Common dental and periodontal diseases: evaluation and management.

Physicians may encounter patients with dental and periodontal diseases in the context of outpatient medical practice. It is important for physicians to be aware of common dental and periodontal conditions and be able to assess for the presence and severity of these diseases. This article reviews common dental and periodontal conditions, their cardinal signs and symptoms, outpatient-setting assessment techniques, as well as common methods of treatment. Physicians detecting gross abnormalities on clinical examination should refer the patient to a dentist for further evaluation and management.

Ehlers-Danlos syndrome type VIII is clinically heterogeneous disorder associated primarily with periodontal disease, and variable connective tissue features.

Ehlers-Danlos syndrome (EDS) type VIII (periodontitis type) is a distinct form of EDS characterized by periodontal disease leading to precocious dental loss and a spectrum of joint and skin manifestations. EDS type VIII is transmitted in an autosomal dominant pattern; however, the mutated gene has not been identified. There are insufficient data on the spectrum of clinical manifestations and natural history of the disorder, and only a limited number of patients and pedigrees with this condition have been reported. We present a four-generation EDS type VIII kindred and show that EDS VIII is clinically variable and although some cases lack the associated skin and joint manifestations, microscopic evidence of collagen disorganization is detectable.We further propose that the diagnosis of EDS type VIII should be considered in familial forms of periodontitis, even when the associated skin and joint manifestations are unconvincing for the diagnosis of a connective tissue disorder. This novel observation highlights the uncertainty of using connective tissue signs in clinical practice to diagnose EDS type VIII.

Challenges in achieving gingival harmony.

Gingival harmony is an important element in the esthetics of the smile. Clinicians need to have the essential knowledge to create an optimal soft-tissue profile around teeth and implant restorations. The goal of this article is to describe the requirements for ideal gingival architecture and techniques used to achieve them. The patient presentations in this article will demonstrate different aspects of esthetic soft-tissue surgery as well as treatment challenges and limitations.

Lip repositioning for reduction of excessive gingival display: a clinical report.

Excessive gingival display can be managed by a variety of treatment modalities, depending on the specific diagnosis. This case report demonstrates the successful management of excessive gingival display with a lip-repositioning procedure. This is accomplished by removing a strip of mucosa from the maxillary buccal vestibule, then suturing the lip mucosa to the mucogingival line. This results in a narrower vestibule and restricted muscle pull, thereby reducing gingival display during smiling. This article reviews the basic technique for lip repositioning and discusses the indications and contraindications for this novel procedure in dentistry.

Heterotopic bone formation around sintered porous-surfaced Ti-6Al-4V implants coated with native bone morphogenetic proteins.

PURPOSE: Coating endosseous dental implants with growth factors such as bone morphogenetic proteins (BMPs) may be one way to accelerate and/or enhance the quality of osseointegration. The purpose of this study was to investigate in the murine muscle pouch model whether sintered porous-surfaced titanium alloy implants coated with BMPs would lead to heterotopic bone formation around and within the implant surface geometry. MATERIALS: Porous-surfaced dental implants were coated with partially purified native human BMPs, with or without a carrier of Poloxamer 407 (BASF Corp., Parsippany, NJ), placed in gelatin capsules and implanted into the hindquarter muscles of mice. Mice were euthanized after 28 days. Sections of retrieved specimens were subsequently prepared for morphometric analysis of bone formation using backscatter electron microscopic images. RESULTS: Human BMPs, either with or without the carrier of Poloxamer 407, led to bone formation within and outside of the sintered porous implant surface. When the sintered implant surface region was subdivided into inner and outer halves, similar levels of bone ingrowth and contact were seen in the 2 halves. Evidence of bone formation to the depth of the solid implant core (i.e., the deepest level possible) also was seen. DISCUSSION AND CONCLUSIONS: Sintered porous-surfaced dental implants can be used as substrate for partially purified BMPs in the murine muscle pouch model. With the addition of these osteoinductive factors, the porous implant surface supported bone formation within the surface porosity provided, in some instances, all the way to the solid implant core. The addition of growth factors to a sintered porous surface may be an efficient method for altering locally the healing sequence and quality of bone associated with osseointegration of bone-interfacing implants.

The use of autogenous bone grafting with platelet-rich plasma for alveolar ridge reconstruction: a clinical report.

Implant dentistry has become an effective and predictable treatment modality in modern dentistry. Patients with missing teeth can benefit from partial or complete tooth replacement. Implants can also be used to improve denture retention, stability and support, and enable improved function and esthetics for patients. Several implant systems are commercially available, and their use is predictable with excellent success rates.

The use of implantoplasty and guided bone regeneration in the treatment of peri-implantitis: two case reports.

A variety of treatment modalities have been proposed for the management of peri-implantitis. These are mostly based on empiric experience and use the systemic administration of an antibiotic in conjunction with surgical intervention. To ensure decontamination of the affected implant surface(s), chemical and/or mechanical debridement is used. For textured implant surfaces, detoxification using implantoplasty could also give favorable results when used as part of the procedure. Two cases are reported in which implants developed localized peri-implantitis lesions. Implantoplasty followed by topical tetracycline decontamination was used in conjunction with guided bone regeneration. In both cases, the procedures were effective in arresting disease and regenerating lost bone. These results suggest that the technique holds promise and should be investigated further.