DZZ International, 03/2021

Immediate treatment concepts in dental implantology are becoming increasingly popular because the reduction in treatment time is highly appreciated by patients and uncomfortable provisional restorations can be avoided. Given the correct indication, the prognoses of immediately placed implants and their prosthetic restoration are comparable to conventional, delayed treatment concepts. Thus, immediate treatment concepts should be considered as therapeutic options in routine dental practice.

Introduction: Periodontitis can result in irreversible loss of connective tissue and supporting alveolar bone. Despite advances in regeneration therapy, treatment of periodontal furcation defects is still a challenge. This case report describes a combined regenerative approach in the treatment of grade II furcation defects in mandibular molars. Material and Methods: In the present case study, 2 clinical cases with advanced localised periodontitis and an occlusal trauma as a cofactor were studied over 8 and 5 years, respectively. Following initial occlusal adjustment, the periodontal defects were treated successfully with guided tissue regeneration along with allogenic cancellous bone, enamel matrix proteins and endogenous growth factors. Results: The treatment was effective in the regenerative therapy of destructive periodontal disease in both patients. Significant amount of bone fill was seen in clinical and radiographic re-evaluation and clinical results were maintained in the follow-up after 8 and 5 years. Conclusion: Successful regeneration of periodontal tissues can be achieved using the combination of guided tissue regeneration (GTR), Allograft bone substitute, Emdogain and plasma rich in growth factor (PRGF). The combination therapy resulted in regeneration of tooth supporting tissue with improved clinical attachment levels and healthy gingiva. Keywords: Allograft bone substitute, Enamel matrix derivates, chronic periodontitis, guided tissue regeneration, occlusal trauma, plasma rich in growth factor

Introduction: In order to achieve an optimal brushing result when performing self-responsible home-based oral hygiene, patients should be able to self-monitor both their brushing process and the cleaning result. This pilot study conducted in cross-over design aimed to determine if an app or an abacus can aid patients in implementing the "CIOTIPlus" tooth brushing system and technique when performing self-responsible home-based oral hygiene. Methods: Sixteen participants (8 female, 8 male; average age: 72.6 ± 4.2 years) were included in the study. The study was divided into 3 phases. In each phase, a different tool (self-developed app or "CIOTIPlus-Abacus") was used to support self-monitor home-based oral hygiene. In the baselinel examination (t0), in addition to the general anamnesis, the DMF-T/S and PSI, QHI and mAPI were recorded. The participants recorded their home-based oral hygiene for 3 weeks by noting the cleaned tooth surfaces/areas in each phase. In phase 1 (t1), the documentation was performed solely by using the app. In phase 2 (t2), the documentation ensued through the use of the app as well, but in contrast to t1, more functions were accessible on the app. In phase 3 (t3), the daily home-based oral hygiene was recorded using an abacus ("CIOTIPlus-Abacus"). The participants were also asked to fill out a questionnaire at t0, t2 and t3. Results: In the basic examination (t0), the participants showed an average QHIt0 of 2.1 ± 0.7 and an average mAPIt0 of 3.5 ± 0.6. At t1, the subjects showed significantly lower plaque-index values (PI values) in the area of the smooth and proximal surfaces (QHIt1 1.6 ± 0.6; p = 0.004; mAPIt1 2.9 ± 0.7; p = 0.003). At time t2, compared to t0 and t1, the average PI values were again significantly lower in the area of both the smooth (QHIt2 0.8 ± 0.4; p 0.0001) and proximal surfaces (mAPIt2 1.7 ± 0.5; p 0.0001). Fourteen participants (7 female, 7 male) were included in phase 3. The PI values in the area of the smooth and proximal surfaces at time t3b were also significantly lower in comparison to both t0 and t1. At time t3b, the PI value in the area of the smooth surfaces did not differ significantly compared to t2 (QHIt2–QHIt3b; p = 0.147), but the PI value in the area of the proximal surfaces was significantly lower (mAPIt2–mAPIt3b; p = 0.024). Conclusion: The results of this pilot study show that an app or an abacus are suitable tools for supporting patients to self-monitor their home-based oral hygiene, which could lead to significantly improved oral health. Keywords: CIOTIPlus-Abacus, CIOTIPlus-App, self-monitoring, self-responsible home-based oral hygiene

Introduction: Neuroinflammation is a hallmark of Alzheimer's disease (AD). Multiple infectious agents have been demonstrated in the brain and proposed to be involved in AD, but robust evidence of causation has not yet been established. It was hypothesized that periodontitis (PD) and infection with Porphyromonas gingivalis may be linked to onset and progression of AD. Although inflammation is present in both diseases, the exact mechanisms and interactions between periodontitis and AD are poorly understood. Method: In this narrative review, we highlight recent progress in exploring potential associations of PD with AD and its surrogates (amyloid plaques) and clinical sequelae (i.e. dementia), respectively. Discussion and Result: Recent evidence suggests that periodontitis interacts with AD to increase the severity of clinical dementia and to accelerate its manifestations. These results indicate that periodontitis may be an emerging risk factor for AD and that the risk may be mediated directly by Porphyromonas gingivalis and its secreted neurotoxic gingipains. The recent development of an oral gingipain inhibitor, which is currently tested in a randomized controlled trial, offers the unique opportunity to verify the infectious hypothesis of AD. If successful, this research can be expected to result in a significant improvement of prevention and treatment of PD and AD. Keywords: Alzheimer's disease, Porphyromonas gingivalis, dementia, gingipain, neuroinflammation, oral prophylaxis, periodontitis, therapy

The replacement of missing teeth after unavoidable tooth loss is a core competence in dentistry. In addition to the obvious rehabilitation of the masticatory function and esthetics, there are increasingly more medical considerations that might warrant the replacement of missing teeth. However, the prospective implant site is often compromised by defects of the alveolar process which are triggered by tooth loss or which develop after extraction. The preservation and, if necessary, the regeneration of the alveolar process thus play a major role in daily clinical practice. Various biomaterials are available to the dental practitioner besides autologous bone grafts. The following questions were addressed in the guideline "Implantological indications for the use of bone substitute materials" of the DGI and DGZMK: 1. which are the indications for bone augmentation, 2. which materials are available, 3. which techniques are recommended? The key scientific statements of the guideline are summarized below. The literature references are therefore adapted to this format. The complete details and background are found in the guideline. Keywords: bone augmentation, bone grafts, bone substitutes, jaw atrophy, tooth loss