Gingival augmentation with an acellular dermal matrix revisited: surgical technique for gingival grafting.

Acellular dermal matrix grafts have become popular in gingival augmentation procedures as they eliminate the disadvantages of autogenous graft materials. Since the healing dynamics of acellular dermal matrix grafts are different from those of autogenous grafts, the surgical technique developed for the autograft may not be adequate for the allograft. This article demonstrates a simple and predictable surgical technique involving an acellular dermal matrix for gingival augmentation, using graft stretching to facilitate tissue adaptation and the development of an early blood supply. Learning Objectives: This article discusses a simple surgical technique for the use of an acellular dermal matrix for gingival augmentation surgery. Upon reading this article, the reader should: Understand how an acellular dermal matrix can be used as a functional equivalent for gingival grafting. Become familiar with graft stretching as a means to facilitate tissue adaptation and the development of an early blood supply.     

The role of hospital-based dentistry in providing treatment for persons with developmental delay

Hospital dentistry is important to the delivery of oral health care to persons with disabilities. Recent cuts in funding for hospital dentistry in Ontario have placed a great strain on the health care system"s ability to meet the demand for such care. General anesthesia is an accepted treatment option for patients who are uncooperative, but involves inherent risks. In this paper, we present the case of a person with developmental delay who received dental treatment under general anesthesia and subsequently developed complications to support the position that a dental program for persons with special needs should be provided in a hospital setting to minimize their risk of suffering serious complications and to ensure their safety.     

The evolution and application of dental maxillofacial imaging modalities

During the last decades, an exciting new array of imaging modalities, such as digital imaging, CT, MRI, positron emission tomography, and cone-beam CT (CBCT), has provided astounding new images that continually contribute to the accuracy of diagnostic tasks of the maxillofacial region. The most recent, cone-beam imaging, is gaining rapid acceptance in dentistry because it provides cross-sectional imaging that is often a valuable supplement to intraoral and panoramic radiographs. The information content in such examinations is high and the dose and costs are low. The increasing trend toward the use of CBCT in dental offices may be expected to result in improved diagnosis, but with increased patient dose and health care costs. Using CBCT as a secondary imaging tool helps optimize health-to-risk ratio.     

Surgery of the parotid region: a new approach

Many disorders of the parotid gland require treatment by subtotal or total parotidectomy. In such situations functional and esthetic complications may arise due to the location of the incisions or from permanent or temporary injuries to the facial nerve. This report describes a modified revision that gives good esthetic and functional results. A review of a similar series of cases treated surgically by the same surgeons using Yoel and Bilesio's technique showed no differences in morbility associated with parotidectomy performed using the proposed incision.     

Periodontal response to long-term abuse of the gingival attachment by supracrestal amalgam restorations

The combined length of the supracrestal connective tissue attachment and the junctional epithelium is referred to as the "biologic width". The long-term (1-year) effect of complete violation of the supracrestal connective tissue attachment was examined in beagle dogs. Full thickness periodontal flaps were elevated, exposing the buccal bony crests of the maxillary and mandibular canines of 3 beagle dogs. The roots of the experimental teeth were planed and class V cavities were prepared. The apical border of each cavity was located at the alveolar bone crest. The cavities were restored with amalgam and the flaps were repositioned and sutured. In the control sites, a notch was prepared at the CEJ and the distance between the notch and the bony crest was measured. The dogs were sacrificed 57 weeks after the operation and the experimental and control sites prepared for histologic analysis. Every 5th section was examined and measurements were taken of the amount of gingival and bone recession, the length of the connective tissue and the epithelial attachment. Control sites healed uneventfully. Gingival recession averaged only 0.5 mm; bone loss was minimal and averaged 0.15 mm. The combined length of the supracrestal connective tissue and epithelial attachment measured 4.47 mm. In experimental sites, the gingiva receded 3.16 mm on average. Moderate bone loss (mean = 1.17 mm) was noted, but no signs of bone resorption were seen at the time of sacrifice. After bone loss, root surfaces which were previously attached to alveolar bone by periodontal ligament were mainly (0.90 mm) attached to connective tissue.(ABSTRACT TRUNCATED AT 250 WORDS)     

A custom mandibular distraction device for the rat

In the last several years, the rat model has been used as a reliable means of studying distraction osteogenesis (DO). This model has several benefits, including lower cost, the availability of molecular reagents for the rat, and the ability to perform a large number of operations in a short time. We have recently developed an external device that is custom-made for the rat mandible and secured at the mandibular ramus. The device consists of a Leone (Florence, Italy) jackscrew distraction assembly (0.2 mm per one-quarter turn), 2 Luhr L-shaped 0.8-mm five-hole microplates, and four 0.8-mm x 3-mm microscrews (Stryker-Leibinger Corp., Kalamazoo, MI) for fixation. Additionally, there is a methylmethacrylate block that is placed on the lingual surface of the angle of the mandible to support the posterior screws. Sterile surgical technique was used, and the same two surgeons performed all operations. To date, we have operated on 153 Sprague-Dawley rats. The procedure has been well tolerated by the animals. We had 17 postoperative deaths (11% mortality), largely as a result of anesthetic complications. There were no wound infections or dehiscence. A mandible fracture was noted in 6 rats (4%), which occurred at the time of device placement. There were no device dislodgments. Postmortem examination showed the device to be well positioned in all rats, with good callous formation at the distraction site. The rats surpassed their preoperative weight after an average of 9.2 days. These results compare favorably with those of other models currently in use. We have developed a device that is currently being used in the study of DO in the rat mandible. Our device is small in size, does not require wide undermining for its placement, and has had a low incidence of device dislodgment or infection. This model has shown great reproducibility and thus should be effective in its application for the histologic and biochemical investigation of DO in the rat.     

Removable partial denture abutments restored with all-ceramic surveyed crowns.

All-ceramic crowns are used as alternatives to conventional metal-ceramic crowns for the restoration of single teeth. Traditionally all-ceramic restorations possessed physical properties that contraindicated their use in many treatment situations. The strength that zirconia ceramics exhibit seems to support the hypothesis that, in specific situations, an all-ceramic crown may be used to restore removable partial denture (RPD) abutments in areas previously reserved for metal or metal-ceramic restorations. Abutments for RPDs may now be fabricated with Procera AllZirkon with the classically prepared guide planes and rest seats. This article provides an overview of a technique for the fabrication of a zirconia-based crown to be used in conjunction with removable partial dentures using the Procera CAD/CAM technology.     

Smoking, a weak predictor of periodontitis in older adults

BACKGROUND: The impact of smoking habits on periodontal conditions in older subjects is poorly studied. AIMS: To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects. MATERIAL AND METHODS: The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed. RESULTS: 60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss. CONCLUSIONS: A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.     

Screening for cardiovascular risk factors in a dental setting

BACKGROUND: The authors assessed the utilization of oral health care professionals (OHCPs) as a resource for identifying patients who were unaware of their increased risk of developing cardiovascular disease (CVD). METHODS: OHCPs administered a CVD risk-screening questionnaire, measured blood pressure and tested cholesterol levels, high-density lipoprotein levels and hemoglobin A1c (HgA1c) levels using "finger-stick" blood testing in 100 patients treated in a dental school clinic who were unaware of their CVD risk status. The authors determined the prevalence of specific risk factors (that is, smoking and abnormal levels of systolic blood pressure, lipids, body mass index and HgA1c) and calculated Framingham 10-year coronary heart disease (CHD) risk scores. RESULTS: Seventeen percent of the 100 patients (35 percent of men, 5 percent of women) had an increased global risk of experiencing a CHD event within 10 years (Framingham risk score>10 percent). Seventy-three percent of participants had one or more risk factors and 31 percent had two or more risk factors present. More men than women had low levels of high-density lipoprotein (45 percent [18/40] of men versus 3.3 percent [2/60] of women; P<.0001). The mean Framingham CHD risk score increased with increasing risk factor burden. CONCLUSIONS: OHCPs identified patients with an increased CHD risk who could benefit from primary prevention activities. A substantial proportion of study patients who were unaware of their risk status were at an increased risk of experiencing a CHD event within 10 years. OHCPs could contribute to public health CHD control efforts.