Hopeless Prognosis Research Articles

Accuracy of Computer-Guided Flapless Implant Surgery in Fully Edentulous Arches and in Edentulous Arches With Fresh Extraction Sockets.

The aim of this study was to evaluate the accuracy of computer-guided flapless implant (CGFI) surgery in edentulous jaws with fresh extraction sockets and compare it to CGFI in fully edentulous jaws. Ten patients with a completely edentulous arch (group A) and ten patients presenting natural teeth with a hopeless prognosis in the upper or lower jaw (group B) were consecutively treated with CGFI. A multipiece radiographic guide was fabricated for group B patients. The accuracy was assessed by matching the planning cone-beam computed tomography (CBCT) with a postoperative CBCT. Global coronal, global apical, angular deviation, and depth deviation were registered. The mean global coronal deviation for group A was 1.12 ± 0.5 mm, the mean global apical deviation was 1.36 ± 0.7 mm, the mean angular deviation was 3.16 ± 1.8 degrees, and the mean depth deviation was 0.51 ± 0.7 mm. The mean global coronal deviation for group B was 1.28 ± 0.6 mm, the mean global apical deviation was 1.65 ± 0.7 mm, the mean angular deviation was 3.42 ± 1.5 degrees, and the mean depth deviation was 0.53 ± 0.9 mm. Global apical deviation was significantly higher in the group B (P = 0.007). CGFI surgery in edentulous arches with fresh extraction sockets may be accurate. However, clinicians should be aware that higher apical deviation may occur in this setting.

EFFICACY OF TWO PIEZOELECTRIC ULTRASONIC SCALERS WITH HAND INSTRUMENTATION: A PROFILOMETRIC AND SEM STUDY

Background: The goal of the present study was to compare the efficacy of two piezoelectric scalers with hand instrumentation in calculus removal, loss of tooth substance and roughness created on root surface.
 Methods: 90 freshly extracted non-carious, non-restored single rooted teeth with hopeless periodontal prognosis were included in the study. They were divided into three groups of 30 teeth each i.e. Group 1,Group 2 and Group 3 where instrumentation was done using two piezoelectric scalers- Piezoelectric scaler A & Piezoelectric scaler B and Gracey curette respectively. Specimens were subjected to Scanning Electron Microscopy (SEM) & Profilometric analysis to evaluate the root surface roughness created by these three instruments.
 Results: Statistically significant difference was observed in Remaining calculus index (RCI) in the three experimental groups with hand instrument being least effective in removing calculus when compared to the piezoelectric scalers(p≤0.05). There was significant difference in mean Loss of tooth substance index(LTSI) and Roughness loss of tooth substance index (RLTSI) scores when compared in the three groups (p value =0.002). Both SEM and profilometric analysis showed that Piezoelectric scaler A and Piezoelectric scaler B caused less root surface roughness compared to hand instruments.
 Conclusion: The findings of the present study suggest that scaling and root planing using both piezoelectric scalers and hand instruments were effective in mechanical debridement of the root surface. However, piezoelectric instruments gave smoother root surface than hand instruments and were also more efficient in calculus removal.
 Key words: Dental scaling, Root planing, Ultrasonics, Scanning Electron Microscopy, Dental calculus

Significance of selected biochemical markers in predicting the outcome of schistosomiasis

This study aimed to correlate the histopathological changes in mice liver with alterations either in liver tissue antioxidants enzymes (catalase and reduced glutathione (GSH)), oxidative stress marker (malondialdehyde (MDA)) or in serum liver function parameters (Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (T.P.) and albumin) to predict the outcome of schistosomiasis. Fourty male Swiss albino mice were used in this study and infected with Schistosoma mansoni for 2, 4, 6 and 8 weeks (8 mice for each group), while, the uninfected mice were used as negative control. Liver tissue antioxidants enzymes, oxidative stress marker and serum liver function parameters were determined in coincide with the liver tissue histopathological changes. All selected biochemical makers showed a strong significant positive correlation (p < 0.05) with liver histopathology score except serum albumin and liver tissue catalase enzyme. The last two parameters exhibited negative correlation with liver histopathology score. These results revealed that the more increase in the level of AST, ALT, T.P. and globulin in serum or liver tissue MDA and GSH indicating severs histopathological changed into the affected liver and hopeless prognosis is expected. On contrary, the increase in albumin level in serum or catalase level in liver tissue of affected patient/animal demonstrating mild liver histopathological changes. Subsequently, good prognosis and response to anti-schistosomal treatment will be predictable. This study opens the way to predict the outcome of schistosomiasis through easy and rapid biochemical test. Therefore, other studies are required to apply such correlation with other biochemical parameters especially that synthesized into the liver.

Validation of multivariable models for predicting tooth loss in periodontitis patients.

A large number of multivariable models which associate independent variables with the outcome tooth loss exist. Directly or indirectly, these make predictions as to the relative risk of tooth loss. We aimed to validate six of these prediction models. We applied each model, if needed after adaptions, in a cohort of 301 compliant periodontitis patients who had been under supportive periodontal treatment (SPT) in a university setting over 21.7±5.6years. The models employed a range of tooth-level and patient-level parameters. Model accuracy, that is, the ability to rightly predict tooth loss during SPT using baseline parameters, was investigated by the area under the receiver-operating-characteristics curve (AUC). Most models showed low accuracy (AUC ranged between 0.52 and 0.67). The classification model from Avila etal. (2009) Journal of Periodontology, 80, 476-491, expressing the risk of tooth loss in five grades, was most accurate (mean AUC: 0.67, 95%CI: 0.65/0.69). When applying this model, the risk of false-positively predicting tooth loss was high, except when the highest grade (i.e. a tooth being considered as having a hopeless prognosis) was used. In this case, the specificity was 84% and the sensitivity 46%. Predicting tooth loss in this specific cohort of periodontitis patients was only limitedly possible.

The association between a marker of oxidative stress in Saliva and severity of periodontal disease

Background: The aim of this study is to determine the relationship between the level of 8-hydroxydeoxyguanosine (8-OHdG) in saliva and severity of periodontal diseaseMaterial and method: Twenty five periodontitis patients were divided into two subgroups according to severity of periodontal disease (fifteen patients with probing pocket depth (PPD) <6mm and ten patients with PPD>6mm). Clinical examination which included measurement of both PPD and bleeding on probing (BOP) were carried out before and after initial periodontal treatment in addition to assessment of 8-OHdG in saliva and gingival crevicular fluid (GCF).Result: Salivary level of 8-OHdG in those with PPD >6mm was higher than those with PPD<6mm. Also this study evaluated 8-OHdG levels in GCF, it was detected only in periodontitis patients with PPD>6mm (mean PPD = 7.34) and only in some cases (4 out of 10).Conclusion: These data suggest that periodontally-involved teeth with deep pockets are a major source of salivary 8-OHdG levels may prove to be useful identifying patients with teeth of hopeless prognosis.

Multidisciplinary prognostic transition of a molar tooth for long-term survival

Patients with periodontitis may have one or few teeth with hopeless prognosis, which would have to be extracted before initiation of orthodontic therapy. Periodontal therapy aims to prolong the lifespan of dentition, as preserving natural dentition is always the best treatment option. The decision to retain a tooth is always based on the probability of long-term success of one or more treatment modality. A 17-year-old female patient seeking fixed orthodontic treatment presented with the left mandibular first molar tooth (36) having hopeless periodontal prognosis with advanced primary periodontal and secondary endodontic lesion, grade III mobility, and grade II furcation involvement. Root canal treatment followed by periodontal surgery using a combination of bone graft (allograft) and platelet-rich fibrin membrane resulted in a clinical and radiographic indication of periodontal healing. The tooth (36) was even used for orthodontic anchorage 3-month postsurgically and was maintained for 2 years. Appropriate diagnosis and meticulous multidisciplinary treatment approach can lead to the restoration of health and function of the teeth with severe loss of attachment and bone loss and can even be used for orthodontic anchorage.

Traumatic sacral fracture following dystocia in a Thoroughbred foal

SummaryA Thoroughbred colt with a history of dystocia was referred for further management of suspected hypoxia. The foal showed signs of neonatal maladjustment syndrome and hindlimb paralysis. Radiography revealed the presence of a severe lumbosacral injury. The foal was subjected to euthanasia due to a hopeless prognosis. Computed tomography was performed post‐mortem and revealed a type I Salter Harris fracture of the cranial physis of the first sacral vertebra.

Informed consent for the diagnosis of brain death: a conceptual argument.

BackgroundThis essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference.MethodsConceptual, philosophical, and ethical analysis.ResultsI first consider a conceptual justification for the use of consent for certain non-beneficial and unwanted medical diagnoses. I suggest that the diagnosis of brain death falls into this category for some patients. Because the diagnostic process of brain death lacks the transparency of traditional death determination, has a unique epistemic structure and a complex risk-benefit profile which differs markedly from case to case, and presents conflicts of interest for physicians and society, I argue that pre-diagnostic counseling and informed consent should be part of the diagnostic process. This approach can be termed as “allow cardiac death”, whose parallel logic with “allow natural death” is discussed. I also discuss potential negative impacts on organ donation and health care cost from this proposal and offer possible mitigation. I show that the pre-diagnostic counseling can improve the possibility for well-thought-out decisions regarding organ donation and terminating life-support system in cases of hopeless prognosis. This approach differs conceptually from the pluralism of the definition of death, such as those in New Jersey and Japan, and it upholds the Uniform Determination of Death Act.ConclusionsMy intention is not to provide an instant panacea for the ongoing impasse of the brain death debate, but to point to a novel conceptual ground for a more pragmatic, and more patient- and family-centered approach. By enabling the family to consent to or decline the diagnostic process of brain death, but not to choose the definition of death, it upholds the current legal definition of death.

Treatment of pathologically migrated teeth via modified intentional replantation: cases report

Pathologic tooth migration (PTM) caused by periodontal disease is a relatively common disease with a prevalance rate of 30~55%. It is one of the reasons for periodontal treatment of patients. PTM occurs when various factors related to the position of the tooth are altered and clinical features of PTM include facial flaring, diastema, proximal tilting, rotation, and extrusion of teeth. The purpose of this study was to assess the treatment of teeth of hopeless prognosis through the practice of modified intentional replantation on pathologic migrated tooth. This study presents cases using modified intentional replantation for the treatment of pathologic tooth migration caused by severe periodontitis. Modified intentional replantation is a technique that prepares extraction socket by using an implant drill. Based on 3 cases performed with modified intentional replantation, an improvement of clinical periodontal indicators such as probing pocket depth, bleeding on probing, tooth mobility, and pathologic teeth migration was observed after surgery. Also, the patients were satisfied with the functional and esthetic improvement.

Using prognostic factors from case series and cohort studies to identify individuals with poor long-term outcomes during periodontal maintenance.

The accuracy of applying prognostic factors to individual patients is uncertain. The aim was to apply prognostic factors from several outcome studies (case series and cohort) to identify: (1) patients who lost a tooth/teeth during periodontal maintenance; (2) patients who were non-responding to treatment; (3) patients needing re-treatment during periodontal maintenance. In addition, tooth loss was related to initial prognosis and it was determined which of the prognostic factors were also risk factors. Chi squared analysis was carried out for the outcomes of patients with-, and without prognostic factors. Significance level was set at p≤0.05. Sensitivity and specificity was calculated for patients with and without prognostic factors. The prognostic factors only identified a small proportion of patients who lost teeth (34-38%). Combining the prognostic factors resulted in a lower accuracy. A higher proportion of patients with no prognostic factors lost teeth (53.8-96.2%). The chance of identifying a non-responding patient based on family history was 5.9%, for stress 32.4%, and for heavy smoking 8.7%. Significantly more patients (29/40 , χ²=16.2 p<0.05) with initial uncertain/poor prognosis and significantly fewer patients (11/40, χ²=16.2, p<0.05) with erratic/no compliance needing re-treatment were identified. 21 of 40 patients (52.5%) (p=0.655) with family history needing retreatment were identified. Combining the prognostic factors identified 5-22% out of a total of 40% of patients needing re-treatment. six out of nine (67%) teeth with an initial hopeless prognosis were lost, 10/109 (9%) teeth with a poor prognosis were lost, 11/346 (3%) teeth with a moderate prognosis were lost and 9/1972 (0.46%) of teeth with a good prognosis were lost. None of the prognostic factors was found also to be a risk factor for developing periodontal diseases. Applying prognostic factors to identify individual patients with poor long-term outcomes is associated with low accuracy.

Survival rate of teeth with periodontally hopeless prognosis after therapies with intentional replantation and perioprosthetic procedures - a study of case series for 5-12 years.

The purpose of the present study was to evaluate the longitudinal survival rate of the treatment of teeth affected with periodontally hopeless prognosis and secondary occlusal traumatism (SOT) using intentional replantation (IR) and periodontal prosthesis. We collected data from 17 individuals who received IR and participated in the study during 1995 to 2014. Of the 17 teeth affected by periodontally extreme conditions with deep angular bone defects, severe alveolar bone loss extending to or beyond the apex, and SOT, was recognized as having hopeless prognosis. Those teeth were treated sequentially using procedures that included basic periodontal therapy, therapeutic provisional prosthesis, IR, fixed dental prosthesis, crown and sleeve‐coping telescopic dentures (CSCTDs), or fixed prosthesis and CSCTD combined. Longitudinal assessments of clinical parameters and radiographic bone change before and after IR were evaluated. Clinical results showed that the overall cumulative survival rate of assayed teeth after IR therapy (5–12 years) was 88.2%. The mean (±SD) estimated radiographic alveolar bone loss was 12.7 ± 2.1 mm (88.5% ± 13.3%) of the root length, initially, and estimated radiographic alveolar bone gain was 4.0 ± 2.2 mm ultimately, in 17 replanted teeth with SOT. Only one tooth (5.9%) exhibited root resorption. Ankylosis was not observed during the study. Periapical radiographs demonstrated that satisfactory periodontal healing of lamina dura and bone fills occurred in all replanted teeth with SOT. Generally, tooth mobility and SOT were significantly improved after therapy. Most treated teeth functioned well and remained stable clinically throughout the periods of study. The present study documented a promising outcome for autogenous IR and periprosthetic therapy of 17 periodontally hopeless teeth for 5–12 years. The present study revealed good bone gain and elimination of SOT and prominent occlusal function. We concluded that the application of IR, minocycline‐HCL and periodontal prosthetic procedures later elevated the prognosis of these otherwise hopeless teeth with SOT, which are valuable options for retaining teeth with periodontally extreme situations.

Immediate 3-dimensional ridge augmentation after extraction of periodontally hopeless tooth using chinblock graft.

Background The aim of the present study was to evaluate clinically and radiographically, the efficacy of immediate ridge augmentation to reconstruct the vertical and horizontal dimensions at extraction sites of periodontally hopeless tooth using an autogenous chin block graft. Material and Methods A total of 11 patients (7 male & 4 female) with localized advanced bone loss around single rooted teeth having hopeless prognosis and indicated for extraction were selected for the study. The teeth were atraumatically extracted and deficient sites were augmented using autogenous chin block graft. Parameters like clinically soft tissue height - width and also radiographic ridge height -width were measured before and 6 months after augmentation. Obtained results were tabulated and analysed statistically. Results After 6 months of immediate ridge augmentation, the mean gain in radiographic vertical height and horizontal width was 7.64 + 1.47 mm (P = 0.005) and 5.28 + 0.46 mm (P = 0.007) respectively which was found to be statistically significant (P < 0.05). Mean change of width gain of 0.40mm and height loss of 0.40mm of soft tissue parameters, from the baseline till completion of the study at 6 months was observed. Conclusions The present study showed predictable immediate ridge augmentation with autogenous chin block graft at periodontally compromised extraction site. It can provide adequate hard and soft tissue foundation for perfect 3-Dimensional prosthetic positioning of implant in severely deficient ridges. Key words:Immediate ridge augmentation, periondontally hopeless tooth, autogenous chin graft, dental implant.

Immediate natural tooth pontic: A new aspect in periodontics

In patients with a hopeless prognosis of the anterior teeth, there is still a strong desire to save them for the sake of esthetics. If not grossly carious, broken down or discolored the extracted tooth after suitable modifications can be placed back in its original site by splinting it to the adjacent stable teeth. This case report describes the replacement of periodontically compromised tooth by natural tooth pontic technique using resin composite and fiber reinforced ribbon.

Fixed Partial Denture Treatment With Mini Dental Implants

Fixed Partial Denture Treatment With Mini Dental Implants

The management of traumatic tooth loss with dental implants: Part 1.

Traumatic dental injuries are relatively common causes of emergency presentation to general dental practitioners. There are well established guidelines for the management of traumatised teeth, which practitioners should be familiar with and able to deliver. Some teeth, however, are either lost at the time of injury or are found to have a hopeless long-term prognosis despite appropriate treatment. The first article in this two-part series covers the important aspects of maintaining teeth where possible, to preserve the supporting hard and soft tissues. It then describes the replacement of a single tooth lost due to trauma and the relative challenges faced. The second article covers more extensive trauma, involving multiple teeth and where significant supporting tissues are lost. It describes the replacement of teeth, including the hard and soft tissues with implant supported restorations, whilst highlighting the need for a multidisciplinary team in severe cases.

Therapeutic hypothermia does not diminish the vital and necessary role of SSEP in predicting unfavorable outcome in anoxic-ischemic coma

Rational medical management of patients who remain comatose following cardio-pulmonary resuscitation (CPR) due to anoxic-ischemic encephalopathy depends upon the early identification of those with a hopeless prognosis – regardless of how aggressively they are managed. Conversely, it is mandatory that we recognize those patients with the potential to recover in order to institute aggressive therapeutic measures. The bilateral absence of the N20 Cortical Somatosensory Evoked Potential has been identified as the most reliable predictor of an unfavorable prognosis in normothermic patients.Two randomized trials have determined that mild therapeutic hypothermia (TH) delivered immediately after CPR improves neurologic outcomes. TH has now become the standard of care in the management of patients with cardio-pulmonary arrest. Eight studies targeting patients who were comatose following CPR, treated with TH, and using SSEP as an outcome predictor are reviewed. There is only one patient treated with TH who appears to have fully recovered following cardiac arrest who was initially found to have bilateral absent cortical potentials. This opinion paper will address whether the criteria that placed reliance upon SSEP to predict unfavorable outcome in post cardio-pulmonary arrest patients after receiving TH, still apply.

Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital.

The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002–2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1–108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.

Platelet-rich plasma and bi-phasic tri calcium phosphate in the management of periodontally compromised teeth with hopeless prognosis: A case report with six-year follow-up and surgical re-entry

One of the main objectives of periodontal therapy is to prolong the lifespan of dentition as there is no ideal substitute for natural dentition even in the era of dental implants. Treatment of teeth with advanced periodontal disease with hopeless prognosis is always extraction. However in this case report, we discuss a novel regenerative strategy using a combination of platelet rich plasma and bi-phasic tri calcium phosphate for a lower central incisor that was considered for extraction. Clinical and radiographic examination during the six-year follow-up postoperatively revealed stable periodontal health in the lower right central incisor. The surgical re-entry done in the sixth year postoperatively revealed good periradicular healing and alloplastic bone graft incorporation within the host bone.

Effect of supportive periodontal therapy on the prevention of tooth loss in Korean adults.

The purpose of this retrospective study was to evaluate the effect of patient compliance with supportive periodontal therapy (SPT) on tooth loss in Korean adults. The periodontal records of 134 patients were reviewed for this study. They completed active periodontal treatment from 1999 to 2001 and were placed on a schedule of periodic follow-up visits for SPT. Patient compliance was classified into complete compliance (CC), erratic compliance (EC), and noncompliance (NC) groups. Re-examinations were carried out 11.0±0.8 years after the active periodontal treatment. The prognosis for each tooth was determined as good, questionable, or hopeless according to the bone loss observed in pretreatment radiographs. The rate of tooth loss of the CC group was significantly lower than that of the NC group. The tooth loss/patient and the tooth loss/patient/year were not significantly different between the three groups. The rates of tooth loss in the good, questionable, and hopeless prognosis groups were 6.7%, 9.5%, and 13.2%, respectively. For the teeth with a good prognosis, the rate of tooth loss of the CC group was significantly lower than that of the NC group (0.4% vs. 5.1%). For the teeth with a questionable prognosis, the CC group showed a significantly lower rate of tooth loss than did the EC group (4.1% vs. 30.7%) or the NC group (4.1% vs. 25.6%). For the teeth with a hopeless prognosis, the rates of tooth loss were not significantly different among the three groups. Within the limits of this study, the patients who showed a poor compliance with SPT were more likely to lose teeth than were the regularly compliant patients. However, the risk of tooth loss with a hopeless prognosis was high irrespective of the compliance.

Concerns about maintenance of natural teeth and dental implants

Periodontal disease is still prevalent according to the recent report from US Centers for Disease Control and Prevention (CDC) (doi: 10.1177/0022034512457373). Nearly a half of adults aged 30 years and older have this disease and its prevalence rate increases with age, given that the two-thirds of adults 65 years and older have periodontal disease, which does not surprise us. When our patients' natural teeth have poor or hopeless prognosis, the best recommendation that we can offer as dentists is the usage of dental implant to replace the teeth, which is mostly welcomed by some patients who are not financially limited. However, other conventional prosthetic solutions, such as crown & bridge and removable partial or full denture often result in unhygienic gum condition or improper masticatory function, which makes it too hard for most patients to keep their gums and underlying bone healthy. On the other hand, dental implant does not decay and is easy to clean compared to the traditional dental prosthesis. Theoretically, patients' peri-implant tissues are more likely to remain healthy. Dental implant is capable of replacing each individual tooth as well as multiple teeth in a row. For edentate patients, dental implant can effectively anchor a full or partial denture. With these numerous advantages, it is obvious that dental implant is now regarded as the treatment of choice for most patients who suffer from unhealthy periodontal condition. We should keep in mind, however, that there is very little consensus on how to define periimplant inflammation. Although the prevalence rate of peri-implantitis is inconsistent, its overall trend shows an increase over a period of time. This phenomenon might have resulted from the durability of dental implant, which is said to be lifetime as opposed to the approximately ten-year durability of conventional prosthesis. As dental implant can last far longer with gum tissue, the healthy status of gum should be a crucial factor for successful dental implantation. Therefore, periodontal treatment must be regarded as equally important as peri-implant therapy. In this issue of JPIS, we have carefully selected papers that present us ensuring periodontal or peri-implant health. The sincere effort of these authors and careful attention of readers would be a cornerstone in the foundation of foremost periodontal & implant science.