Calcium hydroxide: the ultimate medicament?

There has been a trend to the promiscuous use of calcium hydroxide in clinical endodontics. It can be concluded that this medicament is not the principal factor in success following its use. It is reasonable to state that endodontic success is related to the obliteration of the canal system with a solid core root canal filling such as gutta percha.     

Quantitation of blood flow after anterior maxillary osteotomy: investigation of three surgical approaches.

The radioactive microsphere method was used to quantitate preoperative and postoperative blood flows in macaque monkeys when three different surgical approaches for anterior maxillary osteotomy were performed. Despite distinct variations in flap designs among the experimental groups, preoperative and postoperative determinations of blood flow were essentially unchanged. Results of the study suggest that a palatal, labial, or combined mucoperiosteal pedicle should be adequate to preserve the flow of blood to tissues in the osteotomized segment.     

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Ohne Zusammenfassung     

Direction of the mental canal in human mandibles

The direction of the mental canal was calculated in the horizontal and vertical planes with a view to aiding anaesthetic techniques. Based on our data, it is advisable to give the following approximate inclinations to the needle when penetrating the mental canal in anaesthetic procedures: 55 degrees postero-anteriorly in relation to a horizontal plane and 40 degrees latero-medially in relation to a horizontal line tangent to the body of the mandible at the level of the mental foramen.     

The removal torque of titanium implant inserted in rabbit femur coated with biomimetic deposited Ca-P coating

A number of experimental data on biomimetic deposition CaP (BDCaP) coating implants have reported promising outcomes by histological evaluation. But little is investigated on the role of the BDCaP coating and osseointegration mechanism by interface shear strength. To make a direct biomechanical comparison between the BDCaP coating implants and the uncoated rough titanium implants (control), a well-established animal model for implants removal torque testing was employed in rabbits, using a self-matching experimental design. All implants had an identical cylindrical screw shape without any macroscopic retentive structure. After 2, 4, 6, 8 and 12 weeks of bone healing, removal torque testing was performed to evaluate the interfacial shear strength of each implant type. The torqued implants were sputter-coated with gold for morphology observation and observed with a field-emission electron microscopy. Results showed that the interfacial shear strength of the BDCaP coating implants was similar to that of the uncoated rough implants at 2 and 4 weeks of healing. The mean removal torque values of the BDCaP coating implants were lower than those of control implants (P < 0.05) after 6 weeks of healing. The removal torque values for both types of implants revealed similar mean values after 8 and 12 weeks of healing; there were no significant difference between the two types of implants (P > 0.05). It can be concluded that the BDCaP coating implants had no beneficial effect on the interfacial shear strength at early bone healing stage.     

Vergleich der sekundären und tertiären Kieferspaltosteoplastik

Background. The aim of secondary cleft osteoplasty is to provide alveolar bone for the complete eruption of the canine and sometimes of the lateral incisor to the occlusal plane and, thus, preservation of a continuous dental arch. This concept has not changed during the last 20 years in our clinic, providing an opportunity for an analysis of a homogeneous group of cleft patients. This group of patients was compared with a similar group of tertiary osteoplasties, performed during the same time span in our clinic. Material and methods. From 1980 to 1999, 376 cleft osteoplasties were performed in 295 patients, 264 of whom (136 secondary and 128 tertiary osteoplasties) were available for continuous prospective follow-up. Special emphasis was put on preoperative orthodontic treatment with removal of crossbites, oral hygiene, and meticulous disinfection. Autogenous cancellous iliac bone was used exclusively. Results. The postoperative height of the interalveolar septum (Abyholm classes) was I (1/1, 69.4%/45.8%), II (>3/4, 28.2%/41.7%), III (<3/4, 2.4%/10%), and IV (complete failure, 0%/2.5%) (secondary vs tertiary). Complications were infections (6.6% vs 14%), fistulae (0.7% vs 5.8%), and external root resorption (0% vs 7.4%). The lateral incisor was aligned into the arch in 55.5% vs 29.8% and the canine was in the correct position in 100% vs 83.6% (secondary vs tertiary). Conclusion. Secondary cleft osteoplasty was more advantageous than tertiary due to better preservation of the neighboring teeth.     

Soluble CD14 levels in gingival crevicular fluid of subjects with untreated adult periodontitis

BACKGROUND: This study determined soluble CD14 (sCD14) levels in gingival crevicular fluid (GCF) and their potential relationship to periodontal conditions in adult periodontitis. METHODS: GCF was collected from 15 patients with untreated adult periodontitis. sCD14 levels were determined by ELISA and presented as total amount (ng/site) and concentration (microg/ml). The periodontal examination consisted of plaque index (PI), bleeding index (BI), probing depth (PD), and clinical attachment level (CAL). PD and CAL were measured with an electronic probe. RESULTS: sCD14 was detected in all 15 subjects and was found in 59% (62/105) of the sampled sites. The percentage of sites with sCD14 varied greatly, ranging from 14% to 100%. The mean total amount of sCD14 was 1.71+/-0.40, range 0.03 to 5.41 ng/site; the concentration of sCD14 was 14.04+/-4.15, range 0.16 to 51.74 microg/ml. No significant difference in clinical data was found between the sites with and without detectable levels of sCD14. However, on the basis of the individual profile of sCD14 levels, i.e., those individuals with >50% of the sites containing sCD14 and mean levels of sCD14 >5.0 microg/ml, the 15 subjects were divided into a high sCD14 group (9 subjects) and a low sCD14 group (6 subjects). Compared to the high group, the low group showed greater mean PD and a higher percentage of sites with PD > or = 5.0 mm (P <0.05). Consistent with this, sCD14 concentrations showed a negative correlation with PD (r(s) = -0.636, P = 0.0174). CONCLUSIONS: The present study shows that sCD14 levels in GCF varied greatly among subjects with untreated adult periodontitis. Individuals with higher levels of sCD14 in GCF and more sites containing sCD14 had fewer deep pockets. The negative correlation between GCF sCD14 levels and probing depth implies a crucial role of sCD14 in bacterially induced periodontal destruction. The relationship between GCF sCD14 levels and probing depth warrants further investigations.     

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis

AIM: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated. MATERIAL AND METHODS: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months. RESULTS: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001). CONCLUSION: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.