Esthetic evaluation of root coverage outcomes: a case series study

The aim of this study was to conduct a 1-year full esthetic evaluation of the treatment outcomes of gingival recession using the root coverage esthetic score (RES) system. One hundred patients with 195 single or multiple recessions were treated using different techniques. One year after surgery, the clinical outcomes were evaluated. Only 21 of 195 (11%) treated recessions obtained the maximum RES score (10), while 68 recessions (35%) showing complete root coverage obtained lower scores. Both single and multiple recessions treated with a coronally advanced flap with or without connective tissue grafting achieved similar RES scores. Free gingival grafts showed the lowest score.     

Erythema multiforme: a review and contrast from Stevens-Johnson syndrome/toxic epidermal necrolysis

Erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis are separate diseases. Recent evidence suggests that they have different etiologies and require different treatments. This article provides an overview of the two conditions with emphasis on the differences between them. An outline of the diagnosis and management of the diseases is included.     

Prevalence and distribution by gender of occlusal characteristics in a sample of Italian secondary school students: a cross-sectional study

The aim of this study was to describe the prevalence and distribution, by gender, of occlusal traits in a sample of Italian students aged 11-14 years (mean 13 +/- 1 years). Using standardized and validated recording criteria, a single operator measured the overjet, overbite, open bite, anterior and posterior crossbites, crowding, coincidence of the upper and lower midlines, and diastema, in 810 secondary school students (53.6 per cent males). Chi-square, t-test statistics, and odds ratios (ORs) with 95 per cent confidence intervals (CI) were used to investigate the relationship between gender and malocclusion characteristic. Logistic regression was used to further analyse the independent association between gender and each outcome measure. Ninety-three per cent of the subjects showed at least one occlusal trait, with one or two anomalies recorded in 63 per cent of children. The prevalence of occlusal traits ranged from 1.1 (negative overjet) to 54 per cent (upper and lower midlines not coincident). Males were more likely than females to show both an increased overbite and an increased overjet, although the latter result was not confirmed by logistic regression (P = 0.05). Multivariate analysis showed a negative association between overbite and misalignment of the lower incisors and lack of coincidence of the upper and lower midlines, whereas subjects with an increased overbite were more likely to have an increased overjet (all P < 0.01). Further studies are required in order to further clarify these findings and to provide accurate estimates of the orthodontic treatment need in Italian adolescents.     

Friction of conventional and self-ligating brackets using a 10 bracket model

The friction generated by various bracket-archwire combinations previously has been studied using in vitro testing models that included only one or three brackets. This study was performed using a specially designed apparatus that included 10 aligned brackets to compare the frictional resistance generated by conventional stainless steel brackets, self-ligating Damon SL II brackets and Time Plus brackets coupled with stainless steel, nickel-titanium and beta-titanium archwires. All brackets had a 0.022-inch slot, and five different sizes of orthodontic wire alloys used. Each bracket-archwire combination was tested 10 times, and each test was performed with a new bracket-wire sample. Time Plus self-ligating brackets generated significantly lower friction than both the Damon SL II self-ligating brackets and Victory brackets. However, the analysis of the various bracket-archwire combinations showed that Damon SL II brackets generated significantly lower friction than the other brackets when tested with round wires and significantly higher friction than Time Plus when tested with rectangular archwires. Beta-titanium archwires generated higher frictional resistances than the other archwires. All brackets showed higher frictional forces as the wire size increased. These findings suggest that the use of an in vitro testing model that includes 10 brackets can give additional interesting information about the frictional force of the various bracket-archwires combinations to the clinician and the research worker.     

The influence of zero-value subtraction on the performance of two laser fluorescence devices for detecting occlusal caries in vitro

BACKGROUND: The aim of this study was to evaluate the influence of zero-value subtraction on the performance of two laser fluorescence (LF) devices developed to detect occlusal caries. METHODS: The authors selected 119 permanent molars. Two examiners assessed three areas (cuspal, middle and cervical) of both mesial and distal portions of the buccal surface and one occlusal site using an LF device and an LF pen. For each tooth, the authors subtracted the value measured in the cuspal, middle and cervical areas in the buccal surface from the value measured in the respective occlusal site. RESULTS: The authors observed differences among the readings for both devices in the cuspal, middle and cervical areas in the buccal surface as well as differences for both devices with and without the zero-value subtraction in the occlusal surface. When the authors did not perform the zero-value subtraction, they found statistically significant differences for sensitivity and accuracy for the LF device. When this was done with the LF pen, specificity increased and sensitivity decreased significantly. CONCLUSIONS: For the LF device, the zero-value subtraction decreased the sensitivity. For this reason, the authors concluded that clinicians can obtain measures with the LF device effectively without using zero-value subtraction. For the LF pen, however, the absence of the zero-value subtraction changed both the sensitivity and specificity, and so the authors concluded that clinicians should not eliminate this step from the procedure. CLINICAL IMPLICATIONS: When using the LF device, clinicians might not need to perform the zero-value subtraction; however, for the LF pen, clinicians should do so.     

The number of implants required to support a maxillary overdenture: a systematic review and meta-analysis

Purpose

The number of implants needed to support a maxillary overdenture is still a controversial issue. The aim of this systematic review was to investigate the number of implants required to support a maxillary overdenture in order to obtain optimal treatment outcomes in terms of implant survival, overdenture longevity and patient satisfaction.

Clinical and microbiological effects of different restorative materials on the periodontal tissues adjacent to subgingival class V restorations

OBJECTIVES: The relationship between subgingival dental restorations and periodontal health has been thoroughly investigated for many years. However, longitudinal data on the subgingival microflora features after the placement of well-finished subgingival restorations are still lacking. Therefore, this study compares the short-term clinical and microbiological features occurring in the gingiva after the completion of different subgingival restorations. MATERIAL AND METHODS: Sixteen systemically healthy subjects, 10 males and six females (ages: 31.7-45.8 years; mean age 39.3+/-5.1 years), who were non-smokers and were positive for the presence of three cervical abrasion/erosion defects to be restored in three different adjacent teeth were enrolled in this study. The cervical abrasion/erosion defects were each restored by using one of three different materials: amalgam, glass ionomer cement, or composite resin. Immediately before class V cavity preparations and restorations (baseline), clinical monitoring and subgingival plaque sampling were performed in the mid-buccal aspect of each experimental restored tooth and in one adjacent sound, non-treated, control tooth. These procedures were repeated every 4 months over the following 1 year. RESULTS: Throughout the study, the clinical parameters recorded did not change significantly in any of the experimental groups, and no differences were detected among them at each clinical session. Over this time, no significant changes in the composition of the subgingival microflora were observed in amalgam, glass ionomer cement, and control groups. Conversely, in the composite resin group, there was a significant increase in the total bacterial counts, and a significant (p<0.05) decrease in Gram-positive, aerobic bacteria, which was associated with a significant (p<0.05) increase in the Gram-negative, anaerobic microbiota. CONCLUSIONS: Over a 1-year observation period, amalgam, glass ionomer cement, and composite resin subgingival restorations do not significantly affect the clinical parameters recorded. However, composite resin restorations may have some negative effects on the quantity and quality of subgingival plaque.     

Epithelial cells in PDL are critical in resuming the integral relation between tooth root and supporting bone after trauma--a transplantation experiment

OBJECTIVE: The aim of this study was to determine the response of the residual epithelial network following traumatic breakdown of the periodontal ligament (PDL). METHODS: Mandibular incisor sections with PDL (experimental) and sections denuded of PDL (control) from 4- to 6-week-old Wistar-Furth rats were transplanted into the defects created in the frontal bone of the recipient syngeneic rats. At intervals, the defects with implanted teeth roots were collected and processed for histological and biochemical examination. Immunolocalization of epithelial cells was performed to monitor their phenotypic changes during transplantation healing period. RESULTS: (1) Histological observation of the experimental sample revealed the sequence of cellular response characterized by an initial degeneration of PDL followed by a proliferation of granulation tissue. There was also a marked odontoblastic reaction with extensive deposition of regular dentine within the pulp chambers. In the control group, initial signs of bony fusion with dentine led to an extensive ankylosis and bone replacement between roots and defects. (2) Immunostaining indicated that, in experimental groups, the pattern of regularly spaced epithelial cells lying in close approximation to the root surface was distinct 10 days post-transplantation but became diminished afterwards. The immunoreaction against epithelial cells was negative in the control. CONCLUSION: Residual PDL is essential to prevent ankylosis after trauma and epithelial cells may facilitate the re-establishment of root-PDL-bone complex by transforming into mesenchymal cells.     

Clinical and microbiologic effects of subgingival controlled-release delivery of chlorhexidine chip in the treatment of periodontitis: a multicenter study

BACKGROUND: The main therapeutic approach for periodontal diseases is mechanical treatment of root surfaces via scaling and root planing (SRP). Multicenter clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to SRP alone. However, some recent studies failed to confirm these clinical results, and conflicting results were reported regarding the effects of the CHX chip on subgingival microflora. The aim of this study was to provide further data on the clinical and microbiologic effects of CHX chips when used as an adjunct to SRP. METHODS: A total of 116 systemically healthy individuals with moderate to advanced periodontitis, aged 33 to 65 years, were recruited from the Departments of Periodontology of four Italian universities. For each subject, two experimental sites were chosen that had probing depths (PD) > or =5 mm and bleeding on probing (BOP) and were located in two symmetric quadrants. These two sites were randomized at the split-mouth level, with one receiving SRP treatment alone and the other receiving treatment with SRP plus one CHX chip (SRP + CHX). PD, relative attachment level (RAL), and BOP were evaluated at baseline, prior to any treatment, and after 3 and 6 months. Supragingival plaque and the modified gingival index were evaluated at baseline and after 15 days and 1, 3, and 6 months. Subgingival microbiologic samples were harvested at baseline and after 15 days and 1, 3, and 6 months, cultured for total bacterial counts (TBCs), and investigated by polymerase chain reaction analysis for the identification of eight putative periodontopathogens. RESULTS: When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P <0.01) for both treatments. Moreover, the PD was reduced in the SRP + CHX treatment group compared to the SRP treatment group at 3 and 6 months, whereas the RAL was similar for both treatments at 3 months and was reduced in the SRP + CHX treatment group at 6 months. The differences in PD reductions between the treatments were 0.30 and 0.55 mm at 3 and 6 months, respectively (P <0.01); for the RAL gain, the differences were 0.28 and 0.64 mm, respectively (P <0.001). The TBCs decreased significantly with both treatments. A similar, although less evident, pattern was noted when only the pockets with an initial PD > or =7 mm were considered. The percentage of sites positive for BOP was similar between the treatments at each time point. At 15 days and 1 month, the TBC for the SRP + CHX treatment group was significantly lower than for the SRP treatment group (P <0.01 and P <0.05, respectively). Over time, both treatments generally reduced the percentages of sites positive for the eight putative periodontopathic bacteria, although greater reductions were seen often for the SRP + CHX treatment group. CONCLUSIONS: The adjunctive use of the CHX chip resulted in a significant PD reduction and a clinical attachment gain compared to SRP alone. These results were concomitant with a significant benefit of SRP + CHX treatment on the subgingival microbiota.