Local delivery of chlorhexidine gluconate (PerioChip) in periodontal maintenance patients

AIM: The aim of this randomised, split-mouth, single-blind study was to determine the efficacy of controlled-release delivery of chlorhexidine gluconate 2.5 mg (PerioChip) in patients with residual bleeding pockets (>5 mm) at least 3 months following oral hygiene and root debridement phase therapy. MATERIAL AND METHODS: 26 patients (non-smokers) were screened and potential study sites identified. Clinical parameters recorded at baseline and all subsequent visits were plaque index (PI), pocket probing depth (PPD), bleeding index (BI) and clinical attachment level (CAL). All study sites were debrided using ultrasonic instrumentation. PerioChips (PC) were placed in the selected sites of two quadrants (left or right) whilst identified sites in the remaining quadrants were left without adjunctive antimicrobial treatment. Clinical measurements were made at follow-up visits after 1, 3 and 6 months. Mean changes from baseline in PPD, BI and CAL were calculated with the patient as the experimental unit and comparability between the treatments was determined using t-tests. RESULTS: At baseline there were no significant differences between PC and control sites for mean PI, PD, BI or CAL. The mean (SE) reductions in PPD for PC and control treatments were: 0.47 (0.1), 0.46 (0.1); 0.76 (0.1), 0.55 (0.1); 0.78 (0.1), 0.45 (0.1) for months 1, 3 and 6 respectively. Only at month 6 did the difference between treatments approach statistical significance (p=0.06). Mean (SE) reductions in CAL over the same periods were: 0.17 (0.1), 0.04 (0.08); 0.38 (0.1), 0.21 (0.1); 0.43 (0.1), 0.15 (0.09) p=0.048. Mean (SE) reduction in BI between PC and control treatments only reached statistical significance at 6 months: 1.08 (0.1), 0.59 (0.1) p=0.05. CONCLUSION: These data suggest that PerioChip is beneficial for patients on maintenance therapy although the benefit is not apparent until 6 months after placement.     

Exposure of high-density porous polyethylene (Medpor) used for contour restoration and treatment

Porous high-density polyethylene (Medpor) is a biocompatible large-pore, high-density polyethylene implant. It is well tolerated by surrounding tissue, and its porous structure is rapidly infiltrated by host tissue. It is a highly stable and somewhat flexible porous alloplast that has rapid tissue ingrowth into its pores. However, when the implant is placed under a thin cover of skin, there is a risk of exposure. A total of 52 Medpor implants were placed in 31 patients over a four-year period. The implants were used for the chin, malar area, nasal reconstruction, ear reconstruction, orbital reconstruction, and the correction of mandibular contour deformities. Many of these implants were placed in areas considered problematic, such as those with thin or atrophic soft-tissue coverage and extensive scarring. There were nine complications, including three patients in whom the implant was exposed; these are presented here.     

Fatigue behavior of the zinc-phosphate cement layer

PURPOSE: Fatigue behavior of luting cement film between model fixed partial dentures (FPD) and their dies was investigated to gain a better understanding of the mechanical properties of zinc-phosphate cement. MATERIALS AND METHODS: Fifty-six brass dies were made, half of them with grooves and half without grooves. A cantilever FPD for each die was cast in Au-Pd-Ag alloy. Four linear strain gauges were attached to the marginal portions of each retainer. The FPDs were cemented to the dies using zinc-phosphate cement. A fatigue test machine was used to cyclically load the specimens with 50 or 100 N for 5.5 x 10(5) cycles (1 Hz) in 37 degrees C water. During the fatigue test, strain measurements were made after every 0.5 x 10(5) load cycles to discover if strain response was altered. After completion of the fatigue test, ultimate tensile strength of each specimen was measured and statistically analyzed by 2-way analysis of variance. RESULTS: With or without grooves, strain responses were the same at every periodic strain measurement throughout the 50-N fatigue test. For the 100-N fatigue test, strain responses for the specimens without grooves were different before and after cyclic testing, but there was no difference for the specimens with grooves. There were no significant differences in tensile strength among the specimens after the fatigue tests. CONCLUSION: No fatigue fracture was observed in zinc-phosphate cement film after repetitive loading. Repetitive loading may improve stress transmission within the zinc-phosphate cement film.     

Prosthodontic management of the hydroxylapatite denture patient: a preliminary report

A 4-year study and evaluation of nonresorbable hydroxylapatite to augment different alveolar ridges has been reported. The technique used resulted in improved contour, height, and width of the alveolar ridge. It was found that denture comfort improved with ridge augmentation as this allowed improved stability, support, and preservation of the ridge. Patient satisfaction was correlated to both surgical and prosthodontic success with the use of hydroxylapatite. The state and health of the tissues were found to be improved with the use of hydroxylapatite or hydroxylapatite and bone marrow. The prosthetic and surgical procedures were found to be easier to perform, and they produced more permanent and superior results than those previously experienced with only bone grafts and other alloplasts.     

Physicochemical evaluation of silica-glass fiber reinforced polymers for prosthodontic applications

This investigation was designed to formulate silica-glass fiber reinforced polymeric materials. Fused silica-glass fibers were chosen for the study. They were heat-treated at various temperatures (500 degrees C, 800 degrees C and 1100 degrees C), silanized, sized and incorporated in two modified resin mixtures (A and B). The flexural properties in dry and wet conditions were tested and statistically analyzed, and the content of residual methyl methacrylate (MMA) monomer, dimensional changes with temperature, water sorption and solubility were determined. Woven fibers [36.9% (wt/wt)], heat-treated at 500 degrees C, gave the highest strength values for the polymeric composites (an ultimate transverse strength of 200 Mpa and a flexural modulus of 10 GPa) compared with the fibers heat-treated at other temperatures. There was no statistically significant difference in the measured flexural properties between resins A and B regarding fiber treatment and water storage time. These fiber composites had a small quantity of residual MMA content [0.37 +/- 0.007% (wt/wt)] and very low water solubility, indicating good biocompatibility. It was suggested that silica-glass fibers could be used for reinforcement as a result of their anticipated good qualities in aqueous environments, such as the oral environment.