Loss Of Supporting Bone Research Articles

Interdisciplinary orthodontic and prosthodontic approach for esthetic rehabilitation in an adult patient

A 38-year-old female patient reported with a chief complaint of spacing between anterior teeth, and she desire to improve her facial esthetics. The patient was diagnosed with chronic generalized periodontitis with generalized horizontal bone loss on the basis of clinical and radiographic findings. On orthodontic evaluation, she has proclined upper and lower anterior with Class I molar relationship bilaterally and a canine Class I relationship bilaterally. She was treated with an interdisciplinary therapeutic protocol that included nonsurgical periodontal therapy, endodontic treatment, orthodontic therapy, and prosthetic rehabilitation. The orthodontic therapy was performed in generalized horizontal bone loss having loss of bone support in mandibular anterior region. Space closure was done using prosthetic rehabilitation in a healthy periodontium. The interdisciplinary treatment protocol was the key factor in achieving significant improvement in facial and dental esthetics, masticatory function, and quality of life of the patient.

Biologic Shaping in Periodontal Therapy

This article focuses on biologic shaping during periodontal treatment. This is especially important if there is concavity or unevenness of the enamel near the edge of the crown. This can create an unmanageable situation and increase the risk of further loss of bone support. The point is that biologic shaping in periodontal therapy limit unnecessary bone removal and create a biocompatible environment. Biologic shaping preserve bone, creating the biologic width necessary for tooth restoration. However, putting biological shaping into practice requires a team approach with a deep understanding of fundamentals, anatomy, surgical and reconstructive procedures, materials, and final reconstructive contours. When performed correctly, it can improve the long-term prognosis of dental health.

Main Approaches to the Causes and Treatments of Periimplantitis: A Narrative Review


 
 
 
 Periimplantitis is an inflammatory reaction associated with the loss of bone support around the implant, and its main pathological agent is the accumulation of biofilm. The diagnosis is made through radiographic exams, depth of probe, and verification of bone loss, and if the patient presents bleeding and changes in the tissues around the implant, he may already be in the infectious process of periimplantitis. Despite so many treatments offered for peri-implanted, further studies are needed on some aspects of their effectiveness.
 
 
 

Failure analysis of a modular revision total HIP arthroplasty femoral stem fractured in vivo

An implant fracture is an unusual reason for total hip arthroplasty (THA) revision; however, it may cause serious clinical complications. The stress in femoral stems may increase considerably with the loss of bone support around the implant, leading to implant failure. This paper investigates the main reasons for the in vivo fracture of a Ti6Al4V revision femoral ZMR stem. Various methods were used: examination of the patient’s by radiographies; optical emission spectrometry; and Scanning Electron Microscopy (SEM). The titanium (Ti) alloy was also characterized through optical microscopy and a Vickers hardness test was carried out. A finite element analysis (FEA) was conducted to evaluate the stress distribution occurring in the femoral stem revision under loading.The chemical composition and microstructure of the prosthesis did not reveal any non-conformity. The SEM analysis revealed fretting damage near the crack initiation site and the fractured surfaces exhibited characteristic ratchet marks, poorly formed striations and a small final fracture area. The FEA showed a stress concentration located at the proximal–distal taper junction, with a smaller diameter, coinciding with the crack initiation site.The conclusion was that fatigue failure was due to a lack of bone sustainability that increased the stress, associated with design characteristics that caused a localized concentration of stress, and these were potentialized by a fretting mechanism, leading to the failure.

Maxillomandibular Deformity in a Canine with Fibrous Osteodystrophy Secondary to Chronic Kidney Disease

Background: Cases of renal fibrous osteodystrophy are usually associated with nutritional causes, which of renal causes are considered uncommon in dogs. This disorder is characterized by the intense proliferation of fibrous connective tissue in bones, impairing bone stiffness. The aim of this study was to report a case of fibrous osteodystrophy secondary to chronic kidney disease in a canine with a "rubber jaw" facial deformity.Case: A 4-year-old male unneutered mongrel dog weighing 5.2 kg had a history of apathy, progressive weight loss and vomiting for one month, and polyuria and polydipsia for more than three months. In addition, the owner complained about the deformed appearance in the muzzle region of the animal, which was evidenced flexibility of the same, with a displacement of the mandible and maxilla on physical examination, similar to the "rubber jaw". Blood tests revealed macrocytic anemia, elevated total plasma proteins, and lymphopenia-associated neutrophilia, as well as hyperphosphatemia (24 mg/dL), uremia (283.6 mg/dL) and increased creatinine (8.6 mg/dL), ALT (143.2 UI/L) and alkaline phosphatase (3222.2 UI/L), while calcium (8.8 mg/dL) and albumin (1.9 g/dL) were decreased. A serological test for visceral leishmaniasis was also performed, which was negative. Abdominal ultrasound imaging revealed kidneys with alterations in tissue architecture, increased thickness and complete loss of cortico-medullary relationship, while the parathyroid gland was enlarged and spindle-shaped. Cranial radiography showed marked radiopacity of the bilateral maxillary bones, with destruction of the nasal, turbinate and frontal bones, as well as loosening of the teeth and destruction of the mandibular bone matrix, characterizing an aspect of “rubber jaw”. Based on the history, history and evidence of azotemia, hyperphosphatemia and loss of facial bone density, the diagnosis of fibrous osteodystrophy secondary to chronic kidney disease associated with hyperparathyroidism was concluded.Discussion: The clinical and laboratory findings reported in the present study were similar to those described in dogs with renal fibrous osteodystrophy associated with hyperparathyroidism. In the presence of azotemia, the patient was in stage 4 of chronic kidney disease which, despite investigating the infectious etiology, which was negative, remained unknown. Along with chronic kidney disease, the observation of hyperphosphatemia associated with hypokalemia contributed to the clinical investigation, whose pathophysiological mechanisms of this disorder were discussed in this study. The organic alterations observed in the patient's imaging examination coincided with the pathophysiological processes of renal fibrous osteodystrophy. The findings of renal and parathyroid alterations on ultrasound, as well as the damage to the bone matrix, maxillomandibular deformity and loss of bone support evidenced on cranial radiography, led to the conclusion of the diagnosis of renal fibrous osteodystrophy secondary to hyperparathyroidism. Despite the recommended symptomatic therapy, the patient died within 24 hours of hospitalization, and it was not possible to perform a necropsy. This report is highlighted by the occurrence of bone deformity at the maxillary and mandibular level, as a result of renal dysfunction in a young canine, alerting to the importance of complementary exams for proper diagnosis.

The Prosthodontics Care For Geriatric Patients Nowadays


 The global geriatric (elderly) population is growing as a result of increasing life expectancies. One impact of this development is an increase of lifestyle difference. In the scope of health, especially dental health, the patient’s education is important. The decrease in edentulism cases showsed public awareness of the importance in maintaining the health, function and quality of life in the elderly as well as the necessity of preventive attitudes and interventions against disease. Dental services for geriatric patients are affected by the cost of dental services, dental insurance, dental clinics’ access, debt and needs. The current prosthodontic treatment that improve of missing tooth replacements is in demand is an increasing interest in dental implant treatment. Losing tooth has a negative impact on mastication, aesthetic- and oral health-related quality of life. Excessive bone resorption can occur for many reasons, including age, infection, trauma, metabolic disorders and nutritional deficiencies. The resorption of the alveolar bone, especially in medically compromised patients, is caused by focal infections in the mouth and systemic diseases. Periodontitis or other chronic infections resulted from bacterial and host inflammatory cells. The pathology observation can result in a loss of bone support after a long period of extraction procedures is named residual ridge resorption (RRR). The best treatment for RRR is to avoid tooth extraction so that the loss of teeth and their supportive tissues can be prevented. When there is a loss of teeth and RRR, dentures have been made to reduce the occlusal load are necessary. In addition, the importance of periodic control, utilizing vitamins, oral rinse, topical gels or others, and the intake of nutrients greatly affect the good function of dentures and improve the health of the geriatric patient.

The Prosthodontics Care For Geriatric Patients Nowadays

The global geriatric (elderly) population is growing as a result of increasing life expectancies. One impact of this development is an increase of lifestyle difference. In the scope of health, especially dental health, the patient’s education is important. The decrease in edentulism cases showsed public awareness of the importance in maintaining the health, function and quality of life in the elderly as well as the necessity of preventive attitudes and interventions against disease. Dental services for geriatric patients are affected by the cost of dental services, dental insurance, dental clinics’ access, debt and needs. The current prosthodontic treatment that improve of missing tooth replacements is in demand is an increasing interest in dental implant treatment. Losing tooth has a negative impact on mastication, aesthetic- and oral health-related quality of life. Excessive bone resorption can occur for many reasons, including age, infection, trauma, metabolic disorders and nutritional deficiencies. The resorption of the alveolar bone, especially in medically compromised patients, is caused by focal infections in the mouth and systemic diseases. Periodontitis or other chronic infections resulted from bacterial and host inflammatory cells. The pathology observation can result in a loss of bone support after a long period of extraction procedures is named residual ridge resorption (RRR). The best treatment for RRR is to avoid tooth extraction so that the loss of teeth and their supportive tissues can be prevented. When there is a loss of teeth and RRR, dentures have been made to reduce the occlusal load are necessary. In addition, the importance of periodic control, utilizing vitamins, oral rinse, topical gels or others, and the intake of nutrients greatly affect the good function of dentures and improve the health of the geriatric patient.

Finite element analysis of orthodontically induced stress in the periodontal ligament of the maxillary first molar with simulated bone loss

The problems that often arises in orthodontic treatment of adult patients is the presence of periodontal disease and loss of bone support. As a consequence of this, the center of resistance of the tooth is altered. Excessive orthodontic force with advanced periodontal bone loss may traumatize the p eriodontium. Force dosage during orthodontic treatment is one of the most difficult problems at this stag.the purpose of the study is to simulate the effect of orthodontically induced stress in the periodontal ligament of maxillary molar at different levels of bone loss. The study is carried out to estimate the reduction in magnitude of force at different levels of bone loss (2.5 mm, 5 mm and 6.5 mm) necessary to achieve evenly distribution of stress in the periodontal ligament of the tooth as obtained without bone loss and to determine the change in counterbalancing M/F ratio to induce uniform stress distribution in the PDL. A 3-dimensional finite element model of a tooth comprises of maxillary first molar with periodontal ligament and alveolar bone with different levels of bone height was constructed. Bone loss that ranged from 2.5 thrugh 6.5 mm was simulated in a model. Necessary reduction in the magnitude of force and the increase in moment to force (M/F) ratio was determined to obtain evenly distributed stress in the periodontal ligament of a tooth. The results showed that lesser force magnitude is required in simulated 2.5 mm bone loss (80%), 5 mm bone loss (60%), 6.5 mm bone loss (35%) as compared to the initial load applied to the tooth without bone loss. The counter tipping moment to force ratio should be increased from no bone loss (9.65) through 6.5 mm bone loss (12.8) to maintain the same range of stress in the PDL as was obtained without bone loss. The counter rotation moment to force ratio should decrease from no bone loss (5.65) through 6.5 mm bone loss (4.0) to maintain the same range of stress in the PDL as was obtained without bone loss. Combination of decreased force magnitude and increased counter tipping moment to force ratio will bring about uniform stress in the periodontal ligament of a tooth with varying degree of bone loss.

Platform switch dental implants – Search for evidence:An overview

An implant prosthesis allows normal muscle function, and the implant stimulates the bone and maintains its dimensions in a manner similar to healthy natural teeth. Crestal bone loss can result in increased bacterial accumulation resulting in secondary periimplantitis which can further result in loss of bone support, which in turn can lead to occlusal overload resulting in implant failure. In implant dentistry, platform switching is a method used to preserve alveolar bone levels around dental implants. The concept refers to placing restorative abutment of narrower diameter on implants of wider diameter, rather than placing abutments of similar diameter, referred to as platform matching. This article is a literature overview of studies on platform switch implants and their effect on crestal bone loss.

The Role of Inflammatory Cytokines and the RANKL-RANK-OPG Molecular Triad in Periodontal Bone Loss-A Review

Periodontal diseases are chronic inflammatory disorders involving the supporting structures of the teeth. Connective tissue destruction and loss of bone support of the dentition are key features of this disease. Early studies have revealed that biofilm plaque accumulation in the dentogingival area is the primary etiological factor of periodontal diseases. Recent research has not only reinforced the bacterial etiology of periodontal disease, but has also emphasized the role of inflammation in this pathologic process. The host mounts an immune-inflammatory response to combat the bacterial attack. The host response is like a double-edged sword. It eliminates the offending pathogens, but overstimulation and amplification of the same leads to tissue destruction and bone loss. In the mid- 1990s, extensive research in the field of bone biology led to the discovery of the RANKL-RANK-OPG molecular triad. This article explores the mechanisms by which inflammatory host response leads to alveolar bone loss-the role of cytokines, factors that stimulate osteoclastogenesis via the RANKL-RANK-OPG pathway and how inflammation interferes with the uncoupling of bone formation and bone resorption. In addition to the conventional therapeutic modalities aimed at eliminating the microbes, additional therapeutic strategies that interfere with the RANKL-RANKOPG axis may have a protective effect on the bone loss.

Epidemiology of Periodontal Disease

Epidemiology is the study of health and disease in populations and of how these states are influenced by biology, heredity, and physical and social environment, as well as personal behavior. Advances in research over recent years have led to a fundamental change in our understanding of the periodontal diseases. As recently as the mid-1960s, the prevailing model for the epidemiology of periodontal diseases included the following precepts: (1) all individuals were considered more or less equally susceptible to severe periodontitis; (2) gingivitis usually progressed to periodontitis with consequent loss of bone support and eventually loss of teeth; (3) susceptibility to periodontitis increased with age and was the main cause of tooth loss after age 35–55. Since the development of this paradigm, advances in the understanding of periodontal diseases have led this disease model to be reevaluated. Current knowledge has shown that periodontitis does not present a linear progression and is not age dependent. Moreover, its distribution and severity are strongly influenced by host susceptibility and risk factors. Several epidemiological studies evaluating destructive periodontal diseases have been pursuing associations in the incessant identification of risk factors for these diseases. Analytical epidemiology seeks to identify the risk factors associated with a disease, to quantify the strength of those associations and to estimate whether an association is causal. An understanding of risk factors can lead to theories of causation and then to treatment protocols for clinicians to use in their daily practice. The essential features of epidemiology as a method of research, when compared to clinical research and case studies, are that (1) groups rather than individuals are the focus of study; (2) persons with and without a particular disease (e.g., periodontal diseases) and with and without the exposure of interest are included, rather than just patients. The study of population groups rather than individuals is to allow for valid estimates while accounting for normal biological variation (e.g., some individuals form dental biofilm readily; others do not). Broadening a study to include those with and without a disease can provide a reference point against which a risk is quantified. Under such background, this special issue was designed to summarize the current status of periodontal epidemiology. Thus, we have invited authors to submit original research articles and analysis that seek to clarify aspects of the epidemiology of periodontal diseases and the relevant related factors. As a result, various interesting and scientifically significant papers have been accepted. This special supplement presents manuscripts reporting information about the prevalence and distribution of periodontitis, as well as their associations with risk factors. In addition several studies reported tooth loss, one of the most visible results of the evolution of periodontitis that causes physiological and psychological impacts on patient's life. These papers represent an exciting and insightful observation into the state of art, as well as emerging future topics, in this important interdisciplinary field. We hope that this special issue would attract a major attention of the peers.

Grile for Periodontal Diseases Diagnosis at Dogs

The periodontal diseases at dogs of more than 2 years have a high prevalence level, of about 80%. Periodontal disease is a progressive process which involves several stages: 1) the starting point of periodontal disease is dental plaque formationa biofilm composed of food debris, mucin, epithelial cells and bacteria (Bacteroides sp., Porphyromonas gingivalis, Prevoltella sp., Fusobacterium etc.); 2) mineralization of plaque and calculus formation; 3) gingivitis (reversible process) – caused by bacterial enzymes and metabolic toxins; 4) gingival recessionwith pocket formation (non-reversible process); 5) bone loss; 6) tooth mobility; 7) tooth loss; 8) increased blood supply to the area enhances a bacteraemia. The assessment of the dental plaque allow identify the animals with risk for development periodontal disease. An easy method for evidence of dental plaque is the chromatic method (Ronddels Blue Kit). This method allows differentiating the recent plaque from a mature plaque by different coloration. It follows the examination of the calculus (tartar) formation. The gum examination: gingival inflammation due to tartar accumulation, edema, gingival bleeding and gingival recession or gingival hyperplasia. Periodontal probing. The gingival sulcus depth is measured using a calibrate probe. In a dog, the normal sulcus depth is 2-3 mm. In periodontal disease a pocket is formed between the tooth and the gum. In moderate periodontal disease pocket depth is 3-6 mm and in severe periodontal disease it is more than 6 mm. Furcation examination. The furcation is the area between the roots of multirooted teeth and at healthy dogs in this area is found the alveolar bone. In periodontal disease the alveolar bone loss and sometimes is difficult to make a radiological examination to evidence this lesion and in this case it’s recommended the furcation examination. The dimensions of this space is measured with a probe (<1/3 from tooth thickness, between 1/3 and 2/3 tooth thickness or the probe may cross all the tooth thickness). The mobility of the teeth is examined, as well as the amplitude and direction of the movements (sagital, transversal or axial plane). Finally, the periodontal status is established. The periodontal disease may be incipient, moderate or severe. In incipient periodontal disease inflammation of gum, edema, gingival bleeding upon probing occurs. In moderate periodontal disease, in addition bad breath, deep pockets and 10-30% loss of bone support can be present. In severe periodontal disease over 30% bone loss, the teeth are mobile and gum recession is present.

Challenges in total ankle arthroplasty.

In the past, total ankle arthroplasty was largely abandoned due to poor survivorship most often caused by loss of bone support. High complication rates were also reported. Despite this, there is renewed interest in ankle arthroplasty and encouraging results are seen in survivorship with midterm follow-up. The procedure, however, remains more challenging than total hip or total knee arthroplasty. With the limited soft tissue envelope, wound problems are not uncommon. Forces at the ankle are very large and yet the surface area for prosthetic support is small. Therefore, fixation can be more difficult. The strongest bone can be eccentric at the distal tibia. The tibial prosthesis can, therefore, tend to settle into the softer bone often laterally. Polyethylene needs to be sufficiently thick to maintain its integrity but that requires a larger bone resection, which weakens bone support. Polyethylene failure or wear leads to the majority of failures in hip and knee arthroplasty. There is a need for further basic science research in total ankle arthroplasty. The lessons learned from other arthroplasty should be considered in ankle arthroplasty design.