Granulocyte elastase in gingival crevicular fluid: improved monitoring of the site-specific response to treatment in patients with destructive periodontitis

Abstract In 13 patients with severe destructive periodontitis. the response to periodontal therapy was estimated by granulocyte elastase level in gingival crevicular fluid (GCF). 62 sites were classified according to changes of probing depths (PD) and quantitative bone height (BH%) before and after 5–year regular maintenance treatment: (i) 17 consistently healthy sites with no changes of PD and BH%; (ii) 6 initially healthy sites with deterioration in PD and BH%; (iii) 14 diseased sites with improvement in PD and BH%; (iv) 25 diseased sites with no improvement in PD and BH%. GCF was collected by an intracrevicular washing system. The released elastase in the supernatants (EA-S) and the cell-bound elastase in the pellets (EA-P) were determined with a low molecular weight substrate specific for granulocyte elastase. The ratio of EA-S and EA-P (S/P-ratio) was used as a relative measure of elastase released by the granulocytes present. The sites classified as diseased with no improvement or initially healthy but deteriorating, had significantly higher EA-S, EA-P and S/P-ratios than the consistently healthy sites or diseased but improving sites (p < 0.01). Both EA-S and S/P-ratio showed strongly positive correlations with the current levels of gingival inflammation and periodontal destruction (p < 0.001). The present study suggests that increased elastase level is associated with disease progression, and may be used to monitor the response to longitudinal maintenance therapy.     

Retrograde root filling with composite and a dentin-bonding agent. 1

Abstract A method is described, by which retrograde root filling with a composite resin can be performed. The cavity design is a slightly concave dissection of the apical part of the root, which is treated with the bonding agent Gluma followed by an application of Retroplast. Retroplast is a chemically curable composite containing silver for radiopacity and aerosil to obtain a suitable consistency. Endodontically treated teeth with a eugenol-containing root canal sealer did not affect the strength of the bond between Retroplast and apical dentin. A tight seal between the composite and the cavity surface was observed by light and SEM microscopy, and histology of tissue surrounding fillings placed in monkeys revealed absence of inflammatory cells around the filling and a close contact between filling and fibro-blasts with collagenous fibers. In some cases, cementum and Sharpey's fibers formed in contact with the filling. Fillings placed in humans performed successfully in most cases, and the main causes of failure were either inadequate hemostasis during filling, or root fracture unnoticed by the time of filling. The retrograde technique promises a new treatment principle, with a root canal effectively sealed and the periapical ligament restored after apicoectomy.     

Autogenous bone graft in conjunction with enamel matrix derivative in the treatment of deep periodontal intra-osseous defects: a report of 13 consecutively treated patients

AIM: The purpose of the present study was to investigate the effectiveness of a regenerative procedure based on supra-crestal soft tissue preservation in association with combined autogenous bone (AB) graft/enamel matrix derivative (EMD) application in the treatment of deep periodontal intra-osseous defects. METHODS: Thirteen consecutively treated patients, seven females and six males, aged 30-65 years, three smokers, were included. A total of 15 deep, one- to two-wall intra-osseous defects were selected. Immediately before surgery and 6 months after surgery, pocket probing depth (PPD), clinical attachment level (CAL), and gingival recession (REC) were recorded. RESULTS: PPD amounted to 9.4+/-1.8 mm before surgery, and decreased to 4.7+/-1.2 mm post-surgery (p<0.0000). CAL varied from 10.5+/-2.0 mm pre-surgery to 6.2+/-1.7 mm post-surgery (p<0.0000), with CAL gain averaging 4.3+/-1.4 mm. Fourteen (93.3%) defects presented CAL gain >/=3 mm. REC change was 0.4+/-0.7 mm. CONCLUSIONS: Results from the present study indicated that a regenerative procedure based on supra-crestal soft tissue preservation and combined AB/EMD treatment leads to a clinically and statistically significant improvement of soft tissue conditions of deep periodontal intra-osseous defects.     

Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need

The purpose of this study was to investigate the dental health behavior and self-perceived dental treatment need, in relation to depressive symptoms and symptoms of anxiety, among a general population drawn from a sample of 31-yr-old-men and women born in Northern Finland in 1966 (n = 8463). The dental health behavior included toothbrushing frequency and the frequency of dental check-ups. Depressive symptoms, as well as symptoms of anxiety, were determined on the basis of the Symptom Checklist-25 (SCL-25). The participants were also asked about their education and family income. Subjects with a high number of depressive symptoms had lower toothbrushing frequency as well as a lower frequency of dental visits than subjects with no or only a few depressive symptoms. Morover, the self-perceived dental treatment need was more common among those with a high number of depressive symptoms. Symptoms of anxiety were significantly associated with lower toothbrushing frequency. The results support the view that there is an increased risk for impaired dental health among subjects with depressive symptoms or symptoms of anxiety.     

Preferences of dental care providers in maintaining compromised teeth in relation to their professional status: implants instead of periodontally involved maxillary molars?

Aim: The purpose of this study was to evaluate the dentists' decision making in the maxillary molar region to find out how it is influenced by general practitioners' and specialists' characteristics as well as by the external evidence. Material and methods: A questionnaire was developed containing clinical cases and statements to assess practitioners' opinions on the treatment of periodontally involved maxillary molars and implant therapy with sinus grafting. Data were analysed with respect to the dentists' age and speciality. Results: Three hundred and forty questionnaires were evaluated (24% from universities, 76% from educational courses, overall response rate 35.1%). Forty six per cent of all participants indicated they had specialised, 52% placed dental implants, while 33% performed sinus grafting and 64% periodontal surgeries. Forty six per cent were against or were indecisive about having sinus grafting performed on themselves. The treatment proposals given for the clinical cases revealed a preference among older dentists and general practitioners for regenerative treatments even when these were not evidence based in through‐and‐through furcation involvements. Resective therapies were most often selected by periodontists. Prosthodontists tended to prefer more invasive treatment options with extractions and augmentations. More experienced general practitioners favoured conventional fixed dental prostheses in free‐end situations or no treatment rather than the complicated augmentation procedures, which were preferred by younger dentists. Conclusions: Implant placement seems to be widely accepted by almost all subjects, who may either place implants themselves or refer patients. More information seems to be needed on the indications for regenerative therapies for furcation involved maxillary molars, and guidelines required for decision making in complex clinical situations. To cite this article:
Zitzmann NU, Scherrer SS, Weiger R, Lang NP, Walter C. Preferences of dental care providers in maintaining compromised teeth in relation to their professional status: implants instead of periodontally involved maxillary molars?.
Clin. Oral Impl. Res. 22 , 2011; 143–150.
doi: 10.1111/j.1600‐0501.2010.02062.x     

盐酸米诺环素复合明胶海绵治疗干槽症的临床研究

目的:比较盐酸米诺环素复合明胶海绵与碘仿纱条治疗干槽症的疗效。方法:58例确诊为干槽症的患者经常规清创后,随机均分为2组。实验组牙槽窝内置入盐酸米诺环素复合明胶海绵;对照组填塞碘仿纱条,随访比较其疗效。结果:组间比较[实验组/对照组:优(例)23/16;良(例)6/11;可(例)0/2],Kruskal-Wallis检验法检验,疗效评价等级为"优"的实验组病例数多于对照组(P<0.05)。结论:盐酸米诺环素复合明胶海绵对干槽症的疗效优于碘仿纱条。     

口腔颌面部创伤诊治专家系统知识库和推理机的开发

目的:开发适用于口腔颌面部创伤辅助诊断治疗专家系统的知识库和推理机。方法:利用PentiumⅣ2.0G的微机,激光打印机,刻录光盘等硬件,在WindowsXP的操作平台下,采用Visualbasic6.0编程语言和access数据库开发系统应用程序。结果:本系统的知识库规则制定完善,推理机能够进行快速、准确的诊断并提供规范的治疗方案。同时可以对病历资料进行科学的管理和查询。结论:知识库和推理机是专家系统的核心部分,它们的完整性和逻辑性直接关系整个系统的准确性和效率。     

Outcomes of endodontic micro-resurgery: a prospective clinical study

Introduction

This study examined the outcomes of endodontic resurgery by using current microsurgery techniques on failed teeth with previous endodontic surgery. Another goal was to determine any significant outcome predictors of endodontic surgery by determining the causes of failure in the first endodontic surgery.

Methods

The data were collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and May 2009. All 54 teeth that required surgical retreatment were included in this study. All surgical procedures were performed by using an operating microscope and biocompatible root-end filling materials such as mineral trioxide aggregate (MTA) or Super EBA. The patients were recalled every 6 months for 2 years and every year thereafter to assess the clinical and radiographic signs of healing.

Results

The recall rate was 77.8% (42 of 54 patients). Of the 42 cases recalled, 39 cases were included in the success category, giving an overall success rate of 92.9%. The most common possible causes of failure were no root-end filling and incorrect root-end preparation.

Conclusions

The use of microsurgical techniques and biocompatible materials such as MTA and Super-EBA resulted in a high clinical success rate, even in endodontic resurgery.     

Determination of the Initial Apical Canal Diameter by the First File to Bind or Cone-beam Computed Tomographic Measurements Using Micro-computed Tomography as the Gold Standard: An Ex Vivo Study in Human Cadavers

Introduction

This study evaluated the accuracy and reliability of the tactile perception of the first apical binding file (FABF) and cone-beam computed tomographic (CBCT) imaging in estimating the canal diameter at the working length (WL).