Ortodonti ve periodontoloji işbirliği. Modern biyolojik ortodontide periodontal konular

    ÖZET     Ortodontistlerin ve periodontologların yaptıkları klinik tedavilerde periodontoloji ile ortodonti arasındaki ilişkinin biyolojik temellerinin farkında olması gerekmektedir. İki uzmanlık dalı arasındaki uyum, tedavi sonuçlarının olumlu olmasını sağlamaktadır. Bölümler arasında gerçekleştirilen işbirliği ile ortodontik tedavi periodontal sağlığı geliştirdiği gibi periodontal tedavi de ortodontik tedavi sonuçlarını daha da başarılı hale getirebilmektedir. Teknoloji, uzmanlık dalları arasında etkileşimi sağlarken, tedavinin temelini biyoloji oluşturmaktadır. Yeni yüzyılın ortodontisti; bilgili, deneyimli ve sorumluluk sahibi periodontolog ile beraber çalışmalıdır. Ortodontik tedavi görecek hastalar, periodontal riskler, dişeti büyümeleri ve olası alveolar kemik kaybından haberdar edilmelidir. Bu derlemede, aselüler dermal matriks, mine matriks proteinleri, periodontal plastik cerrahi ve yeni bir ortognatik cerrahi alternatifi olan “periodontal olarak hızlandırılmış osteojenik ortodonti” gibi güncel tedaviler ile geleneksel tedaviler tartışılacaktır. Ayrıca aşağıdaki sorulara cevaplar bulunmaya çalışılacaktır; “Ortodontik tedavi periodontal hastalığa sebep olur mu?”, “Periodontal olarak enfekte olan hastalar ortodontik diş hareketleri ile tedavi edilebilir mi?”, “Hastalara ne zaman ve hangi cerrahi yaklaşımlar yapılmaktadır?”, “Hangi tedavi seçenekleri en iyi sonuçları verir ve periodontal dokulara daha az zarar verir?”, “Ne sıklıkla ortodonti hastaları periodontolog tarafından takip edilmelidir?”. Ayrıca periodontal açıdan ortodontik tedavinin endikasyonları, kontrendikasyonları, sınırlamaları, avantaj ve dezavantajları tartışılacaktır.     Anahtar Kelimeler: Ortodonti, Periodontoloji, işbirliği     ABSTRACT     Orthodontists and periodontists must be aware of the biologic basis of periodontal orthodontic relationships during clinical theraphies. Synergism between two specialists should approve the results for favourable treatment outcomes. With collaboration, orthodontic therapy can enhance periodontal health and periodontal therapy can enhance the orthodontic outcomes. While technology provides us the interaction between specialties, biology establishes the basis of treatment. Orthodontist of the new century would consult experienced, responsible and enlightened periodontist. Patients undergoing orthodontic treatment must be informed about possible periodontal risks, gingival overgrowth and alveolar bone loss. In the present article conventional and current theraphies including acellular dermal matrix, enamel matrix proteins and periodontal plastic surgeries and a new orthognatic surgery alternative “periodontally accelerated osteogenic orthodontics” will be discussed. Also we will try to give answers to following questions: “Does orthodontic treatment contribute to periodontal disease?”, “Could periodontally infected patiensts be treated with orthodontic tooth movements?”, “Which and when a surgical approach should be made to patients?”, “Which treatment options give best outcomes and less harm to periodontal tissues?”, “How frequent will orthodontic patients be followed by a periodontist?”. Also, advantages and disadvantages, limitations, indications and contraindications of orthodontic treatment from periodontal perspective will be discussed.     Key Words: Orthodontics, Periodontology, collaboratio

Dehiscence and fenestration in patients with different vertical growth patterns assessed with cone-beam computed tomography

Objective: To test the null hypothesis that the presence of alveolar defects (dehiscence and fenestration) was not different among patients with different vertical growth patterns

Nuclear factor-kappa B ligand and osteoprotegerin levels in serum and gingival crevicular fluid in patients with bone metastases treated with zoledronic acid

Bone metastases are frequently observed in patients with certain types of cancer and are significant cause of morbidity. Zoledronic acid (ZA) is routinely prescribed for patients with bone metastases by affecting osteoclast function. We aimed to assess the effect of ZA over time in patients with bone metastases by analyzing novel bone turnover marker levels including receptor activator of nuclear factor-k B ligand (RANKL) and osteoprotegerin (OPG) in serum and gingival crevicular fluid (GCF). Also, associations between these bone turnover markers with hematological and biochemistry dysregulation were studied. The study enrolled patients with bone metastases including 32 patients diagnosed with solid tumors and 15 patients with multiple myeloma. In these patients, GCF and serum RANKL and OPG levels were measured and compared with measures of hematological and biochemical parameters before and after 3 months of ZA therapy. Mean subject age was 54 years old with a range of 28-80 years. Skeletal-related events were observed in 8.5 % of all patients. After the 3-month treatment of ZA therapy, no significant differences were found in serum and GCF levels of RANKL and OPG when compared with before treatment levels. GCF RANKL levels at baseline and following 3 months of ZA therapy were significantly higher in patients with solid tumors when compared patients diagnosed with multiple myeloma (p = 0.001; p < 0.001, respectively). GCF OPG levels after the entire course of ZA therapy were greater in patients with 5 or more bone metastases (p = 0.04). For patients with multiple myeloma, control GCF OPG was negatively correlated with control platelet and WBC counts (p = 0.018 and p = 0.027, respectively). A negative correlation was observed between control serum RANKL and control serum OPG levels in myeloma patients (p = 0.001). After 3 months of ZA therapy, no significant differences were observed in GCF and serum RANKL and OPG levels when compared with baseline. A negative correlation was observed between serum control RANKL and OPG levels in myeloma patients. OPG levels were greater in patients with 5 or more bone metastases. In patients diagnosed with multiple myeloma, GCF OPG levels were negatively associated with WBC and platelet counts