Interrelación Entre Ortodoncia y Periodoncia en Periodonto Reducido. Estabilidad Periodontal Tras 6 Años de Seguimiento / Interrelation Between Orthodontics and Periodontics in Reduced Periodontium. Periodontal Stability After 6 Years of Follow-up

RESUMEN: En pacientes con periodontitis, la migración dentaria patológica es una consecuencia de la pérdida de soporte periodontal. El siguiente reporte de caso aborda el tratamiento periodontal y ortodóncico de una paciente con periodontitis y migración dentaria patológica. El protocolo utilizado fue el protocolo de la Unidad de Ortodoncia y Periodoncia de la Facultad de Odontología de la Universidad de Chile. La estabilidad periodontal se ha mantenido por al menos 6 años luego de finalizado el tratamiento de ortodoncia logran-do funcionalidad y estética de la dentición natural.

ABSTRACT: In patients with periodontitis, pathologic tooth migration is a consequence of loss of periodontal support. The following case report addresses the periodontal and orthodontic treatment of a patient with periodontitis and pathologic tooth migration. The protocol used was the protocol of the Orthodontics and Periodontics Unit of the Faculty of Dentistry of the University of Chile. The periodontal stability has been maintained for at least 6 years after the end of orthodontic treatment, achieving functionality and aesthetics of the natural dentition.

[NONSURGICAL RECONSTRUCTION METHOD INTERDENTALLY PAPILLAE IN THE RESTATION OF APROXIMAL CAVITIES AS ONE OF THE STAGES OF REHABILITATION OF PATIENTS WITH GENERALIZAD PERIODONTITIS].

Reconstruction of missing papilla--the basis of modern concepts of objective treatment of dental diseases. Interproximal spaces are important anatomical structures, as are bulky in the mouth and repeated many times. Violation of relations between different structural elements increases the risk of inflammation in periodontitis. Patients with approximal caries posteriors and generalized periodontitis studied anthropometric parameters of the structures of the interdental spaces and their impact on the volume papilla before and after restoration, carried out with move a contact point to the apex. The results showed that the relationship between anthropometric data interdental had certain patterns in all groups surveyed. Important was a clear relationship between anthropometric indicators of basic elements of interdental spaces. In the absence of the interproximal papilla length (IPL) was on average 7.2 mm, the distance from the gingival margin to the proximal contact--3.9 mm and the horizontal distance between the roots at the enamel--cement border (HDR) reached 3.2 mm. Following the restoration with move a contact point to the apex to an average of 4.5 mm IPL, there was a significant increase in the interdental papillae. In the case of patients prior to treatment was determined by a thin biotype, the small width of attached gingival significant HDR--volume papilla week after restorations movement of the contact point to the root apex contact point is not increased. The results obtained require long-term studies for the possibility of forecasting the success of the restoration or preservation of the interdental papillae in the restoration of approximal cavities on the stages of rehabilitation of patients with generalized periodontitis.

Accelerated treatment protocols: full arch treatment with interim and definitive prostheses.

With the advent of titanium, root form implants and osseointegration, dental treatment has undergone a metamorphosis in recent years. These new techniques enable dentists to provide anchorage for various kinds of prostheses that improve masticatory function, esthetics, and comfort for patients. Implant treatment protocols have been improved relative to implant macro- and micro-geometries, surgical and prosthetic components, and treatment times. Over the past 20 years, immediate occlusal function (also known as loading) has been established as a predictable treatment modality, provided certain specific criteria are met. In many cases, edentulous patients, crippled by the loss of their teeth, can undergo outpatient surgical and prosthetic procedures and return to a masticatory function that is near normal--sometimes after only one day of surgical and prosthetic treatment. This treatment option is also available for patients with advanced, generalized periodontal disease. Computer-assisted design/Computer-assisted manufacturing (CAD/CAM) has transformed how dental prostheses are made, offering improved accuracy, longevity, and biocompatibility; along with reduced labor costs and fewer complications than casting technologies. This article reviews the principles associated with immediate occlusal loading and illustrates one specific accelerated prosthodontic treatment protocol used to treat edentulous and partially edentulous patients with interim and definitive prostheses.

Twelve-year results of a direct-bonded partial prosthesis in a patient with advanced periodontitis: a clinical report.

Prosthodontic treatment for patients with advanced periodontitis is a therapeutic challenge. A minimally invasive technique is preferred to preserve the remaining mobile abutment teeth. This report describes the initial clinical treatment and 12-year follow-up of a direct-bonded prosthesis reinforced with a cast metal framework, used as a conservative treatment option to replace periodontally involved maxillary lateral incisors.

Recent advances in the development of GTR/GBR membranes for periodontal regeneration--a materials perspective.

UNLABELLED: Periodontitis is a major chronic inflammatory disorder that can lead to the destruction of the periodontal tissues and, ultimately, tooth loss. To date, flap debridement and/or flap curettage and periodontal regenerative therapy with membranes and bone grafting materials have been employed with distinct levels of clinical success. Current resorbable and non-resorbable membranes act as a physical barrier to avoid connective and epithelial tissue down-growth into the defect, favoring the regeneration of periodontal tissues. These conventional membranes possess many structural, mechanical, and bio-functional limitations and the "ideal" membrane for use in periodontal regenerative therapy has yet to be developed. Based on a graded-biomaterials approach, we have hypothesized that the next-generation of guided tissue and guided bone regeneration (GTR/GBR) membranes for periodontal tissue engineering will be a biologically active, spatially designed and functionally graded nanofibrous biomaterial that closely mimics the native extra-cellular matrix (ECM). OBJECTIVE: This review is presented in three major parts, including (1) a brief overview of the periodontium and its pathological conditions, (2) currently employed therapeutics used to regenerate the distinct periodontal tissues, and (3) a review of commercially available GTR/GBR membranes as well as the recent advances on the processing and characterization of GTR/GBR membranes from a materials perspective. SIGNIFICANCE: Studies of spatially designed and functionally graded membranes (FGM) and in vitro antibacterial/cell-related research are addressed. Finally, as a future outlook, the use of hydrogels in combination with scaffold materials is highlighted as a promising approach for periodontal tissue engineering.

Does a clinician's sex influence treatment decisions?

PURPOSE: As more women are entering health professions, the health care system is becoming more feminized. This investigation evaluated gender differences in clinicians' treatment preferences and decision making in a complex treatment situation. MATERIALS AND METHODS: A questionnaire was developed containing clinical cases and statements to assess practitioners' opinions on treatment of periodontally involved maxillary molars and implant therapy with sinus grafting. Data were analyzed with respect to the clinicians' sex, and an overall logistic regression was performed to further investigate possible influences of age, office location, and specialty. RESULTS: Three hundred forty questionnaires were evaluated (response rate: 35.1%). The mean age of female respondents (37%) was 42 years, and the mean age of male respondents was 46 years. Significantly fewer women reported performing implant placement (35% vs 63%), sinus grafting (16% vs 43%), and periodontal surgery (57% vs 68%). Female practitioners tended to refer more patients to specialists. Participants favored sinus grafting more often for their spouses than for themselves. Apart from a preference for regenerative periodontal surgery among women, no gender differences were observed for treatment decisions or views on general statements related to implant preference, tooth maintenance, or conventional reconstructive therapies. CONCLUSIONS: With similar expert knowledge, treatment decisions were made irrespective of sex. While the majority of male care providers performed complex therapies themselves, female clinicians referred more patients to specialists.

Ortodoncia y periodoncia / Orthodontics and periontics

El paciente periodontal se puede beneficiar con un tratamiento combinado de ortodoncia y periodoncia, ya que determinados movimientos dentarios como la extrusión, la intrusión, la rotación, el enderezamiento, etc pueden ser favorables para el periodonto enfermo. Lo que es fundamental antes de empezar el tratamiento de ortodoncia de un paciente periodontal es eliminarla inflamación activa de los tejidos (AU)

Periodontal patients can benefit from a combined treatment of orthodontics and periodontics, because certain tooth movements as extrusion, intrusion, rotation, straightening, etc. may be favourable for the periodontal patient. Which is essential before starting orthodontic treatment of a periodontal patient is to eliminate active inflammation of the tissues (AU)

[Prosthetic rehabilitation of patients with parodontitis based upon the use of 3D-technologies--clinical case example].

Clinical case of prosthetic rehabilitation of patient (female) with generalized parodontitis complicated by defects and deformations of dentitions was offered. Using 3D-technologies position of teeth was corrected with the help of a series of temporary transparent splints-modifiers with subsequent guy splintage and esthetic 3D-planning of front teeth forms. Teeth forms correction was made by composite using preliminary prepared templet.

[Clinical observation of implant immediate loading in periodontitis patients].

OBJECTIVE: To evaluate the clinical performance of implants placed immediately after extraction of remaining teeth due to severe periodontitis and immediately loaded for prosthetic oral rehabilitation. METHODS: Twelve patients in need of complete maxillary or mandibular rehabilitations due to severe periodontitis were enrolled in this study and received periodontal treatment for management of periodontitis. The remaining teeth were extracted, debridement around the periodontally compromised sites was performed. The implants were inserted under guidance by a surgical template, and a prefabricated screwed-retained provisional restoration was immediately delivered on implants. Definitive prostheses were inserted after 6 months. Clinical and radiographic analyses were performed at 1, 6, 12, 24 months. RESULTS: A total of 84 implants were placed, 50 in the maxilla and 34 in the mandible. Thirty-two implants were placed directly in extraction sockets. Four implants in 3 patients failed within the first 6 months, resulting in a total implant survival rate of 95% (80/84). The survival rate was 92% (46/50) in the maxilla, 100% (34/34) in the mandible. Prosthetic success was 100%. All the failures occured in the first 6 months and no failure in the next two years of follow-up. The mean bone level change at 1 and 2 year were (-1.12 ± 0.18) mm and (-1.28 ± 0.14) mm. There were no significant differences in insertion torque and alveolar bone loss between the post-extraction sites and healed sites. CONCLUSIONS: The immediate protocols in periodontally compromised maxilla or mandibular contributed to a satisfactory prosthetic success during the 2-year follow-up.

A telescopic crown concept for the restoration of partially edentulous patients with aggressive generalized periodontitis: a 3-year prospective longitudinal study.

This prospective longitudinal 3-year study compared clinical parameters and implant success rates of removable superstructures supported by both teeth and implants in patients with treated generalized aggressive periodontitis (GAP) and of cemented, implant-retained fixed superstructures in periodontally healthy patients. A total of 17 partially edentulous patients with 54 implants took part in the study. Nine patients with treated GAP received removable superstructures according to the Marburg double crown system, and eight periodontally healthy patients received fixed superstructures. Teeth were examined 2 to 4 weeks before extraction of the nonretainable teeth (baseline) and 3 weeks after insertion of the definitive abutments. Every 3 months over a 3-year period, clinical parameters were recorded and the composition of the subgingival microflora was determined. Intraoral radiographs were obtained at baseline, just after insertion of the superstructure, and 1 and 3 years later. Both groups showed mean plaque and gingival indices below 0.43 at implants and teeth. Mean probing depths around implants increased by approximately 0.7 mm and remained virtually constant for the teeth. Mean attachment loss at implants was 0.9 mm in GAP patients and 0.5 mm in healthy patients. The morphologic distribution of microorganisms in both groups showed healthy conditions. Moderate bone loss at teeth and implants was registered. Implant success rates were 100% in the healthy patients and 97.6% in the GAP patients. No significant differences were seen in the results between the groups.

Terapia antimicrobiana sistêmica no tratamento da periodontite / Systemic antibiotic therapy in the treatment of periodontitis

Inúmeros estudos vêm sendo desenvolvidos a fim de estabelecer formas de se eliminar os microorganismos relacionados à doença periodontal, entre elas, o uso de antimicrobianos sistêmicos. Esta revisão objetiva analisar formas de terapia antimicrobiana sistêmica no tratamento da periodontite, assim como propor um protocolo de tratamento medicamentoso antimicrobiano ideal. A literatura mostra que o uso de antibióticos sistêmicos adjuntos à terapia mecânica só se justifica no tratamento da periodontite crônica, quando refratária. Nos casos de periodontite agressiva, o tratamento mecânico deve ser associado ao uso de antimicrobianos. A doxiciclina é indicada no controle da periodontite agressiva localizada, enquanto que metronidazol e amoxicilina são indicados para periodontite crônica refratária e periodontite agressiva generalizada

Many studies come being developed in the direction to establish the best form of eliminating the microorganisms related to the periodontal disease, including the systemic antibiotics. The purpose of this review is to analyze forms of systemic antibiotics therapy in the treatment of periodontitis, as well as considering an ideal drug protocol. Literature sample that adjunct systemic antibiotic therapy is justified in the treatment of the refractory chronic periodontitis. In cases of aggressive periodontitis, the mechanical treatment always must be associated with antimicrobials. Doxycycline is the best choice in the control of localized aggressive periodontitis, while metronidazole and amoxycillin are the best in cases of refractory chronic periodontitis and generalized aggressive periodontitis

[Reconstruction of a periodontally compromised dentition]. / Rekonstruktion eines parodontal geschädigten Gebisses.

The presented case report describes a systematic treatment concept, the treatment sequence and the maintenance care of a sixty-seven-year old female patient suffering from generalized chronic periodontitis with advanced attachment loss. Due to a pretherapeutic risk assessment, several teeth were classified as "irrational to treat" or "doubtful". Therefore, a comprehensive reconstructive rehabilitation after active periodontal therapy was necessary. The restoration of a periodontally compromised dentition represents various difficulties. The patient wished to have fixed reconstructions. Depending upon anatomical conditions several different reconstructions were used: conventional bridges, partly using a resected molar root, a solely implant-retained bridge and a combined implant-tooth-retained bridge.

Prosthodontic management of periodontally compromised patient.

The fabrication and placement of a conventional immediate denture following extraction of periodontally compromised, non-restorable remaining teeth is a method that is frequently used to help restore form and function in an esthetically pleasing manner. This technique demands knowledge in applied basic sciences and prosthodontic principles. Accurate diagnosis and scrupulous treatment planning help the dentist address the patient's needs.

The distal extension case: an alternative restorative design for implant prosthetics.

A restorative design is introduced in preference to the implant-supported bar, clip, or ball-type removable prosthesis. It has been necessary to develop an alternative treatment approach to the placement and restoration of implants in the posterior mandible or maxilla. In an examination of the available therapeutic choices and their rationales, this treatment option offers greater function, esthetics, and comfort. Four maxillary and one mandibular arches were reconstructed with anterior implant-supported fixed bridges/splinted restorations and a precision partial denture design posteriorly, using an extracoronal universal ball attachment. These cases have demonstrated minimal maintenance up to 7 years in function.