Using Evidence-Based Dentistry in the Clinical Management of Combined Periodontal Conditions.

OBJECTIVE: This report proposes a framework to integrate evidence-based dentistry (EBD) in a systematic approach in the clinical management of a patient diagnosed with drug-induced gingival hyperplasia combined with generalized aggressive periodontitis.This report illustrates the case of a 37-year-old female who presented to the Department of Periodontology at Tufts University School of Dental Medicine with enlarged, tender, bleeding gums, and loose teeth combined with a history of uncontrolled hypertension treated with calcium channel blockers. METHODS: Incorporating the EBD process, a new 5-step framework is proposed: ask the clinical question, acquire and appraise the evidence, apply it in the clinical setting, and assess the subjective and objective outcomes. Articles on aggressive periodontitis and/or gingival enlargement were sought using the assistance of an expert librarian. The search was conducted on the PubMed, Embase, and Scopus databases. RESULTS: Initial literature search identified 34 publications. Articles were reviewed by 2 clinicians, and 31 relevant articles were selected. Twenty-six of the references matched the levels of evidence initially agreed upon. Based on the scientific evidence, patient's chief complaint, and clinical expertise, a decision tree highlighting treatment options was compiled. The outcomes of the clinical management revealed that combined conditions can be successfully treated with nonsurgical therapy before proceeding with surgical therapy. CONCLUSION: Within the limitations of this study, integrating EBD concepts was a reliable method to treat an atypical case, where 2 severe periodontal conditions were combined: drug-induced gingival enlargement and generalized aggressive periodontitis.

A retrospective radiographic study on the effect of natural tooth-implant proximity and an introduction to the concept of a bone-loading platform switch.

PURPOSE: The aim of this study was to evaluate the effect of tooth-implant proximity using an implant system with a double platform shift that was designed to load bone coronal to the implant-abutment cohort study was conducted between January 2008 and December 2009. The sample was composed of patients who had received at least one 5-mm-wide hydroxyapatite-coated single-tooth Bicon implant that had been placed adjacent to at least one natural tooth. Descriptive statistics and univariate and multivariate linear mixed-effects regression models, adjusted for multiple implants in the same patient, were utilized. The primary predictor variable was the horizontal distance between implant and adjacent tooth, and the primary outcome variable was the change in peri-implant bone levels over time. RESULTS: Two hundred six subjects who received 235 plateau root-form implants were followed for an average of 42 months. Tooth-implant distance ranged between 0 and 14.6 mm. Out of 235 implants, 43 implants were placed < 1 mm to an adjacent natural tooth on mesial and/or distal sides. The proximity of a plateau root-form implant was not associated with complications on the adjacent tooth such as bone loss, root resorption, endodontic treatment, pain, or extraction. The proximity of an adjacent tooth was not a risk factor for the failure of a plateau root-form implant. After adjusting for other covariates in a multivariate model, the proximity of a natural tooth did not have a statistically significant effect on peri-implant bone levels (P = .13). The extraction of an adjacent tooth was associated with a significant increase in peri-implant bone loss (P = .008). CONCLUSION: The placement of a plateau root-form implant with a sloping shoulder in close proximity to an adjacent tooth did not cause damage to that tooth or lead to bone loss or the failure of the implant.

Bone Morphometric Evaluation around Immediately Placed Implants Covered with Porcine-Derived Pericardium Membrane: An Experimental Study in Dogs.

Objective. To investigate whether porcine-derived bioresorbable pericardium membrane coverage enhances the osseointegration around implants placed in fresh extraction sockets. Study Design. Twenty-four commercially available endosseous implants were placed in the fresh extraction sockets of the mandibular first molar of mature beagles (n = 6). On one side, implants and osteotomy sites were covered with porcine-derived bioresorbable pericardium membranes, whereas on the other side, no membranes were used. After 6 weeks, samples were retrieved and were histologically processed for histomorphometric analysis. Results. The histological observation showed that bone loss and soft tissue migration in the coronal region of the implant were evident for the control group, whereas bone fill was evident up to the neck of the implant for the membrane-covered group. Bone-to-implant contact was significantly higher for the membrane-covered group compared to the control group, 75% and 45% (P < 0.02), respectively. Conclusion. The experimental membranes proved to regenerate bone around implants placed in fresh extraction sockets without soft tissue intrusion.