Second Attempt of Guided Tissue Regeneration on a Previous Successfully Grafted Site with Periodontal Breakdown—A 5-Year Follow-up

Guided tissue regeneration (GTR) has been proven to promote attachment and regeneration of periodontal tissue. However, there is a 20 to 40% incidence of attachment loss on regenerated attachments reported in the literature. To my knowledge, this is the first case report on a second attempt in GTR on a previous successful grafted site with clinical attachment loss. A healthy 17-year-old Chinese male patient had GTR performed with xenograft particles and bovine resorbable membrane on his root-canal treated, fused upper right lateral incisor and upper right canine (#12-#13) in 2007. Probing depth on the mid-palatal region of #12-#13 was reduced to 4 mm and maintained for the next 4 years. But in the fifth year, probing depth increased to 11 mm with no endodontic symptoms, and a second attempt of GTR using the same materials was carried out. The probing depth at the surgical site was reduced to 4 mm and successfully maintained for another 5 years. Irregular maintenance and the presence of plaque retentive factor could have caused the clinical attachment loss on #12-#13. This case shows it is possible to attempt GTR on a previous successfully grafted site. GTR did not increase tissue resistance against periodontal breakdown. Hence, proper maintenance planning for GTR sites is important to prevent periodontal breakdown.

Periodontitis Risk in Patients With and Without Systemic Lupus Erythematosus: A Retrospective Study

Objectives: Systemic lupus erythematosus is a systemic, long-term autoimmune condition that has chronic inflammatory effects in connective tissue throughout the body. There are numerous studies that have examined the association between systemic lupus erythematosus and chronic periodontitis, with varying conclusions. The purpose of this cross-sectional study is to evaluate and compare the risk for periodontitis in patients with SLE to patients without SLE. Materials and Methods: Medical and dental records were retrospectively reviewed for patients that had been admitted to the Temple University School of Dentistry from 2010 to 2018. A roster of 22 SLE positive patients were generated from the Temple University patient database and matched to a control population of 22 patients without SLE. Periodontal probing depths were then documented and used to evaluate periodontal statuses in both test and control groups. Sites with probing depths ≥ 5 mm were considered to be at increased risk for periodontal breakdown. Prevalence was defined as the percentage of individuals having at least one site with a ≥ 5 mm probing depth, and extent was defined as the average percentage of sites with increased periodontitis risk. The number of missing teeth in patients from each group were also recorded as a secondary outcome. Results: The prevalence of ≥ 5 mm probing depths in SLE and control groups was 50 % (10/20) and 40.9 % (9/22), respectively. Calculations of relative risk (1.22) and odds ratio (1.44) were not statistically significant between the two populations (p > 0.05). The extent of ≥ 5 mm probing depths was 1.5 % in SLE patients and 3.7 % in healthy patients, which was also not significant between groups (p > 0.05). SLE patients were missing an average of 9.6 teeth per individual compared to 3.8 in healthy patients (p < 0.05). Conclusions: The results of the present study indicate that patients with SLE do not have an increased risk for periodontitis when compared to patients without SLE. Risk analysis on the prevalence and the extent of deeper probing depths were not statistically different between SLE and control groups. Further studies with a larger sample size and elimination of unseen confounders are needed in order to validate our results. An interesting observation was the finding that SLE patients have a significantly greater number of missing teeth. The exact mechanism through which SLE patients experience periodontal breakdown and increased tooth loss is an avenue that warrants future research. Keywords: systemic lupus erythematosus (SLE); chronic periodontitis Abbreviations: SLE: Systemic Lupus Erythematosus, CP: Chronic Periodontitis, SLEDAI: Systemic Lupus Erythematosus Disease Activity Index, BOP: Bleeding on Probing, CAL: Clinical Attachment Level.

Orthodontic-Periodontics: An Interdisciplinary Approach

Periodontal pathogenesis is a multi-factorial process and the orthodontist must recognize the clinical forms of inflammatory periodontal disease. Orthodontics is the most conservative and predictable treatment to improve numerous local etiological factors that contribute to periodontal disease including periodontal breakdown. Proper occlusal function and masticatory function are stimulatory to the gingival tissue and the attachment apparatus, while, conversely, a lack of function predisposes to disease that increases plaque retention and calculus formation along with gingival inflammation leading to increased loss of bony support. No matter how talented the orthodontist, a magnificent orthodontic correction can be destroyed by failure to recognize periodontal susceptibility. Therefore, identifying periodontally susceptible patients is critical for the outcome of the treatment. This chapter will highlight the importance of the short-term and long-term outcomes of orthodontic treatment, which are influenced by the patient’s periodontal status before, during and after active orthodontic therapy.

Influence of the treatment with the antineoplastic agents 5-fluorouracil and Cisplatin on the severity of experimental periodontitis in rats

Purpose The determination on how antineoplastic agents interfere on the progression of periodontitis is critical for improvement and even development of novel therapeutic approaches for periodontal management. This study evaluated the influence of chemotherapy with 5-fluorouracil (5-FU) or cisplatin (CIS) on healthy periodontal tissues and on the progression of experimental periodontitis (EP). Methods One-hundred-forty-four male rats were divided into six groups (n = 24). Each group was treated with physiological saline solution (PSS) 0.9%, 5-FU or CIS. Experimental periodontitis (EP) was induced by ligature placement. Animals were euthanized at 7, 15 and 30 days after treatment. Data were statistically analyzed (p ≤ 0.05). Results The groups with EP and treated with 5-FU or CIS showed lower percentage of bone volume in the furcation region and higher percentage of alveolar bone loss, higher number of TRAP-positive cells and lower number of PCNA-positive cells when compared group with EP and treated with PSS (p ≤ 0.05). Groups with EP and treated with 5-FU or CIS showed high immunolabelling pattern of RANKL, TNF-α, IL-1β, moderate of BAX and low of HIF-1α. Histological analysis showed severe tissue breakdown in the groups with EP and treated with 5-FU or CIS. Conclusions Chemotherapy with antineoplastic agents 5-FU and CIS increasing the intensity and duration of the inflammation; and compromising tissue repair by reduction in cellular and vascular turnover. The more severe periodontal breakdown was caused by 5-FU.

The adult orthodontic patient over 40 years of age: association between periodontal bone loss, incisor irregularity, and increased orthodontic treatment need

Objectives Adult orthodontic treatment, especially in patients over 40 years, is steadily increasing. One causal factor for the treatment need in this age group is periodontal breakdown. The aim of this study was to detect correlations between periodontal problems and orthodontic parameters in interdisciplinary patients. Methods This observational, cross-sectional study included 118 patients over 40 years (51 men/67 women; mean age, 58.03 years) classified into three groups according to periodontal breakdown (group I, controls; group II, moderate periodontitis; group III, severe periodontitis). Clinical periodontal and orthodontic parameters as well as the index of orthodontic treatment need (IOTN) were assessed and compared between the groups. Results A gradual deterioration of all periodontal and orthodontic parameters according to periodontal bone loss (lowest values in group I; highest values in group III) was observed. Especially groups I and III differed significantly regarding the overjet (p < 0.001) and the little indices of the maxilla (p < 0.001) and mandible (p < 0.010). The IOTN was highest in group III: 90% of the patients with severe periodontitis were classified to have moderate to very great treatment need. Conclusions The higher the degree of periodontal breakdown was, the more severe were overjet, overbite, irregularity of the anterior teeth, and the orthodontic treatment need. Clinical relevance Adult patients over 40 years represent a challenge for an orthodontic/periodontal treatment approach with high incidence of pathologic tooth migration, orthodontic treatment need, and periodontal breakdown. Therefore, this special patient collective requires a focus in clinical orthodontics and research.

aMMP-8 Point-of-Care/Chairside Oral Fluid Technology as a Rapid, Non-Invasive Tool for Periodontitis and Peri-Implantitis Screening in a Medical Care Setting

This communication article addresses currently available rapid non-invasive methods to screen and detect periodontitis and dental peri-implantitis. In this regard, oral fluid biomarkers have been researched extensively but self-reported oral health (SROH)-questionnaires have also been developed. Both alternatives may offer a quick and easy way to screen and detect diseased patients. Active matrix metalloproteinase (aMMP-8) is one of the most validated biomarkers for screening and detecting periodontal breakdown related to periodontitis and peri-implantitis and monitoring their treatment effects revealing successful, less- and non-successful treatment results. Currently available aMMP-8 lateral-flow technologies allow this kind of analysis, as demonstrated here, to be conducted quantitatively online and real-time as point-of-care/chairside testing in dental and even medical care settings. In this study, an aMMP-8 peri-implant sulcular fluid point-of-care-test diagnosed peri-implantitis and healthy implants far more accurately than bleeding-on-probing or the other biomarkers, such as polymorphonuclear (PMN)/neutrophil elastase, myeloperoxidase and MMP-9. Although, SROH-questionnaires allow screening in similar settings but they lack the information about the current disease activity of periodontitis and peri-implantitis, which is of essential value in periodontal diagnostics and treatment monitoring. Thus, both methods can be considered as adjunct methods for periodontitis and peri-implant diagnostics, but the value of oral fluid biomarkers analysis does not seem to be substitutable.

Prevalence of Amalgam Overhang in Erbil City Population

Overhanging tooth restorations are defined as an extension of amalgam restorative material beyond or after the cavity preparation lines, lead to environmental change of the balance between beneficial bacteria and periodontopathogens, lead to periodontal breakdown. This study aim was to obtain the prevalence of tooth amalgam overhang in Erbil city population. Amalgam overhang restoration prevalence study about 1200 patients examined in College of Dentistry, Hawler Medical University, and (Khanzad) Specialized Center for Dentistry for the presence of proximal amalgam restoration. The patients also have who proximal restorations were examined clinically using dental mirror and explorer and then radiographically by taking bitewing radiograph. The results showed statistical analysis for the prevalence of amalgam overhang among patients attitude in the study (25.4%). The distribution of amalgam overhang was 59.4% for upper teeth and 40.6% for lower teeth and 64.6% for distal surface, 36.4% for the mesial surface. In conclusion, there is a high percentage of amalgam overhang among population that need treatment to prevent subsequent periodontal diseases.