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Dental Research: Periodontal Findings
With so many facets of dentistry that the general dentist must attempt to keep up with, I thought that these occasional perio updates would make your life easier. Summaries get right to the point!
What about the accuracy of bone height measurements using panoramic radiographs?
A recent all-encompassing study was undertaken to quantify angulation and position of the edentulous mandible with regard to persistent allegations of distortion in panoramic radiographs.
It was found that bone density measurements between proposed implants are not accurately demonstrated by the panograph and the distortion is even more severe in the totally edentulous patient. Therefore, the panograph was found not to be a reliable technique for diagnosis and evaluation of the edentulous mandible unless meticulous precautions are taken for absolute reproducible positioning on the apparatus.
The Most Accurate Method of Assessing Periodontal Bone Destruction Using Conventional Radiography Techniques
Several thousand proximal bone surfaces were examined during periodontal flap surgery and also radiographically utilizing periapical and panoramic radiography.
Interestingly, periapical X-ray assessment of bone destruction underestimated the actual destruction in early periodontitis, was relatively accurate in moderate periodontitis but significantly overestimated the level of destruction in severe cases. However, panographic radiography underestimated bone destruction in all levels. Periapicals, while still not the final word in periodontal diagnosis, are still the method of choice in corroborating periodontal lesions.
Comparison of the Effectiveness of Either Popular or Special Orthodontic Toothbrushes in Patients With Orthodontic Fixed Appliances
This study was undertaken as to whether orthodontic tooth brushes were superior to classical toothbrushes in the maintenance of periodontal health through the elimination of microbial dental plaque on teeth with orthodontic brackets. The results revealed no statistically significant difference in the plaque index, sulcus bleeding index and periodontal pocket depths. So it appears that method and determination is most important.
Reproducibility of Periodontal Probing Using a Conventional Manual and Automated Force Controlled Electronic Probe
This study compared the efficacy of both types of probes and while there are multiple electronic probing devices available to the clinician today, it was found that such devices failed to offer significant advantage over the conventional manual probe.
The Feasibility and Reliability of Using Commercial Home Screening Tests to Detect Gingival Inflammation
Health device manufacturers are constantly searching for methods to provide an accurate assessment in the diagnosis or prediction of disease. In utilizing 50 patients from the clinic at University of Kentucky, the authors concluded that such commercial screening devices are strictly a screening tool and not a diagnostic aide, and patients who do test negative should still continue to be seen on recall visits where periodontal status can be accurately determined using more sophisticated diagnostic aides.
The Importance of Periodontal Maintenance for the Dental Implant
A study of various oral hygiene instruments found that the interdental brush, plastic scaler and prophylactic cup all left the implant surface smooth, whereas the surface was severely roughened by ultrasonics and metal curettes. It is not unusual for a patient to resist proper oral hygiene in the implant areas for obvious reasons, however, it is that soft tissue attachment to the implant which needs special care, for it is the first line of defense against the infiltration of pathogenic bacteria.
Some of the more effective means of maintaining the important soft tissue around the implant would be the use of Peridex® or Listerine® mouthwashes and utilizing interdental brushes or rotary untufted brushes as mentioned above.
Relationship of Cigarette Smoking to Intraoral Wound Healing
It is well documented that in all forms, cigarette smoking produces irritation and deleterious effects in the human body, and in a recent study comparing smokers versus non-smokers, 80 percent of the smokers showed significant healing impairment in oral surgical procedures. Only 10 percent of the non-smokers showed slower healing. Cigarette smoking, therefore, is a potentially controllable risk factor strongly associated with problem wounds in these studies.
Comparison of the Antimicrobial Effect of the Application of Chlorhexidine Gel, Amine Fluoride Gel, and Stannous Fluoride Gel in Debrided Periodontal Pockets
While both the general and specialist dentists are bombarded by claims and counterclaims regarding the above or variations, this exhausted study was conducted to compare the medicinals, and the authors concluded that a thorough root planing alone gives optimum results.
Effects of Electrical Stimulation on Osteogenesis and Alveolar Bone
It has been well documented in medical orthopedics that electrical stimulation has induced bone regeneration in both arthroses and non-union fractures. This study demonstrated that similar applications and periodontal defect models did also enhance alveolar and cementum regeneration. Additionally, in the presence of bone replacement grafts, such bone regeneration procedures are even further enhanced. Further studies showed promise in providing information for clinical use in the future.
Keeping Failure Factors to a Minimum in Extensive Restorative Treatment
In order to arrive at a sound treatment plan, a) obtain a detailed history, b) evaluate the health and supporting strength of the dentition. It is important to note that multiple abutments generally provide best support and longevity as long as abutments have been treated periodontally and provide for physiological contours and ease of hygiene. Proper TMJ positioning is of great importance before starting extensive reconstruction.
Survival of Fixed Implant Supported Prosthetics Related to Cantilever Lengths
Although various lengths of cantilevers have been recommended in the literature, presently, there is no scientific evidence available to create specific standards. The authors of the latest study after a seven-year anaylsis, show that cantilevers that are less than 15 mm from their attached sources have a better survival than those that are longer.
A Forty Year Study on the Survival Rate of Periodontally Questionable Teeth
The study included 455 questionable teeth (e.g., excessive bone loss, furcation problems) over a 40 year period in 166 patients in a private periodontal practice study and revealed that only 12 percent of the teeth were lost with an average survival rate of 8.8 years prior to extraction. No teeth were lost in the first two years of observation. While there are many barriers to long term prognosis of severely involved teeth, this long term study demonstrates that teeth without bone loss are not automatically condemned since 88 percent of the teeth have survived over the many years. Competent maintenance and patient compliance in recall attendance had played a major role.
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