RESUMEN
BACKGROUND: The use of demineralized freeze-dried bone allograft (DFDBA) in periodontal therapy is widely accepted. In addition to histologic studies demonstrating its role in regenerating the attachment apparatus, its recognized ability to exhibit osteoinduction in small laboratory mammals has prompted many clinicians to regard it as osteoinductive when utilized in periodontal therapy. Despite such a theoretical deduction, evaluating and establishing the osteoinductive potential of DFDBA in humans has been problematic. The purpose of this study was to investigate, through the use of a novel implantation/recovery model, the potential of DFDBA to induce new bone formation at sites not normally considered capable of de novo osteogenic activity. METHODS: Seven patients scheduled to undergo periodontal therapy utilizing non-absorbable membranes agreed to have sterile polypropylene mesh capsules placed adjacent to the primary surgical site for the purpose of this investigation. One capsule was left empty while the second capsule contained DFDBA. At the appropriate time interval for removal of the therapeutic membrane, the capsules were removed and submitted for histologic analysis. Five of the subjects had procedures directed at regenerating bone within molar furcations (guided tissue regeneration) and had the membranes and associated capsules removed between 6 and 8 weeks. The 2 remaining patients had procedures directed toward ridge augmentation (guided bone regeneration) and had the membranes removed either at 8 or 9 months, respectively. In addition, one of the 2 long-term membrane patients had liberal cortical penetration performed directly beneath the implanted capsule. RESULTS: Histologic analysis of all recovered capsules by 2 independent oral and maxillofacial pathologists could not confirm the presence of either osteoblastic or osteoclastic activity associated with the DFDBA particles, although the 2 longer-term specimens clearly exhibited trace amounts of vital bone non-contiguous with the implanted material. CONCLUSIONS: The results of this pilot study do not support the osteoinductive potential of DFDBA when utilized in quantities normally associated with periodontal bone grafting, although they do support the use of this implantation/recovery model to study other preparations and mechanisms of bone formation.
Asunto(s)
Trasplante Óseo/fisiología , Regeneración Tisular Dirigida , Procedimientos Quirúrgicos Orales , Osteogénesis , Adulto , Regeneración Ósea , Trasplante Óseo/métodos , Técnica de Descalcificación , Femenino , Liofilización , Humanos , Masculino , Membranas Artificiales , Persona de Mediana Edad , Proyectos Piloto , Trasplante HeterotópicoRESUMEN
Dentists frequently balance periodontal, restorative, and esthetic concerns that will provide adequate tooth length, ensure periodontal health, and provide biological predictability. This report discusses the current and classical literature and provides a multidisciplinary approach of predictably "accessing" the restoration margins to facilitate long-term gingival health and tooth survival.
Asunto(s)
Restauración Dental Permanente/efectos adversos , Inserción Epitelial/lesiones , Pérdida de la Inserción Periodontal/etiología , Pérdida de la Inserción Periodontal/prevención & control , Alargamiento de Corona , Inserción Epitelial/microbiología , Gingivectomía , Humanos , Colgajos Quirúrgicos , Técnicas de Movimiento DentalRESUMEN
Epidermolysis bullosa (EB) is a group of genetic disorders in which patients frequently present with fragile skin and mucosal surfaces that blister following minor trauma; 23 subtypes have been recognized, but their precise pathogenesis and etiology remain obscure. There is no treatment for EB, only palliative therapy. Oral bullae are the most common oral finding and affect all surfaces. Patients with EB present a unique challenge in terms of periodontal therapy. The following article reviews this disorder and describes the complications encountered when providing periodontal plastic surgery to a patient exhibiting this condition. A 36-year-old female with dystrophic EB presented for treatment of a 3 mm recession area with minimal attached gingiva on the facial of #24 and 25. Oral evaluation revealed multiple ulcers. The treatment consisted of a subepithelial connective tissue graft in conjunction with a coronally positioned flap and buccal frenectomy. Most of the epithelium associated with the surgical area and buccal vestibule sloughed. During the postoperative course, the frenum had regenerated at a more coronal level and was applying tension on the gingival tissues. It appeared that a connective tissue union had formed between the de-epithelialized surface of the facial flap and the buccal mucosa of the vestibule. A second frenectomy was performed, and a clear acrylic stent was fabricated to prevent the union of the connective tissue of the facial flap to the buccal mucosa. The stent prevented the fusion of both connective tissue layers and allowed time for epithelium migration.
Asunto(s)
Atención Dental para Enfermos Crónicos , Epidermólisis Ampollosa Distrófica/complicaciones , Recesión Gingival/cirugía , Frenillo Labial/cirugía , Úlceras Bucales/cirugía , Adulto , Femenino , Encía/trasplante , Recesión Gingival/etiología , Humanos , Úlceras Bucales/etiología , Reoperación , Colgajos QuirúrgicosRESUMEN
For many decades, investigators have conducted studies of the interrelationship between endodontics and periodontics. This review article examines previously held concepts regarding the endodontic-periodontal continuum in light of new research and explores promising advances in understanding etiology and in diagnosis and treatment.
Asunto(s)
Enfermedades de la Pulpa Dental/fisiopatología , Enfermedades Periodontales/fisiopatología , Pulpa Dental/fisiología , Enfermedades de la Pulpa Dental/diagnóstico , Enfermedades de la Pulpa Dental/etiología , Enfermedades de la Pulpa Dental/terapia , Humanos , Enfermedades Periodontales/diagnóstico , Enfermedades Periodontales/etiología , Enfermedades Periodontales/terapia , Periodoncio/fisiología , Factores de Riesgo , Tratamiento del Conducto RadicularRESUMEN
The decision to initiate occlusal therapy as part of periodontal treatment is often controversial. This case report illustrates an indication for providing such therapy and suggests an appropriate sequence to follow for achieving a desirable outcome.
Asunto(s)
Oclusión Dental Traumática/complicaciones , Pérdida de la Inserción Periodontal/etiología , Adulto , Oclusión Dental Balanceada , Oclusión Dental Traumática/terapia , Humanos , Masculino , Periodontitis/terapia , Movilidad Dentaria/etiologíaRESUMEN
The palato-radicular groove is an anatomic variant which may be associated with significant attachment loss. This article illustrates the need to carefully examine all patients for the presence of such an anomaly and suggests one possible treatment modality in the event an associated periodontal lesion is present. The learning objective of this article is the ability to recognize this anatomic anomaly and to implement corrective measures.
Asunto(s)
Incisivo/anomalías , Periodontitis/etiología , Anomalías Dentarias/cirugía , Raíz del Diente/anomalías , Pérdida de Hueso Alveolar/etiología , Pérdida de Hueso Alveolar/cirugía , Clorhexidina/uso terapéutico , Durapatita , Humanos , Masculino , Persona de Mediana Edad , Periodontitis/tratamiento farmacológico , Periodontitis/microbiología , Colgajos Quirúrgicos , Anomalías Dentarias/complicacionesRESUMEN
Recession associated with the maxillary anterior gingiva can be particularly displeasing to the patient with a high smile line. The coronally positioned flap technique was used in this case to create a more esthetic appearance.
Asunto(s)
Recesión Gingival/cirugía , Gingivoplastia/métodos , Adulto , Clorhexidina/uso terapéutico , Placa Dental/prevención & control , Femenino , Humanos , Incisivo , Maxilar , Colgajos QuirúrgicosRESUMEN
Guided tissue regeneration procedures are intended to selectively favor healing by the periodontal ligament tissues. However, in most studies of the efficacy of guided tissue regeneration, nonresorbable barriers and membranes have been used, necessitating their surgical removal after a time. The present study employed a resorbable collagen barrier to treat Class II function invasions. The results of this treatment were compared with the results of conventional therapy. For most clinical parameters, there was no statistically significant difference in the results of treatment with or without collagen membranes. Sites treated with a collagen barrier did exhibit statistically significant improvement in probing depth and horizontal osseous support; however, these findings cannot be attributed entirely to the placement of the collagen membrane.