Open proximal contact associated with a cast restoration--progressive bone loss: a case report.

A patient presented with early to moderate periodontitis localized around tooth No. 30. This tooth had a cast restoration with an open proximal contact for the previous seven years. Radiographs spanning this time period showed progressive bone loss. Surgical periodontal therapy was performed after correction of the open proximal contact with a provisional restoration. A new porcelain-fused-to-metal crown was placed three months after surgical therapy. The patients has been on a regular six-month recall schedule for three years and has maintained a healthy periodontium. Prior food impaction has been eliminated and the patient is without complaints.

The effectiveness of a magnetized water oral irrigator (Hydro Floss) on plaque, calculus and gingival health.

The purpose of this study was to evaluate the effects of a magnetized water oral irrigator on plaque, calculus and gingival health. 29 patients completed this double-blind crossover study. Each patient was brought to baseline via an oral prophylaxis with a plaque index < or = 1 and a gingival index < or = 1. Subjects used the irrigator for a period of 3 months with the magnet and 3 months without the magnet. After each 3 month interval, data were collected using the plaque index, gingival index, and accretions index. The repeated measures analysis on plaque, gingival and calculus indices yielded a statistically-significant period effect for PlI (p=0.0343), GI (p=0.0091), and approached significance for calculus (p=0.0593). This meant that the effect of irrigation resulted in a decrease of all indices over time. Therefore, the treatment effect on each index was evaluated using only the measurements obtained at the end of the first period (i.e., assuming a parallel design). Irrigation with magnetized water resulted in 64% less calculus compared to the control group. The reduction was statistically significant (p< or =0.02). The reduction by 27% in gingival index was not statistically significant. The reduction in plaque was minimal (2.2%). A strong positive correlation between the plaque index and the Watt accretion index was observed. The magnetized water oral irrigator could be a useful adjunct in the prevention of calculus accumulation in periodontal patients, but appears to have minimal effect on plaque reduction. The results indicated a clinical improvement in the gingival index, but this was not a statistically significant finding.

Guided tissue regeneration with and without decalcified freeze-dried bone in mandibular Class II furcation invasions.

The purpose of this study was to compare periodontal soft and hard tissue repair using expanded polytetrafluoroethylene (ePTFE) membranes with and without decalcified freeze-dried cortical bone allografts (DFDBA). Six patients with 17 mandibular Class II buccal molar furcal invasions received oral hygiene instructions followed by scaling and root planing. Baseline soft tissue measurements with periodontal probes were made to assess probing depths (PD), recession (REC), and probing attachment levels (PAL). After non-surgical therapy, 10 teeth were randomly selected as test sites (ePTFE + DFDBA) and 7 as controls (ePTFE alone). Full-thickness flaps were elevated, and open surgical measurements were made to determine alveolar crestal height (CEJ-AC) and vertical (CEJ-BDF) and horizontal (HPDF) defect depth. The ePTFE membranes were removed at 6 weeks. After 6 months, all sites were reentered and both soft tissue and open surgical measurements recorded. The following mean changes (mm) were found for ePTFE and ePTFE + DFDBA treated sites respectively: decreased PD = 1.5, 2.2; increased REC = 1.3, 1.3; loss(-)/gain PAL = -0.2, 0.8; decreased CEJ-BDF = 3.8, 5.0; increased CEJ-AC = 0.5, 0.4; and decreased HPDF = 2.3, 2.4. None of the changes were statistically significant. The addition of DFDBA to the GTR procedure did not significantly improve any of the mean soft tissue and open surgical measurements between control (ePTFE alone) and test (ePTFE+DFDBA) groups in mandibular Class II buccal furcations. Both treatment procedures resulted in significant decreases in PD, CEJ-BDF, and HPDF and a significant increase in REC. There were no differences for PAL and CEJ-AC within control and test groups seen with this sample. Larger randomized clinical trials are needed to more fully evaluate whether combined graft and GTR procedures offer an advantage over GTR alone.

The effectiveness of the Titan-S sonic scaler versus curettes in the removal of subgingival calculus. A human surgical evaluation.

This study evaluated clinically the effectiveness of hand versus sonic subgingival scaling and root planing in the removal of calculus by visually examining the root surface at the time of periodontal flap surgery. Consideration was given to the method of instrumentation, probing depth, number of roots, and type of tooth surface. Eleven patients with moderate to advanced periodontal disease were evaluated. Four subjects were scaled and root planed with the Titan-S only, four with curettes only, and three with the Titan-S + curettes. At reevaluation 3 to 6 weeks after scaling and root planing, the decision to perform periodontal flap surgery was made based upon probing depth, bleeding upon probing, previous access to the root surface, furcation involvement, and the patient's level of oral hygiene. A full thickness mucoperiosteal flap was elevated to gain access to the root surface and measure the distance from the cementoenamel junction to the residual calculus. A total of 690 surfaces were evaluated surgically. The percentage of surfaces with residual calculus for each method of instrumentation was: Titan-S only (31.9%), curettes only (26.8%), and Titan-S + curettes (16.9%). Overall, 15.7% of the surfaces probing 0 to 3 mm, 29.3% of the surfaces probing 4 to 5 mm, and 44.4% of the surfaces probing 6 to 12 mm had residual calculus.(ABSTRACT TRUNCATED AT 250 WORDS)