Periodontal clinical investigations : official publication of the Northeastern Society of Periodontists最新文献

The treatment of young people with implants requires advanced planning and coordination of many different specialities within dentistry. Timing and sequence of therapy will often decide the success or failure of treatment. Congenital absence of many teeth (oligodontia) associated with or without syndromes poses not only functional but also psychosocial problems for young people. A case is presented in which orthodontist, restorative dentist, and periodontist evaluated and performed the necessary therapy for a young person who at the age of 9 was diagnosed with oligodontia/l. Nine implants were placed: 13 years, 8 months in the mandible and 15 years, 6 months in the maxilla. All implants were restored as single teeth. The patient was followed until age 20.

A procedure is described whereby a patient with a highly localized atrophic maxillary ridge has had the deformity corrected by utilizing a combination of a block of corticocancellous bone and a barrier membrane.

This case report describes an alternative surgical approach which can avoid the need for secondary regenerative techniques for ridge augmentation when planning treatment for dental implants. Our patient had a hopeless maxillary left central incisor, which was subsequently extracted in preparation for implant restoration. The site had a significant defect, which was treated at the time of extraction with a combination of a xenograft and a cortical chin graft. The goal was to preserve the residual ridge contour to avoid a compromise in implant fixture placement and maximize function and esthetics.

The purpose of this study was twofold: (a) to determine if an association exists between severity of localized juvenile periodontitis (LJP) and impairment of polymorphonuclear leukocyte (PMN) chemotaxis and/or colonization by specific microbial isolates; (b) to determine if the number of specific microbial isolates, i.e., Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Eikenella corrodens, and Campylobacter rectus correlates to clinical severity of sites with LJP. Thirty-six first molars in nine subjects with LJP were examined. A clinical severity score was computed based on attachment level and vertical bone loss. The mean score of the four sites was designated as the clinical severity score for each subject. A DNA probe was used to quantitate colonization by A. actinomycetemcomitans, P. gingivalis, P. intermedia, F. nucleatum, E. corrodens, and C. rectus. The chemotaxis of isolated peripheral blood PMNs was measured in Boyden chambers using the leading front technique. It was found that the clinical severity score ranged from 7.8 for mild involvement to 32.5 for severe LJP. The chemotaxis result for each patient (micron/90 min) was expressed as a percentage of the value for a paired healthy control and ranged from 40% to 104%. Four of the nine subjects had chemotaxis values less than 70% of control. Linear regression analysis showed: (a) no significant correlation between PMN chemotaxis and severity of LJP in subjects (r = .14); (b) a significant correlation (r = 0.43) between severe sites with LJP and number of specific microbial isolates. Sites with severe LJP had present at least five different microbial isolates as compared with non-severe sites (P < .05). No particular trend of colonization by periodontopathogens was seen in non-severe sites. Further, severe sites of LJP displayed a statistically significant greater colonization by P. intermedia, E. corrodens, and C. rectus than did non-severe sites (P < .05). It may be concluded that neither the degree of PMN chemotactic impairment nor A. actinomycetemcomitans is a reliable indicator of the severity of LJP.

This study evaluated the validity of radiographic alveolar bone defect depth measurements to direct probing measurements. The study was planned in two parts. The first part consisted of the evaluation of artificially prepared defects in dry mandibles. These consisted of 3-mm intrabony defects created at the mesial aspect of the second mandibular molar and a Class II furcation defect on the buccal aspect of the first molar. A total of six standardized periapical radiographs with grids were obtained. They were then evaluated by 10 independent examiners who recorded the distance between the alveolar crest (AC) or root junction (RJ) and base of defect (BD) in the proximal and furcation areas of the teeth. Intra- and inter-examiner differences were assessed. Radiographic results showed that these measurements overestimated the mean defect depth values within 0.12 mm in intrabony defects and underestimated within 0.40 mm in Class II furcation defects. The differences between the radiographic and direct dry mandible defect depth measurements were found to be statistically significant (P < .05) with correlation values r = .50 and r = .46, respectively. The clinical part of the study included evaluation of 64 preoperative radiographs taken from patients who underwent various types of periodontal surgery. Mean clinical bone defect depth was found to be 4.20 mm and the mean of the radiographic defect depth measurements was found to be 3.92 mm in intrabony defects. In furcation defects these values were 3.92 mm and 3.55 mm, respectively. The results revealed that (1) a strong correlation existed between the radiographic and clinical assessments in both type of defects (r = .85, P < .001), and that (2) the difference between the two types of assessment methods was generally within 1 mm (58%). It can be concluded that in both dry mandible and clinical studies radiographic interpretation of the intrabony and furcation defects showed differences from the actual bone defect depths.

This case report documents the devitalization of an adjacent tooth during osteotomy preparation for implant placement. The fixtures were placed without consulting the patient's dentist. Furthermore, radiographs were not taken during stage 1 surgery. The patient started to experience painful symptoms 1 month after fixture placement, and a radiograph was taken at that time. It revealed periapical pathology on the mandibular left canine, through which the base of the implant penetrated. This traumatic injury at the tooth's apex undoubtedly caused its devitalization. Prompt removal of the fixture and endodontic therapy on the canine resulted in repair of the osseous site within 3 months.