Using Enamel Matrix Derivative to Improve Treatment Efficacy in Periodontal Furcation Defects

Purpose Furcations are complicated periodontal defects. Untreated furcations lead to loss of the involved teeth and supporting tissues. It has been demonstrated that regenerative biomaterials are beneficial in reconstruction of the bone surrounding furcation‐affected teeth. These biomaterials range from bone grafts and nonresorbable/resorbable barrier membranes to biologics that are able to trigger inactive regenerative processes in periodontal tissues. Selection of appropriate material(s) to treat furcations is challenging. The aim of this article is to provide a comparative outlook on different biomaterials applicable in regeneration of furcations with a focus on enamel matrix derivative (EMD). Methods Scientific databases including PubMed/MEDLINE, ScienceDirect, and EMBASE were searched, and 28 articles were found primarily for this specific study. Full texts were studied to identify relevant studies; 17 studies were excluded because of irrelevancy, while 11 main studies were ultimately selected. Other references have been used for general statements. Results EMD is a protein complex widely used in the regeneration of different periodontal defects. To assess the effects of EMD for treatment of root furcations, clinical studies involving EMD with and without barrier membranes and bone grafts were selected and compared. Briefly, this study reveals that when EMD is combined with open flap debridement (OFD), guided tissue regeneration (GTR), or bone grafting (BG), the amount of class II furcations converted to class I increases significantly. EMD also reduces tissue swelling and patient discomfort after treatment. Conclusions This study provides evidence to find the best combination of biomaterials to treat furcation defects. The best results are obtained if EMD is combined with β‐TCP/HA alloplastic bone grafts

Variants of the human PPARG locus and the susceptibility to chronic periodontitis

Apart from its regulatory function in lipid and glucose metabolism, peroxisome proliferator-activated receptor (PPAR)γ has impact on the regulation of inflammation and bone metabolism. The aim of the study was to investigate the association of five polymorphisms (rs10865710, rs2067819, rs3892175, rs1801282, rs3856806) within the PPARG gene with chronic periodontitis. The study population comprised 402 periodontitis patients and 793 healthy individuals. Genotyping of the PPARG gene polymorphisms was performed by PCR and melting curve analysis. Comparison of frequency distribution of genotypes between individuals with periodontal disease and healthy controls for the polymorphism rs3856806 showed a P-value of 0.04 but failed to reach significance after correction for multiple testing (P  0.90). A 3-site analysis (rs2067819-rs1801282-rs3856860) revealed five haplotypes with a frequency of ≥1% among cases and controls. Following adjustment for age, gender and smoking, none of the haplotypes was significantly different between periodontitis and healthy controls after Bonferroni correction. This study could not show a significant association between PPARG gene variants and chronic periodontitis

Teaching periodontal pocket charting to dental students: a comparison of computer assisted learning and traditional tutorials

AIM: The aim of this study was to compare the effectiveness of a computer assisted learning (CAL) programme with that of traditional small group tutorials in teaching theoretical and practical aspects of periodontal pocket charting. METHOD: Sixty-one third year undergraduate dental students were randomized to either receive a tutorial or to work through the CAL programme. Students using the CAL programme completed questionnaires relating to previous computer experience and the ease of use of the programme. All students were assessed immediately after the intervention by means of a confidence log, a practical exercise and a further confidence log. They were assessed again three weeks later by means of a confidence log and a multiple-choice written test. RESULTS: There were very few significant differences between groups for any of the assessments used. However, subjective comments indicated that students occasionally felt disadvantaged if they had not received a tutorial. CONCLUSION: CAL and traditional teaching methods are equally effective in teaching periodontal pocket charting to undergraduate dental students

Clinical and radiographic observation of the periodontium in patients undergoing orthodontic therapy: first twenty-seven months

Thesis (MSD) --Boston University (Periodontics).Includes bibliographic references: leaves 84-89.Twenty-two male patients from 12-14 years of age were selected prior to active orthodontic therapy at Boston University School of Graduate Dentistry's Departmant of Orthodontics. These patients were projected to undergo full-banded orthodontic treatnent. The objective of this investigation was designed as a long tenn project to document the quantitative and qualitative changes occurring in the periodontium during and following orthodontic therapy. The patients were examined for the first 9 month period by Dr. Stuart Sears and Dr. Sergio Tejedor-Leon. Relocation of two families reduced the number of patients to twenty which were examined for the second 9 nonth period by Dr. Robert E. Roe and Dr. Robert P. Rubins. [TRUNCATED

Evaluation of a porous hydroxyapatite alloplast in the management of grade II furcation defects in molars: a case series

Introduction: The present case series evaluates the efficacy of a hydroxyapatite graft material in the management of grade II furcation involvement in first molars. Materials and methods: Eight patients presenting with a total of 9 grade II furcation defects in relation to the facial aspect of either maxillary or mandibular first molars were treated with a porous hydroxyapatite alloplast. The clinical outcomes were measured in terms of change in probing pocket depth and clinical attachment level (vertical and horizontal) at 6 months post-operatively. Radiographs were used as supplements. Results: At 6 months, there was a mean pocket depth reduction of 3.12±1.25 mm, a mean vertical attachment gain of 2.75±1.17 mm, and a mean horizontal attachment gain of 3.25±1.28 mm. Radiographs showed bone fill at all treated sites. The outcomes were better in mandibular teeth compared to maxillary teeth. The use of hydroxyapatite graft is effective in reducing pocket depth and bringing out gain in attachment levels when used in grade II furcation defects

Evaluation of Maxillary Molar Furcations, Clinical Measurements versus Cone Beam Computed Tomography

BACKGROUND: The use of three-dimensional imaging has shown to provide advantages to the clinician in assessing bone morphology. The aim of this study will be to compare the diagnostic efficacy of cone beam computed tomography (CBCT) versus diagnostic clinical measurements in patients presenting with furcation involved maxillary first molars. METHODS: The study population included 20 patients with 34 maxillary first molar teeth with furcation involvement. Clinical horizontal and vertical probing measurements were compared to CBCT measurements taken by two calibrated examiners. RESULTS: Horizontal measurements showed a significant difference between Glickman class II and class III. There were no statistical significant differences with the horizontal measurements between clinical probing, bone sounding and CBCT measurements. CBCT vertical measurements were statistically greater than clinical probing measurements. CONCLUSION: The CBCT can provide similar horizontal measurements to standard clinical horizontal probing measurements and will provide a greater vertical dimension of a furcation defect to standard vertical probing measurements

Periodontal surgery in furcation-involved maxillary molars revisited—an introduction of guidelines for comprehensive treatment

Maxillary molars with interradicular loss of periodontal tissue have an increased risk of additional attachment loss with an impaired long-term prognosis. Since accurate clinical analysis of furcation involvement is not feasible due to limited access, morphological variations and measurement errors, additional diagnostics, e.g., with cone-beam computed tomography, may be required. Surgical treatment options have graduated from a less invasive approach, i.e., keeping as much periodontal attachment as possible, to a more invasive approach: (1) open flap debridement with/without gingivectomy or apically repositioned flap and/or tunnelling; (2) root separation; (3) amputation/trisection of a root (with/without root separation or tunnel preparation); (4) amputation/trisection of two roots; and (5) extraction of the entire tooth. Tunnelling is indicated when the degree of root separation allows for opening of the interradicular region. Alternatively, root separation is performed particularly in root-canal treated teeth with reduced coronal tooth substance requiring crown restorations. As soon as the attachment of one or two roots in maxillary molars is severely reduced, root removal is indicated and performed either as amputation or trisection including the corresponding part of the clinical crown. While the indication for regenerative measures in maxillary molars with furcation involvement is very limited, extraction and replacement with implants is restricted, particularly in sites requiring complex alveolar ridge augmentation and sinus elevation. A systematic approach for decision making in furcation-involved maxillary molars is described in this overview, including what constitutes accurate diagnosis and what indications there are for the different surgical periodontal treatment option

The Deer Flies of Indiana (Diptera: Tabanidae: \u3ci\u3eChrysops\u3c/i\u3e)

(excerpt) The great majority of specimens, over 12,000 out of 13,185, which form the basis of this study, were collected by the writer during the flight season of the summer of 1963. These are on deposit in the Museum of the Department of Entomology, Purdue University, West Lafayette, Indiana. Other specimens in the collections of the Indiana Department of Natural Resources, Indianapolis, Indiana, of Purdue, and of Earlham College, Richmond, Indiana are incorporated herein. Most specimens in the latter museum were collected, some by the writer, during an earlier general insect survey of the Whitewater River watershed

Local application of Metronidazole as an adjunct to surgical debridement of molar furcation sites.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnTilgangur: Markmið þessarar slembnu, klínísku rannsóknar var að athuga hvort það að koma geli sem inniheldur sýklalyfið metronidazole fyrir undir flipa við tannhaldsskurðmeðferð á annarrar gráðu millirótabólgu, bæti árangur af meðferðinni. Efniviður og aðferðir: Tuttugu sjúklingar með eitt par sambærilegra jaxla, einn í hvorri hlið með sambærilega millirótabólgu af gráðu II tóku þátt í rannsókninni. Eftir formeðferð, við upphaf skurðmeðferðar (baseline), voru gerðar klínískar upphafsmælingar. Mæld var tannsýkla (PlI), yfirborðsbólga (GI), pokadýpt (PPD), tannfesta (PAL), lárétt tannfesta (HAL) og svo blæðing við pokamælingu (BoP) og blæðing við lárétta pokamælingu (HBoP). Gerð var flipaaðgerð með aðferð Widmans (modified Widman flap) og metronidazole geli (Elyzol® Dental Gel, 25% metronidazole) komið fyrir undir flipanum, hjá annarri tönn hvers þátttakenda (tilraunahópur, test, T). Við hina tönnina var ekkert gel notað (viðmiðunarhópur, control, C). Að fjórum vikum liðnum voru tannsýkla (PlI) og yfirborðsbólga (GI) mældar. Að sex mánuðum liðnum voru gerðar klínískar lokamælingar. Rannsóknin var gerð með tvíblindu fyrirkomulagi og slembivalið í hópana T og C. Niðurstöður: Lokaniðurstöður byggjast á 15 tannpörum, P < 0,05. Enginn tölfræðilegur munur reyndist á PlI og GI milli hópanna, hvorki í upphafi né við lokamælingar. Tölfræðilega marktækur munur reyndist á milli T og C hvað varðar PPD (T 3,8 mm C 4,2 mm) við upphafsmælingar og á hópunum við lokamælingar PAL (T 4,3 mm og C 5,2 mm). Munur allra annarra mælinga reyndist tölfræðilega ómarktækur. Ályktun: Niðurstöður þessarar rannsóknar benda til þess að klínísk jákvæð áhrif þess að nota metronidazole gel samfara skurðaðgerð á tannhaldi jaxla með millirótabólgu af gráðu II séu harla lítil. Þannig hefur það sýnt sig að þó einróta tennur svari tannhaldsmeðferð mjög vel 3, 44 þá er árangur af slíkri meðferð hjá fjölróta tönnum marktækt síðri.23,25,32,49 Þessi lakari árangur við jaxlana virðist ekki tengjast verra aðgengi til hreinsunar, eins og vænta mætti vegna stöðu þeirra, aftarlega í tannboganum, því sléttir rótafletir jaxla, staðir sem ekki tengjast millirótabilum, svara meðferð á svipaðan hátt og einróta tennur gera.25 Það er því ljóst að þeir staðir sem skera sig úr eru millirótabilin. Þau geta verið flókin að lögun48 sem aftur leiðir af sér að erfitt getur verið að hreinsa þau, hvort sem beitt er skurðaðgerð eða ekki18,27 en það aftur, skilar sér í lakari græðslu. Sýnt hefur verið fram á að sýklalyfjagjöf, hvort sem er kerfisbundin7,17,19,21 eða staðbundin14,4,11,26 getur bætt græðslu eftir tannhaldsmeðferð, tannhreinsun án skurðaðgerðar. Sá möguleiki að sýklalyf geti bætt árangur af tannhaldsmeðferð með skurðaðgerð hefur lítt verið rannsakaður. Áhugaverðustu staðirnir, hvað þetta varðar, eru þeir sem lakar gróa eftir skurðmeðferð til dæmis millirótabil jaxla. Leiða má að því líkur að sýklalyf sem kemst í snertingu við eftirhreytur sýklaskánar sem finna má í millirótabili eftir tannhreinsun, minnki sýkinguna á rótaryfirborðinu. Í gegnum tíðina hafa fjölmargar rannsóknir verið gerðar á áhrifum metronidazole gels þegar það er notað staðbundið, samfara tannhaldsmeðferð án skurðaðgerðar. Niðurstöður spanna allt frá því að sýna lítil sem engin áhrif af lyfjagjöfinni 40, 46 til þess að sýna veruleg áhrif af hinni staðbundnu lyfjagjöf.12 Minna er vitað um hugsanleg, jákvæð áhrif af staðbundinni notkun metronidazole eftir skurðmeðferð á tannhaldi. Annar þáttur sem hafa skyldi í huga er sá að flókin lögun millirótabilsins gæti stuðlað að því að sýklaskán gæti vaxið að nýju (recolonization) á meðan á græðslu stendur. Sé þetta raunin gæti sýklalyfjagjöf stuðlað að þéttara tannholdi og betri lokun á tannhaldspokanum á fyrstu stigum græðslunnar eftir tannhreinsun. Rannsókn Hirooka (1993) styður þessa hugmynd en þar var metronidazole geli (Elyzol® Dental gel) komið fyrir tvisvar, með einnar viku millibili, eftir tannhaldsmeðferð í millirótabili án skurðaðgerðar. Þar reyndust tilraunastaðir gróa betur hvað varðar lárétt festumörk með þéttara tannholdi í millirótabili en viðmiðunarstaðir sem ekkert sýklalyf fengu. Tilgangur þessarar rannsóknar var að meta hvort staðbundin notkun metronidazole gels bæti árangur af tannhaldsmeðferð með skurðaðgerð í millirótabili jaxla, mælt með klínískum aðferðumObjective: The aim of this randomized, controlled, clinical trial (RCT) was to evaluate if a locally applied metronidazole containing gel may have beneficial effect on the healing results obtained following surgical debridement of molar furcation sites, as assessed by clinical means. Materials and methods: Twenty patients referred for treatment of periodontitis were included in the study. To be included they had to have one pair of contralateral molars with furcation involvement, class II. All the participants were initially given cause related therapy. At baseline; Plaque index (PlI), Gingivitis index (GI), pocket probing depth (PPD), probing attachment level (PAL), horizontal attachment level (HAL) , bleeding on probing (BoP) and finally bleeding on horizontal probing (HBoP) at the furcation were measured. Periodontal flap surgery (modified Widman flap) was performed at all the sites and metronidazole gel (Elyzol®Dental Gel, 25 % metronidazole) was applied under the flap before closure at one of the teeth for each subject. Which tooth received the antibiotic, test tooth (T) and which not, control tooth (C) was selected at random by tossing a coin. At four weeks the PlI and GI measurements were repeated. At six months all the clinical measurements made at baseline were repeated. The design of the study is double blind. Results: Final results were based on results from 15 patients, 30 teeth. Statistical analysis in this study uses p < 0.05. PlI and GI showed no statistically significant differences between T and C throughout the study. A statistically significant difference was shown between T and C for PPD (T 3.8 mm, C 4.2 mm) at baseline and between the groups for PAL at six months (T 4.3 mm, C 5.2 mm). No other results showed statistically significant difference between T and C. Conclusion: The findings of the present study demonstrate that the favorable effect of using metronidazole gel as adjunct to surgical treatment of molar class II furcation defects is limited, measured with clinical methods