13 articles found
doi:10.3290/j.qi.a29615, 2013-04-22, PMID:23616981
A paradigm shift in mechanical biofilm management? Subgingival air polishing: a new way to improve mechanical biofilm management in the dental practice
Sculean, Anton / Bastendorf, Klaus-Dieter / Becker, Christian / Bush, Bernita / Einwag, Johannes / Lanoway, Carmen / Platzer, Ursula / Schmage, Petra / Schoeneich, Brigitte / Walter, Clemens / Wennström, Jan L. / Flemmig, Thomas F.
In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner.
Keywords: biofilm management, glycine powder, periodontal maintenance, subgingival air polishing, subgingival biofilm removal
Pemphigus vulgaris is a potentially fatal mucocutaneous, vesiculobullous disorder of autoimmune etiology. Regrettably, affected patients frequently experience considerable discomfort and diagnostic delay for months in spite of multiple clinician contacts. The high likelihood of disease manifestations in the oral cavity and serious nature of potential oral and systemic complications mandates dental professionals to recognize early oral signs and symptoms of pemphigus vulgaris and contribute to timely diagnosis and medical intervention to prevent disease progression. This case report presents a young man with pemphigus vulgaris whose oral disease caused him significant suffering and spread to the skin before he was finally diagnosed 3 months after the onset. The signs and symptoms of the disease are reviewed and the potential role of dental providers in timely recognition and management is emphasized.
Keywords: pemphigus vulgaris, vesiculobullous disorders
Iatrogenic trauma can be defined as any adverse condition in a patient resulting from treatment by a physician or dentist. Orthodontic treatment carries with it the risks of tissue damage and treatment failure. The aim of this article is to present traumatic oral tissue lesions resulting from iatrogenic orthodontic origin with a 2-year follow-up period based on orthodontic intervention followed by periodontal surgery. The management of traumatic injuries is dependent on the severity of the involvement of the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy is sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal/regenerative therapy may be necessary. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to proceed with orthodontic treatment. The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas.
Keywords: dental injury, dental trauma, iatrogenic trauma, orthodontic treatment
Objective: This retrospective study investigated the clinical and radiographic changes in the edentulous maxilla in patients with either ball or telescopic attachments of implantretained mandibular overdentures.
Method and Materials: Thirty-two completely edentulous patients (21 males and 11 females) received two implants in the canine region of the mandible. New maxillary complete dentures and mandibular overdentures were fabricated. Overdentures were connected to the implants either with ball (group 1, n = 16) or telescopic (group 2, n = 16) attachments. Retention and stability of the maxillary denture as well as mucosal changes of the maxillary ridge were recorded after 4 years of denturewearing. Traced rotational tomograms were used for measurements of maxillary alveolar bone loss. The proportional value between bone areas and areas of reference not subject to resorption was expressed as a ratio (R). Change in R immediately before (T0) and after 4 years (T4) of overdenture insertion was calculated for the anterior and posterior regions of the maxilla.
Results: After 4 years of denture-wearing, maxillary denture retention was significantly higher in group 1 than in group 2, while occurrence of flabby ridges was significantly higher in group 2 than in group 1. The change in R of the anterior region of the maxilla was significantly higher than the change in the posterior region in both groups. Group 2 showed significant anterior residual ridge resorption compared to group 1.
Conclusion: Telescopic attachments for implant-retained mandibular overdentures are associated with increased maxillary ridge resorption and flabbiness, and decreased maxillary denture retention when compared to ball attachments.
Keywords: implant, overdenture, ridge resorption, telescopic attachments
doi:10.3290/j.qi.a29611, 2013-04-22, PMID:23616977
A prospective noninterventional study to document implant success and survival of the Straumann Bone Level SLActive dental implant in daily dental practice
Filippi, Andreas / Higginbottom, Frank L. / Lambrecht, Thomas / Levin, Barry P. / Meier, Josef L. / Rosen, Paul S. / Wallkamm, Beat / Will, Christoph / Roccuzzo, Mario
Objectives: Clinical studies to assess dental implants are common in implantology, but such studies are usually performed for specific indications and following a specific protocol with strict inclusion and exclusion criteria. The aim of the current study was to evaluate the Straumann Bone Level SLActive dental implant in a prospective, multicenter, noninterventional trial.
Method and Materials: The implant could be used in whatever manner was deemed suitable by the clinician, within approved indications. No particular placement or loading protocol was specified. A total of 1,532 implants were placed in 852 patients in 123 centers in nine countries in the US and Europe. After exclusion of three countries due to patient enrollment and data issues, 759 patients with 1,355 implants were analyzed.
Results: Most patients received one or two implants (58.6% and 25.3% of patients, respectively), and 90% of cases were performed with a raised flap. A submerged healing protocol was significantly more prevalent in European centers, while transmucosal healing was significantly more prevalent in North American centers. After 1 year, 538 patients with 908 implants were available for evaluation. The cumulative implant survival and success rates were 98.5% and 96.0%, respectively.
Conclusions: This prospective noninterventional study evaluated the use of Straumann Bone Level SLActive dental implants in a large number of patients. The cumulative survival and success rates were similar to those observed in controlled clinical trials, confirming this dental implant's clinical applicability in daily practice.
Keywords: bone level dental implant, daily dental practice, noninterventional study, SLActive
Objective: Dentin desensitizing agents are used in the treatment of dentin hypersensitivity, which is defined as a painful response in the exposed dentin to stimuli that are thermal, evaporative, tactile, osmotic, or chemical. A systematic review was conducted to analyze the clinical effectiveness of current desensitizer with at least 3 months of follow-up.
Method and Materials: Eight electronic databases were searched: MedLine (PubMed), Embase, Lilacs, Ibecs, Web of Science, Scopus, Scielo, and The Cochrane Library. Only those clinical trials published from 2000 to 2012 were included.
Results: A total of 3,029 relevant records were identified. After title and abstract examination, 2,645 articles were excluded. A data extraction form was designed and completed by reviewers from the selected studies for a retrospective comparison. From the 99 studies retrieved for detailed review, only 17 had an evaluation time of at least 3-months follow-up and fulfilled the selection criteria.
Conclusion: Cervitec Plus, SE Bond & Protect Liner F, laser, and iontophoresis have shown satisfactory posttreatment results between 3 and 6 months. However, additional clinical trials are warranted to better compare the different types of treatments and their effectiveness in the longer term.
Keywords: dentin desensitizing agents, dental materials, dentin sensitivity, systematic review
Oral metastases from osteosarcoma are rare, particularly in the soft tissues of the oral cavity. The aim of the current case is to present a patient with labial mucosa metastasis from a long bone osteosarcoma and review the literature. A 55-year-old man who had a recent leg amputation because of a giant cell tumor presented a lesion in the lower labial mucosa. After histopathologic and immunohistochemical analysis the diagnosis was of an undifferentiated sarcoma. The patient quickly developed other lesions on the scalp and on the hand, and biopsy of one of these lesions rendered the diagnosis of a giant cell-rich osteosarcoma. Reviewing all information, it was concluded that the leg tumor was the primary giant cell-rich osteosarcoma misdiagnosed as a giant cell tumor. This case emphasizes the importance of the general clinicians' multidisciplinary approach and association of information to arrive at the proper diagnosis, particularly in rare and difficult situations.
Keywords: giant cells, labial mucosa, mouth, oral metastasis, osteosarcoma
Objective: Color perception is an important variable in detecting and assessing oral conditions. The aim was to investigate clinicians' perception of toluidine blue (Tblue) staining compared to digital color analysis, which may impact mucosal lesion detection, affect the decision to biopsy, and biopsy site selection.
Method and Materials: Four oral lesions were stained with Tblue. Digital color analyses of eight areas on each image were completed and were considered as "gold standard" (GS). Twenty specialists ranked these areas according to their perceived intensity of blue stain in two sessions.
Results: Consistency between GS and observers rankings was 0.8791. However, more than half of the observers inaccurately perceived the intermediate blue tones. Overall interobserver agreement was 0.8714; stability between two sessions decreased to 45% for intermediate tones.
Conclusion: Assessing the equivocal blueness of an oral mucosal lesion in clinical settings may vary due to variation in visual perception. A digital method for objective color analysis in clinical practice may be used to eliminate this deficiency by implementing a mathematical formula.
Keywords: color perception, oral cancer, oral diagnosis, oral medicine, toluidine blue
Objective: Thermal Nd:YAG laser energy is well known for the purpose of blood coagulation. However, little is known about the bleeding frequency following laser-assisted oral surgery in patients on coumarin drugs. Therefore, the purpose of this study was to compare retrospectively the frequency of bleeding complications following Nd:YAG laserassisted versus conventional local coagulation of blood in oral surgery.
Method and Materials: In October 2002, minor oral surgical interventions were found to be indicated in a total of 45 cardiac risk patients. In Group 1, blood coagulation was yielded in 24 patients with a Nd:YAG laser system, whereas in Group 2, treatment was performed in 21 patients with conventional means of local hemostasis. All therapies were performed continuing anticoagulant therapy between November 2002 and March 2003. Clinical data were recorded retrospectively from patient charts in May 2007.
Results: In both Groups 1 and 2, a total of two bleeding complications were recorded. However, local re-interventions were sufficient for local hemostasis.
Conclusion: These results indicate that Nd:YAG laser-assisted local hemostasis was not able to prevent bleeding complications completely. Within the limitations of this retrospective study it was concluded that in patients with anticoagulant treatment undergoing minor oral surgery, Nd:YAG laser-assisted local hemostasis is not superior to conventional methods of blood coagulation with respect to the frequency of bleeding complications.
Keywords: anticoagulant drugs, Nd:YAG laser, oral surgery
Objective: To report a multidisciplinary treatment of gemination/fusion of the left maxillary first incisor.
Case Report: An 11-year-old boy presented to our clinic with the chief complaint of an unpleasant appearance of his anterior teeth. Clinical and radiographic evaluation revealed gemination/fusion of the left maxillary first incisor combined with an Angle's Class II relationship (skeletal), retruded mandible, deep bite, short lower face height, and proclinaion of the maxillary incisors. The multidisciplinary approached treatment included orthodontic treatment engaged with root canal treatment of the left maxillary first incisor followed by periodontal surgical separation of the mesial root of the left maxillary first incisor and restoration of the crown using resin restoration.
Conclusion: Tooth shape anomalies in general dental practice may be rare, but the dentist should be aware of the nature of the problems encountered and the specific treatment needs. The treatment may be complex and contain various treatment protocols that may include interdisciplinary endodontic, surgical, and periodontal interventions.
Keywords: fusion, gemination, orthodontic treatment, periodontal surgery, root canal treatment, root separation
Objective: Recent review articles have shown that open debridement is more effective in the treatment of peri-implantitis than closed therapy. However, surgery may result in marginal recession and compromise esthetics. The purpose of this study was to assess the efficacy of nonsurgical antimicrobial photodynamic therapy (aPDT) in moderate vs severe defects.
Method and Materials: The study encompassed 16 patients with a total of 18 ailing implants. Ten of these implants showed moderate bone loss (< 5 mm; Group 1) and eight implants severe defects (5 through 8 mm; Group 2). All implants received aPDT without surgical intervention. At baseline and 2 weeks, 3 months, and 6 months after therapy, peri-implant health was assessed including sulcus bleeding index (SBI), probing depth (PD), distance from implant shoulder to marginal mucosa (DIM), and clinical attachment level (CAL). Radiographic evaluation of distance from implant to bone (DIB) allowed comparison of peri-implant hard tissues after 6 months.
Results: Baseline values for SBI were comparable in both groups. Three months after therapy, in both groups, SBI and CAL decreased significantly. In contrast, after 6 months, CAL and DIB increased significantly in Group 2, not in Group 1. However, DIM-values were not statistically different 6 months after therapy in both groups.
Conclusion: Within the limits of this 6-month study, nonsurgical aPDT could stop bone resorption in moderate peri-implant defects but not in severe defects. However, marginal tissue recession was not significantly different in both groups at the end of the study. Therefore, especially in esthetically important sites, surgical treatment of severe peri-implantitis defects seems to remain mandatory.
Keywords: antibacterial photodynamic therapy, laser, peri-implantitis
Objective: To evaluate and compare the effect of three different implant positions on strain developed around four implants supporting a mandibular overdenture with rigid telescopic attachments.
Method and Materials: Three experimental acrylic resin overdentures were fabricated on three edentulous mandibular acrylic models. Four implants were placed in each model. According to the implant positions, the models were classified into three groups: in group I (quadrilateral design) the implants were placed at canine and first molar areas; in group II (curved design) the implants were placed at canine and second premolar areas; and in group III (linear design) the implants were placed at lateral incisor and first premolar areas. Overdentures were connected to the implants with rigid telescopic attachments. Eight linear strain gauges were bonded to the acrylic resin around each implant at two sites (mesial and distal). Strains were measured for anterior (lateral incisor and canine) and posterior (premolar and molar) implants at both mesial and distal sites during bilateral and unilateral load applications.
Results: For bilateral and unilateral load applications, group II recorded the highest strain values while group I recorded the lowest. In group II and group III, strain values at distal sites were significantly higher than values at mesial sites. Strain values of posterior implants were significantly higher than values of anterior implants in all groups. The greatest strain values were recorded at the loading side during unilateral load application.
Conclusion: Quadrilateral design showed minimal peri-implant strain compared to curved or linear designs. This design may be recommended when rigid telescopic crowns are used to connect mandibular overdentures to four implants.
Keywords: implant overdenture, implant position, strain, telescopic copings
Objectives: The residual alveolar bone height at the implant recipient site plays a key role in determination of the risk of sinus membrane perforation during crestal sinus elevation. In this study, we aimed to determine the correlation between residual ridge height and perforation limit of sinus membrane and to examine the safety range for the sinus membrane continuity in crestal sinus elevation. Formalin-fixed cadavers were used for the experiment to observe outcomes.
Method and Materials: Crestal sinus elevations were performed on 14 preserved human cadavers' heads. Residual ridge heights were measured using a bone caliper. The physiodispenser was preset to 30 Ncm and sinus floors were elevated by a concave sinus screw with diameter of 4 mm until sinus membrane perforation occurred. The perforations were identified either as Class I or Class II and the portion of the concave sinus screw in the sinus was measured each time using a ruler. Spearman's correlation coefficient was calculated to show the relation between the residual ridge heights and the membrane elevations at the time of perforation of the sinus membranes.
Results: In general, the perforation limit of sinus membrane after elevation was higher with greater residual ridge height. A statistically significant correlation was found between residual ridge heights and perforations of the sinus membrane (r = 0.620, P < .001).
Conclusion: Although it is not always possible to extrapolate results from cadavers to an in vitro clinical setting, it could be considered to have clinical significance. Our findings suggest that higher subsinusoidal elevation may be achieved when the residual ridge bone height increases. The conclusions of this study should be verified with studies of more rigorous design.
Keywords: crestal approach, perforation, sinus lift
show/hide abstract
fulltext (no access granted)
order article as PDF-file