Effect of posterior implant restorations on adjacent teeth and tissues: A case-control study.

INTRODUCTION: Dental implants are an artificial substitute for extracted or missing teeth in the oral cavity and are valuable for improving dental health and quality of life. While many studies on implants can be found, few studies examine their effects on adjacent teeth and tissues. The study aimed to examine complications of teeth adjacent to dental implants in the posterior region. METHODS: In this retrospective case-control study, clinical data of patients treated with implants in the posterior segment were extracted from the medical records in a single community dental clinic between January 9, 2010 and January 9, 2020. The patients were examined clinically and radiographically every 6 months. Data on the adjacent teeth to the dental implants were collected and divided into two groups, complications ("study group") versus no-complications ("control group"). Multivariate logistic regression analysis was performed to find a possible correlation between the complications and the variables checked, followed by checking specific variables in the complication group. RESULTS: A total of 1072 patients were included in the study. There were 179 patients (16.7%) with complications in adjacent teeth, while 893 patients had no documented complications. Predisposing factors for secondary caries were smoking (OR = 2.2, CI = 1.3-3.8) and a higher number of implants (OR = 1.6, CI = 1.1-2.5). Tooth crack and tooth fracture were analyzed together and found to be related to osteoporosis (OR = 8.9, CI = 2.9-27.6), whereas males were more prone to teeth fracture (OR = 2.8, CI = 1.1-7.4). Tooth mobility was related to a higher number of implants (OR = 16.5, CI = 3.7-73.8). Further analyzing the complication group solely, there was a statistical significance for age in primary caries and tooth mobility (p = 0.045). In addition, a higher number of implants was more prevalent with tooth mobility (p = 0.002), wider implant platform was more significant with primary caries (p = 0.012), and periodontal Stage III was more prone to tooth mobility (p < 0.001). The distance between the implant and adjacent tooth was also statistically significant-close proximity with tooth mobility and high distance with dental caries (p = 0.04). CONCLUSIONS: We found a relatively high rate of complications in teeth adjacent to dental implants. Secondary caries was the most common complication. Good understanding and proper position of the implants is essential to avoid adjacent teeth complications.

Efficacy of tooth splinting and occlusal adjustment in patients with periodontitis exhibiting masticatory dysfunction: A systematic review.

OBJECTIVE: To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction. MATERIAL: The primary outcome criterion was tooth loss (TL), and the secondary outcome parameters were change in probing pocket depth (PPD), change in clinical attachment level (CAL), tooth mobility (TM), and patient-reported outcome measures (PROMs). Literature search was performed on three electronic databases (from 01/1965 to 04/2021) and focused on clinical studies with at least 12 months follow-up. RESULTS: From a total of 1515 publications, 51 articles were identified for full-text reading, of which 2 retrospective case series on TS with low risk of bias and 1 randomized and 2 prospective studies on OA with unclear risk of bias were included. For TS, synthesis of data showed that in 72 patients, 26 out of 311 teeth (weighted mean incidence of TL 8.4%) and 156 out of 1541 teeth with no TS (weighted mean incidence of TL 10.1%) were lost over 2 years following non-surgical periodontal therapy. The randomized controlled clinical trial (RCT) indicated CAL gain for teeth with OA compared to no OA. For the effect of OA on TL, PPD, and TM, heterogeneous data were retrieved from the included studies. CONCLUSIONS: Within the limitations of this review and based on a low level of evidence, it is concluded that TS does not improve survival of mobile teeth in patients with advanced periodontitis. OA on teeth with mobility and/or premature contacts may lead to improved CAL, while the effect of OA on the remaining periodontal parameters remains unclear.

Chronic lymphocytic leukemia presenting as gingival swelling and tooth mobility.

Chronic-lymphocytic-leukemia (CLL) is the most prevalent leukemia in developed countries, caused by monoclonal proliferation of CD5+ B-cells and accumulation of mature-appearing-neoplastic lymphocytes in blood, bone marrow, and secondary lymphoid organs. Oral manifestations of CLL are infrequent and rarely reported in literature. We report a new case of a 67-year old man who presented with the complaints of tooth mobility and gingival swelling. Extra-oral examination was remarkable for cutaneous pallor and bilateral cervical lymphadenopathy involving the submandibular, and deep cervical lymph nodes on both sides of the neck. Complete blood count revealed normal red blood cell count (4.25 × 106/µl), normal platelet count (136 × 103/µl) and increased white blood cell count (25.3 × 103/µl). Differential white blood cell count showed marked lymphocytosis (88%), and blood film revealed the presence of leukocytosis, with small mature-looking lymphocytes, and mild thrombocytopenia. A flow cytometry immune-phenotyping revealed that 55% of peripheral blood cells were monoclonal B-lymphocytes expressing CD19, CD20, CD23, CD200, CD22, CD5, CD38, CD11c, sIgD and Kappa light chain confirming the diagnosis of CLL. Oral healthcare professionals should consider systemic causes, such as CLL, in the differential diagnosis of generalized tooth mobility and gingival swelling, particularly in patients with associated symptoms such as lymphadenopathy, fever, weight loss, and general fatigue.

Tooth loss in periodontally compromised patients: Retrospective long-term results 10 years after active periodontal therapy - tooth-related outcomes.

BACKGROUND: Estimating prognosis of periodontally affected teeth at the beginning of supportive periodontal care (SPC) is an important component for further treatment planning. This study aimed to evaluate tooth loss (TL) during 10 years of SPC in periodontally compromised patients and to identify tooth-related factors affecting TL. METHODS: Patients were re-examined 120 ± 12 months after accomplishment of active periodontal therapy. TL was defined as primary outcome variable and tooth-related factors (abutment status, furcation involvement [FI], tooth mobility, mean periodontal probing depth [PD], and clinical attachment level [CAL] at beginning of SPC, and initial bone loss [BL]) were estimated based on an adjusted regression analyses model. RESULTS: Ninety-seven patients (51 females and 46 males; mean age, 65.3 ± 11 years) lost 119 of 2,323 teeth (overall TL [OTL]: 0.12 teeth/patient/y) during 10 years of SPC. Forty of these teeth (33.6%) were lost for periodontal reasons (TLP; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P <0.0001). TLP (OTL) only occurred in 5.9% (14.7%) of all teeth, when BL was at least 80%. Use as abutment tooth, FI degree III, tooth mobility degrees I and II, mean PD, and CAL positively correlated with OTL (P <0.05). For TLP, FI and tooth mobility degree III as well as mean CAL were identified as tooth-related prognostic factors (P <0.05). CONCLUSIONS: During 10 years of SPC, most of the teeth (93.4%) of periodontally compromised patients were retained, showing the positive effect of a well-established treatment concept. Well-known tooth-related prognostic factors were confirmed.

Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment.

AIM: This retrospective longitudinal study assessed the risk of and prognostic factors for tooth loss in patients with generalized aggressive periodontitis (GAgP) after periodontal treatment in a university setting. METHODS: Fifty-seven patients (1,505 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after 17.4 ± 4.8 [range: 9-28] years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox-proportional-hazards shared-frailty model were applied. RESULTS: Overall, 98 and 134 teeth were lost during APT and SPT, respectively, with 0.14 ± 0.18 teeth being lost per patient and year. During SPT, three patients (5%) lost ≥10 teeth, 14 (25%) lost 4-9 teeth, 40 lost 0-3 (70%) teeth, respectively. One-third (n = 19) of all patients lost no teeth. Mean PPD of the teeth surviving SPT was stable from T1 (3.5 ± 1.1 mm) to T2 (3.4 ± 1.1 mm). Nearly, 84% of all survived teeth showed stable or improved bone level at T2. Risk of tooth loss was significantly increased in active smokers (HR[95% CI]: 4.94[1.91/12.75]), the upper dental arch (1.94[1,16/3.25]), with each mm of residual PPD (1.41[1.29/1.53]), teeth with furcation involvement (FI) (HR 4.00-4.44 for different degrees) and mobility (5.39 [2.06/14.1] for degree III). CONCLUSION: Within the provided conservative treatment regimen, GAgP patients lost only few teeth.

Self-Reported Periodontitis and Incident Type 2 Diabetes among Male Workers from a 5-Year Follow-Up to MY Health Up Study.

AIMS: The purpose of this study was to examine whether periodontitis is associated with incident type 2 diabetes in a Japanese male worker cohort. METHODS: The study participants were Japanese men, aged 36-55 years, without diabetes. Data were extracted from the MY Health Up study, consisting of self-administered questionnaire surveys at baseline and following annual health examinations for an insurance company in Japan. The oral health status of the participants was classified by two self-reported indicators: (1) gingival hemorrhage and (2) tooth loosening. Type 2 diabetes incidence was determined by self-reporting or blood test data. Modified Poisson regression approach was used to estimate the relative risks and the 95% confidence intervals of incident diabetes with periodontitis. Covariates included age, body mass index, family history of diabetes, hypertension, current smoking habits, alcohol use, dyslipidemia, and exercise habits. RESULTS: Of the 2895 candidates identified at baseline in 2004, 2469 men were eligible for follow-up analysis, 133 of whom were diagnosed with diabetes during the 5-year follow-up period. Tooth loosening was associated with incident diabetes [adjusted relative risk = 1.73, 95% confidence interval = 1.14-2.64] after adjusting for other confounding factors. Gingival hemorrhage displayed a similar trend but was not significantly associated with incident diabetes [adjusted relative risk = 1.32, 95% confidence interval = 0.95-1.85]. CONCLUSIONS: Tooth loosening is an independent predictor of incident type 2 diabetes in Japanese men.

Are sickle cell anaemia and sickle cell trait predictive factors for periodontal disease? A cohort study.

BACKGROUND AND OBJECTIVE: Periodontal diseases are associated with bacterial challenge and the host immune response, and are also modulated by genetic factors. There is evidence that sickle cell anaemia (SCA) does not represent a risk factor for periodontal diseases. However, it is still unclear whether the heterozygous condition [sickle cell trait (SCT)] is associated with periodontal diseases. SCT is a genetic condition that can cause vaso-occlusive events, which may be associated with a propensity to bacterial infections. The aim of this study was to investigate the association of SCA and SCT with periodontal diseases by evaluating clinical and radiographic characteristics. MATERIAL AND METHODS: The sample (n = 369) was selected and divided into two groups: exposed groups [HbSS (SCA genotype) and HbAS (SCT genotype) = 246] and a nonexposed group (HbAA = 123). HbAA consisted of individuals without SCA and SCT. The clinical parameters evaluated were plaque index, gingival index, calculus index, clinical probing depth, clinical attachment level, gingival recession, tooth mobility and furcation involvement. The percentage of alveolar bone loss was measured using a Schei ruler. Binomial and Poisson regressions were used to estimate correlations of interest (α = 0.05). RESULTS: None of the periodontal parameters was associated with SCA. SCT was associated with gingivitis (p = 0.041) and periodontitis (p = 0.002). Individuals with SCT had a lower plaque index (p = 0.044) but a higher calculus index (p = 0.003) and greater alveolar bone loss (p = 0.010) compared with subjects in the HbAA group. CONCLUSIONS: SCT can act as a predictor for establishment of periodontal diseases. There was no correlation between SCA and periodontal diseases.

Sobretratamento: uma alternativa eficaz na terapia com implante em elemento unitário com reabsorção radicular em paciente portador de periodontite crônica: relato de caso / Overtreatment: an effective alternative in implant therapy on a single tooth with root resorption in patient with chronic periodontitis: a case report

Paciente do sexo masculino, 54 anos de idade, leucoderma, compareceu a uma clínica privada para tratamento odontológico. Na anamnese, verificou-se tratar de um paciente saudável sistemicamente; os exames clínico e radiográfico demonstraram reabsorção dos terços apical e médio da raiz do dente 21. A opção de tratamento foi a realização da extração do elemento dentário e realização de implante imediato com carga tardia, utilizando-se o dente do próprio paciente como provisório fixado aos dentes vizinhos. O paciente foi informado sobre os detalhes das fases pré-, trans- e pós-cirúrgica, e autorizou a execução do tratamento e da documentação fotográfica com fins de publicação e divulgação. A utilização de periótomo foi necessária para uma exodontia atraumática. Após remoção atraumática da raiz, e com o osso alveolar remanescente preservado, optou-se por realizar a instalação imediata do implante (Neodent, Curitiba/PR, Brasil), com formato cônico e encaixe cone morse. O espaço alvéolo- implante foi preenchido com Bio-Oss®; removeu-se do palato um enxerto conjuntivo subeptelial, rotacionado para vestibular, e fez-se a obliteração do alvéolo — nessa fase, é importante garantir a imobilidade do enxerto, para sua revascularização. Passou-se, então, à fase protética do provisório, utilizando a coroa do elemento extraído como provisório e estabelecendo um pôntico, afixado com resina composta nos elementos 11 e 22. Assim, após a etapa de provisório utilizando o pôntico reembasado com resina composta, começou-se a confecção da coroa protética final. Após acompanhamento de três anos do caso, foi possível concluir que a associação das técnicas obteve resultados estéticos previsíveis e satisfatórios para a prevenção da saúde peri-implantar, conforme planejado...

A male, 54‐year‐old, Caucasian patient attended a private clinic for dental treatment. Hismedical history revealed a systemically healthy patient. Clinical and radiographic examination revealed resorption in the apical and middle thirds of tooth 21 root. A treatment option was to perform extraction of tooth 21 and implant placement with late loading, using patient's own tooth as a provisional secured to adjacent teeth. The patient was made aware of the details before, during and after surgery, and authorized the implementation of treatment and photographic documentation for purposes of publication and dissemination. The use of Periotome was required for atraumatic extraction. After atraumatic removal of the root, andwith the remaining alveolar bone being preserved, we chose to perform immediate implantplacement (Neodent‐Curitiba‐PR, Brazil). The implant was of conical shape and of the MorseTaper type. The alveolar‐implant space was filled with Bio‐Oss®, subepithelial connective graftwas harvested from the palate, with buccal rotation, and alveolar obliteration was carried out. At this stage, it is important to ensure graft immobility for vascularization. Subsequently, the prosthetic phase was carried out with the crown of the extracted tooth used as a temporary tooth, establishing a provisional pontic secured to between teeth 11 and 22 with compositeresin. Accordingly, after the temporary tooth phase with a pontic secured with composite resin, the final prosthetic crown was manufactured. After a three‐year follow‐up, we conclude that the combination of techniques yielded predictable and satisfactory outcomes for themaintenance of peri‐implant health, as planned ...

Treatment decisions in 330 cases referred for apical surgery.

INTRODUCTION: Apical surgery is an important treatment option for teeth with postendodontic apical periodontitis. However, little information is available regarding treatment planning in cases referred for apical surgery. This study evaluated the decisions made in such cases and analyzed the variables influencing the decision-making process. METHODS: The study retrospectively assessed clinical and radiographic data of 330 teeth that had been referred to a specialist in apical surgery with regard to the treatment decisions made in those teeth. The clinical and radiographic variables were divided into subcategories to analyze which factors influenced the decision-making process. RESULTS: The treatment decisions included apical surgery (59.1%), tooth extraction (25.8%), no treatment (9.1%), and nonsurgical endodontic retreatment (6.1%). Variables that showed statistically significant differences comparing treatment decisions among subcategories included probing depth (P = .001), clinical attachment level (P = .0001), tooth mobility (P = .012), pain (P = .014), clinical signs (P = .0001), length (P = .041) and quality (P = .026) of the root canal filling, and size (P = .0001) and location (P = .0001) of the periapical lesion. CONCLUSIONS: This study shows that apical surgery was the most frequently made treatment decision in teeth referred to a specialist in apical surgery, but every fourth tooth was considered nonretainable and was scheduled for extraction. The data showed that the most common variables that influenced the decision to extract teeth were teeth with an increased probing depth and tooth mobility and teeth presenting with lesions not located at the apex.

Tooth loss in individuals under periodontal maintenance therapy: 5-year prospective study.

BACKGROUND AND OBJECTIVE: Tooth loss (TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy (PMT) over 5 years. METHODS: The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers (RC) and 116 irregular compliers (IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis. RESULTS: TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p < 0.01). Individuals that were > 55 years old, males and smokers lost significantly more teeth in both groups (with IC > RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups (p < 0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6 mm in up to 10% of sites and irregular compliance. CONCLUSION: IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT.

Correlations between tooth mobility and the Periotest method in periodontally involved teeth.

OBJECTIVE: The aim of this clinical study was to evaluate whether a correlation exists between three-dimensional tooth mobility (TM) and Periotest values for maxillary anterior periodontally involved teeth (pocket depth > 3 mm) before and after periodontal therapy. METHOD AND MATERIALS: Force-related TM was measured in 3 N intervals in 19 participants as they bit down on a load cell. Periotest values were evaluated at reproducible measurement points. Both measurement techniques were performed on maxillary central and lateral incisors and canine teeth before periodontal treatment and after a healing period of 3 months. The Pearson product-moment correlation coefficient was calculated to determine exploratory associations. RESULTS: The comparison between TM and Periotest values indicated "high" and "optimum" correlations for maxillary central incisors before and after periodontal therapy. Lateral incisors exhibited "moderate" and "high" correlations, whereas canines exhibited "weak" and "moderate" correlations before and after periodontal therapy. CONCLUSION: Periotest values may provide valuable information about quantitative metric tooth mobility in periodontally involved teeth. In future investigations, the study design can expand on various dental fields, such as implantology and traumatology.

Importance of root development in autotransplantations: a retrospective study of 137 teeth with a follow-up period varying from 1 week to 14 years.

The aim of the present study was to perform a retrospective study of autotransplanted teeth with a variable but individually maximized follow-up period in order to provide information on the long-term clinical outcome. The sample was obtained from patients who were treated at the University Hospitals KU-Leuven, Belgium, during the period 1996-2010. Of the total of 109 subjects (137 teeth), 98 patients were invited for recall, of whom 68 patients (87 teeth) responded positively. Eleven out of the 109 patients were excluded due to loss of the transplanted tooth. Although 41 patients had no re-examination visit, clinical and radiological data from all 109 subjects were included in the sample. The follow-up period varied from 1 week of 14.8 years, with a mean of 4.9 years. Transplanted teeth receiving orthodontic treatment had a lower risk of ankylosis and were less likely to fail. The risk of root resorption was lower for teeth with stages one-half to three-quarters of root length at the time of transplantation. Molars were more susceptible to ankylosis. Almost all teeth showed partial or full obliteration of the pulp. Absence of further root development was higher in donor teeth with root length stage less than one-half. Trans-alveolar transplantation was less successful. Autotransplantation can be a valid alternative method in young adolescents for replacing missing teeth because of agenesis or trauma. The optimal time to transplant is when the root has reached two-thirds to three-quarters of the final root length.

Severe preeclampsia and maternal self-report of oral health, hygiene, and dental care.

BACKGROUND: Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self-report of oral symptoms/problems, oral hygiene practices, and/or dental service use before or during pregnancy and severe preeclampsia. METHODS: A written questionnaire was administered to pregnant females at the time of prenatal ultrasound and outcomes were ascertained by chart abstraction. The χ(2) test compared maternal oral symptoms/problems, hygiene practices, and dental service use between females with severe preeclampsia versus normotensive females. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe preeclampsia. RESULTS: A total of 48 (10%) of 470 females reported ≥2 oral symptoms/problems in the 6 months before pregnancy and 77 (16%) since pregnancy. Fifty-one (11%) reported previous periodontal treatment. Twenty-eight (6%) of 470 developed severe preeclampsia. Females with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR = 3.71; 95% CI = 1.40 to 9.83) than females without a history of periodontal treatment. Self-reported oral health symptoms/problems, oral hygiene practices, or dental service use before or during pregnancy were not associated with severe preeclampsia when considered in the context of other maternal risk factors. CONCLUSION: Maternal self-report of previous periodontal treatment before pregnancy is associated with severe preeclampsia.

Orthodontic treatment in the severely compromised periodontal patient.

We describe the diagnosis and treatment of a class II division 1 malocclusion complicated by severe periodontal disease, tooth loss, dentoalveolar protrusion associated with tipping and extrusion of the maxillary incisors, and a traumatic occlusion. Treatment involved the use of a modified palatal arch to intrude and retract the maxillary incisors and high-pull headgear to enhance anchorage and correct the Class II relationship. After active treatment for 19 months, a good anterior occlusion was achieved, with 17° of lingual retroclination and 3 mm of intrusion at the apex of the maxillary incisors. An acceptable occlusion and periodontal status was maintained over a retention period of 2 years. With the patient's cooperation, a successful outcome was achieved with this approach.

Survival of molar teeth after resective periodontal therapy--a retrospective study.

AIM: To study outcomes of molar teeth after resective therapy performed with the intention to prolong the lifespan of teeth having one or more unsaveable roots, and without which tooth extraction would be inevitable. MATERIAL AND METHODS: Clinical records of 149 subjects who had undergone resective therapy were retrieved. Demography and dental history were recorded, and a recall examination was undertaken. Cox regression models were performed. RESULTS: Of the 149 resective therapies, 132 (88.6%) were performed for periodontal reasons. Eighty-nine (59.7%) teeth subjected to resective therapies had been extracted by the time of recall (mean 10 years post-resection). The median survival period was 74 months. Factors significantly associated with shorter survival duration of teeth subjected to resective therapy were: age at resective therapy; pre-operative radiographic bone height of the remaining root(s) <50%; pre-treatment mobility II or above and not being splinted to neighbouring teeth nor incorporated as a bridge abutment. CONCLUSION: There was increased risk of tooth loss with increasing age at resection, grade II mobility or above, and reduced pre-operative radiographic bone heights around roots to remain. Splinting of a resected tooth to neighbouring teeth appeared to confer a protective effect towards its survival.

The evaluation of oral health in stroke patients.

OBJECTIVE: As tooth loss has been suggested as a potential risk factor for stroke, oral examinations were carried out on stroke patients to review the oral condition of those patients. METHOD: The subjects were patients consecutively discharged from the recovery rehabilitation unit of Hiroshima City General Rehabilitation Center between April 2008 and December 2009. All patients were offered oral examination and 358 of 443 patients accepted. Patients receiving dental examination were divided into two groups: one group comprising stroke patients and the second, patients with other disorders. These two groups were then compared for the number of remaining teeth by age group. RESULTS: Among the examined patients, the number of remaining teeth in stroke patients in their 50s and 60s was significantly lower than for patients in corresponding age groups (18.4 ± 9.4 vs. 24.5 ± 5.4 and 18.3 ± 9.2 vs. 22.2 ± 7.2, respectively, with p < 0.05 for both age groups) who were hospitalised for other conditions. In addition, the number of remaining teeth in stroke patients in their 50s was also significantly lower than the number reported in the Survey of Dental Diseases (24.1 ± 6.1; p < 0.05). CONCLUSION: The results of this study suggest an association between tooth loss and early occurrence of stroke.

Revascularization of an immature permanent tooth with periradicular abscess after luxation.

An immature permanent mandibular central incisor with periapical involvement in a 7-year-old boy was treated to promote revascularization. The tooth suffered from acute apical periodontitis after periodontal treatment by a general practitioner. An access cavity was prepared in the tooth and the cavity was left open until the next visit to achieve drainage through the canal. The root canal was not mechanically cleaned during the treatment period, but was irrigated with hydrogen peroxide and sodium hypochlorite. Calcium hydroxide compound was used for disinfection. At the fifth visit vital tissue appeared in the canal near the apical region, and calcium hydroxide compound was placed in contact with the soft tissue in the root canal. The access cavity was sealed with glass-ionomer cement followed by an adhesive composite resin filling. Radiographic examination 30 months after the initial treatment confirmed closure of the apex and thickening of the root wall. The case was observed for up to 13 years and root development was confirmed.

Diabetes and oral health: the importance of oral health-related behavior.

PURPOSE: The objective of this study was to explore oral health-related behavior, how patients with diabetes differ from patients not diagnosed with diabetes in their oral health and whether oral health-related behavior moderates the oral health status of patients with diabetes. METHODS: Survey and chart review data were collected from 448 patients (52% male, 48% female, average age: 57 years) of which 77 were diagnosed with diabetes (17%). RESULTS: Patients with diabetes had a higher percentage of teeth with mobility than those not diagnosed with diabetes (14% vs. 8%, p=0.023), as well as gingival recession (16% vs. 12%, p=0.035) and more teeth with recession in the esthetic zone (1.17 vs. 0.88, p=0.046). They also had more decayed, missing and filled surfaces due to caries (101 vs. 82, p<0.001) and more missing teeth due to caries (11 vs. 7, p<0.001). Patients with diabetes brushed and flossed less frequently. Patients with diabetes who did not brush regularly had poorer periodontal health (percentage of teeth with probing depth of <4 mm: 82% vs. 60%, p=0.039, 4 to 6 mm: 34% vs. 17%, p=0.059) and more caries (percentage of decayed teeth: 32% vs. 15%, p=0.033) than regularly brushing patients with diabetes. CONCLUSION: Educating patients with diabetes about the importance of good oral self care needs to become a priority for their oral health care providers.