Localized Periodontal Disease Research Articles

Corrigendum to: Gingival Squamous Cell Carcinoma Masquerading as Localized Periodontal Disease in the Maxilla: A Case Report

Corrigendum to: Gingival Squamous Cell Carcinoma Masquerading as Localized Periodontal Disease in the Maxilla: A Case Report

Aesthetic rehabilitation in a patient with skeletal mandibular deficiency and open bite: journey from splinted metalloceramic prosthesis to all-ceramic crowns

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. The final results were aesthetically pleasing with good marginal fit. The patient was extremely satisfied with the outcome as all her concerns were addressed. It is, therefore, advisable to consider placing individual crowns rather than multiunit splinted prosthesis whenever possible.

Oral Ornaments: An Overview

Nowadays, people desire to look attractive and have become very alert about their appearance and smile. Since the face is most exposed part of our body, and mouth a prominent feature, teeth are getting enormous share of attention. Intraoral jewellery has currently gained popularity and is slowly becoming a craze, but this fashion trend is also associated with some significant health issues. These ornaments though are said to enhance beauty cause problems such as increase pain, infection, scar formation, tooth fractures, metal hyper-sensitivity reactions, localized periodontal disease, speech impediment, and nerve damage. This review draws special attention to the prevalence, complications, and side effects of dental jewellery in humans. Here we suggest people must be aware of all the risks associated with wearing dental jewellery, and they should undergo dental check-ups regularly.

Clinical pathology conference case 5: bilateral maxillary sinus resorptive disease with palatal ulceration in a 42-year-old patient

A 42-year-old female presented with bilateral periodontal swellings of 6 months’ duration in the maxillary area palatal to the maxillary molar and premolar teeth. The lesions had been treated by a general dentist as localized periodontal disease, and because of local pain, root canal treatment of tooth #2 was administered. As a result of medial expansion of the lesions toward the hard palate (Figure 1) over the next few months and the occurrence of pus-like discharge, orthopantomography (Figure 2) and computed tomography (CT) (Figure 3) were performed, and the examinations showed bilateral lytic lesions of the hard palate involving the roots of teeth # 4 to #14, respectively.

Evaluation of biodegradable gel containing flax seed extract (Linum usitatissimum) as a targeted drug delivery for management of chronic periodontitis

Treatment of periodontitis has been one of the most challenging aspects of periodontal therapy. The role of host immune inflammatory response in periodontal disease forms the basis of modernistic therapeutic approaches. The present study evaluates the efficacy of an indigenously formulated flax seed extract in the form of biodegradable gel, as an adjunct in the treatment of chronic periodontitis. Sixty patients diagnosed with localized periodontal disease having pocket probing depth ≥ 5 mm were selected. All the patients were treated with professional oral prophylaxis and root instrumentation as part of the standard periodontal care protocol. The participants were divided into 3 groups with 20 subjects in each group. One group received the formulated flax seed extract gel and second group received flurbiprofen gel. The third and/or control group did not receive any adjunct therapy. The following measurements were recorded at baseline, first and third month, which included, Gingival crevicular fluid (GCF) and saliva samples for estimation of drug release followed by record of clinical parameters i.e. plaque index, gingival index, pocket probing depth and clinical attachment levels. The results of the study demonstrated that the flax seed extract gel could be equally associated to the effectiveness of flurbiprofen gel, at the end of 90 days (p = 0.001). Hence, this randomized clinical trial sets a route for incorporating herbal constituents as targeted drug therapeutic agents for the management of chronic periodontitis. Also, the use of these phytotherapeutic agents can be further encouraged considering its safety, low risk and economical options.

Cost differentials of dental outpatient care across clinical dentistry branches

Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was adopted. Sample size was 752 complete episodes of treatment in 250 patients, selected in 2012/2013 throughout several specialist state- and private-owned dental clinics in Serbia. All direct costs of dental care were taken into account and expressed in Euros (€).Results: Mean total costs of dental care were € 46 ± 156 per single dentist visit while total costs incurred by this population sample were € 34,424. Highest unit utilization of services belongs to conservative dentistry (31.9%), oral surgery (19.5%) and radiology (17.4%), while the resource with the highest monetary value belongs to implantology € 828 ± 392, orthodontics € 706 ± 667 and prosthetics € 555 ± 244. The most frequently treated diagnosis was tooth decay (33.8% unit services provided), pulpitis (11.2%) and impacted teeth (8.5%), while most expensive to treat were anomalies of tooth position (€ 648 ± 667), abnormalities of size and form of teeth (€ 508 ± 705) and loss of teeth due to accident, extraction or local periodontal disease (€ 336 ± 339).Conclusion: Although the range of dental costs currently falls behind EU average, Serbia’s emerging economy is likely to expand in the long run while market demand for dental services will grow. Due to threatened financial sustainability of current health insurance patterns in Western Balkans, getting acquainted with true size and structure of dental care costs could essentially support informed decision making in future.

Enamel Pearls Implications on Periodontal Disease.

Dental anatomy is quite complex and diverse factors must be taken into account in its analysis. Teeth with anatomical variations present an increase in the rate of severity periodontal tissue destruction and therefore a higher risk of developing periodontal disease. In this context, this paper reviews the literature regarding enamel pearls and their implications in the development of severe localized periodontal disease as well as in the prognosis of periodontal therapy. Radiographic examination of a patient complaining of pain in the right side of the mandible revealed the presence of a radiopaque structure around the cervical region of lower right first premolar. Periodontal examination revealed extensive bone loss since probing depths ranged from 7.0 mm to 9.0 mm and additionally intense bleeding and suppuration. Surgical exploration detected the presence of an enamel pearl, which was removed. Assessment of the remaining supporting tissues led to the extraction of tooth 44. Local factors such as enamel pearls can lead to inadequate removal of the subgingival biofilm, thus favoring the establishment and progression of periodontal diseases.

Localized Periodontal Disease Induced by Bacterial Plaque and Palatal Radicular Groove: Treatment and Considerations

The palatal radicular groove is a morphological tooth defect, which act as local predisposing risk factor favoring accumulation of the bacterial plaque, permitting microbial invasion via root groove way, directly into periodontal structures. A patient diagnosed with palatal radicular groove and a localized periodontal disease was treated by procedures to control bacterial action and procedures to eliminate local predisposing risk factor. To treat the periodontal bone defect a sequelae of periodontal disease, a guided tissue regeneration technique was applied by using allograft and xenograft materials associated with a resorbable demineralized bovine cortical bone membrane. The objective of surgical regenerative procedure was to recover the periodontal tissues nearly as they were before periodontal disease destruction.

The relationship between root concavities in first premolars and chronic periodontitis

To evaluate the significance of first premolar root concavity on clinical indices of chronic periodontal disease and alveolar bone defects. Three-dimensional reconstruction by cone beam computed tomography was used to observe root surface anatomy and the type of alveolar bone defect seen in the mesial and distal sites of 272 first premolars from 99 patients who had presented with chronic periodontitis. Periodontal clinical indicators at each site were measured using a Florida Probe Corporation (Gainesville, FL, USA). The incidence of mesial and distal root concavities of the maxillary first premolars was 100% and 39.3% respectively, and in the mandibular, the incidence was 42.5% and 31.3% respectively. The distributions of the different types of concavities in terms of both age and gender of the patients were not statistically significant. The mean probing depth and clinical attachment loss of the first premolars with root concavities were significantly higher than those without concavity (p < 0.05). Plaque accumulation was significantly different in the premolars with/without root concavities (p < 0.001). The type of alveolar bone defects with concavities was significantly different from those without concavities (p < 0.05). Ramp shape bone defects were dominant for teeth without concavities, while crater shape was seen for teeth with concavities. Root concavities of the first premolars were associated with periodontal disease, and the type of interproximal alveolar bone defect. Root concavities may be important in contributing to local periodontal disease of the first premolars.

English

Ph: 0091 9447378920 ABSTRACT The use of intraoral jewellery and piercings of oral and perioral tissues have been gaining popularity among adolescents and young adults. Intraoral jewelry or other oral accessories may lead to increased plaque levels, gingival inflammation and/or recession, caries, diminished articulation, and metal allergy.(26,27) Oral piercings involving the tongue, lips, cheeks, and uvula have been associated with pathological conditions including pain, infection, scar formation, tooth fractures, metal hyper-sensitivity reactions, localized periodontal disease, speech impediment, and nerve damage.(28,29). Life-threatening complications associated with oral piercings have been reported, including bleeding, edema, endocarditis, and airway obstruction.(30,31). Unregulated piercing parlors and techniques have been identified by the National Institutes of Health as a possible vector for disease transmission (eg, hepatitis, tetanus, tuberculosis) and as a cause of bacterial endocarditis in susceptible patients.(26)

Enamel pearl on an unusual location associated with localized periodontal disease: A clinical report

Bacterial plaque has been implicated as the primary etiologic factor in the initiation and progression of periodontal disease. Anatomic factors (such as enamel pearls) are often associated with advanced localized periodontal destruction. The phenomenon of ectopic development of enamel on the root surface, variedly referred to as enameloma, enamel pearl, enamel drop or enamel nodule, is not well-understood. Such an anomaly may facilitate the progression of periodontal breakdown. A rare case of enamel pearl on the lingual aspect of mandibular central incisor associated with localized periodontal disease is presented. Removal and treatment of enamel pearl along with possible mechanisms to account for the pathogenesis of ectopic enamel formation are also discussed.

Clinical and Radiographical Evaluation of the Use of Platelet Rich Fibrine Membrane and Autogen Bone Graft in Regenerative Treatment of Periodontal Infrabony Defects. Case Series

Blood sourced biomaterials have recently been used as grafting material in various surgical procedures. Platelet rich fibrine (PRF) is a second generation platelet concentrate, and it is so easily produced biomaterial as it is obtained without biochemical manipulation of blood. In this case series, regenerative treatment of the teeth with infrabony periodontal defects depending on advanced localized periodontal disease with the combination of autogen bone graft and PRF membrane was presented. Pre- and post-operative clinical and radiographical comparisons showed that using of PRF as a membrane was successful for periodontal healing and bone formation in infrabony periodontal defects. Key words: Platelet rich fibrine, infrabony defect, periodontal regeneration

A Case of Squamous Cell Carcinoma Presenting as Localized Severe Periodontitis in the Maxillary Gingiva

Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. The clinical features of gingival SCC include alveolar bone loss and erythematous lesion. Therefore, gingival SCC sometimes presents as advanced periodontitis. This case report describes a patient diagnosed with gingival SCC after the extraction of molars presenting as being affected by localized severe periodontitis. The patient was a 61-year-old man whose chief complaint was pain in the left maxillary area. Clinical and radiographic examinations revealed common findings of a periodontal abscess on the left maxillary first and second molars. These teeth were extracted based on a diagnosis of a periodontal abscess. Three months later, a rapidly growing exophytic soft tissue mass was observed, and a biopsy of the mass was performed. According to the biopsy, the final diagnosis was a well-differentiated SCC. The patient was treated with a partial maxillectomy of the left maxilla and split-thickness skin graft. Two years after treatment, the patient remained free of recurrence. Gingival SCC is quite different from other forms of SCC, mimicking localized periodontal disease. Therefore, it can be misdiagnosed as localized periodontal disease and is generally discovered after extracting teeth. Therefore, clinicians must diagnose these lesions carefully and follow up with the patient after tooth extraction.

Successful treatment of osseous lesion associated with palatoradicular groove using local drug delivery and guided tissue regeneration: A report of two cases

Developmental grooves are not rare and often appear on maxillary lateral and central incisors and are an important predisposing factor to localized periodontal disease. Various techniques have been adopted to eliminate the groove and regenerate lost periodontium. This report of two cases describes the technique of using the local drug delivery system with chlorehexidine and the guided tissue regeneration (GTR) to control the disease progression and regeneration.

Outcomes of Dental Extractions in the Neutropenic Patient

Oral and maxillofacial surgeons are frequently consulted in the hospital setting for the evaluation of neutropenic patients. Often they are asked to rule out an odontogenic source of infection in the setting of fevers of unknown origin. If a possible odontogenic source is detected, a decision must be made as to what is the best management for these medically compromised patients. There is a paucity of data regarding the effect of severe neutropenia on outcomes following dental extractions. Our study retrospectively reviewed outcomes in neutropenic patients undergoing dental extractions at Mayo Clinic. IRB approval was obtained prior to chart review. Search criteria included all patients undergoing extractions who also had concurrent diagnoses of neutropenia, pancytopenia, aplastic anemia, or malignant neoplasms of the lymphatic and hematopoietic tissues. Chart review was then performed to identify patients who were neutropenic (< 1.5 × 109/L) at the time of dental extraction. Complications including local infection, delayed healing, bleeding, bacteremia, and fever were recorded. Preliminary chart reviews of 200 patients, who underwent extractions between 2007 and 2010, revealed 27 patients that met full inclusion for this study. Descriptive statistical analysis was performed using JMP 8.0 software. Patient demographics were: 14 males/13 females, mean age 53.7 years (range 6-93). The mean absolute neutrophil count at the time of extractions was 0.633 × 109/L (range 0-1.48), and mean platelet count was 94.9 (range 21-389). Clinical findings pre-extractions included: 63% of patients with radiographic caries, 74% with radiographic periapical radiolucencies, 44% with radiographic evidence of local periodontal disease, 48% with clinical caries, 52% with pain on percussion, 22% with clinical evidence of dental abscess, and 56% with complaints of spontaneous oral pain. Mean number of teeth extracted per patient was 2.96 (range 1-11) with 48% coded as simple extractions, 44% as surgical extractions, and 7% as extractions of impacted teeth. Median post-operative follow up was 163 days (range 4-1,404). Post-operative complications were found in 5/27 cases including 2 patients with delayed healing (although both patients had a history of BRONJ), 2 with pain after healing, and 1 with minor transient bleeding. No local infections were noted at the extraction sites. Three patients had pre-operative fever, of which two had resolution of fever within seven days of extractions. This retrospective study revealed no significant complications following dental extractions in neutropenic patients. Specific antibiotic regimens were not controlled for, although most patients received wide-spectrum antibiotics during the post-operative period as part of their medical management. Of five patients with post-operative complications, three consisted of pain or minor transient bleeding while the other two represented delayed healing in patients with a BRONJ history. The lack of local post-operative infection in this study is notable. Although this preliminary review lacks sufficient sample size for definitive conclusions, it appears that the benefits associated with extraction of indicated teeth in severely neutropenic patients may outweigh the associated risks. A broader study, with larger sample size, is underway to better characterize outcomes following dental extractions in the severely neutropenic patient population.

Le snus

The use of snus (smokeless tobacco) can be detrimental to health. Containing carcinogenic nitrosamines (Swedish snus do not contain nitrosamine). Snus delivers rapidly high doses of nicotine which can lead to dependence. It do not induce bronchial carcinoma differently smoked tobacco. Lesions usually develop in the area of the mouth where the snus is placed. Non-malignant oral lesions include leukoedema, hyperkeratotic lesions of the oral mucosa and localised periodontal disease. The most frequently occurring premalignant lesion is leukoplakia. Studies reveal conflicting evidence about the risk of oral and gastroesophageal cancer with regard to snus users. However, the use of snus has proved to be a risk factor in developing pancreatic cancer and increases the risk of fatal myocardial infarction and ischemic stroke. During pregnancy, snus is associated with an increased risk of pre-eclampsia and premature delivery. Nicotine substitution therapy and bupropion and varenicline reduce withdrawal symptoms and tobacco craving during snus cessation. However, they have not been shown to assist in long-term abstinence. Information concerning potential hazards of using snus products must be incorporated into health educational programmes in order to discourage its use. Snus is not a recommended product to help in stopping to smoke.

Rapports réciproques entre orthodontie et parodontologie. Intérêt d'une synergie d'action effective

The aim of this article is to review evidence on the reciprocal relationships between orthodontics and periodontics. Normal intra-arch and inter-arch relationships have long been considered as an anatomic prerequisite for the preservation of dental health and function. Certain malocclusion traits are associated with difficulties in maintaining good oral hygiene and as a consequence to poor periodontal condition. Therefore, proper alignment of the teeth provided by orthodontic treatment may promote good control of soft deposit and calculus and subsequent periodontal inflammation. The tendency of orthodontic appliances, particularly the brackets and bands to promote the accumulation of plaque and thus increasing the risk of developing localized periodontal disease must however be constantly emphasized. Periodontitis involves progressive loss of the alveolar bone around the teeth, pathological tooth migration and gingival recession with pathological tooth migration and gingival recession as a possible outcome. The effectiveness of orthodontics in conjunction with periodontics in the management of these esthetic and functional defects is highlighted in this review.

Treatment of localized periodontal disease in pregnancy does not reduce the occurrence of preterm birth: results from the Periodontal Infections and Prematurity Study (PIPS)

The purpose of this study was to test whether treating periodontal disease (PD) in pregnancy will reduce the incidence of spontaneous preterm delivery (SPTD) at < or = 35 weeks of gestation. A multicenter, randomized clinical trial was performed. Subjects with PD were randomized to scaling and root planing (active) or tooth polishing (control). The primary outcome was the occurrence of SPTD at <35 weeks of gestation. We screened 3563 subjects for PD; the prevalence of PD was 50%. Seven hundred fifty-seven subjects were assigned randomly; 378 subjects were assigned to the active group, and 379 subjects were assigned to the placebo group. Active treatment did not reduce the risk of SPTD at <35 weeks of gestation (relative risk, 1.19; 95% confidence interval [CI], 0.62-2.28) or composite neonatal morbidity (relative risk, 1.30; 95% CI, 0.83-2.04). There was a suggestion of an increase in the risk of indicated SPTD at <35 weeks of gestation in those subjects who received active treatment (relative risk, 3.01; 95% CI, 0.95-4.24). Treating periodontal disease does not reduce the incidence of SPTD.

Effets du tabac sur la maladie parodontale

Smoking is an independent risk factor for periodontal disease and tooth loss. Smoking impairs inflammatory and immune responses to periodontal pathogens, and exerts both systemic and local effects. Periodontal disease is increased both in prevalence and severity in smokers. Smoking is a predisposing factor to acute necrotizing ulcerative gingivitis and is associated with an increased rate of periodontal disease in terms of pocket formation and attachment loss, as well as alveolar bone loss. Cigar, pipe, water-pipe and cannabis smoking have similar adverse effects on periodontal health as cigarette smoking. Passive smoking is also an independent periodontal disease risk factor. Smokeless tobacco is associated with localized periodontal disease. Smokers respond less favourably to both non-surgical and surgical treatments and have higher failure rates and complications following dental implantation. Smoking cessation may halt the disease progression and improve the outcome of periodontal treatment. Smoking cessation counselling should be an integral part of periodontal therapy and prevention.

Surgical management of a palatal radicular groove and an associated periodontal lesion in a maxillary lateral incisor

The presence of a palatal-radicular groove (PRG), more frequently observed at the level of the upper lateral incisors, may compromise both the radicular pulp and the periodontium leading to endodontic-periodontal lesions. Frequently, the prognosis of such cases is compromised because of the missed diagnosis or because of the complex therapeutic approach that is necessary to cure the associated pathologies. The authors have presented a clinical case of a palatal-radicular groove on a non-vital maxlllary lateral inclsor with associated localized periodontal disease. The general clinician's initial diagnosis was incorrect; this led to incomplete treatment and subsequent fail- ure of the treatment. Subsequent retreatment was carried out for failed root canal treatment fol- Inwed hy surgirai management of palatal-radicular groove.