within daily practice, so that the presence of defects of the alveolar ridge that results from bone resorption has led to the development of many bone augmentation procedures with the intention of improving the quantity and quality of the bone to achieve a predictable dental implant treatment. The objective of this review of the literature is to present the main procedures related to the management of horizontal defects of the alveolar ridge, which are always a challenge for clinicians.

Porcine acellular dermal matrix has recently been introduced in dentistry as an alternative to the gold standard connective tissue graft especially for the use in gingival recession treatments and soft tissue augmentation in implant surgery. Connective tissue grafts are inconvenient and require a second surgical site leading to greater morbidity, longer surgical procedures, and a more painful postoperative phase for the patient. Other options such as allografts have ethical concerns and are less available in Europe. Thus, dental professionals have sought other techniques and materials. Porcine acellular dermal matrix results in periodontal recession treatment with a gain in recession coverage as well as increased keratinized tissue and soft tissue augmentation. This leads to more keratinized mucosa and greater tissue thickness. Many studies have been published using collagen matrices, but a few strictly use porcine acellular dermal matrix, which have been studied in prospective randomized clinical trials with a large number of patients and longer follow-up periods (more than 5 years). Nevertheless, more data are needed to confirm that the porcine acellular dermal matrix is a suitable alternative although its favourable results to date suggest a positive future.

60 y 30. Desde sus inicios, la implantología dental ha caminado de manera paralela a los descubrimientos en el campo de la medicina ortopédica. Desde las cápsulas de plata, implantes de cromo cobalto, molibdeno, vitalium, tantalio, hasta llegar al titanio. En 1951 Gottlieb S. Leventhal, cirujano ortopedista de Filadelfia, buscando un metal idóneo para la fijación de fracturas, encontró que el titanio era “inerte” ya que no producía reacción tisular, y los tejidos subcutáneos parecían normales. La era de titanio había dado inicio.

A review of the available techniques is presented in this article to achieve closure for first intention of a post extraction implant, highlighting a approach with connective tissue pedicle graft applied in a case where the benefits are evident for both the patient and successful treatment, especially in factors related to the stability and survival of the graft.

Murakami S, Bartold M, Meyle J, Agarwal R, Anagnostou F,  Bakalyan V, Bunyaratavej P,  Chitguppi R, Darby I, Gamal A, Jacob S, Jin Y, John J, Kale R, Liechter J, Minh NT, Nagata T, Nazreth B, Nishida M, Pack A, Patnaik S, Shibutani
T, Singh P, Soeroso Y, Spahr A, Yang YC, Yeung S.

Group C. Consensus paper.
Periodontal regeneration--fact or fiction? J Int Acad Periodontol. 2015 Jan;17(1
Suppl):54-6. PubMed PMID: 25764592.

Abstract

Numerous techniques have been tried and tested to regenerate tissues lost to periodontal disease. While there has been some success to date, more work is required to move this to a reliable and clinically predictable procedure. Much of the future success for such treatments will rely largely on our understanding of the biology of both developmental and regenerative processes. Nonetheless, despite the noble goal of periodontal regeneration, the relevance of re-creation of a connective tissue attachment has been questioned. Since formation of a long junctional epithelial attachment to the tooth following a variety of periodontal treatment procedures has been shown to be no more susceptible to further breakdown than a non-diseased site, the question arises as to what purpose do we seek the ultimate outcome of periodontal regeneration? The answer lies in the "fact and fiction" of periodontal regeneration. There is no doubt that the regenerative procedures that have been developed can be shown to be biologically successful at the histological level. Furthermore, the results of periodontal regeneration (particularly guided tissue regeneration) have been stable over the long term (at least up to 10 years). However, the techniques currently under use which show the greatest promise (guided tissue regeneration and growth factors) are still clinically unpredictable because of their highly technique-sensitive nature. In addition, whether the slight clinical improvements offered by these procedures over routine open flap debridement procedures are of cost or patient benefit with regards to improved periodontal health and retention of teeth remains to be established. The next phase in regenerative technologies will undoubtedly involve a deeper understanding of the molecular signaling (both intra- and extra-cellular) and cellular differentiation processes involved in the regenerative processes. So in answer to the question of whether periodontal regeneration is fact or fiction, the answer clearly is that it is both. However, with more work it will become established fact with little fiction and the desired clinical endpoint of predictable regeneration of the periodontal tissues damaged by inflammation to their original form and function will be achieved.

Dental transposition is a form of ectopic eruption with change in position of normal adjacent teeth. Its prevalence is very low in general population and could be frequently missed on oral examination. We present a rare case of dental transposition between left mandibular canine and first premolar in a 22 year old Libyan male patient.

compaRative evaluation of the efficacy of allogRaft (dembone) and alloplaStic bone gRaft (oSteogen) in the tReatment of peRiodontal intRaoSSeouS defectS -a clinico-RadiogRaphic Study ABSTRACT Aim: To compare the clinical and radiographic efficacy of allograft (dembone) alloplastic graft (osteogen) in treatment of periodontal intraosseous defects. Materials & Methods: 30 subjects with atleast one intrabony defect with a probing depth of ≤7mm and vertical radiographic bone loss ≥3 mm were enrolled in the study. The patients were divided randomly into two groups -group A received allograft (dembone) with resorbabale collagen membrane and group B received alloplastic material (osteogen) with bioresorbabale GTR membrane. Clinical parameters were recorded from base line till 9 months after surgery and included probing depth, clinical attachment level, recession and amount of defect fill. Results: In both groups, significant gains occurred during the study period. At 9 months, group A exhibited mean probing depth reduction of 3.13 ± 0.8 mm, clinical attachment gain of 4.33 ± 1.12 mm, gingival recession gain of 1.2 ± 6.8 mm and defect fill of 4.53 ± 1. 53 mm. Corresponding values of group B were 3.00 ± 0.63 mm, 4.13 ± 1.0 mm, 1.13 ± 0.8 and 5.1 ± 1.31 mm respectively. There were no significant differences in clinical parameters of both groups (p>0.05). Conclusion: The clinical benefits of dembone were equivalent to osteogen. Osteogen may be an appropriate alternative to conventional grafting materials. However, long term clinical trials in future would further clarify the regenerative efficacy of alloplastic bone grafts.

The purposes of this study were to quantify some clinical parameters that are useful as esthetic guidelines when the gingival contour is modified and to compare the left and right sides of the six maxillary anterior teeth. Materials and Methods: Two hundred and forty interdental papilla sites in 20 healthy patients were evaluated. Interdental papilla heights of maxillary anterior teeth were measured from the gingival zenith, along with clinical crown lengths. Percentages of papilla height to crown length were computed and defined as papilla proportion, mesial papilla proportion (MPP) and distal papilla proportion (DPP). Results: Mean interdental papilla heights of maxillary teeth was 3.83 mm mesially and 3.8 mm distally. Mean MPP was 43.69% (n = 120) and DPP was 44.57% (n = 120). No significant differences were found between MPP and DPP for maxillary incisors (P ≥ 0.5). Conclusion: Papilla proportions were approximately 44% for all tooth groups. Canines demonstrated a trend toward increased distal papilla heights. In the present study the average MPP and DPP of the central incisor (CI), lateral incisor (LI) and canine (CA) measured were 43%, 41%, 46%, 40%, and 42% 51% respectively.

A variety of systemic diseases in the past decade have been shown to have a relationship with periodontal diseases. The present literature points to a relationship between liver diseases and periodontal diseases. In this review, we attempted to identify, whether liver diseases have a detrimental effect on the periodontal health and vice versa. We have also attempted to identify the possible biological mechanisms that link the two diseases. Electronic databases of Medline, Pre-Medline, and Medline Daily Update were searched for articles published in English from 1964-2013 to identify variables associated with periodontitis and liver diseases. We found the studies to show that the patients with liver diseases have more periodontal attachment and alveolar bone loss. More plaque and calculus and a higher amount of virulent periodontal bacteria were found in periodontal pockets of liver disease patients compared to the controls. It was also shown that post-liver transplantation patients maintained stable clinical periodontal parameters for long periods. In addition, possible biological linking mechanisms were withdrawn from the studies. However, as the majority of the studies were cross sectional and lack the necessary power to elucidate the relationship, further researches are necessary with better study design and the exclusion of the confounding factors. This article is the first known attempt to review the bidirectional relationship and at the same time the possible mechanisms that link the two diseases.

Aim: To explore the influence of obesity/overweight on development and treatment outcome of periodontal diseases (PD), and to explore possible mechanisms of interaction between obesity and PD.Method: A literature search was conducted using the PubMed and Go Pubmed databases.Conclusion: Obesity and PD can exert similar pathogenic effects via common pathways, and can influence each other bidirectionally. Elucidating the relationship between obesity and PD allows for the development of care guidelines and recommendations for clinicians and the public. Obesity  and  periodontal  diseases  (PD)  are  very  prevalent  among U.S. adults during recent years [1-4]. Since both can lead to severe  chronic  health  conditions  and  impair  people’s  life  quality  by exerting similar influences [5-10], a clear understanding of the association between obesity and periodontal diseases is warranted to reduce health and medical costs in the U.S. [5] The objective of this review is to explore the influence of obesity/overweight on development and treatment outcome of PD, and to explore possible mechanisms of interaction between obesity and PD.

Implant-retained mandibular ball-supported and bar-supported overlay dentures are the two most common treatment options for the edentulous mandible. The superior option in terms of strain distribution should be determined. The three-dimensional model of mandible (based on computerized tomography scan) and its overlying implant-retained bar-supported and ball-supported overlay dentures were simulated using SolidWorks, NURBS, and ANSYS Workbench. Loads A (60 N) and B (60 N) were exerted, respectively, in protrusive and laterotrusive motions, on second molar mesial, first molar mesial, and first premolar. The strain distribution patterns were assessed on (1) implant tissue, (2) first implant-bone, and (3) second implant-bone interfaces. Protrusive: Strain was mostly detected in the apical of the fixtures and least in the cervical when bar design was used. On the nonworking side, however, strain was higher in the cervical and lower in the apical compared with the working side implant. Laterotrusive: The strain values were closely similar in the two designs. It seems that both designs are acceptable in terms of stress distribution, although a superior pattern is associated with the application of bar design in protrusive motion.

Periodontitis is a destructive disease that targets tooth-supporting structures through complex and multifactorial pathogenic processes. Alveolar bone destruction, a hallmark of periodontitis progression and one of the major causes of tooth loss in human, is mediated by the host immune and inflammatory response to microbial challenge. The discovery of the receptor activator of nuclear factor-kappa B (RANK)/ RANK ligand (RANKL)/osteoprotegerin (OPG) axis has improved the knowledge of bone metabolism regulation. The RANKL/RANK interaction is needed for differentiation and maturation of osteoclast precursor cells to activate osteoclasts and for the survival of mature osteoclasts. Osteoprotegerin is the naturally occurring inhibitor of osteoclast differentiation. It binds to RANKL with high affinity and blocks RANKL from interacting with RANK. The RANKL/OPG ratio is increased in periodontitis compared to healthy individuals, suggesting that this molecular interaction may be important in modulating local bone loss.

C arious lesions, as periodontal inflammatory and peri-implantar processes are the most frequent infectious forms in the oral cavity. These destructive diseases are caused mostly by the presence of microbial biofilms that find in mouth the ideal condition for its development and proliferation. Peri-implantitis are the main cause in the failure of implants and its pathogenesis is similar to that of a chronic periodontitis. of autolysinmediated DNA release in biofilm formation of Staphylococcus epidermidis. Microbiologyl 2007; 153: 2083-2092. 2 Shibli JA, Melo L, Ferrari DS, Figueiredo LC, Faveri M, Feres M. Composition of supra-and subgingival biofilm of subjects with healthy and diseased implants. Clin Oral Impl Res 2008; 19: 975-982. 3 Lindhe J, Meyle J. Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol 2008; 35 (Suppl. 8): 282-285. 4 Zitzmann NU, Berglundh T. Definition and prevalence of peri-implant diseases. Mendes P, Cutrim A, Braz M, Santos R, Ferreira M, Nociti F. Effect of anti-infective mechanical therapy on clinical parameters and cytokine levels in human peri-implant diseases.

The goal of modern implant therapy entails more than just the successful osseointegration of the implant. A successful result must also include an esthetic and functional restoration surrounded by stable peri-implant tissue levels that are in harmony with the existing dentition. In an attempt to improve long-term bone maintenance around implants, a new implant-to abutment connection referred to as "platform switching" has been proposed. It refers to the use of an abutment of smaller diameter connected to an implant neck of larger diameter. Platform switching is a simple and effective way to control circumferential bone loss around dental implants. This short communication aims to present an overview of concept of platform switching in dental implantology.

The most common recommendation of dentists to patients is to brush twice a day, clean your tongue, use a mouth rinse and floss regularly. Flossing is in fact the one recommendation of dentists that patients find most difficult to do.

Dentists, nevertheless, have insisted that flossing prevents gum disease and dental caries. But is there enough evidence that flossing is really essential to your overall oral health?

Raging on the internet and many dental associations across the world is now a debate on whether flossing is of any help at all. It all started after a recent story by Associated Press (AP) that there is little evidence that flossing actually works. They reported that when the federal government issued its latest dietary guidelines, the recommendation of flossing had been removed. Even the government acknowledged that the effectiveness of flossing had never been researched as required.

Dr.Niranjan Prabhakar, Executive Editor DT SEA speaks to two eminent Periodontists in India, Dr.Sudhindra Kulkarni and Dr.Rajeev Chitguppi to understand what they make of this new development in Oral health care.

Is it good to say, good bye to flossing? Let us find out.

Radicular cysts are the most common cystic lesions affecting the jaws. They are most commonly found at the apices of the involved teeth. This condition is usually asymptomatic but can result in a slow-growth tumefaction in the affected region. The following case report presents the successful treatment of radicular cysts using autologous periosteum and platelet-rich fibrin with demineralized freeze-dried bone allograft.