Does occlusal splint affect posture? A randomized controlled trial

ABSTRACT

Objective

The aim of this study was to evaluate the effect of an occlusal splint on body posture of intra-articular temporomandibular joint (TMJ) disorders patients.     

The papilla amplification flap for the treatment of a localized periodontal defect associated with a palatal groove

BACKGROUND: Teeth with a palatal groove often present with severe localized periodontal attachment loss including pocket formation and alveolar bone loss. The aim of the present case report was to describe the regenerative surgical treatment of periodontal and bone lesions associated with the subgingival extension of a palatal groove affecting a maxillary lateral incisor. METHODS: The left maxillary lateral incisor of a systemically healthy young subject presented with a palatal probing depth of 10 mm with no gingival recession at the buccal and palatal surfaces; the neighboring interdental papillae were intact. The radiograph showed a radiolucency area distal to the affected tooth. Treatment procedures consisted of: 1) the papilla amplification flap with the use of enamel matrix proteins as the regenerative periodontal material; 2) the elimination/flattening of the radicular portion of the palatal groove; and 3) the sealing of the coronal portion of the groove with composite flow. RESULTS: The clinical examination at 1 year revealed a clinical attachment gain (8 mm) with a shallow residual probing depth (2 mm) and no increase in gingival recession. The radiographic examination showed the complete disappearance of the radiolucency area suggesting bone fill. CONCLUSIONS: The present study indicated that localized periodontal defects associated with a palatal groove can be successfully treated by means of the papilla amplification flap with the use of enamel matrix protein as the regenerative material. The long-term stability of such successful results needs to be determined.     

Alveolar ridge dimensions in maxillary posterior sextants: a retrospective comparative study of dentate and edentulous sites using computerized tomography data

Aim: To compare the alveolar ridge dimensions between edentulous sites and contralateral dentate sites of maxillary posterior sextants in the same individuals. Materials and methods: Computerized tomography scans of 32 patients with one fully edentulous and one fully dentate maxillary posterior sextants were analyzed. Results: When compared with dentate sextants, edentulous sextants showed (i) a lower bone height (BH) at second premolar, first molar and second molar sites, which was associated with a more coronal position of the maxillary sinus floor at second premolar site; (ii) a more apical position of the ridge at second premolar and second molar sites; (iii) a lower bone width (BW)_{1 mm} at first and second premolar sites, and a lower BW_{3 mm} at all sites, (iv) a lower, although not significant, prevalence of premolar and molar sites with BH≥8 mm and BW_{1 mm}≥6 mm. Conclusions: The edentulous sextants in the posterior maxilla showed a reduced height and width of the ridge when compared with contralateral dentate sextants. The reduced vertical dimensions observed in edentulous sextants were variably associated with ridge resorption as well as sinus pneumatization. To cite this article:
Farina R, Pramstraller M, Franceschetti G, Pramstraller C, Trombelli L. Alveolar ridge dimensions in maxillary posterior sextants: a retrospective comparative study of dentate and edentulous sites using computerized tomography data.
Clin. Oral Impl. Res. 22 , 2011; 1138–1144.
doi: 10.1111/j.1600‐0501.2010.02087.x     

Effect of pre-cure temperature on the bonding potential of self-etch and self-adhesive resin cements.

OBJECTIVES: To assess whether the pre-cure temperature of resin cements significantly influenced the bonding potential to dentin. METHODS: Forty extracted molars were randomly divided into 8 groups (n=5): Groups (1-4) RelyX Unicem (RU, 3 M ESPE) and Groups (5-8) Panavia F 2.0 (PF, Kuraray Co.), at pre-cure temperatures of 4, 24, 37, and 60 degrees C, respectively. Cements were used in dual-cure mode for luting composite overlays (Paradigm MZ100, 3 M ESPE) to dentin. Microtensile bond strength testing and scanning electron microscope (SEM) observations of cement-dentin interfaces were performed. RESULTS: Group 4 had to be eliminated as RU at 60 degrees C underwent such an accelerated curing that was already set at the time of dispensing. The bond strengths (MPa) measured at refrigerator, room, and intraoral temperature were, respectively: RU 5.4+/-1.7, 11.4+/-6.1, 10.6+/-4.2; PF 7.4+/-3.7, 13.9+/-6.2, 12+/-5.2. The statistical analysis revealed that both luting agents developed a significantly weaker adhesion when used at refrigerator temperature (p<0.05). No statistically significant differences in bond strength were recorded when either cement was used at 24 or 37 degrees C (p>0.05). Pre-heating of PF to 60 degrees C resulted in a significant increase in bond strength (20.7+/-9.4 MPa; p<0.05). SEM observations disclosed an enhanced potential of PF to form a hybrid layer as the temperature increased over 4 degrees C. RU exhibited a less porous and more homogeneous layer at intraoral than at refrigerated temperature. SIGNIFICANCE: It is advisable to let refrigerator-stored resin cements warm up to at least room temperature prior to clinical use. Pre-heating to 60 degrees C enhances the bonding potential of PF.     

Osseous resective surgery: long-term case report

This case report evaluated the long-term effects of osseous resective therapy in the treatment of a patient with moderately advanced periodontal disease. In 1984, the patient underwent initial therapy followed by a periodontal surgical phase consisting of osseous recontouring with an apically positioned flap. After 20 years, in 2003, the patient presented with a traumatic complication. An exploratory surgery revealed a fracture on the roof of the pulp chamber on the maxillary left first molar. The buccal roots were resected, preserving the palatal root, and a reevaluation of the long-term outcome of osseous resective surgery was performed. It is suggested that the positive treatment result is the consequence of the reestablishment of tissue morphology favorable for oral hygiene and plaque control by the patient.     

Efficacy of bisphosphonates for the control of alveolar bone loss in periodontitis

Periodontal disease is characterized by periodontal bone loss. For this reason, we conducted a study to test the effect of alendronate (ALN), an inhibitor of bone resorption, on alveolar bone mass. A total of 335 patients with periodontal disease (men = 162, women = 173), aged 30 to 79, were randomized to either placebo or ALN 70 mg once weekly. All patients received prophylaxis at baseline, and at 6, 12, and 18 months. Smokers accounted for 62% of patients, and 71% of the patients had severe periodontal disease. The primary efficacy endpoint was the change in alveolar bone loss (ABL). When all subjects were analyzed, 2 years of treatment with alendronate 70 mg once weekly did not significantly change either ABL or alveolar bone density (ABD) relative to placebo. However, in the subgroup of patients with low mandibular bone mineral density (BMD) at baseline, alendronate significantly reduced bone loss relative to placebo (p < 0.01). No such effect was seen in patients with normal baseline mandibular BMD. The overall and upper gastrointestinal safety and tolerability profile of alendronate after 2 years of treatment was very favorable compared to placebo. No cases of osteonecrosis of the jaw were observed. In summary, in patients with periodontal disease receiving prophylaxis, alendronate 70 mg once weekly was well tolerated, but did not have a detectable effect on alveolar bone loss, except in those patients with low mandibular BMD at baseline.     

Five-year changes in periodontal parameters after apical surgery

Introduction

Most clinical studies on the outcome of apical surgery concentrate on periapical healing based on radiographic and clinical characteristics (signs and symptoms). This study focuses on long-term changes in periodontal parameters after apical surgery.

Methods

Periodontal parameters (ie, probing depth [PD], level of gingival margin [GM], and calculated clinical attachment level [CAL]) were collected at baseline and at 1 and 5 years after apical surgery. Changes in PD, GM, and CAL were calculated over time and were also evaluated in relation to patient-, tooth-, and treatment-related covariables.

Results

One hundred eighty-six of 242 initially identified teeth could be evaluated. Significant changes in GM and CAL were observed at facial sites during the first year after surgery (mean recession of GM was 0.29 mm, mean CAL loss was 0.20 mm), but none of the periodontal parameters significantly changed between 1 and 5 years after apical surgery. With regard to covariables, the type of incision technique was found to be the major factor affecting changes in GM and CAL between baseline and 1 year after surgery. Age, smoking, and type of periapical healing were the variables influencing the periodontal parameters over the longer observation period of up to 5 years.

Conclusions

Patients should be informed about possible changes in periodontal parameters (gingival recession and loss of attachment) after apical surgery. The surgery itself appears to account for changes observed during the first year, whereas patient- and healing-related factors seem to affect periodontal changes seen thereafter.     

Dry mouth as an initial sign of food-borne botulism: a case report and review of the literature

Botulism is a rare neuroparalytic disease caused by a potent neurotoxin produced by Clostridium botulinum. There are different clinical types of botulism. Early diagnosis of the condition is essential for effective treatment. We report a case of food-borne botulism in identical twins characterized by severe initial oral involvement and a review of the literature about the condition.     

Immediate implant placement with transmucosal healing in areas of aesthetic priority. A multicentre randomized-controlled clinical trial I. Surgical outcomes

OBJECTIVES: To compare the clinical outcomes of standard, cylindrical, screw-shaped to novel tapered, transmucosal (Straumann Dental implants immediately placed into extraction sockets. Material and methods: In this randomized-controlled clinical trial, outcomes were evaluated over a 3-year observation period. This report deals with the need for bone augmentation, healing events, implant stability and patient-centred outcomes up to 3 months only. Nine centres contributed a total of 208 immediate implant placements. All surgical and post-surgical procedures and the evaluation parameters were discussed with representatives of all centres during a calibration meeting. Following careful luxation of the designated tooth, allocation of the devices was randomly performed by a central study registrar. The allocated SLA titanium implant was installed at the bottom or in the palatal wall of the extraction socket until primary stability was reached. If the extraction socket was >or=1 mm larger than the implant, guided bone regeneration was performed simultaneously (Bio Oss and BioGide. The flaps were then sutured. During non-submerged transmucosal healing, everything was done to prevent infection. At surgery, the need for augmentation and the degree of wound closure was verified. Implant stability was assessed clinically and by means of resonance frequency analysis (RFA) at surgery and after 3 months. Wound healing was evaluated after 1, 2, 6 and 12 weeks post-operatively. RESULTS: The demographic data did not show any differences between the patients receiving either standard cylindrical or tapered implants. All implants yielded uneventful healing with 15% wound dehiscences after 1 week. After 2 weeks, 93%, after 6 weeks 96%, and after 12 weeks 100% of the flaps were closed. Ninety percent of both implant designs required bone augmentation. Immediately after implantation, RFA values were 55.8 and 56.7 and at 3 months 59.4 and 61.1 for cylindrical and tapered implants, respectively. Patient-centred outcomes did not differ between the two implant designs. However, a clear preference of the surgeon's perception for the appropriateness of the novel-tapered implant was evident. CONCLUSIONS: This RCT has demonstrated that tapered or standard cylindrical implants yielded clinically equivalent short-term outcomes after immediate implant placement into the extraction socket.     

GTR treatment of intrabony defects in patients with early-onset and chronic adult periodontitis

Young, systemically healthy subjects may suffer from early-onset forms of periodontitis characterized by the presence of localized deep vertical bony defects. The aim of this study was to compare the healing response after guided tissue regeneration (GTR) treatment of similar intrabony defects in patients affected by early-onset and chronic adult periodontitis. Twenty systemically healthy, nonsmoking subjects were enrolled in the study; 10 were affected by early-onset periodontitis (EOP) and 10 by chronic adult periodontitis (CAP). In each subject, only one deep vertical bony defect (intrabony component > 4 mm, probing attachment level > or = 8 mm) was treated according to the principles of GTR therapy with titanium-reinforced e-PTFE membranes. At the time of the surgery and at the 1-year follow-up, a microbiologic test for the identification of the main periodontopathogens was performed in each of the treated sites. There was no statistically significant difference at 1 year in the amount of clinical attachment gain (P = .4), reduction of probing pocket depth (P = .3), or increase in gingival recession (P = 1.0) between EOP and CAP patients. The 1-year microbiologic results demonstrated the complete disappearance of the putative periodontopathogens from all surgically treated sites in both patient groups. The results of the study demonstrated that deep intrabony defects in patients with EOP can be successfully treated by means of GTR procedures and that the suppression of periodontopathogens under threshold values can be maintained for at least 1 year, provided that the patient is enrolled in a maintenance program consisting of recalls for professional tooth cleaning and reinforcement of self-performed oral hygiene measures at 1-month intervals.