Parodontologie (Berlin, Germany)最新文献

A prophylactically oriented concept of periodontal treatment is inconceivable without purpose-trained personnel. This fact led to the new profession of dental hygienist, being introduced into many countries more than 15 years ago. In Germany, attempts were made to close the gap with the profession of dental assistant (ZMF). This model has, however, proved a failure because--besides the advanced training curriculum not being sufficiently specialized--the demand for dental assistants is far greater than the supply. Many dentists, therefore, employ assistants with relevant training in the form of updating courses. Apart from the fact that this frequently results in legal misgivings, it also fails to meet the demand. For this reason, it is absolutely essential that personnel structures be adapted nationwide to a prophylactically oriented concept of periodontal treatment. Account is being taken of experience already gained abroad, as well as current opportunities for training and advanced training in Germany, including the legal principles valid in this country.

A review of the founding and development of the German ARPA (Association for Periodontal Research) and the ARPA International is presented. Those researchers who shaped and influenced the ARPA were also instrumental in the development of periodontics in Germany. The changes in nomenclature and therapeutic concepts over the decades are also depicted. In 1970 the ARPA became the DGP (German Society of Periodontology). The DGP was one of the founders of the Journal of Clinical Periodontology. In Germany over the past few decades, an attempt has been made to place periodontics in its appropriate position within dentistry with respect to teaching and research.

This review deals with the different methods of lengthening the clinical crown and discusses the advantages and/or disadvantages of each method. Different flap procedures, including ostectomy and osteoplasty, reduce the height of the alveolar crest aiming at a distance of about 3 mm to a future reconstruction margin. Root planing may avoid reattachment of surgically separated fibers. Other methods like gingivectomy, electrosurgery, intra-alveolar transplantation, and forced eruption might contain considerable biological disadvantages. However, if the extrusion is combined with regular fiberotomy, this method becomes the most conservative with respect to the periodontal tissues of neighboring teeth. On the other hand, not all situations which require lengthening of the clinical crown can be solved by orthodontic extrusion and fiberotomy. Therefore, depending on the clinical problem, either the surgical lengthening of the clinical crown or the orthodontic extrusion with separation of the fibers are the recommended procedures.

Subgingival plaque control is a decisive factor in periodontal therapy. Up to the present, removal of plaque and calculus by repeated scaling procedures has been regarded as the only viable method to achieve this goal. Recent investigations, however, suggest that the topical application of antibacterial substances or subgingival irrigation procedures are capable of yielding comparable improvements of periodontal health. This review paper is dedicated to subgingival irrigation. Besides an overview of techniques and results, we discuss our own experiences, including two case presentations. The results so far are encouraging. Nevertheless, due to the general lack of scientific data with extended time intervals, this method is not suitable yet as an alternative to conventional procedures in periodontal routine care. Until further long-term evidence has been gathered, subgingival irrigation should be regarded only as a valuable adjunct to scaling and root planing.

Telescope crowns are well established as prosthodontic retainers for removable partial dentures. After a short review of the advantages and disadvantages of telescope crowns, the specifies of tapered crowns are described. By the use of appropriate tooth preparation and the fabrication of modified, fully resin-veneered tapered crowns, it is possible to improve on the crown contours and the aesthetics provided by conventional tapered crowns. Periodontal prophylactic conditions are also considered.

When fixed partial dentures are provided for edentulous areas of the alveolar ridge, the previously impaired masticatory and phonetic functions as well as esthetics are restored immediately; in the long run, the restoration helps to stabilize the occlusion, thus maintaining the integrity of the temporomandibular joints and the neuromuscular system. The reabsorption of connective tissues following the loss of teeth as well as the changes in the dimensions of edentulous areas that occur over time will have to be taken into account in that the basic shape of the tooth or teeth to be replaced needs to be modified. Pontics usually present a larger surface than natural teeth; on this surface, plaque may accumulate. The self-cleaning mechanisms are ineffective on the surfaces facing the adjacent teeth or the tissues of the alveolar ridge. For this reason, the pontics and their flexible or rigid connectors to the abutments must be considered the weakest parts of the restoration. The long-term success of the restoration, once periodontal treatment and optimum prosthodontic care have been provided, depends on whether considerations of periodontal prevention played a role in the design of the restoration and on postinsertion periodontal care.

Periodontal lesions are primarily diagnosed using the periodontal probe. Using site-specific probing attachment level measurements in defined time intervals, dentists can identify patients and dentition segments that suffer temporarily from a high periodontitis progression rate. The present article describes whether sites where clinical measurements suggested a high progression rate had tissue characteristics different from nonprogressing sites. Ten patients with untreated advanced adult periodontitis were monitored for 10 months by measuring clinical parameters every 30 days. These parameters were gingival index, plaque index, bleeding index, bleeding on probing, probing depth and probing attachment levels. Every month pairs of contralateral sites were sought where one site had lost 2 mm (P-2) or more (P greater than 2) probing attachment (P-sites) and the other site had not (C-site). From these sites supracrestal soft tissue biopsies were taken. After histological processing, a first analysis determined the number of inflammatory cells in 9 standard areas in P- and C-biopsies. A second analysis evaluated cell populations at the apical end of the junctional epithelium. The results showed that bleeding on probing, probing depth and probing attachment loss were statistically significantly greater at P-sites. At C-sites there were only few inflammatory cells. At P-2-sites there were numerous inflammatory cells, and in P greater than 2-sites the number of these cells was statistically significantly greater than in corresponding control sites. The cell populations at the apical end of the junctional epithelium were different between P- and C-sites. At P-sites, the percentage of mast cells, monocytes/macrophages and plasma cells was statistically significantly greater than at C-sites. At C-sites, the percentage of fibroblasts was statistically significantly greater than at P-sites. These results demonstrate that clinical probing identifies episodes of periodontitis progression, which are associated with pronounced changes in tissue characteristics, namely greater numbers of inflammatory cells.