A modified placement technique to improve retention. Of tetracycline-impregnated fibers.

Controlled-release, tetracycline-impregnated periodontal fibers offer a promising treatment for recurrent adult periodontitis when they are used as an adjunct to scaling, root planing and surgery. In the conventional placement technique, the surface tissue topography is changed by the layer of set adhesive holding the fiber in place, and patients often explore this area with their tongues, resulting in premature loss of the fiber. This article offers an alternative fiber-placement technique that minimizes changes to the surface tissue and results in improved fiber retention.

Titanium endosseous implant-soft tissue interface: a literature review.

Background information about normal periodontal anatomy and titanium used in endosseous implant fabrication is provided. Literature is reviewed concerning epithelial and connective tissue attachment to titanium. Information about the adequacy of cell attachment to implants, possible mechanisms of cell attachment formation, and the effect of implant surface properties on attachment is presented. A chemical attachment between titanium implant surface oxide layer and epithelium has been demonstrated in vitro and in vivo. This attachment is mediated by a glycoprotein similar to that seen between epithelium and natural tooth surfaces. While only minimal histological evidence exists, connective tissue fibers adjacent to titanium implanted surfaces may bring the tissue in tight apposition to the implant without an absolute biologic attachment between the implant and connective tissue. Alteration of the titanium surface morphology may selectively enhance the attachment of either epithelial cells or fibroblasts, theoretically enhancing the formation of a biologic seal between the implanted titanium surface and its adjacent tissue. A greater understanding of the mechanisms of attachment and of the factors which enhance the integrity of the biologic seal between implant and soft tissues should permit an improved prognosis for functioning titanium implants.

Reduced oral contraceptive effectiveness with concurrent antibiotic use: a protocol for prescribing antibiotics to women of childbearing age.

PIP: A brief literature review and update on the effect of concurrent antibiotic administration with oral contraceptive use is presented for dentists, with advice on how to manage antibiotic prescription to minimize legal repercussions in case of contraceptive failure. In the U.S. approximately 30% of women of childbearing age are using oral contraceptives, so it is quite likely that a dentist prescribing antibiotics may encounter patients on these agents. Since 1971 reports of breakthrough bleeding or contraceptive failure have concerned rifampicin, penicillins, tetracyclines, erythromycin, metronidazlole, sulfonamides, griseofulvin and cephalosporins. There have been 63 reported contraceptive failures to the British Committee on Safety of Medicine, and 29 reports to the U.S. Dept. of Health and Human Services. A case of contraceptive failure in a woman prescribed antibiotics by her dentist has been ruled in favor of the woman, making the dentist responsible for child support. The probable mechanisms for these failures are diminished enterohepatic re-circulation due to elimination of bacteria that regenerate active estrogens from conjugated estrogens in the gut, and induction of liver cytochrome P450 enzymes resulting in faster catabolism of the drugs. There are conflicting reports in the literature on how or whether these mechanisms are active in clinical situations. For the working dental practitioner it is recommended that a history of contraceptive use be taken and signed by the patient; that the dentist inform the patient of possible lower contraceptive efficacy; that the woman taking antibiotics be advised to use additional means of contraception throughout the cycle; and that women on long-term antibiotics be urged to consult their physician about increasing the does of oral contraceptives. All this advice and the antibiotic prescription should be documented in the patient's chart.^ieng