The use of chemotherapeutic agents in localized periodontal pockets.

Gingival diseases are the most widely dispersed diseases in the United States. In some patients, periodontal disease appears in a generalized form, but more often it appears in localized areas. Furthermore, after treatment with scaling and root planing in generalized cases, the disease is often reduced to a few local areas in the patient's mouth. Because periodontitis is a bacterial infection with known pathogenic microorganisms, the local delivery of antimicrobial agents has been considered to be a possible solution for treating and controlling localized forms of periodontal disease. Three local chemotherapeutic agents are reviewed in this paper: tetracycline fiber, doxycycline gel, and chlorhexidine chip. With the advancement of local drug delivery systems, restorative dentists, periodontists, and their patients have new alternatives for the treatment of periodontal disease. Local chemotherapeutic agents offer an additional mode of therapy and should be used on a case-by-case basis, not necessarily as an initial treatment.

Failure of resin ionomers in the retention of multi-rooted teeth with Class III furcation involvement: a rebuttal case report.

BACKGROUND: Severe periodontal furcation invasion has long been a treatment dilemma for the clinician. Many techniques have been advocated in the treatment of multi-rooted posterior teeth ranging from conventional scaling and root planing (SRP), apically positioned flaps, root amputations, root resections, tunnel procedures, guided tissue regeneration, and restorations. The keys to success depend on the clinician's ability to access the furcation to remove local factors and create an environment that enhances the patient's own hygiene efforts. Long-term success in treating teeth with furcation invasion depends upon tooth retention and arresting the destructive processes within the furcation area. METHODS: A Class III furcation invasion in a mandibular molar was treated by surgical access for SRP along with obliterating the furcation utilizing a resin ionomer restoration. RESULTS: Initially, the patient was asymptomatic. Within 3 months of treatment, the patient presented with suppuration that was refractory to local efforts. Radiographs taken only 5 months postsurgery demonstrated advanced bone loss apical to the restoration. The tooth ultimately was extracted because mobility increased and the tooth became symptomatic. CONCLUSIONS: The clinician must consider the multi-factorial etiology of periodontal breakdown within a furcation. For this patient, the technique of sealing off the exposed furcation with restorative material appeared to have resulted in progressive bone loss and accelerate tooth loss. This single case report is presented as a rebuttal to recently published articles, which have demonstrated excellent results when treating furcations with ionomer restorations.

Periodontal disease and its association with systemic disease.

Periodontal diseases are oral disorders characterized by inflammation of the supporting tissues of the teeth. Usually, periodontitis is a progressively destructive loss of bone and periodontal ligament (loss of the attachment apparatus of the teeth). Periodontitis has documented risk factors, including but not limited to specific plaque bacteria, smoking, and diabetes mellitus. Initially, the link between systemic disease and periodontal diseases was thought to be unidirectional. Currently, there is increasing evidence that the relationship between these entities may be bidirectional. Recent case-control and cross-sectional studies indicate that periodontitis may confer a 7-fold increase in risk for preterm low birth weight infants and a 2-fold increase in risk for cardiovascular disease. These early reports indicate the potential association between systemic and oral health. Additionally, these studies support the central hypothesis that periodontal disease involves both a local and a systemic host inflammatory response. This knowledge of disease interrelationships may prove vital in intervention strategies to reduce patient risks and prevent systemic disease outcomes. Based on the current evidence of the periodontal-systemic disease connection, the purpose of this report is to help establish the groundwork for closer communication between physicians and periodontists in the military health care setting.

Ridge augmentation with a folded acellular dermal matrix allograft: a case report.

Deformities of the dentoalveolar ridge are usually the result of developmental defects, periodontal disease, trauma, or surgical insult. Various techniques are available to correct ridge defects. In this case presentation, ridge augmentation was achieved utilizing an acellular dermal matrix allograft in lieu of an autograft. This report demonstrated an acceptable esthetic result with a significant improvement in the bucco-lingual dimension of the dental ridge. Color match was judged to be excellent. Furthermore, there was no post-surgical loss in papillae height. This case report illustrates an innovative soft tissue surgical technique for clinicians attempting to correct dentoalveolar ridge defects.

Post-surgical hemorrhage: formation of a "liver clot" secondary to periodontal plastic surgery.

Bleeding is a common sequela of periodontal and oral surgery. Generally, bleeding is self-limiting. Special circumstances require additional procedures to reduce or eliminate active hemorrhage. Occasionally hemorrhage can be under control when a patient is dismissed from their surgical appointment and, subsequently, the patient will experience either slow seepage of blood or extravascular clot formation. This case report describes the unique formation of a "liver clot" or "currant jelly clot" following periodontal plastic surgery. The clotting cascade and common laboratory tests to evaluate bleeding disorders are also presented.

Site-specific chlorhexidine: a periodontal alternative.

Three case reports demonstrate the clinical use of an adjunctive chlorhexidine chip capable of sustaining local antimicrobial activity for 7-10 days. The chip is easy to place, requires no additional chair time for removal, is self-adherent, and can be provided to periodontal maintenance patients on a recurring basis. This is another adjunct that can be part of the clinician's armamentarium when presented with a clinically challenging localized periodontal defect.

Maintenance and repair of high-speed dental handpieces.

High-speed dental handpieces constitute an integral part of the dental practice. A handpiece that is worn or malfunctions is inconvenient and may affect production. This article is designed to help practitioners understand the factors that contribute to handpiece wear and breakdown. Basic maintenance and options for repair also are discussed.

Localization of G protein alpha-subunits in the human fetal adrenal gland.

The aim of the present study was to investigate the presence and localization of the main G protein alpha-subunits in the human fetal adrenal gland during the second trimester of gestation. Immunofluorescence studies conducted on sections from frozen glands obtained immediately after therapeutic abortion indicated that the alpha s subunit of the heterotrimeric Gs protein was detected in all adrenal cell types, except for endothelial cells. The other alpha-subunits had a more specific pattern of distribution. Indeed, the alpha il-2 protein was restricted to the definitive zone, whereas alpha i3 labeling was mainly expressed in the fetal zone. The alpha q protein subunit was localized in vascular endothelial cells at the periphery of the adrenal gland and in fetal cells at the center. Finally, chromaffin cells expressed alpha s, alpha q, and alpha o1, but not alpha o2 nor alpha i. Altogether, these results indicate that the human fetal adrenal gland is not only unique in its particular morphology and expression of steroidogenic enzymes, but also by the differential expression of G protein alpha-subunits. Such cell specific distribution in glands from midgestational fetuses may account for the absence or the different responses to stimuli, when compared with the adult adrenal gland.

Radiographic osseous regeneration after initial therapy with systemic doxycycline.

Early-onset periodontal diseases are often diagnosed in the military as a result of the requirements for annual dental examinations and the youthful population served. A young soldier diagnosed with rapidly progressive periodontitis completed initial therapy of root planing with the systemic antibiotic doxycycline but was poorly compliant with additional treatment. During a subsequent mandatory dental examination, new radiographs demonstrated a significant improvement in the quantity and quality of alveolar bone, illustrating the regeneration potential of the young patient with early-onset periodontal disease.

Ridge preservation utilizing an acellular dermal allograft and demineralized freeze-dried bone allograft: Part I. A report of 2 cases.

Alveolar ridge deformities are usually the result of trauma, periodontal disease, surgical insult, or developmental defects. Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several techniques are available to prevent ridge collapse. In these case presentations, ridge preservation was achieved utilizing an acellular dermal matrix as a barrier membrane with a demineralized freeze-dried bone allograft. This report demonstrated an acceptable esthetic result with no loss of ridge height or width. Soft tissue dimensions were also preserved. The two graft materials were well accepted by the body and healing was rapid and without significant discomfort. The technique illustrated provides the surgeon with another option to prevent ridge collapse and ultimately improve esthetics.

Ridge preservation utilizing an acellular dermal allograft and demineralized freeze-dried bone allograft: Part II. Immediate endosseous implant placement.

When maxillary anterior teeth are extracted, subsequent ridge collapse can significantly compromise esthetics. Preservation of an adequate volume of bone is vital to successful implant placement. Ridge preservation achieved utilizing an acellular dermal matrix as a barrier membrane with a demineralized freeze-dried bone allograft has been previously reported. In this case presentation, guided bone regeneration was achieved around an immediate endosseous implant when this same technique was used. As in the previous case reports, this technique demonstrated an acceptable esthetic result with virtually no loss of ridge height or width. Soft tissue dimensions were also preserved. Both the hard and soft tissue grafts were well accepted by the body and healing was rapid and without significant discomfort. This surgical technique provides the clinician with an option to provide immediate implant therapy when primary closure cannot be achieved.

Occurrence and effect of PACAP in the human fetal adrenal gland.

In the study reported in this paper, we characterized PACAP in the human fetal adrenal gland and we investigated the effect of PACAP on steroid secretion from cultured fetal adrenal cells. The adrenal gland from 20-week-old fetuses contained substantial concentrations of PACAP-immunoreactive material (88.6 ng/g wet tissue). HPLC analysis of adrenal extracts revealed the presence of both PACAP27 and PACAP38, the latter being the predominant form. Incubation of cultured fetal adrenal cells with PACAP38 (10(-7) M) significantly increased cortisol and DHEAS secretion. Administration of the beta-adrenoreceptor agonist isoproterenol mimicked the stimulatory effect of PACAP on both steroid secretion whereas preincubation of fetal cells with the beta-adrenoreceptor antagonist propranolol suppressed the steroidogenic effect of PACAP. These data, together with the observation that PACAP receptors are exclusively located on chromaffin cells, suggest that, in the fetal human adrenal gland, the effect of PACAP on steroid secretion is mediated via the local release of catecholamines.

Smile enhancement via internal gingivectomies.

Periodontal plastic surgical procedures provide a wide range of techniques to improve the esthetics of the mucogingival complex. Often these procedures are prerequisites for successful restorative therapy. This article presents a simple means of enhancing a patient's smile that can be provided by simple internal gingivectomies. The technique can be provided as a stand-alone procedure or in conjunction with restorative care. The surgery is simple and predictable with virtually no postsurgical sequellae.

Subgingival restorations with resin ionomer: a periodontal alternative.

The successful use and placement of subgingival resin-ionomer restorations in both anterior root and molar furcation defects are demonstrated in this article. Sustained tissue health and minimal probing depths at the surgical site demonstrate clinical success. These case reports illustrate the continued success of alternative treatment procedures for restoring subgingival mechanical root or periodontal lesions.

Early creeping attachment after frenectomy: a case report.

An abnormal labial frenutomy is capable of causing retraction of gingival margins, formation of diastema and inhibition of lip and tongue movements. When aberrant frenula are present traditional frenectomy procedures are very successful. Often mucogingival procedures are needed to correct the defects that result from harmful frenum pulls. In this case presentation, an aberrant frenum was diagnosed to be associated with an area of recession on a mandibular left central incisor. Surgery was planned as a staged approach. The first phase of care was a simple frenectomy. A follow-on procedure consisting of a connective tissue graft for root coverage was planned. After only four weeks of healing from the frenectomy, creeping attachment of 1.0 mm was appreciated and the patient was able to avoid the secondary corrective surgery.

Nasal fistula associated with dental infection: a report of a case.

Most clinicians have come across a patient with difficult symptoms to diagnose. Often confusion occurs between odontogenic and nonodontogenic causes of sinus discomfort. On many occasions, sinus pain is due to purely dental causes, whereas in other situations dental pain is reported when the sinuses are infected. Due to the intimate association between the roots of the maxillary teeth and the floor of the nasal cavity and maxillary sinuses, diagnosis may be difficult. The following is a case report of a nasal fistula that developed from an abscessed maxillary central incisor.

Root coverage with an acellular dermal allograft: a three-month case report.

Treatment of gingival recession has been a common practice in periodontics for years. As esthetic demands of periodontal patients increase, more root coverage procedures will be performed to satisfy esthetic demands. Often patients present with multiple areas requiring treatment. Palatal anatomy may limit the amount of autogenous tissue that can be harvested, limiting the number of procedures that can be performed. A patient may not desire to have additional tissue transplanted from the palate, due to increased pain and morbidity associated with multiple transplant procedures. The following is a case presentation of multiple adjacent recession defects. The patient presented with a shallow palate from which one side would not yield an adequate quantity of connective tissue. Furthermore, the patient declined to have both sides of his palate harvested simultaneously. As an alternative, an acellular dermal matrix allograft was utilized to correct these gingival defects negating the requirement for a second palatal surgical procedure.

Endodontic perforation repair with resin-ionomer: a case report.

Root perforations are significant complications of endodontic treatment. However, when teeth are of strategic value, perforation repair is clearly indicated. The successful utilization and placement of a subgingival resin-ionomer restoration to repair an endodontic root perforation is demonstrated. Sustained tissue health and minimal probing depths at the surgical site demonstrate clinical success.

Peripheral giant cell granuloma: a case report.

The peripheral giant cell granuloma is a reactive lesion of the soft tissue of the oral cavity. Clinical appearance ranges from normal tissue coloration to dark red or purplish. These are elevated lesions generally 5-15 mm in diameter. Etiology is considered to be chronic irritation. To decrease the risk of clinical recurrence, treatment is complete excision to include the underlying periosteum. Histologic features of the peripheral giant cell granuloma include multinucleated giant cells with a stroma that may contain osteoblasts, myofibroblasts, macrophages, and Langerhans cells. A case report is presented.