Parodontologie (Berlin, Germany)最新文献

The present status of root surface debridement is reviewed. Recently it was shown that the influence of root surface roughness and endotoxin-contaminated cementum was overestimated. The method of instrumentation (i.e., hand instrument, sonic or ultrasonic scaler) does not influence wound healing after periodontal surgery. The operator's technique is of utmost importance.

The experience gained by the training of dental assistants using individual education programs shows that there is a need for similar training and education of dental hygienists. The presently existing education programs in this field are not related specifically to training of periodontal procedures and prophylaxis and are insufficient for the treatment of patients with periodontal diseases. This was also the conclusion of a committee for dental auxiliary personnel that was recently initiated by the German Society of Periodontology.

Placing restorations in patients who have a limited number of teeth and reduced periodontal support is no longer controversial, given careful selection of patients, preprosthetic periodontal treatment, and a thorough maintenance program. In this paper, attention is drawn to general prosthetic planning, including the use of long-span bridges. Because of increased tooth mobility, cross-arch stabilization of the bridges with interlocks or with postsolder connections is advocated. The framework should be rigid enough to avoid deflection of the bridges. Preparation of the vital and nonvital abutment teeth needs much attention. To avoid using a removable prosthesis, a cantilever bridge can be used, but it makes the construction more prone to fracture. A number of periodontal-prosthetic patients demonstrate a "posterior collapsed bite." Rehabilitation requires the restoration at a "new" vertical dimension of occlusion. This can be done, without functional hazards, in a one-step clinical procedure. A long functional adaptation period is unnecessary. The treatment outcome of furcations is not always predictable. Therefore, hemisection or amputation are often the treatments of choice. On these hemisected roots, bridges can be made and successfully maintained. Finally, it should be stressed that not all teeth have to be replaced: a premolar, shortened-arch occlusion is often sufficient for adequate function.

This paper demonstrates the clinical variety of gingival enlargement. An increase of the number of individuals who suffer from local or general enlargement caused by microbial gingival inflammation or different drugs can be demonstrated. All imbalances of leukopoesis or homeostasis require particular diagnostic attention by dentists, because early diagnosis is decisive for patient prognosis.

Effective preventive treatment requires detailed knowledge of the etiological factors which contributed to the respective disease. For this reason, the various concepts of infectious disease that were discussed at one time or another are presented here. Special attention is given to the nonspecific and the specific plaque hypotheses. Current preventive strategies are based, however, on the concept of "opportunistic infections", which is scientifically well-documented and has been described in much detail. The following three preventive strategies are feasible: (1) eliminating plaque regularly and completely; (2) eliminating plaque to the level of the individual patient's characteristic limits for the disease in question; and (3) effecting changes in the microbiological composition of the plaque in order to eliminate the more highly pathogenic organisms and possibly to replace them with less pathogenic organisms.

The implantation of alloplastic materials in infrabony defects is controversely discussed. Only calcium phosphate ceramics have been proven as implantation materials for clinical use. All of the materials not being inert they undergo biodegradation. The extent of biodegradation is most pronounced with tricalciumphosphate (TCP). It had been shown in clinical studies that reduction of probing depth and gain of probing attachment level increased with implantation when compared to surgery only. Formation of new attachment however, can only be verified by histological analysis. Block sections of human teeth demonstrated different results in terms of gain of attachment when porous hydroxyapatite (HA) was implanted. Histometric analysis of a study in dogs showed significant gain of attachment by implanting porous HA and TCP in infrabony defects. Using solid HA or a modified Widman flap healing occurred only by reparation forming a long junctional epithelium. In conclusion, it can be stated that regeneration of periodontal tissues may be achieved by means of implantation of porous HA and TCP. However, long term results are not available and the clinical parameters to obtain predictable results still have to be defined.

Adhesive fixed partial denture (FPD) technology has gradually become viable in recent years, suitable for use in general dental practice. The most important prerequisites for success are patient selection and meticulous production techniques. Indications and limits of this technique are evaluated on the basis of the current state of the art. Initial preprosthetic treatment and clinical procedures are described. Research that has been done so far appears to demonstrate that adhesive FPDs are compatible with healthy periodontal tissues, even though some over-contouring of the adhesive tabs on the abutment teeth seems to be unavoidable. First clinical long-term studies have shown, however, that the failure rate of adhesive FPDs is higher than with conventional crown and bridge techniques. Porcelain-fused-to-metal FPDs on pure titanium frames and full ceramic FPDs are new developments in adhesive FPD technology which are not yet fit for use in dental practice.