The role of home care therapy in periodontal disease treatment and management.

Home care therapy is indispensable to manage periodontal disease successfully. Often, during and following initial periodontal treatment, it is unclear how much of the clinical improvement was due to patients' home care or to professional intervention, as these two therapeutic components are often amalgamated in clinical practice as well as in studies. In this case series, four patients with periodontal disease received education on using oral hygiene devices and used them competently prior to initiation of professional periodontal treatment. The changes in their clinical presentations, solely attributed to their home care therapy, were documented. The rationale and suggested clinical guidelines are also presented. Conclusion: Home care therapy is an indispensable but often overlooked step in the successful management of periodontal diseases. Ideally, this step should be solidified prior to proceeding with any professional treatment. By motivating patients to participate in the treatment more actively, clinicians can significantly improve the outcome and longevity of their professional interventions.

Influence of dental college funding and time established on the satisfaction of dental graduates with their undergraduate experience in Saudi Arabia.

OBJECTIVE: With the emergence of graduates from all government and private-funded dental colleges in Saudi Arabia (SA), it is pressing to explore the graduates' satisfaction with the dental undergraduate education and training they received. The aim of the present study was to investigate the graduates' satisfaction with their education and training according to college funding arrangements (government vs private-funded) and time since establishment (established- >15 years vs new-<15 years). METHODS: A piloted, electronic questionnaire was emailed to all the members of the Saudi Dental Society who had graduated from government and and private dental colleges in SA (2,185 registrants). RESULTS: The response rate was 36.4%, with 580 government-funded college graduates (72.9%) and 216 private college graduates (27.1%) having completed and returned the questionnaire. The distribution of participants between established and new colleges was 'established' 396 (49.8%) and 'new' 400 (50.2%). Levels of dissatisfaction were recorded for graduates from established and new, government-funded and private colleges. The levels of dissatisfaction were greater amongst the graduates of established and government-funded colleges. CONCLUSION: The findings of the present study indicate concerning levels of dissatisfaction with important aspects of dental education in SA. It is suggested that there is a pressing need for more integration of basic and clinical sciences and an emphasis on hands-on training. National coordination of arrangements for dental curricula could make a major contribution to addressing the problems identified.

A nationwide survey assessing the satisfaction of dental colleges graduates with their undergraduate experience in Saudi Arabia.

OBJECTIVE: To date, there are no publications on the Saudi graduates' perceived value of their dental curriculum. The aim of this nation-wide survey was to investigate graduates' satisfaction with specific disciplines of their dental education and training. The first part of this study addressed findings according to the respondents' gender and the number of years of postgraduate experience (Graduate-related factors). METHODS: An electronic questionnaire was emailed to registrants of the Saudi Dental Society, specifically dental interns, general dentists, and specialized dentists who graduated from private and governmental dental colleges in Saudi Arabia (n = 2185). RESULTS: The response rate was 36.4 %. The number of male respondents was (n = 352, 44.2 %), the remainder being female (n = 444, 55.8 %). The number of recent dentists (≤ 5 years since graduation) was (n = 428, 53.8 %) and experienced dentists (n = 368, 46.2 %). There were statistically significant gender variations in satisfaction levels, and among dentists with different post-graduation experiences. Although male and female dental students are taught similar curriculums and have similar graduation requirements, there were statistically significant differences in various subjects covered. Similarly, recent and experienced dentists reported statistically significant differences in satisfaction in various subjects. CONCLUSION: This study provides graduates' perspectives on the strengths and weaknesses of their dental education in Saudi Arabia. The findings help in curriculum reform and collaborations between the dental colleges nationally. Ultimately this can lead to formulating a national dental accreditation and assessment body. CLINICAL SIGNIFICANCE: The findings of this study provide graduates' perspective on the dental education received in Saudi Arabia. This will help stimulate discussion and collaboration within and amongst the colleges on improving their curriculum in this fast-paced, evolving field of dentistry.

Nonsurgical and surgical management of biologic complications around dental implants: peri-implant mucositis and peri-implantitis.

Biologic complications around dental implants may be categorized into peri-implant mucositis and peri-implantitis. Peri-implant mucositis is defined as reversible inflammation in the peri-implant mucosa without any apparent bone destruction. Peri-implantitis refers to inflammatory process that resulted in destruction of alveolar bone and attachment. Potential etiologic and contributing factors to both diseases are discussed in this review. By targeting and eliminating the etiologic factors nonsurgically as well as surgically, dental implants presenting with peri-implant diseases may be rescued, and then maintained with proper long-term peri-implant supportive therapy. Furthermore, clinical cases and their management are presented to demonstrate the available treatment options. Implant therapy should be carefully planned and executed with consideration of potential etiologic and contributing factors to developing biologic complications. During the initial consideration, patients should be informed of the potential biologic complications in dental implant therapy. Clinicians should monitor implants for any development or recurrence of peri-implant disease to ensure timely therapeutic intervention.

Nonsurgical periodontal therapy based on the principles of cause-related therapy: rationale and case series.

Cause-related therapy is key in the management and resolution of the two most common oral diseases: dental caries and periodontal disease. This is the first phase of treatment for those diseases. The aim is to remove, reduce, or eliminate the main causes of the disease. When referring to caries and periodontal disease, the primary etiology is bacterial plaque so the cause-related therapy phase should include plaque control as a major component. This can be achieved by constantly and continuously educating patients about the pathophysiology of the diseases and by helping them develop proper daily plaque removal techniques. Furthermore, various professional therapeutic interventions are delivered as necessary to eliminate or suppress other etiologic or risk factors. In this case series, the principles of proper cause-related therapy are demonstrated through three cases that were successfully managed by nonsurgical periodontal therapy. Biologic and clinical rationales are also discussed.

Volumetric Analysis of Allogenic and Xenogenic Bone Substitutes Used in Maxillary Sinus Augmentations Utilizing Cone Beam CT: A Prospective Randomized Pilot Study.

PURPOSE: The purpose of this prospective randomized clinical pilot study was to compare the three-dimensional changes of grafted maxillary sinuses when deproteinized bovine bone (DBB) or cortical mineralized allogeneic bone (MAB) was used. MATERIALS AND METHODS: Seventeen patients were randomly assigned to receive either DBB or MAB for lateral-approach maxillary sinus augmentation. Cone beam computed tomography (CBCT) scans were performed preoperatively (T0), immediately after (T1), and at approximately 6 months posthoperatively (T2). Three-dimensional analysis of the radiographic volumetric changes was performed for DBB and MAB by measuring the difference in unoccupied sinus volumes at T1 and T2. RESULTS: In the DBB group, a statistically significant increase in unoccupied sinus volume was found at T2 when compared to T1 (P = .001). It represents a mean resorption rate of 23.8% ± 15.9%. Similarly in the MAB group, a statistically significant increase in unoccupied sinus volume was found at T2 when compared to T1 (P = .007). The mean resorption rate in the MAB group was 19.5% ± 10.1%. There was no statistically significant difference between the contraction of DBB (23.8%) and MAB (19.5%) (P = .52). CONCLUSION: Both DBB and MAB showed sufficient volume stability at T2 (mean 6.3 ± 1.6 months) postoperatively for 10- to 13-mm-implant placement without the need for additional grafting.

Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence - A Systematic Assessment.

BACKGROUND: The aim of this review is to evaluate the levels of clinical evidence for bone replacement grafts available in the United States for periodontics and oral implantology purposes. METHODS: A search was performed using PubMed, the Cochrane Library, and Google Scholar for articles relating to the use of bone replacement grafts in implant and/or periodontics by two independent reviewers. Articles unrelated to the topic, not involving patients, not including abstracts, or in languages other than English were excluded. Selected articles were graded according to "levels of evidence" based on guidelines originally introduced by Wright et al. (2003). RESULTS: There was limited published peer-reviewed clinical literature available regarding US commercially available bone replacement grafts in periodontics and oral implantology. Of 144 bone replacement grafts available in the United States according to Avila-Ortiz et al. (2013), only 52 met the inclusion criteria. The majority of materials used were allografts (26 of 93 available in the United States), followed by alloplasts (15 of 30) and xenografts (11 of 21). CONCLUSION: Dental providers should be aware of the limited evidence that qualified for a strong rating supporting the clinical efficacy of these materials for periodontics and oral implantology purposes using the inclusion criteria selected in this study.

Unintentional root fragment retention in proximity to dental implants: a series of six human case reports.

There has been renewed interest in intentionally placing dental implants in proximity to or in contact with tooth root fragments. In clinical practice, human teeth are usually extracted due to nonrestorable caries, vertical or horizontal root fractures, periodontal disease, or endodontic failure, which is commonly accompanied by inflammation and bacterial contamination. The aim of this case series is to present the adverse effects in humans of clinically undetected root-to-implant contact (CURIC), where implants were unintentionally placed in proximity to undetected retained root fragments. The adverse effects of small (3 to 5 mm) root fragments were detectible 6 to 48 months post implant placement. Three out of seven implants in six patients were removed due to severe coronal bone loss. This differs from retrograde peri-implantitis, where only the apical area of the implant is affected and the coronal portion remains integrated. The detrimental effect of root fragment-to-implant contact is described along with its clinical management. Based on the review of currently relevant data, mixed results have been documented regarding the success of dental implants in proximity to tooth-root fragments. Careful evaluation of long-term, postloading results in humans where hopeless teeth have been extracted due to infection and significant bone loss are required before intentional root fragment retention is considered a safe and reliable clinical option for implant placement.

Peri-implantitis induced by a retained retraction cord.

This paper presents a case of purulent peri-implantitis at an implant in the maxillary right lateral incisor position. The lesion was unresponsive to close debridement and, thus, open flap surgery was performed. Profound bone loss was evident around the implant and a retained retraction cord at the cervical portion of the implant was observed. Treatment included a sequence of decontamination steps and guided bone regeneration with the aim of eliminating the etiology and enhancing implant survival. In the presented case, it can be speculated that the retraction cord served as a plaque retentive factor which ultimately led to bacterial accumulation and periimplant disease. Thus, it is crucial to ensure that no plaque retentive factors (cement remnants, retraction cord, ill-fitting margins of crowns, etc.) are present when restoring an implant. Plaque retentive factors might result in a destructive effect on the peri-implant tissues and bone.