Complications associated with diabetes mellitus after guided tissue regeneration: case report.

Dental practitioners need to be aware of the complications that can arise in the management and treatment of patients with diabetes mellitus. Patients with diabetes, and patients with a family history of diabetes, are at-risk dental patients. They are more likely to develop periodontal disease, and the periodontitis is more likely to be severe. Diabetes influences the progression and severity of periodontitis through changes in the small blood vessels, decreased collagen formation, and impairment of the host's defense mechanisms. Furthermore, complications associated with diabetes, such as impaired wound healing, can affect the patient's response to periodontal therapies like guided tissue regeneration (GTR). The case report in this article discusses the postsurgical complications that occurred during GTR treatment of a patient with non-insulin-dependent diabetes. The diabetic's susceptibility to periodontal disease and impaired wound healing can affect the progression of the disease and its treatment. Dental patients with diabetes require close supervision and frequent monitoring of their medical and dental health by the dental clinician.

Clinical and laboratory evaluation of powered electric toothbrushes: in vivo determination of average force for use of manual and powered toothbrushes.

Mechanical oral hygiene instruments are intended to aid in the removal of stain and dental plaque from tooth surfaces. Certain home hygiene procedures, however, can lead to soft and hard tissue trauma. Power assisted brushing instruments are gaining in popularity, yet there is limited information on the interaction of these home care instruments with commercial dentifrices, and the resultant impact on oral tissues. In this study, the average forces applied during in vivo toothbrushing were determined for three powered brushing instruments (Rota-dent, Interplak and Braun Oral-B Plaque Remover) and a manual toothbrush (Oral-B P40). The Rota-dent instrument was found to be used with the lowest brushing pressure followed, in order, by the Braun Oral-B Plaque Remover. Interplak and the manual toothbrush. The average amount of dentifrice applied to the three powered brush heads was directly related to the size of the head, with Rota-dent typically receiving the least and Interplak the most applied dentifrice.

Clinical and laboratory evaluation of powered electric toothbrushes: laboratory determination of relative abrasion of three powered toothbrushes.

Previously established data on average forces applied to various brushing instruments during in vivo toothbrushing were incorporated into a laboratory abrasion model. The apparatus included a specially constructed and standardized brushing machine and utilized an acrylic resin substrate. Three powered brushing instruments (Rota-dent, Interplak and Braun Oral-B Plaque Remover) and a manual toothbrush (Oral-B P40), were compared in this model. The system demonstrated excellent precision and could distinguish between brushing instruments with as little as 10% difference in abrasivity. It was found that brushing abrasivity increased in the order of Rota-dent < Braun < Interplak.

Clinical and laboratory evaluation of powered electric toothbrushes: relative degree of bristle end-rounding.

Toothbrush bristles with sharp edges have been postulated to represent a greater threat to dental tissues than end-rounded bristles. This study evaluated the effect of both in vivo and laboratory use on bristle wear rate, tip geometry and in vitro abrasivity. Three soft manual brushes (Oral-B P40, Crest Complete and Butler GUM) and one powered brush (Rota-dent) were tested. The results of this study show that the wear rate varied directly with brushing load and amount of dentifrice, and inversely with bristle diameter. Despite the initial geometry, a flat tip with rounded rims was typically observed after only 30 minutes of manual or Rota-dent brush use. There was no statistical difference in in vitro abrasion for new brushes versus used brushes.

Clinical and laboratory evaluation of powered electric toothbrushes: laboratory determination of relative interproximal cleaning efficiency of four powered toothbrushes.

The clinical brushing data from the paper entitled, Clinical and Laboratory Evaluation of Powered Electric Toothbrushes: In Vivo Determination of Average Force for Use of Manual and Powered Toothbrushes, by Boyd et al. in this Special Issue, were incorporated into a laboratory cleaning model. Utilizing a standardized brushing machine and a methyl methacrylate substrate, four powered brushing instruments were tested for cleaning efficiency: Rota-dent. Braun Oral-B. Interplak and Sonicare, and a manual toothbrush (Oral-B P40). The Sonicare powered brushing instrument was tested at the manufacturer's recommended brushing force of 0.5 N as well as a calculated force of 1.0 N. The results showed that the Rota-dent was more efficient (p < 0.01-0.001) in removing stain from both flat and interproximal surfaces than any of the other tested brushes. These results, together with those reported by McLey, et al. in Clinical and laboratory Evaluation of Powered Electric Toothbrushes: Laboratory Determination of Relative Abrasion of Three Powered Toothbrushes in this Special Issue, demonstrate that the rotary action Rota-dent instrument has the most efficient combination of low abrasion and high cleaning efficiency of the four powered brushes and the manual brush when all instruments were tested using clinically documented pressures.

Treatment of intrabony defects with collagen membrane barriers. Case reports.

Two separate investigations were undertaken to assess the clinical characteristics and the safety, and to determine whether an absorbable type 1 bovine collagen barrier membrane would result in the improvement of clinical parameters during guided tissue regeneration in humans. The collagen membrane barrier was placed over a total of 21 interdental intrabony periodontal defects in 18 patients. The surgical procedures and postsurgical regimen were similar in both components of the investigation. Sulcular incisions were used and the sites were surgically exposed by reflection of full thickness mucoperiosteal flaps. The intrabony defects were debrided and the root surfaces prepared with automatic scalers and curets. Four 1-minute applications of tetracycline HCl 50 mg/ml were applied to the root surface. The collagen membrane barrier was hydrated in sterile saline until pliable, then trimmed so it covered the osseous defect and extended 2 to 3 mm beyond the defect. In both investigations, the collagen barrier membrane was not sutured, but retained by "pouching" or undermining the flap. Healing occurred without complications. There were no untoward or adverse reactions to the material in either phase of the study. In the initial investigation, 13 intrabony defects with probing depths of > or = 5 mm were treated in 9 patients having a mean age of 50.6 years. No controls defects were treated. Soft and hard tissue measurements were taken at the time of initial surgery and at 2, 4, and 6 months. In the second phase, 9 patients were enrolled with a mean age of 49.7 years. They had similar bilateral interdental intrabony defects with probing depths > or = 6 mm. One defect received the collagen membrane barrier, while the other was treated by flap debridement alone. The collagen membrane had undergone modification since the initial investigation, and was more highly cross-linked to retard absorption. After initial therapy, and prior to the surgical procedure, a series of 3 dermal patch tests were used to determine whether the patient would elicit a reaction to the collagen. Venous blood was drawn at baseline, 7 to 10 days, 18 to 21 days and at 8 weeks for analysis by ELISA for comparison of test and control sites relative to baseline. There were no allergic response to the dermal tests, and the ELISA tests indicated no significant differences between test and control sites. An automated probe was used to record soft and hard tissue measurements. These included the probing depths and clinical attachment levels.(ABSTRACT TRUNCATED AT 400 WORDS)