[ impact of clinical steps of porcelain fused to metal restorations on periodontal health]

Statement of Problem: Periodontal health plays a key role in the success of restorative treatment and clinical stages of restorative treatments may affect the health of periodontium

Purpose: The aim of the present study was to investigate the effects of clinical stages of porcelain fused to metal [PFM] restorations on free gingival margin [FGM], clinical attachment level [CAL], plaque [PI], and gingival [GI] indices

Material and Method: 15 patients requiring PFM restoration on the maxillary central incisor or maxillary and mandibular premolars [test group] with an intact adjacent counterpart [control group] were selected. FGM, CAL, PI, and GI were measured and recorded at baseline [0], after preparation [1], after impression [2], after final cementation [3], 7 days after cementation [4], 1 and 6 months after cementation [5 and 6]. Independent Sample T-test and Man-Whitney U Test were used for comparison of intra-group and inter-group differences, respectively

Results: Statistically significant differences were seen between the test and control groups in FGM [3], CAL [2, 3 and 6], and GI [6]. In the test group, significant differences were observed in FGM [1-3], CAL [1-6], and GI [3 and 6] compared to the baseline. In the control group, however, the variables did not show any significant difference compared to the baseline except for PI [4-6] and GI [6]

Conclusion: The findings of the present study indicated that clinical stages of making porcelain fused to metal [PFM] restorations were accompanied by a significant loss of clinical attachment level, increase in GI, and deepening of the gingival sulcus

[ clinical comparison of free gingival graft harvested from palate versus attached gingival]

Despite doubts about the necessity of the presence of keratinized gingival tissue around teeth, increasing its width is still of special importance in particular situations. Among currently used procedures, free gingival autograft is more common. The aim of this study was to clinically compare the free gingival graft taken from palate[FGGP] versus free gingival graft taken from attached gingival [FGGA] following a healing period of one, two and three month that will determine and introduce the superior procedure to be used in practice. The present study was a controlled, split mouth clinical trial which 10 pairs of lower anterior and premolar teeth requiring gingival augmentation were exposed to surgery using [FGGP] and [FGGA]. Statistical data analysis was done using SPSS software. Chi- square [X[2]] test was used for comparison of color matching between two groups. Nonparametric Mann- Whitney test was used for comparison of mean keratinized gingival width and dimensional changes of graft between two groups. This study demonstrated that the increased amount of keratinized gingival width three months following the surgery, was significant for both groups but there were no statistically significant differences between two groups. [P>0/05]. With regard to the color matching with adjacent tissue, the results of [FGGA] was superior to [FGGP] [P<0.05]. The amount of dimensional changes in the [FGGP] was more than [FGGA][P<0.05]. Both procedures had the ability to increase the keratinized gingival width, however [FGGA]had lower dimensional changes. In addition, [FGGA] had better color matching and esthetic

Diagnostic value of bone sounding technique for estimation of level in periodontal defects

Alveolar bone level measurement in periodontal disease is very important because it may affect planning of forthcoming surgery, treatment response and prognosis. Surgical approach is the most accurate procedure for obtaining this measurement. Nowadays, transgingival probing as a non-invasive and accurate method has been claimed to be a proper substitution for surgical measurement and direct visualization. This study aimed at evaluation of diagnostic value of bone sounding technique in estimation of bone level in I, II and III-wall periodontal defects. Ninety vertical defects in 37 individuals with chronic periodontitis having one, two or three-wall defects were assessed. Bone levels were measured by UNC-15 probe. The resulted values were compared with the values obtained during surgery. Collected data were analyzed using Paired samples T test and Pearson's correlation coefficient. High and significant correlation was found between the results of transgingival probing and surgery methods [0.97, 0.94 and 0.95 in one, two, and three-wall defects respectively [p < 0.001]]. The mean bone levels measured by transgingival probing were 0.21, 0.53 and 0.19 mm less than their assigned values in surgery and there was no significant difference between one and three- wall defects [p < 0.001]. The findings of this study indicated a high correlation between the two procedures, bone sounding and surgery, in detection of bone level. Due to the negligible difference, it seems that trans gingival probing could be considered as a feasible replacement for invasive surgical approach in detection of alveolar bone level

effects of removable partial dentures on the periodontal health status of abutment and non abutment teeth

A removable partial denture [RPD] is a common treatment modality for restoration of partially edentulous ridges. However this type of treatment may produce serious periodontal problems for remaining teeth. The aim of this study was to determine the effects of RPDs with RPI design on the periodontal indices of abutment and non abutment teeth. For this interventional and prospective study, 22 patients [30-68 years old; mean age of 48 years] were selected. All patients has Kennedy class I partial edentulous areas and were supposed to use removable partial dentures. Forty eight abutment and 48 non abutment teeth were assigned for this study. Clinical parameters including clinical probing depth [CPD], clinical attachment level [CAL], keratinized gingival width [KG], gingival index [GI] were measured in abutment and non-abutment teeth at baseline,1,4 and 12 months after delivery of RPDs. Data were analyzed using wilcoxon test. All clinical indices with the exception of gingival index, at the time of baseline to 12 months, showed significant differences between abutment and non-abutment teeth [p < 0.001]. Significant differences were also noted for all indices between abutment and non-abutment teeth after 12 months. The results of this study indicated that removable partial denture with RPI design plays an important role in producing and intensifying the periodontal diseases in both abutment and non abutment teeth. It seems that this effect is due to the accumulation of more bacterial plaque. So, use of appropriate design and recommendation of good oral hygiene may decrease the severity of side effects

clinical detection of helicobacter pylori in dental plaque using polymerase chain reaction

Helicobacter pylori [H.pylori] are considered to be a pathogen responsible for gastritis and peptic ulcers as well as a risk factor of gastric cancer. Recently, H.pylori has been detected in dental plaques, hence oral cavity has drawn attention to be the second site for H.pylori. However, it is not yet clear whether the oral cavity acts as a reservoir for this bacterium. The aim of this study was to clarify whether the oral cavity is the reservoir for H.pylori, and to find out any relationship between gastritis and dental plaque the infection. In this study, PCR was used for detection of Helicobacter pylori as a noninvasive method with higher sensitivity and specificity. Samples of the supragingival and sub gingival dental plaque were collected from 67 patients [44 with periodontitis, and 23 suffered from both gastritis and periodontitis]. Using sequences of different H. pylori genes, four pairs of oligonucleotide primers were designed to optimize a sensitive and specific protocol for diagnosis and detection of H.pylori. The data were analyzed using Chi Square and Fisher statistical tests. The level of significance was considered at p

[Evaluation of alteration in mucogingival junction location following use of connective tissue graft and coronally advanced flap]

One of the most successful procedures in root coverage is free connective tissue graft combined with coronally advanced flap. The assessment of mucogingival junction [MGJ] changes during healing period is of great importance. The aim was to assess the positional changes of MGJ following use of connective tissue graft in combination with coronally advanced flap in 3- 6- and 12- month intervals. In this cross sectional and interventional study, 19 cases of gingival recession in 10 patients with Miller class I and II defects >/= 4 mm were treated with connective tissue graft and coronally advanced flap. After phase I therapy, an acrylic stent was made. Clinical parameters monitored in this study included clinical attachment level [CAL], mucogingival junction [MGJ], keratinized gingival [KG] width and attached gingival [AG] width. Each parameters were measured at baseline, and 3- 6- and 12- month intervals. For comparison, statistical analysis was performed using Paired-T test at p < 0.05.The mean distance from MGJ to acrylic stent at baseline was 5.94 +/- 0.88 mm which during surgery, was moved coronally by 4.39 +/- 0.65 mm. Distance from MGJ to CEJ immediately after surgery was 1.55 +/- 0.58 mm. This distance during healing periods at 3, 6, and 12 months changed to 3.13 +/- 0.87, 3.34 +/- 0.66, and 3.65 +/- 0.64 mm, respectively indicating a gradual regression of MGJ to presurgical position. Keratinized gingival width had remarkable changes in 3-, 6- and 12 month intervals in comparison to the baseline. Mean presurgical width of keratinized gingiva was 1.55 +/- 0.76 mm which increased to 3.44 +/- 0.49 mm [p <0.05]. Mean presurgical attached gingival was 0.36 +/- 0.62 mm and 12 months after surgery it was increased to 2.18 +/- 0.50 mm 12 month after surgery [p <0.05]. Presurgical clinical attachment level was 5.81 +/- 0.88 mm which was decreased to 1.55 +/- 0.57 mm, 12 month after surgery.Based on the findings, it seems that mucogingival junction has a gradual tendency to moved back to its presurgical position after use of free connective tissue graft with coronally advanced flap technique

Clinical comparison between potassium nitrate and strontium chloride in decreasing hypersensitivity following resective periodontal surgery

Dentin hypersensitivity is a transient toothache with multiple external stimuli that has high prevalence in adults [about one out of every seven patients]. The aim of this study is clinical comparison of the role of potassium nitrate and strontium chloride in decreasing hypersensitivity following periodontal resective surgery. Fifty one patients with tooth hypersensitivity following resective periodontal surgery participated in this study. Patients were randomly divided into 3 groups, group I: patients using Sensodyne toothpaste containing potassium nitrate, II: patients using Sensodyne toothpaste containing strontium chloride and group III: as control. The patients used the dentifrices for 14 days. The severity of hypersensitivity was recorded in specific questionnaires designed for this study and verified by visual Analogue Scale [VAS]. Furthermore, the severity of hypersensitivity of different teeth and the different irritants producing hypersensitivity according to gender and age were recorded. Collected data was statistically analyzed using exact Fisher and Chi-square tests. Out of 51 participants in the study there were 30 females and 21 males. No statistically significant differences were found between group I and group II [P>0.05], but there were significant differences in hypersensitivity reduction between group III with group I and II [P<0.05]. Cold was the most common irritant in this study 96.2% and after that, heat with 33.3% of cases. The most common involved teeth were m and ibular lateral and central incisors respectively. According to the high rate of tooth hypersensitivity following resective periodontal surgery, the use of desensitizing agents such as potassium nitrate and strontium chloride along with good oral hygiene are recommended

evaluation of prevalence and severity of gingival recession in anterior and premolar teeth in referring patients to Tabriz dental faculty during 2004-2005

Gingival recession can cause several complications such as esthetics, root caries and plaque control that treatment of each necessitate time and cost from the patient. Regarding the importance of gingival recession, this study was undertaken in order to evaluate prevalence and severity of this clinical entity in anterior and premolar teeth. This study was performed on 246 patients between 10-70 years old who referred to Tabriz Dental Faculty. All measurements of recession depth and width were done with periodontal probe and under sufficient illumination. Furthermore the type of gingival recessions was evaluated based on Miller's classification. Some measurements were done twice randomly in order to examine intra-observer agreement of data. Statistical analysis was accomplished using Kappa, chi-square and T. Test. Our findings showed that 45.9% of patients had gingival recession. The trend of recession was upward between 10-30 [22.3%] to 50-70 years of age [100%]. Prevalence of recession in males was significantly higher than females [P<0.05]. The most prevalent recession sites were detected in lingual surface of lower right lateral [37.4%], lower left lateral [37%], buccal surface of lower left central [20.7%], lower right central [20.3%], respectively. Class I Miller was the most common type of recession. Considering the high prevalence of this clinical entity, implementation of oral hygeine instructions and conducting analytical and experimental researches would be a neccessity

[ clinical assessment of the effects of smoking on periodontal tissues in referring patients to Tabriz dental faculty during 2005-2006]

Many risk factors cause progression of peridontitis. Smoking is one of these factors and due to increasing rate of smokers, there is need to study more about the effect of smoking on periodontal indicators. The aim of this study was clinical evaluation of smoking effects on periodontal tissues in referring patients to oral medicine and periodontics department in Tabriz dental faculty. This study was an analytical, cross-sectional study. Sample size consisted of one hundred patients with chronic periodontitis. Of these patients, 50 smoker patients [34 Heavy smokers and 16 Light smokers] entered into case group and 50 non-smoker patients entered into control group. After ensuring age matching between smokers and non-smokers, periodontal measurements such as clinical probing depth [CPD], gingival recession [GR], clinical attachment level [CAL], tooth mobility [TM] and bleeding on Probing [BOP] were obtained and recorded in special questionnaires. Data analysis was performed by SPSS soft ware and Tukey and Pearson tests. Clinical probing depth, gingival recession, clinical attachment loss and tooth mobility increased significantly in Heavy smokers compared with non-smokers and Light smokers [p<0.05], while no statistically significant differences were found between non- smoker and light smoker groups. Considering bleeding on probing, there was declining trend in BOP in Heavy smokers compared with non-smokers and Light smokers [p=0.00]. There was not significant differences upon the effect of cigarette consumption [based on pack years] in the mentioned indices [p>0.05] between the two groups. Based on the results of this study which showed an increasing rate of intensity in periodontal indicators in smokers group compared with non-smoker, specific programs to increase public awareness on the effect of smoking should be recommended

[Reproducibitity of keratinized gingival width assessment with three methods of mucogingival junction determination]

Although the need for "adequate" amount of keratinized tissue [KT] for periodontal health is questionable, the mucogingival junction [MGJ] often serves as a measurement landmark in periodontal evaluations. Limited information is available on the reproducibility of KT width [KTW] assessment. The purpose of this study was to assess reproducibility of 3 different methods to identify MGJ location. In this test evaluation study, fourteen patients contributed with 40 teeth. At the midbuccal aspect of each tooth, KTW was assessed by 2 independent examiners after MGJ identification by the visual [VM], functional [FM], and visual with histochemical staining [HM] method. Data analysis was based on intra-class correlation coefficients [ICC] and paired t test. The results of this study exhibits no significant differences in keratinized tissue width assessment in visual and histochemical methods, but a significant difference in functional method is found. Intra- and inter-examiner reproducibility has been shown to be substantially consistent when different methods of mucogingival junction determination are used to measure in order to determining corono apical dimension of the gingival. Finally the results of this study indicate that all three methods for detecting MGJ location are accurate and reproducible, but if we need more accuracy and reproducibility, the histochemical method is recommended