Changes in periodontal parameters of splinted versus non-splinted posterior teeth during ten years of supportive periodontal therapy - A retrospective evaluation.

OBJECTIVES: To compare periodontal parameters of splinted posterior teeth versus control teeth over ten years of supportive periodontal therapy (SPT) and to assess the survival rate of splints. MATERIAL AND METHODS: Retrospective data of 372 SPT-patients was screened for splints (composite/fiberglass-reinforced composite) in the posterior (molars/premolars) which were inserted at least ten years before due to increased tooth mobility. For each splinted tooth (test), a corresponding control tooth had to be present at the first SPT-session after splint insertion (T1). Data was assessed at T1 and ten years later (T2). Possible influencing covariates for splint survival (mobility degree/Eichner class) were tested by Cox regression. The change in clinical attachment level (ΔCAL), probing pocket depth (ΔPPD) and the testing of possible influencing covariates was analyzed by using mixed linear regression. RESULTS: Twenty-four patients (32 splints, 58 splinted teeth) were included. Ten test and two control teeth were lost. No differences were observed between ΔCAL and ΔPPD of test teeth compared to control teeth (ΔCAL -0.38 ± 1.90 vs. 0.20 ± 1.27 mm; ΔPPD -0.17 ± 1.18 vs. 0.10 ± 1.05 mm). Twenty-two splints fractured during the observation period (survival-rate: 31%). Mobility degree and Eichner class did not influence time until fracture. CONCLUSIONS: Splinting of periodontally compromised and mobile posterior teeth does not have any disadvantage regarding the clinical periodontal situation when regular SPT is applied. However, splint fractures occur very often. CLINICAL RELEVANCE: Splinting of posterior teeth is a treatment option in addition to active periodontal therapy when patients are disturbed by tooth mobility but splints have a high susceptibility to fracture.

Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration (GTR) followed by orthodontic intrusion (OI) versus OI followed by GTR: a controlled clinical trial.

BACKGROUND: Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss. METHODS: Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography. RESULTS: Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement (P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference (P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes. CONCLUSION: There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.

Comparison of two composite resin materials for splinting of dental luxation injuries: A double blind randomized controlled trial.

BACKGROUND/AIM: Luxation is a common traumatic dental injury treated with a wire composite (WC) splint. However, bulk-fill flowable composite and conventional packable composite have not been compared for retaining these splints. Therefore, the objectives of this randomized controlled trial were (1) to compare retention of WC splints, and (2) to compare adhesive point dimension, application and removal time, and effect on tooth mobility between the two WC splints. MATERIALS AND METHODS: In this parallel group, non-inferiority double blind randomized controlled trial, a total of 90 patients, aged 16-50 years participated. They were randomly allocated into two groups, the packable composite group (PC) n = 45 and the bulk-fill flowable composite group (BF-FC) n = 45 by lottery method. Following measurements were taken at the splint application appointment. Horizontal tooth mobility measured via Periotest, splint application time, and frontal images of splinted teeth to measure the percentage composite adhesive point area. After 2 weeks, splints were visually inspected for retention, whereas mobility and removal times were also recorded. Statistically, comparisons were made using independent samples sample T-test, Fisher's exact test, and Mann-Whitney U at p ≤ .05. RESULTS: A total of 88 patients with 156 luxated teeth completed the trial, as two patients were lost to follow-up. Two patients in the PC group reported with completely de-bonded splints while none de-bonded in the BF-FC group. Both groups were similar in terms of splint retention (p = .352), reduction of mobility (p = .426), and splint removal times (p = .372). The BF-FC group performed significantly better in adhesive point dimension percentages (p < .001) and splint application time (p < .001). CONCLUSION: Both groups were comparable in most parameters of the study. However, for BF-FC group application time and adhesive point dimension were significantly less.

EVALUATION OF THE CLINICAL CONDITION OF THE ORAL CAVITY BEFORE ADHESIVE SPLINTING OF MOVABLE TEETH.

The purpose of the study is to analyze the condition of the oral cavity tissues to choose the method of adhesive splinting of the anterior teeth. Increasing the efficiency of patient curation strategies and tactics based on forecasting the functional capabilities of the dental and periodontal complex. In the period from 2017 and 2021, 81 male and female patients aged 35 to 45 years were examined and treated for preventive examination and rehabilitation at the University Clinic Educational and Medical Center of Bukovinian State Medical University and diagnosed with periodontitis of varying severity. The following criteria were taken into account when forming patient groups: type of bite, absence of foci of chronic infection in the body, absence of multiple lesions of hard dental tissues, depth of periodontal pocket. During the examination, attention was paid to the shape of the dental arch, the inclination of the crowns of the teeth in the anterior region, the location of individual teeth, occlusion, the state of the oral vestibule (places of attachment of the transitional fold, depth, presence of gingival recession). Among the pathological conditions that interfere with splinting, the following were identified: traumatic occlusion (95.7%), anomalies in the location of individual teeth, fan-shaped tooth separation, crowded teeth (73.5%), pathology of the oral vestibule (46.7%), and the third degree of tooth mobility. These pathological conditions required preliminary orthodontic preparation or surgical treatment. The predominant complaints in periodontal tissue diseases were gum bleeding when brushing teeth (82.7%), tooth mobility of varying degrees (80.2%), bad breath (40.7%), and tooth bleeding when eating (30.8%). Oral hygiene was not maintained by 45.6% of the surveyed. The pathology of the attachment of the transitional fold of the oral cavity was detected in 46.7% of patients, that is, almost half of the examined. Abnormalities of the position of individual teeth were found in 73.5% of the examined. Traumatic occlusion was detected in 95.7% of the subjects.

Changes in Tooth Mobility and Position in an Established Dentition Following Placement of a New Restoration.

The aim of this study is to examine and evaluate physiologic tooth mobility and movement in different groups of patients. Four groups of patients were examined and recordings were taken. Group A1 consisted of 12 undergraduate students under the age of 30, A2 consisted of 11 members of staff over the age of 30 and A3 consisted of 9 patients with periodontal disease between the ages of 40-65 years old. The fourth Group B, 14 patients between 30-70 years old, received single-tooth restorations and recordings were taken immediately after, a month and four months following the cementation of the restoration. Patients in the first 3 groups showed no significant change in tooth mobility and movement between appointments. The fourth group demonstrated a non-statistically significant increase in tooth mobility following the cementation of the restoration due to the force applied on the occlusal surface of the tooth during the cementation process, while tooth movement was not observed beyond that of physiological tooth migration. Regardless of the age or the restorations a patient receives over the years, with careful occlusal consideration, no significant changes in tooth mobility and movement should be observed.

Digital workflow for periodontal splinting with a guided device.

OBJECTIVE: To detail a technique for bonding periodontal splint precisely in a digital workflow. CLINICAL CONSIDERATIONS: Periodontal splinting can be considered to stabilize the mobile teeth, especially for mandibular anterior teeth. Reliable bonding of periodontal splints is a prerequisite for successful clinical performance. However, when bonding the indirect splint to place or making direct splint intraorally, there is a significant risk of mobile teeth drifting away from the splint. To guide accurate insertion of periodontal splint with no risk of displacement of mobile teeth, a guide device fabricated by digital workflow is introduced in this article. CONCLUSIONS: Periodontal compromised teeth can be provisionally fixed during splinting, with the help of the guided device, and precise bonding of the splint is readily accomplished by using such digital workflow. This technique is not only applicable to the lingual splints, but also suitable for the labial ones. CLINICAL SIGNIFICANCE: The use of a guided device, after being digitally designed and fabricated, enables to stabilize the mobile teeth, in case of any displacement during splinting. It is straightforward, and beneficial to reduce the risk of complications, such as debonding of the splint, and secondary occlusal trauma.

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.

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.

A digital technique for splinting periodontally compromised mobile teeth in the mandibular anterior region.

A digital technique for fabricating a periodontal splint is presented. The lingual surface of periodontally compromised mandibular anterior teeth is captured and registered to form the emergence profile of the periodontal splint. An accurate periodontal splint is fabricated for mandibular anterior teeth with increased mobility after scaling and root planing.

Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática / Eficácia Clínica da MTA em Pulpotomias Pediátricas de Pacientes: Uma Revisão Sistemática / Clinical Efficacy of MTA in Pediatric Patient Pulpotomies: A Systematic Review

Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

Mobility to Stability-Journey of a Hopeless Tooth.

The impact of implant dentistry is such that, today, very few dentists think about saving grade III mobile teeth with recurrent periodontal abscess. This case report presents the management of grade III mobile lower anterior teeth with recurrent periodontal abscess. Treatment included SRP, splinting of the lower anterior teeth using wire and composite, RCT of the lower anterior teeth, periodontal flap surgery, and placement of bone graft and PRF. A patient was evaluated at one week and then every three months up to one year. Clinical examination showed reduction in mobility, resolution of inflammation, and abscess; radiographic examination showed bone fill.

Evaluation and comparison of stress distribution around periodontally compromised mobile teeth splinted with different materials: Three-dimensional finite element analysis.

BACKGROUND: Progressive attachment loss around the teeth because of periodontal disease can result in increased tooth mobility. This adversely affects patient's comfort, function, and esthetics. Periodontal splinting helps in accomplishing stability by redistributing the functional and parafunctional forces. There are various materials that have been used for periodontal splinting. Fiber-reinforced composite, composite resin, and metal-reinforced composite are often used as splinting materials for periodontally compromised teeth. In our study, a comparison was done among these materials for their ability to distribute the stresses at different bone levels in mobile lower incisors splinted together with canines. MATERIALS AND METHODS: Five patients of age group 25-50 years with Grade 2 and 3 mobile incisors having 40% or more bone loss and firm canines with optimal bone support were selected. From the computed tomography scan of each patient, three models were developed demonstrating splinting of mandibular incisors and canines with metal-reinforced composite, fiber-reinforced composite, and composite resin. So in total, 15 models were developed and each one of them was subjected to vertical and transverse loads of 150 N. Pattern of stress distribution was observed in these models using three-dimensional finite element analysis. RESULTS: After splinting, the stress on the canine increased when bone levels around incisors decreased while stress on incisors reduced. CONCLUSION: Tested splinting materials were successful in stress distribution, and metal-reinforced composite was found to be better than the other splinting materials.

Reattachment of complex fractures; a reality by advances in self-etch bonding systems.

An 18-year-old female patient reported to the Department of Conservative and Endodontics with the chief complaint of fractured tooth with respect to 21 and increased pain and mobility tooth with respect to 22. Intraoral periapical radiograph of 21 revealed coronal loss of tooth structure involving enamel, dentin, and pulp, suggestive of split tooth with respect to 21. Intraoral examination revealed a fracture of coronal structure of 22 and increased mobility in the coronal aspect, suggestive of horizontal crown-root fracture. For management of 21, after endodontic phase, placement of fiberpost, and coronal buildup, intentional reimplantation was done to expose and reattach the vertically fractured root fragment. For management of 22, after endodontic phase, crown lengthening was done, and the fractured fragment was reattached by making it a Natural Richmond's Crown. Radiographs revealed a complete sealing of the fractured fragment and proper positioning of the tooth.

Effect of incisal loading during orthodontic treatment in adults: A randomized control trial.

OBJECTIVE: To measure the changes in tooth mobility, alveolar bone, and receptor activator of nuclear factor kappa-B ligand (RANKL)/osteoprotegerin (OPG) in the gingival crevicular fluid (GCF) during orthodontic treatment to regain incisal function in the presence and absence of biting exercises. MATERIALS AND METHODS: Thirty-six females (42.3 ± 6.5 years old) with periodontally compromised upper incisors received orthodontic treatment to obtain ideal incisor relationships. Eighteen subjects in the experimental biting exercise group were instructed to bite a soft plastic roll for 5 min/d; the 18 control subjects were not given plastic rolls. Alveolar bone thickness, height, and density around the upper incisors were assessed at three root levels using cone-beam computed tomography. GCF was collected at the labial and palatal sites of the upper incisors at pretreatment (T0), end of treatment (T1), 1 month after T1 (T2), and 7 months after T1 (T3). RANKL/OPG was determined using enzyme-linked immunosorbent assays. RESULTS: Labial and palatal bone thickness significantly increased (>twofold) from T1 to T3 in the experimental group at all three root levels (all P < .05). Bone thickness correlated negatively with RANKL/OPG ratio between T1 and T2 ( P < .05). Tooth mobility, bone height, and density were not significantly different between T1 and T3. CONCLUSIONS: Biting exercises significantly increased bone thickness but did not affect tooth mobility, bone height, or density. The RANKL/OPG ratio decreased 1 month after treatment (T2) and correlated with increased bone thickness. ( ClinicalTrials.in.th TCTR20170625001).

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.

Un nuevo recurso para generar expansión transversal en los maxilares / A new resource to generate transversalexpansion in the jaws

La filosofía de la bioadaptación transversal de los maxilares preconiza una nueva forma de generar crecimiento a nivel de los tejidos dento alveolares, a través de una mecánica ortodoncia biológicamente más segura a la hora de realizar expansión transversal. El principio básico de esta filosofía no es soloel uso de brackets autoligantes, ni marcas comerciales específicas, ya que puede utilizarse cualquiera de ellas; se trata de no generar daños colaterales denominados “costos biológicos”, frecuentemente ligados a fuerzas excesivas. Se pretende proporcionar una menor fricción entre bracket y arco, reduciendo así el uso de aparatos auxiliares y el tiempo de tratamiento, aprovechando los beneficios de cada componente. Para generar el crecimiento transversal del maxilar es fundamental el uso de gomas intermaxilares, teniendo como tutores a los segundos molares superiores que son los menos afectados por las disfunciones. Podemos decir que después del correcto estímulo de una fuerza que inicie el proceso de desequilibrio y consecuente respuesta tisular, las fuerzas naturales de la musculatura oral, más las existentes en el sistema de brackets, serán suficientes para definir la necesaria bioadaptación dentoalveolar individual del paciente.

The transverse bioadaptation philosophy of the jaws advocates a new way of generating growth at thelevel of dentoalveolar tissues, through a biologically safer orthodontic mechanics when carrying outtransversal expansion. The basic principle of this philosophy is not only the use of self-ligating bracketsor specific trademarks, since any of them can be used, but also not to generate collateral damagescalled "biological costs" frequently due to excessive forces. Aiming at providing less friction betweenbracket and bow, thus reducing the use of auxiliary appliances and treatment time, taking advantageof the benefits of each component. In order to generate maxilla transversal growth the use ofintermaxillary gums is fundamental, having as tutor the upper second molars that are the least affectedby the dysfunctions. It can be stated that after the correct stimulus of a force that initiates the process of imbalance and consequent tissue response, the natural forces of the oral musculature plus thoseexisting in the bracket system will be sufficient to define the necessary individual dento alveolar bioadaptation of the patient.

Periodontal Regenerative Therapy in Patient with Chronic Periodontitis and Type 2 Diabetes Mellitus: A Case Report.

We report a case of generalized chronic periodontitis and type 2 diabetes mellitus requiring periodontal treatment including regenerative therapy. The patient was a 66-year-old man who presented with the chief complaint of gingival inflammation and mobile teeth in the molar region. He had been being treated for type 2 diabetes mellitus since 1999. His glycated hemoglobin (HbA1c) level was 7.8%. An initial examination revealed sites with a probing depth of ≥7 mm in the molar region, and radiography revealed angular bone defects in this area. Based on a clinical diagnosis of generalized chronic periodontitis, the patient underwent initial periodontal therapy. An improvement was observed in periodontal conditions on reevaluation, and his HbA1c level showed a reduction to 6.9%. Periodontal regenerative therapy with enamel matrix derivative was then performed on #16, 26, and 27. Following another reevaluation, a removable partial denture was fabricated for #47 and the patient placed on supportive periodontal therapy (SPT). To date, periodontal conditions have remained stable and the patient's HbA1c level has increased to 7.5% during SPT. The results show the importance of collaboration between dentist and physician in managing periodontal and diabetic conditions in such patients.

An Effective Technique for Minor Rotation Correction.

INTRODUCTION: Although ratated teeth are easier to correct and difficult to retain, sometimes they pose a great challenge to the clinician. Play between the arch wire and the bracket slot, and the method of ligation affect full correction of rotation. Various techniques have been described for correction of rotation, but this paper describes a simpler approach with resilient arch wire, elastic module, and metallic ligature wire. TECHNIQUE: The effective correction of rotation is achieved with figure-8 tie in one of the wings under the resilient archwire which is further ligated to the bracket in the other wing giving wedging effect correcting minor rotations easily with over-correction. DISCUSSION: This technique is easy to apply in day-to-day clinicalpractice without any extra inventories.