Effect of smoking on periodontal health in molar teeth

BACKGROUND: It is generally accepted that the primary cause of periodontitis is bacterial infection of long duration. In addition, there are several risk factors that may increase the probability and severity of periodontitis. For example, an increased breakdown of alveolar bone has been observed in smokers compared to never-smokers. The objective of this study was to investigate the association between cigarette smoking and periodontal health, in particular, furcation involvement in molar teeth. METHODS: One hundred twenty (120) adult regular dental patients, presenting with at least 20 teeth each, third molars excluded, were evaluated. Sixty of the subjects consumed an average (+/- SD) of 16.8 +/- 3.8 cigarettes daily and had smoked for 21.4 +/- 5.7 years. The remaining subjects presented a negative history of smoking. Periodontal conditions for the molar teeth were recorded at the first and second mandibular molar buccal furcation area. RESULTS: Oral hygiene standards and dental care habits did not differ notably between smokers and never-smokers. Smokers exhibited significantly fewer molar teeth than never-smokers (2.2 +/- 1.1 versus 3.0 +/- 0.8; P<0.01). Also, smokers exhibited significantly advanced gingival recession, probing depth, clinical attachment loss, furcation involvement, and tooth mobility compared to never-smokers (P<0.01). CONCLUSIONS: The results of this study suggest that long-term cigarette smoking significantly worsens periodontal health including degree and incidence of furcation involvement in molar teeth.     

A growth-related concept for skeletal class II treatment.

The use of a combined activator--high-pull headgear appliance for treatment of Class II, Division 1 malocclusion is presented as a preliminary report. The activator itself is equipped with a palatal bar, lower lip pads, and torque-control auxiliaries for the upper incisors. The face-bow is mounted directly on the activator, and the extraoral force vector is equivalent to that of an anterior high-pull vector. During bite registration the veritcal displacement of the mandible is restricted to a minimum, and the anterior displacement should not exceed 6 mm. On the basis of current knowledge of the growth of the bony facial structures, treatment objectives and a specific approach for skeletal Class II correction are defined. Following these objectives, the therapy aims at correcting the malocclusion without diverting the anterior landmarks of the bony face from their specific lines of growth. This is brought about by the corresponding mechanics of the activator-headgear combination. The corrective effect of this appliance may be assumed to be the result of several different factors. The maxillary dentition is restrained in a posterior cranial direction, and an inhibitory effect on the maxilla counter to its line of development is attained. The mandibular dentition is influenced in an anterior downward direction by means of the bite registration, and the occlusion is unlocked during treatment. Any transfer of distally directed headgear forces from the maxilla to the mandible is prevented. Temporary stimulation of condylar growth, possibly combined with temporary posterior deflection of condylar growth, may also be induced. In this way it is possible to take maximum advantage of condylar growth in the sagittal dimension. Thus, not only is the malocclusion corrected but, at the same time, decisive profile improvement is achieved by anterior development of the mandible. From the experience gained so far with a Class II, Division 1 sample undergoing treatment with the activator-headgear combination, it would appear that skeletal control of the direction of facial growth during treatment is possible. A quantitative report on this group of approximately forty patients, some of whom are still receiving treatment, is in preparation.     

Root substance removal by scaling and root planing.

The amount of root substance removed by scaling and root planing is largely unknown. The present study evaluated in vitro the root substance loss caused by a defined number of working strokes at known forces. Forty extracted teeth with loss of connective tissue attachment into the middle third of the roots were washed and embedded in plaster, leaving one entire corono-apical tooth aspect exposed. The teeth were reproducibly repositioned in a bench-vise, where a profilometer repeatedly measured root surface levels at the same location. In a standard area of the roots a total of 40 working strokes were applied. Low forces were used in 30 teeth and high forces in 10 teeth. The forces were recorded using a piezo-electric receiver built into the upper shank of the curet. Root substance loss was measured after 5, 10, 20, and 40 working strokes. The results showed that the mean low force used per working stroke across all 40 strokes was 3.04 Newtons for the low forces, and 8.48 Newtons for the high forces. Mean cumulative loss of root substance across 40 strokes was 148.7 microns at low forces, and 343.3 microns at high forces. The mean force per stroke increased slightly across the 40 strokes, while substance removal per stroke decreased. Substance removal per stroke during strokes 1 to 5 was 6.8 microns using low forces and 20.6 microns using high forces. During strokes 21 to 40 mean removal per stroke was 2.3 microns at low forces, and 5.6 microns at high forces. These results suggest that high forces remove more root substance, and loss per stroke becomes less with increasing numbers of strokes.     

Plasma antibody levels in periodontitis patients and controls

BACKGROUND: A major aspect of the adaptive host response in periodontitis is the production of antibodies. Several risk and susceptibility factors for periodontitis, including smoking, age and composition of the subgingival microflora, have also been suggested to influence antibody production. AIM: The present study was conducted to investigate plasma levels of immunoglobulin (Ig) G, A and M antibodies in periodontitis patients of Caucasian European heritage in relation to disease severity, smoking, diagnosis and prevalence of periodontopathogens. METHODS: In this study, 29 patients with severe periodontitis, 51 with moderate periodontitis and 55 controls without periodontal destruction were enrolled. From the total of 80 patients, 18 were diagnosed with aggressive periodontitis and 62 with chronic periodontitis. Total IgG, IgA and IgM as well as IgG isotypes were analyzed in plasma samples. RESULTS: Levels of total IgG, IgA and IgM were not different between patients and controls; however, in periodontitis, higher levels of IgG1 and IgG2 were observed. Smoking appeared to be significantly and inversely related to antibody levels in periodontitis, in particular for total IgG and IgG2. The absence of an elevated total IgG and IgG2 in smoking patients was irrespective of severity, prevalence of periodontal pathogens and diagnosis. The elevation of total IgG and IgG1 and IgG2 in non-smoker periodontitis patients was observed in patients with moderate periodontitis and even greater in patients with severe periodontitis, but was independent whether patients were infected with Actinobacillus actinomycetemcomitans or Porphyromonas gingivalis and independent of diagnosis. Clinically, it was observed that patients who smoked had more periodontal bone loss; the current findings on antibody levels may be one of several mechanisms related to more extensive periodontal breakdown in smoker patients. CONCLUSION: The current study shows that non-smoker periodontitis patients have higher levels of total IgG and IgG2 than smoker periodontitis patients.     

Platelet rich plasma (PRP) as adjuvant tool for bone augmentation

New bone formation requires sufficient number of osteogenic progenitors capable of forming the bone desired. The site of engraftment must be filled with a matrix that facilitates attachment, migration and differentiation of osteoblastic progenitors. It is also necessary that the cells receive stimuli by growth factors that allow them to progress toward a bone phenotype. Another critical step in new tissue formation is the construction of new blood vessels--angiogenesis. Platelets contain growth factors that induce osteoinductive stimuli and accelerate angiogenesis. One strategy for harnessing this benefit is to apply platelet rich plasma (PRP) to bone graft site. The present article review platelets and growth factors physiology. We discuss the interaction between growth factors, thrombin and cells that form bone and blood vessels: osteoblasts, mesenchimal stem cells and endothelial cells. Methods and defaults of PRP preparation and safety issues are presented. The knowledge of platelet physiology and the mechanism by which growth factors effect cell proliferation and differentiation allow the dental surgeon to properly use this treatment modality and to achieve the ultimate goal of durable and effectively functioning bone.     

Effects of different exposure values on diagnostic accuracy of digital images.

OBJECTIVE: The aim of this in vitro study was to compare the effects of different exposure values on the image clarity of 3 digital radiographic systems and 1 conventional direct-exposure emulsion x-ray film. METHOD AND MATERIALS: Three digital radiographic systems, Digora, RVG, and Sidexis, were compared with the conventional dental x-ray film, Ektaspeed Plus. A medullary bone fragment and human teeth were radiographed with varying voltage, exposure time, and focus-receptor distance. Clinical criteria to evaluate image clarity were detail resolution, sharpness, contrast resolution, and artifacts of the different tooth and jaw structures. RESULTS: The optimal exposure times for digital imaging varied between 0.02 and 0.13 seconds and depended on the objects and the imaging systems. Optimal resolution was obtained when a voltage of 60 kV was used. The focus-receptor distance of 33 to 40 cm resulted in the best contrast and sharpness. Digital images did not always provide the detail resolution or sharpness achieved by conventional radiographs. CONCLUSION: The recommended exposure time for digital images amounted to approximately half the time needed for conventional film. Digital images had to be modified by adjusting the contrast and brightness to optimize the visibility of the areas to be diagnosed.     

Post-extraction bleeding—An aid to diagnosis? Case report

Haemophilia A, the most common of bleeding disorders is characterzed by bruishing and spontaneous bleeding into the joints but may remain undiagnosed if present in the mild form. A case is discussed where episodes of bruising and joint sweelling as a child were misdiagnosed as rheumatic fever and the bleeding disorder was diagnosed following recurrent episodes of bleeding after extraction of an upper molar tooth.