Distraction osteogenesis versus autogenous onlay grafting. Part II: biology of regenerate and onlay bone.

PURPOSE: Few studies have directly compared the quality of bone generated by distraction osteogenesis with that generated by autogenous onlay grafting. The purpose of this study was to compare rates of bone turnover at 5 months in bone produced by distraction osteogenesis and onlay grafting. MATERIALS AND METHODS: Alveolar defects created in jaws of American foxhounds were augmented with distraction osteogenesis or onlay grafting and allowed to heal for 5 months. The animals were then sacrificed and the jaws were resected and prepared for decalcified and undecalcified histologic examination. RESULTS: Both procedures produced bone containing a mixture of haversian systems and trabecular bone. A significantly greater ratio of osteoblast-covered bone surface to total trabecular bone surface (mean +/- SEM) was noted in distraction bone (0.124 +/- 0.049) compared to onlay bone (0.081 +/- 0.048) or control host bone (0.085 +/- 0.042 microm) (P < .05). In addition, significantly (P <.05) greater numbers of osteoclasts per microm of bone surface were noted in distraction bone (0.939 +/- 0.07) compared to onlay bone (0.605 +/- 0.06) or control host bone (0.725 +/- 0.08). No differences in rates of mineralization were noted between the groups. DISCUSSION: While bone from both experimental groups appeared adequate for implant placement, distraction bone appeared to be remodeling at a higher rate than either onlay or control bone. CONCLUSION: Given that the state of healing of the bone in each of these comparative groups was examined at a static point in time, it is premature to draw conclusions about the efficacy of one procedure over the other.

Esthetic management of multiple recession defects in a patient with cicatricial pemphigoid.

Cicatricial pemphigoid is one of a number of mucocutaneous disorders that can present in the oral cavity with desquamation, pain, and bleeding of the gingiva and oral mucosa. This case report describes the management of cicatricial pemphigoid in a patient with multiple sites of gingival recession using connective tissue grafting to alleviate root surface sensitivity and improve esthetics. The treatment rationale is presented and discussed in terms of timing of therapy and implications for wound healing in patients who present with desquamative gingivitis.

Occlusal trauma--periodontal concerns.

While there is evidence that suggests that occlusal trauma is a risk factor for periodontal destruction, there is no evidence that indicates that occlusal trauma will initiate periodontal destruction. Effective plaque control and compliance with periodontal maintenance recommendations are key and essential factors necessary to assure successful treatment and control of periodontal disease.

The use of a bioabsorbable barrier for regenerative management of marginal tissue recession. I. Report of 100 consecutively treated teeth.

BACKGROUND: Periodontal plastic surgical procedures aimed at coverage of exposed root surfaces have evolved into routine treatment modalities. The present study was designed to assess the effectiveness and the predictability of a bioabsorbable barrier in the treatment of human recession defects utilizing a single-step surgical procedure. METHODS: One hundred consecutive single and multiple adjacent Miller Class I, II, and III buccal recession defects in 41 patients were treated with a combination of a bioabsorbable barrier and coronally advanced flap technique. Clinical parameters were recorded immediately prior to surgery, at 3 months, and after a minimum of 6 months. RESULTS: A highly significant reduction in recession depth from a mean value of 3.2 +/- 0.9 mm preoperatively to 0.3 +/- 0.5 mm postoperatively, corresponding to a mean root coverage of 92. 7% +/- 14.1%, was obtained. Complete (100%) root coverage was obtained in 75% of the sites. Factors adversely affecting root coverage were membrane exposure postoperatively and preoperative recession depth > or =4 mm. In addition, inferior results were achieved at mandibular incisor and maxillary molar sites. Factors having no effect on root coverage included maxillary versus mandibular sites and single versus multiple adjacent sites. CONCLUSIONS: The use of guided tissue regeneration in periodontal plastic surgery is highly predictable, and highly esthetic root coverage can be gained without requiring a second surgical procedure or a second surgical site and is, therefore, an attractive alternative to conventional grafting techniques.

The effect of locally delivered controlled-release doxycycline or scaling and root planing on periodontal maintenance patients over 9 months.

BACKGROUND: This research report evaluates clinical changes resulting from local delivery of doxycycline hyclate (DH) or traditional scaling and root planing (SRP) in a group of patients undergoing supportive periodontal therapy (SPT). METHODS: In all, 141 patients received either DH (67) or SRP (74) treatment in sites > or =5 mm on one-half of their dentition at baseline and month 4. RESULTS: Clinical results were determined at month 9. Baseline mean probing depth recordings were similar between the two groups (DH = 5.9 mm; SRP = 5.9 mm). Mean month 9 results showed similar clinical results for attachment level gain (DH 0.7 mm; SRP 0.8 mm) and probing depth reduction (DH 1.3 mm; SRP 1.1 mm). Percentage of sites showing > or =2 mm attachment level gain at month 9 was 24.7% in the DH group and 21.2% in the SRP group. Thirty-nine percent (39%) of DH sites and 38% of SRP sites showed > or =2 mm probing depth reduction. When treated sides of the dentition were compared to untreated sides, DH showed a difference in disease activity (> or =2 mm attachment loss) from 19.3% (untreated) to 7.2% (treated); and SRP from 14.3% (untreated) to 8.1% (treated). CONCLUSIONS: Results show that both DH without concomitant mechanical instrumentation and SRP were equally effective as SPT in this patient group over the 9-month study period.

Subpontic osseous hyperplasia: a case report.

Subpontic osseous hyperplasia is an ectopic growth of bone occurring on the edentulous ridge beneath a fixed partial denture replacing a mandibular first molar. A 56-year-old woman experienced an enlargement of the hard and soft tissues beneath the pontic region of a fixed partial denture replacing her mandibular left first molar. Following removal of the fixed partial denture, the bony enlargement was surgically removed, and the bony fragments were submitted for histologic analysis, which demonstrated mature lamellar bone and appositional growth. One year postoperatively, there has been no recurrence of the lesion. The possible etiologies and treatment modalities are reviewed and a rationale for treatment is presented.

Effects of smoking on local delivery of controlled-release doxycycline as compared to scaling and root planing.

This paper examines the effects of smoking on the treatment outcomes of two nonsurgical therapies: (1) scaling and root planing alone (SRP) or (2) controlled-release of subgingivally delivered doxycycline hyclate in a polylactic acid based polymer gel. Subjects from 2 9-month multicenter studies were classified as nonsmokers (never smoked: 100 subjects), former smokers (137 subjects), and current smokers (> or = 10 cigarettes/day: 121 subjects). Clinical parameters were analyzed for treated sites with baseline probing depths > or = 5 mm and for a subset of treated sites with baseline probing depths of > or = 7 mm. Clinical parameters (plaque levels, clinical attachment levels, pocket depths, and bleeding on probing) were analyzed at baseline, 4, 6, and 9 months. In the doxycycline treated group in general, there were neither marked significant differences in clinical attachment gain nor differences in probing depth reduction among the 3 smoking groups. On the other hand, in the scaling and root planing treated group in general, there were significant differences in clinical attachment gain and pocket depth reduction, with non-smokers responding better than former smokers and current smokers at 6 and 9 months. These differences in clinical response between scaling and root planing alone versus controlled-release of locally-delivered doxycycline hyclate among these 3 smoking groups are discussed in relation to treatment implications for smokers.

Two multi-center studies evaluating locally delivered doxycycline hyclate, placebo control, oral hygiene, and scaling and root planing in the treatment of periodontitis.

BACKGROUND: The clinical efficacy and safety of doxycycline hyclate (8.5% w/w) delivered subgingivally in a biodegradable polymer (DH) was compared to placebo control (VC), oral hygiene (OH), and scaling and root planing (SRP) in 2 multi-center studies. METHODS: Each study entered 411 patients who demonstrated moderate to severe periodontitis. Patients had 2 or more quadrants each with a minimum of 4 qualifying pockets > or =5 mm that bled on probing. At least 2 of the pockets were > or =7 mm. Treatment with DH, VC, OH, or SRP was provided at baseline and again at month 4. Clinical parameters were recorded monthly. RESULTS: DH and SRP resulted in nearly identical clinical changes over time in both studies. Mean 9 month clinical attachment level gain (ALG) was 0.8 mm for the DH group and 0.7 mm for the SRP group in Study 1, and 0.8 mm (DH) and 0.9 mm (SRP) in Study 2. Mean probing depth (PD) reduction was 1.1 mm for the DH group and 0.9 mm for the SRP group in Study 1 and 1.3 mm for both groups in Study 2. Frequency distributions showed an ALG > or =2 mm in 29% of DH sites versus 27% of SRP sites in Study 1 and 31% of DH sites versus 34% of SRP sites in Study 2. PD reductions > or =2 mm were seen in 32% of DH sites versus 31% of SRP sites in Study 1 and 41% of DH sites versus 43% of SRP sites in Study 2. Comparisons between DH, VC, and OH treatment groups showed DH treatment to be statistically superior to VC and OH. Safety data demonstrated a benign safety profile with use of the DH product. CONCLUSIONS: Results of this trial demonstrate that treatment of periodontitis with subgingivally delivered doxycycline in a biodegradable polymer is equally effective as scaling and root planing and superior in effect to placebo control and oral hygiene in reducing the clinical signs of adult periodontitis over a 9-month period. This represents positive changes resulting from the use of subgingivally applied doxycycline as scaling and root planing was not limited regarding time of the procedure or use of local anesthesia.

Occlusal trauma: effect and impact on the periodontium.

This focused review is limited to a number of investigations in an attempt to specifically address the histological and clinical effects of excessive occlusal forces on the teeth and periodontium and to provide a basis of classification for this interaction. This review does not include the effects of occlusal forces on dental implants or dental prostheses/appliances.

A comparative study of the effects of metallic, nonmetallic, and sonic instrumentation on titanium abutment surfaces.

This study compared the effects of metallic, nonmetallic, and sonic instrumentation on titanium abutment surfaces in vitro. Designated test surfaces in each of seven abutments were instrumented either for 25 strokes or 30 seconds, and for 50 strokes or 5 minutes. One abutment served as an untreated control. Scanning electron microscopy photomicrographs were coded and scored by five investigators and designated as smooth (comparable to control (0), slightly roughened, (1), moderately roughened (2), or severely roughened (3). Based on this investigation, the increasing order of surface alteration for each instrumentation was as follows: Implacare < Implant Support < Steri-Oss < Dynatip < Columbia 13/14 < Sonic scaler < Implarette scaler. The Implacare and Implant Support nonmetallic (plastic) scalers appear to be the instruments of choice for debridement of titanium abutment surfaces if preservation of surface integrity is the primary objective.

Observations of root surfaces from patients with early-onset periodontitis and leukocyte adhesion deficiency.

The purpose of this investigation was to report observations of the root surfaces of teeth from 2 siblings with leukocyte adhesion deficiency (LAD). In previous publications, the clinical, radiographic and immunologic findings in the family were presented. 38 permanent teeth from the 2 siblings were prepared for microscopic examination, 11 for light microscopy (LM), and 27 for scanning electron microscopy (SEM). In addition, 8 healthy teeth obtained from 2 patients requiring extractions for orthodontic treatment served as controls. LM observations on healthy teeth revealed cementum with normal structural appearance which exhibited a mosaic or mogul-like pattern with SEM. In LAD specimens, cementum apical to the dentogingival junction exhibited resorption lacunae and areas of poor structural definition characterized by aplasia and hypoplasia (hypomineralization). Areas of hypoplasia presented as distinct irregular surfaces with a pebbly or globular-like appearance. Alteration in cementum formation and maturation may play a role in the etiology of early-onset periodontitis.

Dentistry and the cancer patient: Part 2--Oral health management of the chemotherapy patient.

The increase in the incidence of head and neck cancer has been accompanied by a more widespread use of chemotherapy. As a result, the dental community has frequent contact with patients who are undergoing or have undergone chemotherapy. In many of these patients, immunosuppression leads to an increased risk of infection, and the chemotherapeutic agents themselves can cause a variety of oral complications. The dentist must be familiar with available treatments for managing these conditions and for preventing further deterioration of oral and systemic health.

Dentistry and the cancer patient: Part 1--Oral manifestations and complications of chemotherapy.

Chemotherapy is frequently used as a primary or adjunctive modality in the treatment of patients with cancer. As the incidence of cancer in the population increases, the ability to properly detect, diagnose, and treat oral side effects of chemotherapy becomes ever more important. Depending on the types and dosages of chemotherapeutic agents used, a wide range of oral complications may appear. This article, in two parts, reviews the potential oral manifestations associated with cancer chemotherapy and appropriate management techniques.

Clinical perspectives of periodontal and restorative interactions.

Restorative treatment and periodontal health are directly interrelated. A restorative treatment plan must consider periodontal support and provide for adequate maintenance of the health of the periodontium. For example, prosthetic design must facilitate hygiene practices and not violate the physiologic dimensions of the periodontium. The relation of the periodontium to margin preparation, margin placement, crown contours, and pontic design are discussed in this article.

The head and neck radiotherapy patient: Part 2--Management of oral complications.

As the incidence of head and neck cancer increases and the use of high-dose radiation treatment rises, the dentist will be called on to treat a wide variety of radiation-induced oral maladies. Treatment planning for radiotherapy patients begins immediately after tumor diagnosis and is directed first and foremost toward prevention of oral complications. In the event such complications occur, the dentist must be familiar with available treatment regimens for managing these conditions and preventing future deterioration in oral health.

The head and neck radiotherapy patient: Part 1--Oral manifestations of radiation therapy.

The incidence of head and neck cancer increases annually in the United States, and radiation therapy is frequently a primary or adjunctive mode of therapy. As the number of radiotherapy patients rises, the need for proper detection, diagnosis, and treatment of oral lesions likewise increases. Depending on tumor site and size, radiation dosage, and preexisting oral conditions, a variety of oral radiation side effects may be present. These range from mild and reversible changes to severe and potentially disfiguring or life-threatening alterations. This article, in two parts, will review the oral manifestations of cancer radiation therapy and appropriate management techniques.

Occurrence and resolution of focal epithelial hyperplasia in two siblings with leukocyte adhesion deficiency.

Focal epithelial hyperplasia is an uncommon disorder characterized by formation of multiple asymptomatic oral mucosal papular and/or nodular lesions. This article relates the occurrence and clinical course of FEH in 2 adolescent siblings with leukocyte adhesion deficiency. Histological findings are described and insights into potential causes are discussed.