Potential barriers to the rational antibiotic use in dental and periodontal practice: A questionnaire-based online survey.

BACKGROUND: Dentists, through inappropriate antibiotic prescription, may contribute to the global problem of antibiotic resistance (AR). OBJECTIVES: Understanding dentists' antibiotic prescription patterns, source of knowledge, and the driving forces behind their prescription practices may be crucial for the effective implementation of the rational use of antibiotics (RUA) in dentistry. MATERIAL AND METHODS: Active members of the Turkish Dental Association were invited to participate in an electronic survey comprising questions focusing on their role, knowledge and perceptions regarding RUA, the perceived barriers to adapting RUA in daily dental work, and the actual antibiotic prescription practices. The potential impact of age, gender, professional experience, and the mode of dental practice was also evaluated. Dentists' prescription practices for periodontal disease/conditions were evaluated as well. RESULTS: Based on 1,005 valid responses, there was consensus on the necessity of RUA (99.1%); however, its implementation was low. The main barriers were dentists' own safety concerns (74.4%), strong patients' demands (42.2%) and the fact that prescribing antibiotics became a professional habit (35.8%). Different educational background resulted in clear variances in everyday prescription practices. CONCLUSIONS: The implementation of RUA was not sufficient and the perceived barriers had an impact on daily prescribing habits. Support for dental professionals through the efficient dissemination of evidencebased clinical guidelines and decision-making aids is likely to require additional help from professional organizations in order to actively combat AR.

Comparison of two techniques in gingival recession treatment: A randomized one-year clinical follow-up study.

BACKGROUND: Gingival recession (GR) is highly prevalent in the general population and represents a significant concern for patients and clinicians. Various surgical techniques have been proposed to treat gingival recession. Well-designed trials with clinicianand patient-based parameters, evaluating the envelope connective tissue graft (E-CTG) and semilunar coronally advanced flap (SCAF) techniques are still needed. OBJECTIVES: The aim of this trial was to compare the effectiveness of E-CTG and SCAF in the treatment of GR during a 1-year follow-up. MATERIAL AND METHODS: A total of 42 patients with GR were treated with E-CTG (n = 20) or SCAF (n = 22). Clinician-based recordings of recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), tissue thickness (TT), clinical attachment gain (CAG), root coverage (RC), keratinized tissue change (KTC), and wound healing index (WHI), as well as patient-based parameters of dentine hypersensitivity (DH), tissue appearance, patient expectations, and esthetics were collected at baseline (BL), 6 weeks (T 1 ), 6 months (T 2 ), and 1 year (T 3 ). RESULTS: After the treatment, E-CTG demonstrated better outcomes than SCAF in terms of CAG (50.70% vs. 33.33%), RC (85.60% vs. 35.60%) and KTC (1.70 ±1.49 mm vs. 0.36 ±0.96 mm) at T 3 . Similar findings were detected in terms of WHI, tissue appearance, patient expectations, and esthetics. Although inconvenient surgical experience was recorded, better results were obtained after E-CTG in terms of DH and meeting the RC expectations. CONCLUSIONS: Despite it being more difficult surgical experience and the risk of keloid formation, E-CTG was superior to SCAF in terms of RC percentage, reducing DH and obtaining satisfactory RC. However, it is still necessary to improve patient comfort in the case of E-CTG.

Evaluation of Single Tooth Loss to Maxillary Sinus and Surrounding Bone Anatomy With Cone-Beam Computed Tomography: A Multicenter Study.

BACKGROUND: Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. RESULTS: The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. CONCLUSION: The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

A genome-wide association study identifies nucleotide variants at SIGLEC5 and DEFA1A3 as risk loci for periodontitis.

Periodontitis is one of the most common inflammatory diseases, with a prevalence of 11% worldwide for the severe forms and an estimated heritability of 50%. The disease is characterized by destruction of the alveolar bone due to an aberrant host inflammatory response to a dysbiotic oral microbiome. Previous genome-wide association studies (GWAS) have reported several suggestive susceptibility loci. Here, we conducted a GWAS using a German and Dutch case-control sample of aggressive periodontitis (AgP, 896 cases, 7,104 controls), a rare but highly severe and early-onset form of periodontitis, validated the associations in a German sample of severe forms of the more moderate phenotype chronic periodontitis (CP) (993 cases, 1,419 controls). Positive findings were replicated in a Turkish sample of AgP (223 cases, 564 controls). A locus at SIGLEC5 (sialic acid binding Ig-like lectin 5) and a chromosomal region downstream of the DEFA1A3 locus (defensin alpha 1-3) showed association with both disease phenotypes and were associated with periodontitis at a genome-wide significance level in the pooled samples, with P = 1.09E-08 (rs4284742,-G; OR = 1.34, 95% CI = 1.21-1.48) and P = 5.48E-10 (rs2738058,-T; OR = 1.28, 95% CI = 1.18-1.38), respectively. SIGLEC5 is expressed in various myeloid immune cells and classified as an inhibitory receptor with the potential to mediate tyrosine phosphatases SHP-1/-2 dependent signaling. Alpha defensins are antimicrobial peptides with expression in neutrophils and mucosal surfaces and a role in phagocyte-mediated host defense. This study identifies the first shared genetic risk loci of AgP and CP with genome-wide significance and highlights the role of innate and adaptive immunity in the etiology of periodontitis.

Evaluation of Extraction Site Dimensions and Density Using Computed Tomography Treated With Different Graft Materials: A Preliminary Study.

PURPOSE: The preliminary human study was designed to evaluate extraction site changes using CT after socket preservation (SP) with different materials. MATERIALS AND METHODS: Fifty-two sockets from 17 Turkish individuals (8 women and 9 men; mean age 44.70 ± 9.99 years) localized at the maxillary anterior area were treated with demineralized bone matrix + collagen membrane (CM) (N = 14), hydroxyapatite bone substitute (HBS) + CM (N = 14), CM (N = 13), or left empty (N = 11). CT scans were taken 10 and 120 days after the procedure. Horizontal and vertical socket dimensions and Hounsfield unit (HU) values were evaluated. RESULTS: First 3 groups showed a significant horizontal decrease from day 10 to 120. No significant change was detected in vertical socket dimension. For both horizontal and vertical, no intergroup difference was detected at days 10 and 120. At days 10 and 120, HU values in HBS + CM group were significantly higher compared with others. Apical and coronal HU values were not different at any period. CONCLUSION: Even if it did not provide better socket dimensions, HBS + CM treatment brought higher tissue density and thus, can be recommended to increase the bone quality and implant success after SP in upper anterior area.

Evaluation of the adjunctive effect of platelet-rich fibrin to enamel matrix derivative in the treatment of intrabony defects. Six-month results of a randomized, split-mouth, controlled clinical study.

AIM: This study aimed to compare the results obtained with enamel matrix derivative (EMD) and EMD + platelet-rich fibrin (PRF) in the treatment of intrabony defects (IBDs) in chronic periodontitis patients. MATERIALS AND METHODS: Using a split-mouth design, 28 paired IBDs were randomly treated either with EMD or with EMD + PRF. Clinical and radiographic measurements including clinical attachment level (CAL), probing depth (PD), gingival recession (GR), defect depth (DD), defect width (DW) and defect angle (DA) were recorded at baseline (BL) and at six months following therapy. RESULTS: BL clinical and radiographic measurements were similar for EMD and EMD + PRF groups. Although postsurgical measurements revealed significant reduction for PD and CAL in both groups, no intergroup difference was detected. When EMD and EMD + PRF groups were compared, defect fill was not also statistically different. CONCLUSIONS: Both therapies resulted in significant clinical improvement in IBD treatment. Addition of PRF did not improve the clinical and radiographic outcomes.

Management of Limited Vertical Bone Height in the Posterior Mandible: Short Dental Implants Versus Nerve Lateralization With Standard Length Implants.

Inferior alveolar nerve lateralization (IANL) and short dental implants (SDI) are 2 viable implant-based treatment approaches in the presence of atrophied posterior mandible. Despite the risks of dysfunction, infection, and pathologic fractures in IANL, it becomes possible to place standard implants. The purpose of this study was to compare SDI and IANL approaches from clinical and radiographic aspects. Fifteen subjects having unilateral atrophic mandibles were allocated to SDI and IANL treatment groups. Following surgical procedures, early postoperative complications, implant survival, and periimplant clinical and radiographic parameters including probing pocket depth, attachment level, keratinized tissue amount, vertical tissue recession, and marginal bone loss were recorded at baseline and 1-year after prosthetic rehabilitation. In both groups, no implant was lost. Except usual postoperative complications, 2 patients had transient paraesthesia after IANL. According to time-dependent evaluation, both groups showed significant increase in probing pocket depth and attachment level at 1-year follow-up compared with baseline (P < 0.05). Except a slight but significant increase in mesial surface of SDI group (P < 0.05), no remarkable time-dependent change was identified in vertical tissue recession. Keratinized tissue amount did not exhibit any inter- or intragroup difference during whole study period. Marginal bone loss did not show any difference between IANL and SDI groups at follow-up. SDI placement or standard length implant placement with IANL can be considered promising alternatives in the treatment of atrophic mandibular posterior regions. However, SDI may be preferred in terms of lower complication risk.

The Adjunctive Effect of Platelet-Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel-Group Controlled Trial.

BACKGROUND: Platelet-rich fibrin (PRF) is an autologous preparation that has encouraging effects in healing and regeneration. The aim of this trial is to evaluate the effectiveness of coronally advanced flap (CAF) + connective tissue graft (CTG) + PRF in Miller Class I and II recession treatment compared to CAF + CTG. METHODS: Forty patients were treated surgically with either CAF + CTG + PRF (test group) or CAF + CTG (control group). Clinical parameters of plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), keratinized tissue width (KTW), horizontal recession (HR), mucogingival junction localization, and tissue thickness (TT) were recorded at baseline and 3 and 6 months after surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated. RESULTS: All individuals completed the entire study period. At baseline, mean VR, HR, CAL, KTW, and TT values were similar (P >0.05). In both groups, all parameters showed significant improvement after treatment (P <0.001), and except TT (P <0.05), no intergroup difference was observed at 6 months after surgery. The amount of RC and AG, but not KTC and CRC, was higher in the PRF-applied group (P <0.05). CONCLUSIONS: According to the results, the addition of PRF did not further develop the outcomes of CAF + CTG treatment except increasing the TT. However, this single trial is not sufficient to advocate the true clinical effect of PRF on recession treatment with CAF + CTG, and additional trials are needed.

Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery.

AIM: Evaluating effectiveness of a medicinal plant extract (MPE) in achieving haemostasis and early wound healing at free gingival graft (FGG) donor site in a randomized controlled fashion. METHODS: Forty patients requiring FGG at lower anterior area were randomly assigned into two groups. FGG was performed to all patients and following graft procurement; wet gauze (WG) was applied alone (control: WG group) or with MPE (test: MPE + WG group) for haemostasis. Donor site working time, bleeding (BLE), colour match (CM), pain, epithelization (EP) and sensation loss (SL) were evaluated. RESULTS: Thirty-three participants completed a 6-month period study. In the test group, primary BLE was shorter (p < 0.001) and fewer individuals showed secondary BLE during 3 days (p < 0.001). During the 6 days, pain scores were higher in WG patients (p < 0.05). Later on, no inter-group difference was observed. EP was relatively faster (p < 0.001) and CM was slightly better (p < 0.05) in MPE + WG group. CONCLUSION: MPE provided faster and continuous haemostasis that made a positive contribution to the early soft tissue healing to some extent but due to limitations; further trials are needed to demonstrate the efficiency of this material.

Fifteen months follow-up of a hopeless tooth treated with two-step procedure involving intentional replantation and free gingival graft.

The aim of the report is to document 15-month results of mucogingival surgery applied following intentional replantation (IntR). A mandibular left lateral incisor with severe periodontitis and malposition was replanted and splinted following root canal treatment. Three months after IntR, a free gingival graft (FGG) was placed. Fifteen months follow-up of the case demonstrated significant improvement in periodontal healing parameters and significant bone fill was detected around the root apex. As a conclusion, IntR may be speculated as a convenient alternative to keep the periodontally hopeless teeth and supportive approaches such as FGGs may improve the outcomes following IntR.

Forced eruption and implant site development in the aesthetic zone: A case report.

A multidisciplinary approach to develop the future implant site in the aesthetic zone was illustrated. A patient with perio-endo combined lesion at her upper central incisors was treated. Before extraction, forced eruption was performed and 12 months later, satisfactory amount of bone apposition was detected. At 2 weeks after atraumatic extraction, implants were placed and loaded with implant-supported restorations following osseous healing. Variables related to crown dimensions, periodontal/peri-implanter soft-tissue health and patient's aesthetic satisfaction were recorded at baseline, before extraction and after prosthetic treatment. At 12-month control, crown dimensions in the implant site were identical to the baseline and in addition to the healthy peri-implant tissues, successful aesthetics were obtained. Forced eruption is a successful non-invasive method to develop the aesthetics of the peri-implant tissues and implant-supported restorations.

Treatment of peri-implant defect with modified sandwich bone augmentation. Case report and follow-up.

This report describes correction of an osseous defect around a dental implant with a modification of a sandwich bone augmentation (SBA) technique. It gives detailed information about preparation and application of the autologous platelet rich plasma (PRP). A 58-year-old female patient complaining of halitosis, function loss and discharging pus at her right lateral dental implant was referred to the Department of Periodontology at Hacettepe University. An implant had been placed two years prior; a porcelain restoration was completed a year after surgery. An advanced peri-implant problem was noticed, and an SBA technique modified with PRP and tri-calcium phosphate application was subsequently performed. Clinical parameters and radiological evaluations were performed at baseline, 3, 6 and 12 months following the procedure. A 2 mm attachment gain, 3 mm reduction in probing depth and 2 mm alveolar bone gain were achieved a year after the surgical procedure. SBA technique modified with PRP application resulted in clinical benefits. Early wound healing was achieved without any postoperative bleeding. Peri-implantitis defect treated with SBA technique with autologous PRP and tri-calcium phosphate application appears to improve early wound healing and may influence acceptable regeneration.

Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial.

BACKGROUND: Platelet-rich plasma (PRP) was speculated to be a promoter of periodontal regeneration. There are only a few clinical comparative studies using PRP in the treatment of gingival recession. AIM: The aim of the present study was to compare connective tissue graft (CTG)+PRP with CTG alone in the treatment of gingival recession. MATERIAL AND METHODS: Forty patients with Miller I/II recessions were included. Each recession was randomly treated with either CTG+PRP or CTG. Clinical variables were recorded at baseline and at 6 weeks, 6 and 12 months. Root coverage (RC) and attachment gain (AG) were also calculated. RESULTS: Probing depth, recession depth, clinical attachment level, keratinized tissue width and recession width (RW) were improved in both study groups. However, no difference was observed between groups, except RW. RW in the control group was statistically lower than the test group at all follow-up periods. CONCLUSION: Treatment of recession with CTG or a CTG-PRP combination resulted in favourable clinical outcomes. However, no difference could be found between CTG and CTG+PRP. Whether much longer follow-up studies with higher statistical power may change these results remains questionable.

Multidisciplinary approach for the treatment of an oblique root fracture: a case report.

This clinical case study describes a multidisciplinary modified technique for the treatment of an oblique root fracture. A-38-year old woman with a history of trauma and a broken tooth was referred to our clinic. There was an oblique crown fracture extending the coronal third of the root just underneath the cingulum of the crown. The patient was willing to keep her tooth in function by any means. Two weeks after root canal therapy the flap was raised. The coronal two third of the root canal was enlarged. An impression of the enlarged root canal and tooth surface with surrounding bone was taken. The flap was sutured and the impression was sent to the laboratory for the post-casting preparation. After 7 days, the flap was opened again and casting was cemented. The flap was sutured. Ten days after the second surgery, three anterior teeth were prepared and a final impression was taken for the preparation of porcelain crowns. Restoration was finished 15 days after the second operation. The patient is still under maintenance therapy and the 12 month results are presented in this report. Extraction may not be the only alternative for the root fractures. Even for fractures under the alveolar margin, alternative multidisciplinary approaches can be used to restore and allow the tooth to survive.

Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series.

The shrinkage of free gingival grafts (FGGs) is a well-known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGGs. The aim of the study is to examine the shrinkage of FGG in both horizontal and vertical dimensions and calculate the changes in the surface area of the graft at early and delayed periods of healing. The FGG procedure was applied to 15 consecutive patients in their mandibular anterior area. The graft sizes and areas were measured and the shrinkage of the graft was calculated at baseline and days 10, 21 and 180. Hemorrhage, sense alteration and pain symptoms were also examined. Change in the horizontal direction was not statistically significant during the whole study period (p > 0.05). However, there was a statistically significant reduction in the vertical direction in all visits, except day 10 (p < 0.05). Calculated graft area was also significantly reduced during the study period at all time-points compared to the baseline (p < 0.001). At day 10, 4 (26.7%) recipient sites and 5 (33%) donor sites demonstrated paresthesia. Only one (0.07%) recipient site demonstrated paresthesia at day 21 where the donor site resulted with an uneventful healing. At day 10, 5 (33%) patients demonstrated bleeding at their donor regions and resulted with a complete cessation of bleeding at day 21. Pain symptom was found in 8 (53.3%) recipient sites where 3 (20%) donor regions presented pain symptom at day 10. Graft shrinkage in the vertical dimension seems to affect the clinical outcomes of the FGG procedure. However, the influence of horizontal graft shrinkage was minimal.

Intentional replantation for a periodontally involved hopeless incisor by using autologous platelet-rich plasma.

The aim of the present case is to describe the use of autologous platelet-rich plasma (PRP) in an intentional replantation procedure for a periodontally involved lower right central incisor with 18 months follow-up. Brief information is also given on the preoperative preparation of PRP in the dental office. PRP preparation is a new biotechnology, and the prepared material contains thrombocyte concentrates and high levels of growth factors. This material promotes healing time in a range of various sites. In this case, a tooth with severe periodontal breakdown was treated with PRP with intentional replantation procedure. This tooth was previously treated with root canal treatment and root planing. The tooth was extracted, and was replanted with autologous PRP. Clinical and radiographic follow-up for 18 months demonstrated new bone formation around the apical portion of the root and all clinical parameters indicated a trend of healing. The mobility of this previously grade III mobile incisor returned to normal limits. We speculate that intentional replantation with PRP application may induce wound healing and may induce bone formation.

Treatment of periapical inflammatory lesion with the combination of platelet-rich plasma and tricalcium phosphate: a case report.

Periapical surgery is an important treatment alternative in the presence of a periapical inflammatory lesion. To achieve optimal healing and regeneration of the bone, different bone substitutes or barrier membranes can be used after degranulation of the lesion. Tricalcium phosphate (TCP) graft material is one of these substitutes. Platelet Rich Plasma (PRP) preparation is a new biotechnology and can be used in many different surgical procedures. It consists of thrombocyte concentrates and high amounts of growth factors (GFs), especially platelet derived growth factor (PDGF), insulin-like growth factor (IGF-I) and transforming growth factor (TGF-beta), which are important in wound healing and regeneration. In this case report, use of platelet gel in conjunction with TCP in the treatment of periapical inflammatory lesion and the results of 12 months has been reported.