Revue belge de medecine dentaire最新文献

An accurate prediction of disease progression after periodontal therapy would enable the clinician to intervene where and whenever necessary and to individualize supportive care. Unfortunately, predicting continued clinical attachment loss on the basis of clinical parameters on a site and tooth level seems relatively unreliable. Consequently, the clinician could play safe by possibly performing overtreatment. Reality shows, however, that persistent pathology prevails in some cases. A recent study has indicated that deep residual pockets of at least 6 mm following active periodontal therapy represent a risk for further disease progression and tooth loss. Significant associations have been shown on a site, tooth and patient level. This finding promotes a pocket elimination approach for the treatment of periodontitis. The strategy, which includes a strict extraction policy for hopeless teeth and thorough pocket disinfection usually by means of surgery, reduces the work load during supportive care. Indeed, additional tooth loss will be limited and a low prevalence of deep residual pockets limits the need for re-treatment. Besides active periodontal therapy supportive care is of pivotal importance to limit disease progression. The appropriate interval is selected on the basis of the patient's risk profile by the periodontist. Since specialists are usually understaffed to provide this for all patients, a 'co-management' concept seems the best alternative. This concept includes regular visits to the specialist and general practitioner. On the other hand, auxiliary personnel can be helpful to assist careproviders in organizing supportive therapy. This concept has proven to be effective over the world except for Belgium where oral hygienists are nonexisting and not allowed by law. Maybe it is time to reorganise health care policy in the benefit of clinicians and patients.

Mechanical debridement, with of without flap elevation, is a difficult and technique-sensitive procedure resulting in suboptimal treatment outcome from time to time. Therefore, it is not surprising that antibiotics and antiseptics, used alone or in combination with scaling and root planing, have always been fairly successful in clinical practice. For a number of reasons discussed in this paper, routine use of these agents cannot be justified. Especially in general practice these agents should not be prescribed; at least not for treating periodontitis.

Judgment and actions based on scientific evidence are modified by the unique caregiver-patient relationship. Caregivers relying exclusively upon "rational" decisions in line with evidence-based clinical recommendations avoid their relational responsibility. The "noble" purpose illustrates that decisions to treat can be at the same time pointless and valuable. Dia (through) - logue (knowledge) makes it possible to go beyond informed consent, which holds caregivers responsible for providing information and patients for the decision to treat. Finally, where healing is no longer achievable and autonomy dies away, compassion rather than therapeutic tenacity might be the answer. These examples are explained corresponding to the philosophical ideas of respectively Emmanuel Levinas en Roger Burgraeve (noble purpose), Martin Buber (dialogical thinking) and Daniel C. Dennett (autonomy loss).

Millions of partially or fully edentulous patients worldwide have been treated by means of dental implants ever since the description of the osseointegration process by PI Brånemark. Despite high success rates, different biological and mechanical complications do occur. Peri-implantitis is a chronical infection around dental implants with irreversible crestal bone loss. Like periodontitis, peri-implantitis is a multifactorial disease caused by pathogenic species in a sensitive host. Today treatment of peri-implantitis is highly unpredictable, hence regular follow-up and prevention seems warranted. As the number of patients rehabilitated with dental implants is growing, the incidence will certainly increase. Guidelines about diagnostics, prevention and treatment of peri-implantitis are mentioned in this article based on current scientific evidence.

Guidelines for the prophylaxis of infective endocarditis have historically evolved and have been based on limited medical evidence. New data suggest that infectious endocarditis is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, gastrointestinal (GI) or genitourinary (GU) tract procedure, that prophylaxis may prevent an exceedingly small number of cases of endocarditis in patients who undergo a dental, GI tract or GU tract procedure and that the risk of antibiotic-associated adverse events may exceed the benefit from prophylactic antibiotic therapy. Based on these data the 2007 guidelines of the American Heart Association radically limit the indications for endocarditis prophylaxis. In its new consensus guidelines, the UZ Leuven restricts candidates for endocarditis prophylaxis to patients with cardiac conditions with an increased risk for infectious endocarditis and the highest risk of an adverse outcome. Prophylaxis is indicated in these patients in case of dental procedures that involve manipulation of gingival tissue, periapical region or in case of perforation of the mucosa. Daily oral hygiene and regular evaluation and treatment by a dentist are essential in the prevention of infectious endocarditis. The publication of these guidelines intends to stimulate discussion in order to develop uniform Belgian guidelines.

Violation of the biologic width could induce different periodontal consequences depending on many factors such as the type of the restorative material used. In this study, the histological performance and the marginal adaptation of three filling materials (amalgam, composite resin and compomer) are evaluated after a period of three months. Class V cavities with apical margin located at the alveolar bone crest were prepared on Pointer dogs teeth and restored with these three materials. Histological analysis showed that lesions in epithelial attachment were mainly noticed with amalgam fillings and the scale of inflammatory cells was the highest when amalgam was used. Compomer showed the best marginal adaptation.

Vascular epulide or Lobular capillary hemangioma is a form of epulide which is marked by an inflammatory infiltrate rich of blood vessels. Angiogenic factors seem to be responsible of the important vascular proliferation. Therapeutic implications include cautions toward hemorrhagic risk. Complete ablation is also required to avoid the risk of high recurrence.

Pulpotomy is the most performed and controversial therapeutic in pediatric dentistry. Since formocresol is known to have a toxic effect on living tissues, plus a mutagenic and carcinogenic potential with a systemic uptake of formocresol via pulpotomized teeth, other alternative products have been investigated. Twenty-five decayed primary canines and twenty-five healthy primary canines necessitating disking for orthodontic purposes were pulpotomized using non modified Zinc Oxide Eugenol. The effects of this material were evaluated both clinically and radiographically. Post operative control examinations were performed at 1, 6, 12, and 24 months trying to detect spontaneous or stimulated pain, pathological tooth mobility, abscesses or fistulas, internal or external pathological tooth resorption, periapical bone destruction, or canal obliteration. Pain was absent at 24 months post operatively. Half of the treated canines presented with a mobility, while internal and external resorptions were more frequent in decayed teeth and their number increased with time. On the other hand, abscesses and fistulas were equally found in both treated groups. The observations were compared to others related to formocresol ferric sulfate, MTA, and laser pulpotomies, using the binominal law, or the comparative test of an observed proportion to a reference proportion. In this study, and based on the excessive negative results in both groups, we demonstrated that non fixative pulpotomies on temporary canines were not a promising technique.

As the prevalence of periodontitis is more than 40 % in the adult Belgian population, periodontists are clearly understaffed to treat this disease in all patients. Therefore, it seems logic that mild forms of chronic periodontitis are treated by the general practitioner especially because Belgium lacks dental hygienists. Important prerequisites for organizing periodontal care as such relate to the general practitioner who should use the same techniques, have comparable communicative skills to motivate patients and create a similar amount of time for periodontal treatment as the specialist. After all, the patient has the right to qualitative treatment regardless of the level of education of the care provider. In order to guarantee this in general practice as much as possible, there is a need for clinical guidelines developed by specialists. These guidelines should not only support the general practitioner in treating disease; above all, they should assist the dentist in periodontal diagnosis. Hitherto, periodontal screening by general dentists seems to be infrequently performed even though reimbursement of the Dutch Periodontal Screening Index is implemented in the Belgian healthcare security system. In this manuscript possible explanations for this phenomenon are discussed. Apart from the need for guidelines in general practice, guidelines for surgical treatment seem compulsory to uniform treatment protocols in specialized practice. Extreme variation in the recommendation of surgery among Belgian specialists calls for consensus statements.

In many disciplines of medicine guidelines are developed for the diagnosis and treatment of disease. These are essentially intended to standardize care and to optimize communication between the general practitioner and the specialist. Guidelines have already been described in the literature for chronic periodontitis. However, given the unique conditions in Belgium, these may not be appropriate for the average dental practice. In this manuscript the development of Belgian clinical guidelines for the diagnosis and treatment of chronic periodontitis is described. Basically, ten clinical questions were used as a basis for a thorough literature search. Evidence-based clinical guidelines were developed and adapted during three peer review sessions. In the final session Belgian specialists, who had all been invited, participated. This made sure that the scientific input was sufficiently transformed into clinical guidelines which are actually feasible today in Belgium.