Infrabony Pockets Research Articles

Significance of maxillary sinus mucosal thickening in patients with periodontal disease

To characterise and measure the Schneiderian membranes of individuals with periodontal diseases in China and to analyse the factors impacting maxillary sinus mucosal thickness using cone-beam computed tomography (CBCT). A cohort of 221 patients with periodontal disease was subjected to cross-sectional CBCT examination. Various parameters, including age, sex, alveolar bone loss, furcation lesions and vertical infrabony pockets, were analysed as correlates of mucosal thickening (MT). Sinus mucosal thickness ≥ 2 mm qualified as MT. MT was detected in 103 (48.9%) patients, increasing in frequency as the degree of alveolar bone loss advanced (mild, 14.5%; moderate, 29.5%; severe, 87.9%). The association between MT and vertical infrabony pockets was statistically significant (P < 0.001). The likelihood of MT increased with moderate [odds ratio (OR) = 1.02] and severe (OR = 4.62) periodontal bone loss (P < 0.001), as well as with furcation lesions (OR = 2.76) and vertical infrabony pockets (OR = 13.58). Relative to the case in patients with periodontitis and normal mucosa, the probability of MT increased dramatically as alveolar bone loss worsened. Periodontal pathologies (i.e. furcation lesions and vertical infrabony pockets) were also more likely to coincide with MT.

Effect of temperature on the dental implant osseointegration development in low-density bone: an in vivo histological evaluation.

To make an in vivo evaluation of the effects of 2 different bone temperatures, on the development of implant osseointegration, in low-density bone. Fifteen implant osteotomic sites were prepared in the iliac crests of sheep. Before the implant insertion, 5 sites were heated to 50°C for 1 minute, 5 sites to 60°C for 1 minute, and 5 sites were not overheated. Fifteen titanium dental implants (Cortex, Israel) were inserted. After a healing period of 2 months, the histomorphometric parameters calculated for each implant were the Bone-Implant Contact percentage (%BIC) and the infrabony pocket depth. Unpaired t test was applied to find statistical differences between groups. No implants failed. Statistical significant differences in %BIC and periimplant bone loss were found between the 60°C group and control group. No significant differences were found between the 50°C group and control group, although bone suffering signs were present. An osteotomic site overheating up to 60°C for 1 minute in low-density bone, before implant insertion, did not lead to implant failure, but it induced significant crestal bone loss during healing and lower %BIC.

Factors Associated with Orthodontic Tooth Movement in Periodontally Compromised Patients

There is no consistent relationship between malocclusion and periodontal disease but certain characteristics of malocclusion can promote a pathologic environment conducive to periodontal disease. One of the dramatic means available to improve the local environmental factors is through orthodontic tooth movement. The pretreatment periodontal conditions can include excessive tooth mobility, advanced crestal bone loss, infrabony defects, tipped molars, furcation involvement, and hard and soft tissue dehiscences. Movement of teeth in the presence of periodontal inflammation can result in an increased loss of attachment and irreversible crestal loss. Although absolute reduction in bone and attachment levels does not contraindicate orthodontic correction, it does increase the difficulty of delivering controlled orthodontic mechanics that would potentially minimize further bone loss. The present review article discusses the various factors that are associated with orthodontic tooth movement in periodontally compromised patients namely: 1) tooth movement into infrabony pockets; 2) tooth movement into compromised bone areas; 3) tooth movement through cortical bone; 4) extrusion (eruption); 5) intrusion; 6) tipping.

Effect of 50 to 60°C heating on osseointegration of dental implants in dense bone: an in vivo histological study.

To evaluate, in vivo, the effects of bone temperatures increased up to 60°C introduced before implant insertion on titanium implant osseointegration. Twenty-four acid etched and sandblasted implants (Cortex Dental Implants) were inserted in the inferior edge of sheep mandibles. Osteotomic sites were randomly divided into 3 groups before inserting the implant. In test 1 group and in test 2 group, implant sites were overheated, respectively, up to 50°C for 1 minute and 60°C for 1 minute, with an electronic controlled probe of 3 mm in diameter and 10 mm in length. Osteotomic sites in control group were not overheated. Implants were inserted according to standard procedures. After 2 months healing, % bone implant contact (%BIC) and infrabony pockets' depth were measured. Unpaired t test was applied to find statistical differences between groups. No implant failure occurred. No statistical significant difference in %BIC was found among groups. Histological analysis showed that mean infrabony pockets were statistically deeper in 60°C group than in other groups. Bone temperature up to 60°C for 1 minute does not seem to significantly impair titanium dental implant osseointegration. Bone damage signs evident in the 60°C group suggest that careful drilling procedure with sufficient irrigation is necessary to avoid periimplant infrabony pockets' formation. More in vivo evaluations are needed to identify what is the value of bone temperature increase for irreversible inhibition of implant osseointegration.

Orthodontic movement and periodontal bone defects: Rationale, timing, and clinical implications

Advanced periodontitis may be characterized by the formation of infrabony pockets, infrabony defects, and possible pathologic tooth migration. An interdisciplinary approach is often required in planning the treatment of advanced periodontitis. Periodontal nonsurgical and surgical therapies control the microbial infection whereas orthodontic therapy realigns the migrated teeth. To avoid further periodontal breakdown, active orthodontic movement must always follow proper periodontal therapy. Consequently, orthodontic treatment is no longer a contraindication in patients with controlled periodontal disease. Teeth can be moved into infrabony defects, leading to defect closure, bone fill, and possibly new attachment formation. Orthodontic stimulation at the periodontal ligament level has positive effects on the quality of periodontal wound healing, especially when orthodontic movement starts shortly after surgical periodontal treatment. When the infrabony defects are subject to augmentation procedures, the graft material does not impede orthodontic tooth movement that seems to enhance defect healing. The present article describes the effects of orthodontic movement into infrabony defects adjacent to pathologically migrated teeth.

Pathologic Tooth Migration-Spontaneous Repositioning Following a Non-Surgical Periodontal Therapy: A Case Report

This case report describes the spontaneous correction of a pathologic tooth migration (PTM) and reduced infra-bony pockets after a nonsurgical periodontal therapy.

The Use of Leukocyte- and Platelet-Rich Fibrin During Immediate Postextractive Implantation and Loading for the Esthetic Replacement of a Fractured Maxillary Central Incisor

I mplant-supported restoration of the maxillary anterior segment that is biologically, functionally, and esthetically acceptable following traumatic injuries in the maxillary anterior segment is always complex. Careful extraction of the fractured root, residual labial bone preservation, proper flap design, ideal positioning of the implant, appropriate softtissue contour, and the crown emergence are all important steps necessary to achieve a predictable, stable, functional, and esthetic success. However, healing of the tissues is always difficult to control and the development of new techniques and materials to improve these treatments is still necessary. The use of platelet concentrates is an interesting approach. Platelet concentrates for surgical use are widely used and continuously investigated in oral and maxillofacial surgery. The objective is to gather platelet growth factors and to inject them on a surgical site to stimulate the healing process. A significant percentage of the literature is focused on the platelet-rich plasma (PRP) families. PRP is a liquid platelet suspension often activated into a platelet-rich gel (like fibrin glues). Another technology called leukocyteand platelet-rich fibrin (L-PRF) allows for the preparation of strong fibrin membranes enriched with cells (activated platelets, leukocytes, circulating cells) and platelet growth factors. This autologous healing biomaterial is free of additives (no anticoagulant during blood harvest, no chemicals for activation), simple, inexpensive, and quick to prepare (15 minutes for all steps). This technique is specifically adapted to the practical needs in daily implant dentistry. Several articles have reported the use of these L-PRF membranes for the stimulation of bone and 1 Private practice, Turin, Italy. 2 Private practice, Ra’anana, Israel. 3 Clarion Research Group, Clarion, Penn. Department of Restorative Dentistry, State University of New York at Buffalo, Buffalo, NY. 4 LoB5 Unit, Research Center for Biomineralization Disorders, School of Dentistry, Chonnam National University, Gwangju, South Korea. Department of Stomatology, Oral Surgery, and Dental and MaxilloFacial Radiology, School of Dental Medicine, University of Geneva, Geneva, Switzerland. * Corresponding author, e-mail: LoB5@mac.com DOI: 10.1563/AAID-JOI-D-12-CL.3802

Erratum

Dear Editor, In regards to the 28(4) STEP-BY-STEP article “Guided Tissue Regeneration for Infrabony Pocket Treatment in Dogs” the authors would like to make a correction to the published manuscript. Page 282, paragraph five, sentence five reads “While both products act as scaffolding for migrating cells to form new bone (osteoconduction), the allograft is a source of cells (osteogenisis) and bone morphogenic proteins (osteoinduction) which may enhance bone production.” The demineralized ostoeoallograft is considered osteoconductive and osteoinductive, however it does not provide a source of viable cells and therefore should not be considered osteogenic. True osteogenisis could be achieved with the application of an autogenous bone graft that provides viable bone forming cells. Sincerely, Wade Gingerich

Guided Tissue Regeneration for Infrabony Pocket Treatment in Dogs

Guided Tissue Regeneration for Infrabony Pocket Treatment in Dogs

Modified Distal Wedge Excision for Access and Treatment of an Infrabony Pocket in a Dog

A six-year-old male neutered Dachshund dog presented with generalized moderate gingivitis and calculus formation. A comprehensive oral examination performed under general anesthesia revealed infrabony pockets and horizontal bone loss associated with the left mandibular first and second molar teeth. The left mandibular second molar tooth was extracted, while the left mandibular first molar tooth was treated by staged periodontal therapy, including a modified distal wedge excision for open root planning and bone augmentation. Preoperative probing depths of 9-mm associated with the distal root of the left mandibular first molar tooth were reduced to 2-mm following treatment. The patient continued to maintain normal periodontal probing depths, with no gingival recession at 3, 6, 16, and 33-months following periodontal treatment.

Prevalence of mucosal abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography: results from the Health 2000 Health Examination Survey

Mucosal thickening and mucosal antral cyst (MAC) in the maxillary sinus are incidental findings in panoramic radiographs. The study sample consisted of 5021 participants in a nationally representative Health 2000 Health Examination Survey using panoramic radiography. The prevalence of mucosal thickening was 12% and of MACs 7%, both being twice as frequent in men as in women. Mucosal thickening was most common in the 40- to 49-year age group, whereas MACs were most often seen in younger age groups. Pathologic dental findings and root canal treatments were significantly associated with mucosal thickening but not with MACs. The odds ratios of vertical infrabony pockets were 5.2-fold compared with edentulous. This nationally representative study indicates that dental infections are etiologic for antral mucosal thickening, but not for MACs.

Combined periodontic-orthodontic-endodontic interdisciplinary approach in the treatment of periodontally compromised tooth

Orthodontic treatment in adult patients is one of the most frequently encountered components involving multidisciplinary approaches. In the present report, a 28-year-old male patient was treated for localized chronic periodontitis with pocket formation, mobility, pathologic migration and malalignment of maxillary left lateral incisor tooth #22. The periodontal therapy included motivation, education and oral-hygiene instructions (O.H.I.), scaling and root planing and periodontal flap surgery. Subsequently on resolution of periodontal inflammation, orthodontic therapy was carried out using the orthodontic aligner for a period of 6 months. Post-treatment (3 years) results showed complete resolution of infrabony pocket with significant bone fill, reduced tooth mobility and complete alignment of the affected maxillary left lateral incisor, thus restoring the esthetics and function.

Immediately loaded titanium implant with a tissue‐stabilizing/maintaining design (‘beyond platform switch’) retrieved from man after 4 weeks: a histological and histomorphometrical evaluation. A case report

After implant insertion and loading, crestal bone usually undergoes remodeling and resorption. If the horizontal relationship between the outer edge of the implant and a smaller-diameter component ('platform switching') is altered, there seems to be reduced crestal bone loss. Immediate loading allows immediate restoration of esthetics and function, reduces morbidity, and facilitates functional rehabilitation. Three Morse cone connection implants were inserted in the right posterior mandible in a 29-year-old partially edentulous patient. The platform of the implant was inserted 2 mm below the level of the alveolar crest. After a 1-month loading period, the most distal mandibular implant was retrieved with a trephine bur for psychological reasons. At low-power magnification, it was possible to see that bone was present 2 mm above the level of the implant shoulder. No resorption of the coronal bone was present. No infrabony pockets were present. At the level of the shoulder of the implant, it was possible to observe the presence of dense connective tissue with only a few scattered inflammatory cells. Newly formed bone was found in direct contact with the implant surface. The bone-implant contact percentage was 65.3+/-4.8%. Abutments smaller than the diameter of the implant body (platform switching) in combination with an absence of micromovement and microgap may protect the peri-implant soft and mineralized tissues, explaining the observed absence of bone resorption. Immediate loading did not interfere with bone formation and did not have adverse effects on osseointegration.

Synthetic Platelet-Derived Growth Factor (rhPDGF) May Improve Bone Fill Over β-Tricalcium Phosphate (β-TCP) Alone

Article Title and Bibliographic Information Platelet-Derived Growth Factor Stimulates Bone Fill and Rate of Attachment Level Gain: Results of a Large Multicenter Randomized Controlled Trial Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, et al. J Periodontol 2005;76(12):2205-15 Level of Evidence 1a Purpose/Question 1. Among adults with chronic periodontitis and infrabony pockets, is synthetic platelet-derived growth factor (rhPDGF–BB) plus bone substitute (β-tricalcium phosphate [β-TCP]) more effective in regeneration than bone substitute alone? 2. Among adults with chronic periodontitis and infrabony pockets, is 0.33 mg/mL rhPDGF–BB plus β-TCP more effective in regeneration than 1.0 mg/mL rhPDGF–BB plus β-TCP? Source of Funding Industry: BioMimetic Therapeutics, Franklin, Tennessee Type of Study/Design Multicenter Triple-Blinded Randomized Controlled Trial

Guided Tissue Regeneration of the Mixture of Human Tooth-Ash and Plaster of Paris in Dogs

This study evaluated the efficacy of periodontal tissue regeneration using guided tissue regeneration (GTR) with a mixture of tooth ash and plaster as a bone substitute material in the treatment of class II furcation defects in dogs. GTR was performed at the site of a surgically formed mandibular premolar bifurcation area in dogs. Four adult dogs were used in the animal study. The animals were in a good periodontal state without any systemic disease. A resorbable membrane (Bio-Gide®, Swiss) and bone graft material using a mixture of tooth ash and plaster were used to examine the biological activity. The defect in the control group was filled a Bio-Gide® only. For the experimental group, the defects were filled with a mixture of tooth ash and plaster and covered by a Bio-Gide®. Oral rinsing with 0.12% chlorhexidine was performed twice a day for 2 weeks. In control group, new bone formation was observed adjacent to the preexisting bone. Soft tissue ingrowth was also noted. In experimental group, new lamellar type trabecular bone formation as well as centum and PDL regeneration was observed in the base of the infrabony pocket. More bone regeneration would be expected when GTR is performed using a mixture of human tooth-ash and plaster of Paris as a bone graft material.

Alveolar bone levels in adults as assessed on panoramic radiographs. (I) Prevalence, extent, and severity of even and angular bone loss

There is limited information regarding the prevalence and intraoral distribution of infrabony lesions potentially suitable for regenerative procedures in common patients seeking regular dental care in a dental practice. The aim of the present study was to investigate the prevalence and extent of alveolar bone loss and infrabony defects in randomly selected orthopantomograms of adult patients in different age groups seeking treatment at the dental service of the German Armed Forces. A total of 240 panoramic exposures were available for analysis, 60 in each of the age groups <30, 30-39, 40-49, and >or=50 years of age. At each tooth, distances between the cementoenamel junction or margin of restoration and the alveolar crest as well as the bone level were measured with a calliper to the next 0.1 mm. Whereas virtually no bone loss was present in the youngest age group, a major change in bone level frequency distributions occurred after age 30 years. At age 50 years, about 50% of subjects had considerable bone loss of more than 4 mm at 10% or more sites, and 6 mm or more at about 5% sites. Deep infrabony defects were infrequently found before age 40 years. About 20% of patients at least 50 years of age had radiographic evidence of infrabony pockets of 4 mm or more at not more than 5% of sites. Bone loss was more pronounced in the maxilla, especially at molars. In this predominantly male population, periodontal bone loss gradually increased with age. However, prevalence of infrabony defects was very low.

Spontaneous Correction of Pathologic Tooth Migration and Reduced Infrabony Pockets Following Nonsurgical Periodontal Therapy: A Case Report

This case report describes the spontaneous correction of pathologic tooth migration and reduced infrabony pockets after nonsurgical periodontal therapy. A 3-mm diastema between the maxillary incisors was closed completely, and the mandibular teeth, which had migrated pathologically, returned to the optimal position. Clinical evaluation showed a significant reduction in probing depth, with increased clinical attachment and bone deposition demonstrated radiologically.

Treatment of an Infrabony Pocket in an American Eskimo Dog

This case report describes the use synthetic bone graft particulate and 24% EDTA gel to treat an infrabony defect adjacent to the mandibular right first molar tooth in an American Eskimo dog. Postoperative examination 33-months following surgery showed osseous integration at the infrabony defect and restoration of the periodontal ligament space with a small refractory periodontal pocket.

Crown Lengthening for Mandibular and Maxillary Canine Teeth in the Dog

Crown lengthening is the exposure of root structure to function as clinical crown for restorative coverage.1 Indications for crown lengthening include increasing the amount of clinical crown available for attachment of a prosthesis (crown or bridge) following crown fracture, and exposure of a malerupted tooth crown allowing management of any pathologic changes. Types of crown lengthening procedures include simple gingivectomy [type I], apically repositioned flap(s) following bone recontouring [type II], or orthodontic extrusion [type III]. Type I and II crown lengthening procedures involve periodontal surgery requiring maintenance of the biological width of the gingiva composed of the gingival sulcus, junctional epithelium, and connective tissue attachment (Fig. 1). Each of these zones is approximately 1-mm wide in humans, and may be 2 to 3-mm wide in large dogs. In type II crown lengthening procedures in dogs, the apically repositioned flap should maintain a minimum 3-mm biological width of the gingiva coronal to the newly formed alveolar crest to provide space for the three zones to reestablish. Failure to maintain gingival biological width physiology may cause an inflammatory response that results in crestal bone resorption and apical migration of periodontal soft tissues.1 Advanced periodontal disease resulting in the formation of infrabony pockets may jeopardize tooth maintenance.1 Crown preparation may be performed acutely, however a 2 to 3-week interval is recommended between crown lengthening and preparation to allow for accurate assessment of gingival margin location following wound healing. Type II crown lengthening of the mandibular and maxillary canine teeth is described step-by-step.

Dental diseases and loss of teeth in a group of Finnish alcoholics: a radiological study

A total of 85 Finnish alcohol-dependent subjects and 53 controls were studied with panoramic radiography. The aim was to study the possible associations between prolonged alcohol consumption and dental health. The mean number of teeth, caries lesions, endodontic treatments, periapical lesions, marginal bone loss, and periodontal infrabony pockets was studied. The subjects met the diagnostic criteria of alcohol dependence as set out in DSM-IV and ICD-10. The control group comprised social drinking volunteers with an AUDIT score h 8. For the final results the subjects were divided into groups on the basis of sex and age. The social backgrounds of the subjects were similar, except for employment and smoking. The results show significantly fewer teeth and more caries in the alcoholic group. There was a tendency for the alcoholics <45 years of age to have more endodontically treated teeth than the controls, but no difference in the number of periapical lesions in endodontically treated teeth was found. Horizontal bone loss and the presence of calculus were more frequent in alcoholic men than in alcoholic women. Significantly more horizontal bone loss was observed in the group of alcoholic nonsmokers than in nonalcoholic nonsmokers. In the nonsmoking groups alcoholics had significantly more periodontal destruction than the nonsmoking controls. We conclude that radiological dental health among individuals dependent on alcohol is weakened by more caries, more horizontal bone loss, and more numerous vertical infrabony pockets than social drinkers.