Membranes for Periodontal Regeneration

U ovome su članku prikazane različite vrste membrana za vođenu regeneraciju parodontnih tkiva. One se upotrebljavaju za pokrivanje defekata i poticanje regeneracije koštanih stijenki u parodontnome džepu. Membrana treba biti biokompatibilna i omogućiti da se stanice isključe kako bi se odvojio gingivni režanj od fibrinskoga ugruška te očuvao prostor za novu alveolnu kost i periodontni ligament. Membrane mogu biti resorbirajuće i neresorbirajuće. Neresorbirajuće membrane zahtijevaju drugi kirurški zahvat kako bi ih se uklonilo, zbog čega se sve manje upotrebljavaju. Većina tih membrana izrađuje se od politetrafluoretilena, kao na primjer Gore-Tex membrane. Resorbirajuće membrane skraćuju vrijeme liječenja, jer ih ne treba odstraniti nakon zahvata. Mogu biti od prirodnih materijala, pretežito od kolagena, i sintetičkih resorbirajučih materijala, najčešće derivata organskih alifatskih termoplastičnih polimera. Upotrebljava se poliglikolna i polilaktična kiselina. U tu skupinu spada Atrisorb membrana koja se pripravlja intraoperativno. Danas se ispituje i upotreba poliuretanskih membrana. Idealnih membrana nema. Do sada se najviše rabe kolagene membrane koje imaju najbolju biokompatibilnost, iako im se vrijeme razgradnje teško može predvidjeti.This article reviews different types of membranes for guided tissue regeneration. They are used to cover defects and stimulate regeneration of osseous defects in periodontal pockets. A membrane should be biocompatible, enable cell exclusion separating the gingival flap from the fibrine clot and guard space for the new alveolar bone and the periodontal ligament. Membrane can be non-resorbable and resorbable. When non resorbable membranes are used, another surgical procedure for their extraction is needed. They are therefore used less frequently today. The majority of these membranes are made of polytetrafluoretylene, e.g. Gore-Tex membrane. Resorbable membranes shorten the treatment since there is no need for their removal. They can be made from natural materials like collagen, laminar bone, dura mater or connective tissue transplants and from synthetic resorbable materials, most frequently derivatives of organic aliphatic thermoplastic polymers. Polyglycolic and polylactic acids are mostly used. This group includes the Atrisorb membrane that has to be prepared intraoperatively. The use of polyurethane membranes is presently being tested. So far the perfect membrane has not been discovered. Collagen membranes are most popular due to their optimal biocompatibility, although their rate of resorption is difficult to predict

[Electrosurgical methods in periodontology]

U radu se ukazuje na mogućnosti upotrebe elektrokirurgije u parodontologiji i da li se pravilnom primjenom elektrokirurških zahvata mogu postići povoljni klinički rezultati u modeliranju gingivnog tkiva. Ističe se da su najčešća indikaciona područja elektrokirurgije u parodontologiji gingivektomija i gingivoplastika. Pritom se posebno dobri rezultati postižu u tretmanu hiperplastičnih gingivitisa, zatim rekonturiranja gingivnog tkiva nakon kirurških zahvata ili preboljelog ulceronekrotičnog gingivitisa. Autori prikazuju nekoliko slučajeva primjene elektrokirurgije u terapiji dilantin gingivitisa, pubertalnog gingivitisa, i rekonturiranja hiperplastionog gingivnog tkiva za rekonstruktivnu stomatologiju. Iskustva autora ukazuju da je elektrokirurgijom moguće vrlo precizno modelirati gingivno tkivo i postići funkcijski i estetski vrlo povoljne rezultate. Proces cijeljenja u svim slučajevima bio je bez kliničkih komplikacija ili subjektivnih poteškoća. Naglašava se da razni oblici aktivnih elektroda omogućuju vrlo dobar pristup u sve dijelove zubnog niza, a nedostatak krvarenja vrlo preciznu konturaciju gingivnog tkiva. Pritom treba posebno paziti da se aktivnom elektrodom ne dođe u kontakt s periostom i ti alveolnom kosti, jer u tom slučaju mogu nastati nekroza i sekvestracija kosti. Autori zaključuju da je eleEtrokirurgija, uz pravilnu indikaciju i primjenu, te odgovarajuće iskustvo terapeuta, vrijedna i korisna terapijska metoda u parodontologiji.The authors describe the potential use of electrosurgery in periodontology and how, with its proper application, satisfactory clinical results can be achieved in the modeling of gingival tissue. Electrosurgery can be most commonly used in gingivectomy and gingivoplasty. Especially good results are achieved in the treatment of hyperplastic gingivitis, reconstruction of gingival tissue after surgery or after ulceronecrotic gingivitis. The authors report the results of electrosurgery in the therapy of di latin g ingivitis, pubertal gingivitis and reconstruction of hyperplastic gingivial tissue for reconstructive stomatology. The authors\u27 experience indicates that gingivial tissue can be precisely modeled with electrosurgery, achieving functionally and esthetically favorable results. The healing process was clinically unenventful in all patients. The various shapes of active electrodes allow a good approach to all parts of the dental arch and very precise shaping of gingivial tissue because of the absence of hemorrhaging. Special care should be taken to keep the active electrodes from coming into contact with the periosteum and alveolar bone since this could lead to ,necrosis and sequestration of bone. The authors conclude that electrosurgery, when properly indicated and applied by an experienced therapist, is a valuable and useful therapeutic procedure in periodontology

Comparison of Initial Periodontal Therapy Outcome in Aggressive and Chronic Periodontitis

Upalne bolesti parodonta globalni su problem zdravstvene zaštite i jedan su od glavnih uzroka gubitka zuba. Ispitali smo uspješnost inicijalne terapije u oboljelih od kroničnoga parodontitisa (KP) i agresivnoga parodontitisa (AgP), te usporedili klinički odgovor među ispitivanim nskupinama raščlambom dubine sondiranja parodontnih džepova prije i poslije terapije, kao najvažnijega kliničkog indeksa za predikciju daljnje progresije bolesti. Istraživanje je provedeno na 35 pacijenata oboljelih od AgP-a i 71 oboljelog od KP-a. U oboljelih od AgP-a terapija je uključivala sustavski antibiotik i lokalnu irigaciju otopinom klorheksidina. Ispitanici s AgP-om imali su znatno dublje džepove od ispitanika s KP-om (4,49 ± 0,93 mm za AgP i 3,87 ± 0,78 mm za KP). Inicijalna je terapija u objema skupinama znatno smanjila dubinu parodontnih džepova (p < 0,001). U oboljelih od AgP a nađeno je znatno veće smanjenje dubine sondiranja nego u oboljelih od KP-a (1,05 ± 0,80 za AgP i 0,55 ± 0,69 za KP). Kada se razdvoje plitki i duboki džepovi, ta se razlika gubi. Kombinacija mehaničke i antimikrobne terapije u oboljelih od AgP-a poboljšala je klinički status parodonta i pružila zadovoljavajuće kliničke rezultate pa može služiti kao klinički protokol u inicijalnoj terapiji tih bolesnika.Inflammatory periodontal diseases present a global health care problem and are one of the main reasons for tooth loss. We investigated success of the initial periodontal therapy in patients with chronic (CP) and aggressive (AgP) periodontitis, and compared clinical outcome between these groups. We used periodontal pockets probing depth before and after the therapy, being the most important clinical index for prediction of further disease progression. Investigation included 35 patients with AgP, and 71 patients with CP. In the AgP group the therapy included systemic antibiotics and local irrigation with chlorhexidine solution. Subjects with AgP had significantly deeper pockets than subjects with CP (4.49 ± 0.93 mm AgP group, 3.87 ± 0.78 mm CP group). The initial therapy significantly reduced periodontal pocket depth in both groups (p < 0.001). AgP subjects showed significantly higher probing depth reduction than CP subjects (1.05 ± 0.80 za AgP i 0.55 ± 0.69 za CP). When deep and shallow pockets were separated, the difference between the groups was not significant. The combination of mechanical and antimicrobial therapy in the AgP subjects improved clinical periodontal findings, provided good clinical results, and can therefore be used as a clinical protocol for the initial periodontal therapy of these patients

General Health Status and the Periodontium

Nesporno je da su bakterije lokalizirane na vratu zuba glavni etiološki čimbenici oštećenja parodonta. Utvrđeno je da stupanj upalne destrukcije varira oviseći o individualnim razlikama odgovora tkiva domaćina na bakterijsku iritaciju, a kako je parodont integralni dio organizma, u tijesnoj je korelaciji s općim zdravstvenim stanjem organizma i nekim sistemnim bolestima. Čimbenici rizika kao što su dob, spol, društveni status, pušenje, diabetes i stres u značajnoj mjeri utječu na razvoj i progresiju parodontnih bolesti, a također i na terapiju i fazu održavanja postignutih rezultata. Iz tih je razloga godine 1989, Svjetska udruga kliničkih parodontologa donijela je koncepciju potporne parodontne skrbi (PPS) koja se odnosi na ulogu općeg zdravstvenoga stanja organizma u održavanju zdravlja parodonta. Prema toj koncepciji proširen je pristup prevencije parodontnih bolesti ne samo na održavanje dobre oralne higijene nego i na jačanje općeg zdravstvenog stanja organizma.Undoubtedly bacteria localized in the neck of the tooth is the main aetiological factor responsible for damaged periodontium. It has been confirmed that the degree of inflammatory destruction varies, depending on individual differences in the response of the host tissue to bacterial irritation, and as the periodontium is an integral part of the organism, it is in close correlation with the general state of health of the organism and some systemic diseases. Risk factors, such as age, sex, socioeconomic status, smoking, diabetes and stress, influence to a great extent the development and progression of periodontal diseases and also treatment, i.e. maintenance of the attained results. Consequently, in 1989 the World Association of Clinical Periodontologists initiated the concept supportive periodontal care (SPC), which concerns the role of the general health status o f the organism in the maintenance o f healthy periodontium. According to this concept the approach to the prevention o f periodontal diseases has been broadened, not only with regard to maintaining good oral hygiene but also to improving the general health status of the organism

The influence of unfavourable occlusive contacts on parodontolysis

Povoljni okluzijski kontakti su osnovni funkcijski zahtjev, o kojem ovisi kontinuirano održavanje potpornih struktura zuba. Glavni uzroci funkcijskih smetnja su odstupanja od morfološko-fiziološke »idealne« okluzije, nastale zbog okluzijskih suprakontakata pri zatvaranju usta i artikulacijskih zapreka, koje onemogućavaju harmonične kretnje donje čeljusti. Namjera je bila odrediti u kojoj su mjeri zastupljeni nepovoljni okluzijski kontakti u pacijenata is parodontolizama. U tu svrhu, u ustima i na modelima čeljusti 50 ispitanika, koji su bili liječeni u Zavodu za parodontologiju, analizirana je žvačna funkcija. Pritom su u većini slučajeva bili registrirani nepovoljni okluzijski kontakti.The main causes of functional disturbances are deviations from the »ideal« morphological and physiological occlusion which are due to occlusive supracontacts occurring when the jaws are closed and articulatory obstacles which make impossible the harmonic movement of the lower jaw. The work is aimed at determining the effect of unfavourable occlusive contacts in patients with parodontolysis. For this purpose masticatory function was analyzed on the mouths and the models of the jaws of 50 patients treated at the Institute of Parodontology. Unfavourable occlusive contacts were recorded in the majority of the analyzed cases

Influence of Smoking on the Periodontal Status of Adolescents

Mnoga su istraživanja potvrdila da je pušenje jedan od najvažniji čimbenika rizika za nastanak, progresiju i uspješnu terapiju parodontalne bolesti. No samo je nekoliko istraživanja provedeno da bi se utvrdio utjecaj pušenja na mlađu populaciju. Poznato je da je težina parodontalne bolesti izravno povezana s dnevnom količinom cigareta, ali i s godinama pušenja. Potrebno je prepoznati prve znakove negativna utjecaja kako bi se moglo djelovati. Svrha ovoga istraživanja bila je odrediti postotak pušača među učenicima, utvrditi ima li razlike u parodontalnom statusu pušača i nepušača, te ustanoviti utjecaj pušenja na gubitak pričvrstka. Istraživanje je provedeno na 517 srednjoškolskih učenika. Uzimani su podatci o dobi, mjestu stanovanja. socijalnom statustu, navici pušenja, navici pušenja roditelja, navikama oralne higijene i posjeta stomatologu. Parodontalni se je status prikupljao s pomoću CPI i LA indeksa. 34,6% ispitanika bili su redoviti pušači. Dob u kojoj srednjoškolci počinju pušiti sve je niža. Oni koji sada imaju 16 godina počeli su pušiti s 14, ali oni koji sada imaju 14 i 15 godina počeli su pušiti s 12. Djeca kojima roditelji puše imaju dvostruko veću vjerojatnost da i sami postanu pušači, u usporedbi s onom djecom kojoj roditelji ne puše. Krvarenje je češće u pušača (4,61) nego nepušača (4,19) (p=0,001).Pušači imaju znatno više sekstanata s kamencem (1,47) nego nepušači (0,88) (p<0,001). Gubitak pričvrstka znatno je veći u pušača (1,68) nego nepušača (,59) (p<0,001). Količina popušenih cigareta ima velik utjecaj na gubitak pričvtstka. Godišnji gubitak pričvrstka u redovitih i jakih pušača iznosi 0,07 mm. Navike oralne higijene ne razlikuju se između pušača i nepušača, ali učenici s lošom oralnom higijenom imaju veći gubitak pričvrstka. Pušenje utječe na parodontalnu bolest, čak i u mladoj populaciji. Zato je prijeko potrebno obavijestiti mlade pušače o negativnim posljedicama te navike.Different studies have proven that smoking is one of the most important risk factors for the occurrence, progression and successual therapy of periodontal disease. However, only few studies have been conducted to prove the influence of smoking in a younger population. As we know that the severity of periodontal disease is directly associated with the amount of daily smoked cigarettes and also with the duration of smoking, it is important to find out when the first signs of negative influence appear so that we can act appropriately. The aim of this study was to determine if the periodontal status of smokers and non-smokers has differences, and to establish the influence of smoking habits on loss of attachment.The study was conducted on 517 highschool students. For each examinee data was taken concerning their age, place of residence, social status, smoking habits, smoking habits of their parents, oral hygiene habits and attendance to a dentist. The periodontal status was measured by the CPI and LA indices. Among the examines 34.6% were regular smokers. Students who are now 16 started to smoke when they were 14, but students who are now 14 and 15 started at age of 12. Children whose parents smoke had a two-fold increase of becoming smokers themselves, compared to children whose parents did not smoke. Bleeding was more frequent in non-smokers (4.61), than in smokers (4.19) (p=0,001). Smokers had significantly more sextants with calculus (1.47) than nonsmokers (0.88) (p<0,001). Loss of attachment was significantly greater in smokers (1.68) than in non-smokers (1.59) (p<0.001). The amount of smoked cigarettes had a great influence on loss of attachment. The annual loss of attachment in regular and intensive smokers measured 0.07 mm. Oral hygiene habits did not differ between smokers and non-smokers, but students with poor oral hygiene habits had greater attachment loss. Smoking has an influence on periodontal health even in this young age population, therefore it is necessary to inform young smokers about the negative cosequencese that smoking has

New Classification of Periodontal Diseases

Problem klasifikacije parodontnih bolesti vrlo je težak i kompleksan. Promatrajući povijesni razvoj parodontologije, očito je kako su postojale različite težnje da se mijenja i sama terminologija u parodontologiji i klasifikacija parodontnih bolesti. Posljedica toga je velik broj najčešće vlastitih sustava klasifikacija, a općepriznate klasifikacije nastale su tek u posljednjih deset godina. Zbog toga je svrha ovoga rada bila prikazati najnoviju općeprihvaćenu klasifikaciju koja je nastala na prijedlog priznatih svjetskih stručnjaka prigodom međunarodnog Workshopa za klasifikaciju parodontnih bolesti i stanja 1999 godine.The problem of classification of periodontal diseases is extremely difficult and complex. When the development of periodontology is analysed it can be seen that different attempts have been made to change not only terminology in periodontology but also classification of periodontal diseases. This frequently resulted in a large number of individual systems of classification, while those that were generally acknowledged appeared during the last ten years. Consequently the aim of this study was to present the latest generally accepted classification, proposed by acknowledged world experts during the International Workshop for Classification of Periodontal Diseases and Conditions, in 1999

Effects of 10% Carbamide Peroxide Teeth Whitening System on Periodontal Health

Svrha rada bila je istražiti utjecaj sredstva za izbjeljivanje zuba s 10 %-tnim karbamidnim peroksidom (VivaStyle, Ivoclar Vivadent, Schaan, Liechtenstein) na zdravlje parodonta. U studiju je bilo uključeno 10 ispitanika u dobi od 22 do 29 godina, s klinički zdravim parodontnim tkivima, a željeli su promijeniti nijansu boje zuba. Tijekom 12 dana njihovi su zubi bili svaki dan podvrgnuti jednosatnom tretmanu 10 %-tnim karbamidnim peroksidom. Svi su morali tijekom postupka voditi dnevnik mogućih nelagoda. Na početku - šestog i dvanaestog dana - kod svih ispitanika izmjerene su vrijednosti API-a i PBI-a te su im zubi fotografi rani u zagrizu. Svi su zubi postupkom izbijeljeni barem za jednu nijansu. Tijekom tretmana nije bilo promjena ni u akumulaciji plaka, ni u upali gingive. Taj postupak nema nikakva utjecaja na zdravlje parodonta.The aim of this study was to examine the effects of a 10% carbamide peroxide bleaching gel (VivaStyle, Ivoclar Vivadent, Schaan, Liechtenstein) on periodontal health. Ten participants, 22 to 29 years of age, with clinically healthy periodontal tissues and a wish to change the shade of their teeth, participated in this study. Subjects were treated with 10% carbamide peroxide for one hour daily during 12 days. The volunteers were instructed to keep a diary of possible disturbances during the teeth whitening procedure. At baseline, on 6th and on 12th day API score and PBI score were measured and clinical photograph of teeth in intercuspidation relation was taken. All teeth demonstrated change of at least one shade. There was no change in either plaque accumulation, or gingival inflammation during the teeth whitening procedure. This teeth whitening procedure seems not to have any influence on the periodontal health

Proinflammatory Factors in Saliva as Possible Markers for Periodontal Disease

Studies have indicated that host inflammatory proteins, enzymes and indicators of bone metabolism present in saliva differ in different types of periodontal disease. However, the number of markers analyzed was limited and the effect of edentulousness was not examined.We measured the concentration of host inflammatory proteins: C-reactive protein (CRP), C3 and C4 complement components, alpha-2-macroglobulin (a -2M) and tumor-necrosis factor (TNF) in unstimulated saliva of 14 periodontally healthy (PH), 9 edentulous persons (EP), 10 patients with chronic periodontitis (CP) and 18 with aggressive periodontitis (AgP). TNF was below the level of detection in all samples except one. Edentulous persons and patients with CP had significantly reduced concentrations of CRP, C3 and a -2M. Edentulous persons and AgP patients had lower C4 concentrations. We can conclude that edentulous persons and CP patients have reduced salivary concentrations of host inflammatory proteins. These findings suggest that a reduction in host responsiveness might play a role in the pathogenesis of CP