Endodontic complications following periodontal and prosthetic treatment of patients with advanced periodontal disease

A retrospective analysis was carried out to determine the frequency and onset of endodontic complications occurring in 52 patients treated for advanced periodontal disease. Comparisons were made between teeth which, following periodontal treatment, were used as abutments in fixed prosthetic reconstructions and nonabutment teeth. The study included 672 teeth with initially vital pulps (255 abutment teeth and 417 nonabutment teeth). The observation period varied from 4 to 13 years with a mean of 8.7 years. Pulpal necrosis including periapical lesions developed with a significantly higher frequency in abutment teeth than in nonabutment teeth (15% vs. 3%). The majority of these lesions did not appear until several years following the completion of active treatment. Conceivable reasons for the development of pulpal necrosis in teeth subjected to combined periodontal and prosthetic treatment are discussed.     

Endodontic and periodontal treatment of dens invaginatus: Report of 2 clinical cases

Objectives, materials and methodsThe purpose of this work is to describe the treatment of two lateral incisors affected by developmental abnormalities (Oehlers, types I and II) treated respectively through periodontal regenerative therapy associated with conservative correction of shape anomaly, and orthograde retreatment.ResultsBoth therapies used resulted in complete remission of the initial symptoms and total healing of the lesions present.Conclusions“Dens invaginatus” is a dental development malformation that can predispose to the onset of caries, pulpal involvement and periodontal lesions, the treatment of which may require a specialized and often multidisciplinary approach. This malformation should therefore be recognized in time in order to establish effective prevention protocols, when possible, or prevent related consequences generating non-recoverable endodontic, periodontal or combined disease.     

Interdisciplinary treatment for the advanced periodontal and restorative case

While recent advances in implant therapy have expanded options for providing care, preserving the natural dentition in an optimal state of health, function, comfort, and esthetics remains a primary goal of dentistry. For patients with moderate to advanced periodontal disease, retention of the teeth through regenerative therapy has become a predictable form of treatment for many osseous defects. Periodontal therapy, including regenerative treatment, often can enhance restorative options by retaining key abutment teeth for fixed or removable partial dentures. A case involving regenerative and resective periodontal therapy as well as fixed prostheses is described.     

Autotransplantation of third molars as treatment in advanced periodontal disease

The aim of this study was to investigate the prognosis of replacing molars with advanced periodontitis by autotransplanted fully developed third molars. The patient sample consisted of 18 subjects, 24-58 years of age. The patients selected had at least 1 molar with advanced periodontal tissue destruction. After extraction of the diseased molar, autotransplantation of a third molar was immediately performed. After a splinting and healing period of 2-3 weeks, endodontic treatment was carried out. The follow-up included recordings of the clinical parameters, probing periodontal pocket depth, probing attachment level, percussion sound, and mobility. Radiographs were taken immediately after the surgical procedure, after 6 months, 1 year, and thereafter annually. The results of this study indicate that autotransplantation may be an alternative treatment procedure for molars with advanced periodontal disease.     

Soft tissue surgical procedures in treatment of advanced periodontal disease

Abstract — An attempt has been made to establish some basic principles underlying the proper handling of soft tissues in the surgical treatment of advanced periodontal disease. These elementary principles have been based on known or presumed histology.     

Costs of periodontal and prosthodontic treatment and evaluation of oral health in patients after treatment of advanced periodontal disease

Abstract Retrospective estimations of dental care costs of periodontal and prosthodontic treatment and evaluation of oral health in 37 patients with advanced periodontal disease were carried out. Measures of their subjective evaluation of oral health 7–10 yr after the treatment are presented as a health profile and as indices in single numbers. The relations between oral health as an index and the dimensions in the health profile are analyzed. Dental care costs for treatment in the mandible was SEK 35 550. for the maxilla SEK 45 380 and for both jaws SEK 74 230. After the treatment oral health as well as general health were in excess of 75 on a 0 to 100 scale. Chewing ability, comfort and aesthetics were the variables found to significantly affect the subjective oral health. Oral health in terms of periodontal and prosthodontic conditions was maintained over the observation period.     

Periodontal and prosthodontic treatment for patients with advanced periodontal disease

This article describes prosthetic management of advanced periodontally involved dentitions. Overall prognosis and means of assessing scores to prospective abutment teeth are presented. Esthetic treatment and prognosis of surgically elongated dentitions is discussed, and a method to determine what the patient will look like after completion of treatment is presented. A specific approach using ceramometal restorations with modified long bevel and minimum gold collar and the use of electrosurgery for subgingival access is covered.     

牙周牙髓联合治疗与单纯牙周治疗对重度牙周炎疗效的临床对比研究

目的 探索重度牙周炎牙齿的牙髓治疗时机及牙周牙髓联合治疗对重度牙周炎的疗效。方法 采用多中心研究方法,选择重度牙周炎患牙180颗,随机分为牙周牙髓联合治疗组（试验组）和单纯牙周治疗组（对照组）,各90颗患牙。对照组仅进行牙周治疗;试验组记录牙髓状态,行根管治疗及牙周治疗;两组分别在治疗前和治疗后1、3、6及12个月进行检查,记录临床指标。结果 试验组90颗患牙中,22颗牙髓完全坏死,45颗部分坏死（冠髓坏死或根髓部分坏死）,23颗为活髓。治疗前,对照组和试验组各项临床指标的差异均无统计学意义（P>0.05）;治疗后3个月,试验组和对照组的临床指标开始出现差异（P<0.05）。结论 牙髓活力迟钝的重度牙周炎患牙及时进行完善的牙髓治疗,可控制炎症的发展,有利于牙周组织的愈合。     

Experiences with guided tissue regeneration in the treatment of advanced periodontal disease

Abstract The aim of this study was to evaluate the predictability of guided tissue regeneration (GTR), using ePTFE-membranes (Gore-Tex®) in the treatment of advanced periodontal disease. The study presents long-term results for 88 teeth in 23 patients at least 9 months after membrane surgery. The periodontal lesions included severe horizontal and/or vertical bone loss. The bone level (BL and BL) and the tissue level (TL), a new parameter between cemento-enamel junction and coronal margin of the tissue in the defect, were recorded during surgery: immediately before application of the membrane (BL), after membrane removal (TL) and during a re-entry procedure (BL') 9 to 12 months later. The average tissue gain in the periodontal defect (BL-Tl) at membrane removal was 65.7% (p < 0.001) and the average gain in mineralized tissue at re-entry (BL-BL'), 30.4%, meaning more than 46% of the gained tissue at removal was mineralized at reentry. The decreased amount of mineralized tissue at re-entry in relation to the tissue gain at membrane removal might be due to formation of a so-called long connective tissue attachment or to mineralization-induced shrinkage of the new tissue and some surgical difficulties in coverage of the newly formed tissue. Nevertheless, an absolute gain of 31% mineralized tissue after GTR can provide a marked improvement in the prognosis of a periodontally severely damaged tooth.     

The use of metronidazole and amoxicillin in the treatment of advanced periodontal disease

Abstract. The present clinical trial was performed to study the effect of systemic administration of metronidazole and amoxicillin as an adjunct to mechanical therapy in patients with advanced periodontal disease. 16 individuals, 10 female and 6 male, aged 35–58 years, with advanced periodontal disease were recruited. A baseline examination included assessment of clinical. radiographical, microbiological and histopathological characteristics of periodontal disease. The 16 patients were randomly distributed into 2 different samples of 8 subjects each. One sample of subjects received during the first 2 weeks of active periodontal therapy, antibiotics administered via the systemic route (metronidazole and amoxicillin). During the corresponding period, the 2nd sample of subjects received a placebo drug (placebo sample). In each of the 16 patients, 2 quadrants (1 in the maxilla and 1 in the mandible) were exposed to non-surgical subgingival scaling and root planing. The contralateral quadrants were left without subgingival instrumentation. Thus, 4 different treatment groups were formed; group 1: antibiotic therapy but no scaling, group 2: antibiotic therapy plus scaling, group 3: placebo therapy but no scaling, group 4: placebo therapy plus scaling. Re-examinations regarding the clinical parameters were performed, samples of the subgingival microbiota harvested and 1 soft tissue biopsy from 1 scaled and 1 non-scaled quadrant obtained 2 months and 12 months after the completion of active therapy. The teeth included in groups 1 and 3 were following the 12-month examination exposed to non-surgical periodontal therapy, and subsequently exited from the study. Groups 2 and 4 were also re-examined 24 months after baseline. The findings demonstrated that in patients with advanced periodontal disease, systemic administration of metronidazole plus amoxicillin resulted in (i) an improvement of the periodontal conditions, (ii) elimination/suppression of putative periodontal pathogens such as A. actinomycetemcomitans, P. gingivalis, P. intermedia and (iii) reduction of the size of the inflammatory lesion. The antibiotic regimen alone, however, was less effective than mechanical therapy with respect to reduction of BoP—positive sites, probing pocket depth reduction, probing attachment gain. The combined mechanical and systemic antibiotic therapy (group 2) was more effective than mechanical therapy alone in terms of improvement of clinical and microbiological features of periodontal disease.     

Patterns of attachment loss in advanced periodontitis patients monitored following initial periodontal treatment

Abstract 2 main concepts seem to exist for the progression of periodontitis: (1) a slow continuous process of attachment loss; (2) periodic bursts of activity followed by quiescence or remission. This study addresses this problem and presents data for 69 sites having experienced a net loss of probing attachment amounting to ≥3.0 mm over 42 months. The sites originated from 16 adult patients monitored after nonsurgical treatment of advanced chronic periodontitis. Probing attachment level recordings were obtained every 3rd month. The sequential probing attachment level data for each site were smoothed using cubic splines. Subjective evaluation of the raw and the smoothed data from the study sites suggested that the majority of the sites seemed to lose probing attachment in a continuous fashion, and over periods of 12 months or more. The smoothed curves were subjected to principal components analysis, which allowed the 69 sites to be ordered according to curve similarity. Nonparametric runs test failed to show that the shape of the curves for the sites was significantly associated with any of the following characteristics: patient, tooth type, tooth surface, initial probing depth, bleeding frequency, occurrence of suppuration, or a combination of inflammatory characteristics of sites.