Treatment of peri-implant defects with combination growth factor cement.

BACKGROUND: The use of growth factor agents in the regeneration of oral tissues is an area of current investigation. Combinations of growth factors have been used synergistically to improve tissue regeneration. The aim of this study was to determine the effects of a combination growth factor cement (GFC) on guided bone regeneration around dental implants. METHODS: A combination of bone morphogenetic protein-2 (BMP-2), transforming growth factor-beta (TGF-beta), platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) was used in a bioabsorbable, non-hydroxyapatite, calcium phosphate cement. Five adult hound dogs were used to compare the effects of GFC, plain cement, and control (no cement). The right and left second, third, and fourth mandibular premolar teeth were extracted; the implant osteotomies were prepared; and a uniform circumferential gap was prepared 1.5 mm beyond the width of the implant in the coronal half of the osteotomy for cement placement. Titanium machine-polished dental implants were placed in the prepared sites, and coronal defects were treated according to previously randomized, assigned modality. A bioabsorbable collagen membrane was secured over the control site, and the flaps were closed primarily. The dogs were maintained on a soft diet to avoid soft tissue trauma. The dogs were sacrificed at 3 months. The specimens were sectioned, mounted, and stained with Stevenel's blue and van Gieson's picric fuchsin. The bone-to-implant contact and bone 1 mm peripheral to the implant surface were recorded with a computerized microscopic digitizer. RESULTS: The findings of this study indicate a significant effect of GFC on increased bone-to-implant contact and amount of bone per surface area compared with the other treatment modalities (P <0.0009). Plain cement demonstrated slight but nonsignificant increases compared with the control (P>0.05). CONCLUSIONS: GFC increases bone-to-implant contact and bone surface area within peri-implant defects. Further studies may be beneficial to determine the feasibility of its use for other regenerative applications.

Qualitative analysis of peripheral peri-implant bone and influence of alendronate sodium on early bone regeneration.

BACKGROUND: Alendronate sodium increases alveolar bone density with systemic use. It inhibits osteoclast activity and is thought to result in a net increase in osteoblastic activity. However, little is known about local in vivo use. The purpose of this study was to evaluate the effect of local delivery of alendronate on bone regeneration within peri-implant defects. Peri-implant bone was examined histomorphometrically to evaluate the amount of supporting bone peripheral to the bone-implant interface. METHODS: Six adult hound dogs were evenly divided into 2 groups, with one group receiving alendronate-coated dental implants and the other group serving as controls. Dental implants were placed immediately after extraction of right and left second, third, and fourth mandibular premolars. Forty-eight dental implants were placed (2 types in each dog: 24 hydroxyapatite [HA]-coated and 24 titanium machine-polished [TMP]), for a total of 4 variables. A bioabsorbable collagen membrane was secured over the implants and defects, and the flaps closed primarily. The dogs were sacrificed on day 28. Specimens were sectioned, mounted, and stained with Stevenel's blue and van Gieson's picric fuchsin. The amount of bone adjacent and 1 mm peripheral to the implant surface was recorded with a computerized microscopic digitizer. RESULTS: Locally applied alendronate resulted in significantly increased amounts of bone (P<0.0002, ANOVA) in the peripheral area with both HA and TMP implants. However, the most influential factor in the amount of peripheral bone was the type of implant surface (P<0.0001). CONCLUSIONS: Local application of alendronate is useful in increasing the amount of peripheral peri-implant bone. Also, the amount of supporting bone was not related to the bone-to-implant contact but to the surface characteristics of the implant. The findings of the present study indicate that the evaluation of dental implant-supporting bone should include peripheral bone as well as bone-to-implant interface.

Use of alendronate in peri-implant defect regeneration.

BACKGROUND: Previous studies have demonstrated an increase in bone mass and density with use of systemic alendronate sodium. This agent acts as an inhibitor of osteoclast activity, and is thought to result in more net osteoblastic activity. The objective of this study was to determine the effects of locally applied alendronate sodium on guided bone regeneration around dental implants. METHODS: Six adult mongrel dogs were divided into 2 groups: one group received alendronate-coated dental implants, and the other group served as control. Two types of dental implants were used in each dog: hydroxyapatite (HA)-coated and titanium machine-polished (TMP), for a total of 4 groups. Dental implants were placed immediately after extraction of the right and left second, third, and fourth mandibular premolars; a resorbable collagen membrane was secured over the implants and defects; and the flaps were closed primarily. Fluorescent labels were administered intravenously on days 0, 6, 12, and 22 to measure bone formation rate. Dogs were sacrificed on day 28. The specimens were sectioned and mounted, and bone formation rate was recorded with a computerized microscopic digitizer. Specimens were stained with Stevenel's blue and van Gieson's picric fuchsin. Bone-to-implant contact was recorded with a computerized microscopic digitizer. RESULTS: The results indicated a significant effect of locally applied alendronate (P < 0.0001) with both types of implants (HA and TMP), as well as the HA coating (P< 0.02) on increased bone formation rate. Additionally, alendronate had a significant effect on bone-to-implant contact, with an increase in the TMP model (P < 0.0001) and a decrease in the HA model (P < 0.0001 ). HA coating also had a significant effect on increasing bone-to-implant contact (P < 0.04). CONCLUSIONS: The results indicate that alendronate increases early bone formation rate around dental implants. Additionally, the local application as described resulted in greater bone-to-implant contact with TMP implants.

Mesenchymal chondrosarcoma of the jaw bones: clinicopathologic study of 19 cases.

BACKGROUND: Patients with mesenchymal chondrosarcomas in general have a 5-year survival rate ranging from 42-54.6% and a 10-year survival rate of 28%. Nineteen cases of mesenchymal chondrosarcoma of the jaw bones were reviewed to study their clinicopathologic features and to compare their clinical behavior with that of mesenchymal chondrosarcomas of other locations. METHODS: The patients were 10 males and 9 females (age range, 2-51 years). Sixteen patients were age < 30 years, and the average age at presentation was 19 years. Eleven tumors involved the mandible and eight involved the maxilla. RESULTS: Histologically, the classic picture of a bimorphic tumor, composed of islands of well differentiated hyaline cartilage juxtaposed to a small cell undifferentiated malignancy, was present in every case. Resection, including hemimandibulectomy and hemimaxillectomy, was the main treatment in 16 patients. Seven patients had local recurrence, and five patients developed distant metastases. Six patients died of disease, and the 5-year and 10-year survival rates were 82% and 56%, respectively. CONCLUSIONS: Mesenchymal chondrosarcoma of the jaw bones appears to have a more indolent course than mesenchymal chondrosarcoma of other anatomic

A case report. Treating localized refractory idiopathic gingivitis with Superoxol.

The authors describe a case of localized refractory idiopathic gingivitis in a 29-year-old patient that was successfully treated with hydrogen peroxide (Superoxol, Sultan Chemists, Inc.). The gingivitis was refractory to previous oral hygiene measures and was persistent in the face of meticulous oral hygiene. This case illustrates a successful treatment measure for an uncommon clinical challenge.

Dental considerations and treatment of the oncology patient receiving radiation therapy.

As many as 400,000 out of 1 million patients newly diagnosed with cancer may develop oral complications. The trend toward people's maintaining their teeth longer coupled with the rising age of the population suggest that dentists frequently may be treating patients with cancer, and should be informed about aspects of their oncologic care that will affect their oral health. This article highlights some of the important clinical considerations and offers guidelines for treating patients receiving radiation therapy.

Periodontal treatment for patients with cancer.

Today's periodontist is likely to come into contact with, be consulted about, or asked to treat a cancer patient. The periodontal evaluation and treatment of such a patient should reflect the changes in periodontium, the possibility of acute exacerbation of periodontal disease and systemic infection, oral changes, and the consequences and possible complications of radiation or chemotherapy, as well as the patient's overall health.

Periodontal manifestations of systemic disease and management of patients with systemic disease.

Many studies show a strong association between diabetes mellitus and risk for periodontal disease destruction. Patients with non-insulin-dependent diabetes mellitus have an increased risk of developing destructive periodontal disease. Under similar plaque conditions, adult patients with long-term, poorly controlled diabetes mellitus have more attachment and bone loss than controlled diabetic patients. Most patients with diabetes mellitus respond to conventional periodontal treatment, but in some cases the response may be related to the degree of metabolic control. Periodontal treatment may have a beneficial effect on the metabolic status of poorly controlled diabetes. Tetracycline therapy may be an effective adjunctive treatment in the management of periodontal disease in diabetic patients by blocking collagenase-dependent periodontal tissue destruction. Pyostomatitis vegetans is frequently associated with chronic inflammatory bowel disease and is a marker for the disease. Plaque control with chlorhexidine gluconate should be preceded by mechanical removal of plaque and calculus in patients with leukemia undergoing chemotherapy. A distinct gingival lesion is associated with Wegener's granulomatosis, a potentially fatal disease that, if detected early, has a favorable prognosis.

Orofacial manifestations of Melkersson-Rosenthal syndrome. A study of 42 patients and review of 220 cases from the literature.

We investigated orofacial manifestations in 42 patients with Melkersson-Rosenthal syndrome who were examined at our institution between 1965 and 1990. Patient histories and histologic and clinical findings were reviewed in detail. These data were compared with the oral findings in 220 cases that were reported in the literature between 1965 and 1990. There were 28 females in our study. The age at onset of signs and symptoms varied widely with a mean of 33.8 years. Most frequent initial signs were labial edema, facial swelling, and Bell's palsy. During the course of the disease, 75% of all patients had labial swelling, 50% had facial edema, and 33% had Bell's palsy. Swelling, erythema, or painful erosions that affected the gingiva, buccal mucosa, palate, or tongue were common intraoral symptoms. A comparison with patients reported in the literature revealed a similar frequency of extraoral symptoms but more prevalent intraoral symptoms in our patients.

Denture sore mouth.

Denture sore mouth is most often caused by improperly fitting dentures. Ulcers, stomatitis, hyperplasia, bone resorption, and chronic candidiasis may develop under improperly fitting dentures. If extensive bone resorption occurs, dental implants may be necessary. Malignant changes can develop.

Biosynthesis of prostaglandins in gingiva of patients with chronic periodontitis.

This study was undertaken to determine the ability of inflamed and normal gingival tissues to synthesize prostaglandins (PGs) from the precursor arachidonic acid. Thirteen samples of inflamed human gingival tissue and six samples of normal human gingival tissue were studied. The inflammation was characterized histologically. After incubation of the tissue with [14C]arachidonate, PG metabolites were separated by thin-layer chromatography and identified by comparison with co-chromatographed standards. Inflamed gingival tissue synthesized significantly larger amounts, compared to normal tissue, of 6-keto-PGF1 alpha (P less than 0.05), thromboxane B2 (P less than 0.01), PGD2 (P less than 0.05), and PGA2 (P less than 0.001). Some unidentified metabolites, possibly lipoxygenase products were detected in significantly (P less than 0.001) larger amounts in inflamed than in normal tissue.

Effect of retention of gingival sulcular epithelium on attachment and pocket depth after periodontal surgery.

Both the modified Widman flap and the intrasulcular incision technique produced significant and similar reductions in pocket depth and increases in attachment. Loss of attachment occurred where the initial pocket depth was less than 3 mm. Both techniques resulted in significant and similar increases in gingival recession. Neither technique affected tooth mobility or plaque scores to a clinically important degree. Historically, the necessity for removal of the sulcular epithelium in the course of periodontal therapy is a widely accepted tenet. This study fails to clinically validate this concept.

Albers-Schönberg disease complicated with periodontal disease. Report of a case with 36-year history.

A patient had the benign form of Albers-Schönberg disease complicated by periodontitis. Review of the patient's 36-year history revealed that the long-term prognosis can be good. Determining factors in the prognosis are the severity of bony involvement and proper periodontal and dental maintenance.

Lyophilized bone allografts in periodontal intraosseous defects.

Nine patients with 10 pairs of intraosseous periodontal defects were treated. Most of the patients had identical bilateral lesions (referred to as "mirror-image" defects). In each pair, one of the defects was randomly selected and treated as a flap and currettage control whereas the other defect was grafted with freeze-dried cortical powdered allografts of bone. Evaluation was based on radiographs, photographs, and measurements taken during both the initial surgery and at reentry approximately 1 year after transplantation. Control procedures (flap and curettage) demonstrated the same amount of osseous regeneration as that seen with the graft procedure. The amount of osseous regeneration demonstrated with the grafting procedures agreed with previously published studies. Evaluation revealed that (1) an autologous control such as incorporated in the "mirrow-image" design of this study is probably the most valid experimental model available for evaluating the clinical effectiveness of any human periodontal grafting procedures; (2) the effectiveness of freeze-dried cortical powdered bone allografts in human periodontal osseous defects is questionable and needs additional study; and (3) nongrafting procedures may be more effective in generating new attachments or reattachments in human periodontal osseous defects than previously believed.

Lymphocytotosicity for gingival epithelial cells in periodontal disease.

An immune pathogenesis has been implicated in periodontal disease. Lymphocytotoxicity assays utilizing a suspension of peripheral blood lymphocytes incubated with allogeneic trypsinized gingival epithelium were performed. The results demonstrate a significant in vitro lymphocytotoxicity for gingival epithelial target cells when the aggressor lymphocytes are from patients with destructive periodontal disease (high PDI). No significant lymphocytotoxicity was demonstrated with lymphocytes for periodontal disease-free (low PDI) patients. We conclude that there is a significant reduction in gingival epithelial cell survival after an 18-hour incubation with aggressor lymphocytes obtained frompatients who have destructive periodontal disease, and suggest there is a pathologic relationship between the patient's lymphocytes and the disease process.

Uninherited dentinogenesis imperfecta.

The rare hereditary disease, dentinogenesis imperfecta, is a disturbance of dentin formation in both the deciduous and permanent dentitions. It may be associated with osteogenesis imperfecta, though it is probably that the two diseases are carried by different genes. This association was recognized in a 19-year-old man. Dentinogenesis imperfecta had been diagnosed at the age of 6 and had been regarded as a mutation; 11 years later, an atypical form of osteogenesis imperfecta developed. The case is atypical because of the apparent absence of dentinogenesis imperfecta in the patient's family. The dental manifestations may have heralded the bone disease.