Quintessence International, 03/2014

The goal of regenerative periodontal therapy is to completely restore the tooth's supporting apparatus that has been lost due to inflammatory periodontal disease or injury. It is characterized by formation of new cementum with inserting collagen fibers, new periodontal ligament, and new alveolar bone. Indeed conventional, nonsurgical, and surgical periodontal therapy usually result in clinical improvements evidenced by probing depth reduction and clinical attachment gain, but the healing occurs predominantly through formation of a long junctional epithelium and no or only unpredictable periodontal regeneration. Therefore, there is an ongoing search for new materials and improved surgical techniques, with the aim of predictably promoting periodontal wound healing/regeneration and improving the clinical outcome. This article attempts to provide the clinician with an overview of the most important biologic events involved in periodontal wound healing/ regeneration and on the criteria on how to select the appropriate regenerative material and surgical technique in order to optimize the clinical outcomes. Keywords: biology, enamel matrix proteins, furcation, guided tissue regeneration, periodontal regeneration

Objective: The aim of this study was to compare the clinical efficiency of a diode laser as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis patients, and also to evaluate the changes in the clinical parameters such as clinical attachment level in teeth with periodontal pockets and blood reactive oxygen metabolites. Method and Materials: A total of thirty patients (mean age 38.2 years) with chronic periodontitis were selected for this study. The patients were randomly assigned into two groups of 15 patients each, as the control group and test group. The control group received only conventional SRP and the test group received conventional SRP and diode laser (GaAlAs)-assisted pocket debridement. The clinical parameters (Plaque Index, bleeding on probing, probing pocket depth, and clinical attachment level) were recorded at baseline and day 60, and the serum levels of reactive oxygen metabolites were estimated at baseline, day 30, and day 60 for both the groups. Results: When the groups were compared, there was statistically significant improvement in Plaque Index score, decrease in bleeding on probing and probing pocket depth, and gain in clinical attachment level (P .001) in both the groups from baseline to day 60. There was significant reduction in reactive oxygen metabolites in both the groups from baseline to day 30 and day 60 (P .001). However no statistically significant changes were present between the treatment groups from baseline to day 60 in terms of clinical parameters and blood reactive oxygen metabolites. Conclusion: From the results observed in this study it can be concluded that use of diode laser as an adjunct to SRP did not provide any significant difference compared to use of SRP alone in terms of clinical parameters and reactive oxygen metabolites. Keywords: periodontal disease, reactive oxygen species, serum

The treatment of an infected socket with a severe facial dehiscence/ fenestration defect presents a therapeutic dilemma to the dental team. Both implant-supported restoration and fixed partial denture are viable options to restore function and occlusion, each with its benefits and disadvantages. In the present case report, a multi-stage regenerative approach was selected to enable implant-supported single crown. The first phase of the treatment after extraction of the maxillary central incisor was the stabilization of the blood clot with a collagen plug. Six weeks later, the surgical site was re-entered and the socket was grafted with biphasic calcium sulfate (BCS). Six months later, a dental implant was placed and a core biopsy taken. However, the central portion of the facial defect demonstrated only partial regeneration resulting in exposure of six implant threads. Freeze-dried bone allograft (FDBA) and a collagen membrane were utilized to augment the ridge and cover the exposed threads. The histology of the bone core showed a complete resorption of the grafted material with the presence of new woven bone throughout the specimen. Clinically, complete defect regeneration and augmentation of the alveolar ridge were attained after 4 months. Thus, the clinician should consider the pros and cons of this regenerative approach along with other more conservative treatment alternatives when dealing with similar cases. Keywords: biphasic calcium sulfate, collagen membrane, collagen plug, freeze-dried bone allograft, guided bone regeneration, histology, ridge augmentation, socket preservation

Objective: The aim of this retrospective study was to analyze collected data concerning the effect of an air-abrasive device (Perio-Flow®) during surgical treatment of peri-implantitis without addition of any antimicrobials. Method and Materials: Data reports from 22 implants with peri-implantitis surgically treated using either an air-abrasive device (Perio- Flow) (test group), or plastic curettes and cotton pellets impregnated with saline (control group) were analyzed for the present study. Clinical and radiographic parameters plaque index (PI), gingival index (GI), probing pocket depth (PPD), and bone loss (BL) were previously assessed at baseline, 6 months, and 12 months after treatment. A repeated measures ANOVA test was used for each clinical and radiographic parameter (PI, GI, PPD, and BL). The implant and the patient were considered separately as the statistical unit. Results: Regarding betweengroup comparisons, PI scores remained low during the entire study period (at implant and patient levels). At the end of the study, GI and PPD reductions were statistically higher (P .05) in the Perio-Flow group (implant level), and no differences were observed between the two groups at patient level (P > .05) (repeated measures ANOVA test). It was also noted that BL analyses (implant and patient levels) revealed no differences between baseline and 12 months in both groups. Nevertheless, only 8% from each treatment group were considered stabilized after 12 months. Conclusion: Within the limitations of the present study, both groups (Perio-Flow and its control group) revealed a significant reduction of the clinical parameters. Moreover, the air-abrasive device group yielded better improvements regarding GI and PPD when the implant was considered as the statistical unit. However, if the stabilization of the disease was the final objective, these two treatments failed in resolving its activity. A longer follow-up and a larger number of patients would be needed to confirm these results and the benefit of adding this air-abrasive method of decontamination to the surgical procedure. Keywords: air-abrasive device, biologic complications, peri-implantitis, plastic curettes, stabilization, surgical treatment

Objective: This retrospective observational pilot study examined differences in peri-implant bone level changes (ΔIBL) between two similar implant types differing only in the surface texture of the neck. The hypothesis tested was that ΔIBL would be greater with machined-neck implants than with groovedneck implants. Method and Materials: 40 patients were enrolled; n = 20 implants with machined (group 1) and n = 20 implants with a rough, grooved neck (group 2), all placed in the posterior mandible. Radiographs were obtained after loading (at 3 to 9 months) and at 12 to 18 months after implant insertion. Case number calculation with respect to ΔIBL was conducted. Groups were compared using a Brunner-Langer model, the Mann-Whitney test, the Wilcoxon signed rank test, and linear model analysis. Results: After the 12- to 18-month observation period, mean ΔIBL was −1.11 ± 0.92 mm in group 1 and −1.25 ± 1.23 mm in group 2. ΔIBL depended significantly on time (P .001), but not on group. In both groups, mean marginal ΔIBL was significantly less than −1.5 mm. Only insertion depth had a significant influence on the amount of periimplant bone loss (P = .013). Case number estimate testing for a difference between group 1 and 2 with a power of 90% revealed a sample size per group of 1,032 subjects. Conclusion: ΔIBL values indicated that both implant designs fulfilled implant success criteria, and the modification of implant neck texture had no significant influence on ΔIBL. Keywords: implant collar, implant collar design, microgrooves

Botryoid odontogenic cysts (BOC) are considered to be rare polycystic variants of lateral periodontal cysts characterized by a multilocular growth pattern. The most frequent location of BOC is the mandible, predominantly the premolar-canine area, followed by the anterior region of the maxilla. The cyst shows a slight female predilection. This case report of a BOC demonstrates a treatment with initial fenestration and decompression of the cyst in order to prevent damage to adjacent structures such as the inferior alveolar nerve. The present case report emphasizes the importance of accurate clinical, radiographic, and histologic diagnostic procedures of unspecific radiolucent lesions in the jaws to establish a firm diagnosis and avoid inappropriate treatment strategies. Keywords: botryoid odontogenic cyst, cone beam computed tomography, decompression, diagnosis, therapy

Patients with hemophilia are at high risk of bleeding following oral surgery. As an X-linked recessive chromosomal bleeding disorder it is very rare in female patients. This is the first described case of management of third molar removal in a female patient suffering from severe hemophilia B. Excellent hemostasis was achieved by following a protocol using defined pre- and postoperative doses of factor IX and local hemostatic measures of collagen fleece, fibrin glue, primary suture, and tranexamic acid solution. Following defined protocols is essential in the management of oral surgery in patients with hemophilia and helps to prevent postoperative hemorrhages. Keywords: bleeding disorder, factor replacement, female patient, hemophilia B, local measures, third molar removal

Fordyce granules of the oral mucosa are often discovered during routine dental examinations. They are considered anatomic variations and are typically seen on the labial and buccal mucosa in adults. The present case report describes for the first time in the literature an atypical location of an enlarged Fordyce granule with local bone destruction. The diagnostic process, surgical treatment, and follow-up are presented and discussed. Keywords: cone beam computed tomography, ectopic sebaceous glands, Fordyce granules, intraoral sebaceous hyperplasia

Objectives: The aim of the study was to determine the relationship between idiopathic osteosclerotic lesions and occlusal forces using the T-Scan II computerized occlusal analysis device, and to test the sensitivity of the system in occlusal analysis. Method and Materials: The study was conducted with 21 volunteers with idiopathic osteosclerosis (IO; 14 women, 7 men) aged between 17 and 62 years (mean 29.95). For every patient, seven or eight recordings were made with the T-Scan II occlusal analysis device in maximum intercuspation, and the last two (excluding any with technical problems) were chosen for evaluation. For each lesion-related area, the distribution of high occlusal forces from two different movies was analyzed. Results: In 18 patients (85.71%), lesions were observed in an area of high occlusal force, and in 13 patients (61.9%), the lesions were located at the first area subjected to high occlusal forces. The percentage distribution of high forces at a lesion related area ranged from 0% to 88%. On average, the high forces at an osteosclerotic lesion area accounted for 20% of the maximum total force. No statistical differences were observed between the measurements of the two selected recordings (P > .05). Conclusion: The findings of this study suggest a possible relationship between IO and occlusal forces and primary contacts. T-Scan II was found to be a successful diagnostic device for detecting primary contacts and excessive occlusal forces. Keywords: enostosis, idiopathic osteosclerosis, occlusal analysis systems, occlusal forces, primary contacts, T-Scan II

Objective: The aim was to answer the clinical research question: is incisal/occlusal tooth wear assessment on dental casts performed by five professionals with expertise in different fields of dentistry reliable? Method and Materials: Five examiners with different fields of expertise in the dental profession assessed tooth wear on dental casts of 45 subjects, based on a six-degree rating of incisal/occlusal wear. After a calibration meeting, the examiners evaluated the casts individually and various issues concerning interexaminer agreement and reliability were assessed. Results: A total of 872 teeth were evaluated. The five examiners agreed only for the rating of 6.6% of the teeth. The teeth with the highest percentage of agreement were the premolars. Pairwise comparison of the assessments of the examiners #1 (bruxism expert), #2 (orthodontist), #3 (temporomandibular disorders [TMD] and occlusion expert), #4 (dental nurse) showed fair to moderate agreement, with κ-values ranging from 0.306 to 0.577, whilst the examiner #5 (lab technician) achieved low interexaminer reliability values with all the other four examiners. Conclusion: The interexaminer reliability of tooth wear assessment on dental casts performed by five professionals with expertise in different fields of dentistry is highly variable. General practitioners should keep in mind that consensus decisions by the examiners and assessment by raters belonging to the same dental discipline are recommended strategies to increase the reliability of tooth wear evaluation in the clinical setting. Clinical significance: This investigation adds to the literature suggesting that, in a clinical setting, a single examiner's assessment of tooth wear on dental casts does not have optimal reliability and that it may be source of internal validity problems in the research setting. Keywords: dental cast, interexaminer reliability, tooth wear

Objective: To investigate the extent to which dental hygienists target their efforts toward patients' oral hygiene instruction. Method and Materials: A population of 179 dental hygienists who attended an annual meeting were given a structured anonymous questionnaire to assess information regarding their habits of instructing patients about oral hygiene measures. Results: The dental hygienists were females aged 21 to 68 years (mean age 39.05 ± 18.18); 49.7% worked in private practice, 21.7% in public practice, and 28.57% in both. Overall, 70.9% reported that they provided oral hygiene instruction to all their patients; 28.5% to most of their patients; and 0.6% reported that they never provided oral hygiene instruction. Among the participants, 54.5% reported giving instruction at every treatment, 41% at every periodic treatment, and 4.5% only on first meeting. The reasons for not instructing their patients included: lack of time (21.7%), the patients know how to brush (61.5%), and the patient appears uninterested (23.6%). Most of the participants (77.7%) reported giving the same hygiene instructions for patients at high and low risk for caries and/or periodontal disease. Conclusion: Participants did not use enough demonstration methods in order to improve their patients' performance. Dental hygienists should pay more attention to instruction and education regarding oral hygiene preventive measures. Dental practitioners employing hygienists should encourage oral hygiene instruction programs in their clinics. Those programs should include repetitious demonstrations and reinforcement in order to improve overall outcome and prevention of future disease. Keywords: brushing, instruction, interproximal brush, prevention, rinsing, toothpaste, toothpick