Periodontal Complications Research Articles

Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients.

BackgroundThe placement of fixed orthodontic appliances may alter the composition of oral microbiota and has the potential risk of periodontal complication. Porphyromonas gingivalis fimbriae play a critical role in colonization of P. gingivalis in subgingival regions. In this study, we investigated the association between the prevalence of P. gingivalis-specific fimA genotypes and periodontal health status in adolescent orthodontic patients, to identify the pathogencity of P. gingivalis during orthodontic therapy.MethodsSixty-one adolescent orthodontic patients were enrolled in the case group, while the control group consisted of 56 periodontally healthy adolescents. At baseline (T0), clinical parameter (gingival index) was tested, and subgingival plaque samples were obtained from the lower incisors. The incidences of P. gingivalis and fimA genotypes were detected by polymerase chain reaction. All parameters were reassessed after 1 month (T1), 2 months (T2), 3 months (T3), and 6 months (T4) in the case group and then compared with those of the controls.ResultsBoth microbiological and clinical parameters from orthodontic patients started to increase after placement of fixed appliances. Maximum values were reached at 3 months after placement and followed by their decreases at six months. However, the microbiological and clinical parameters in the case group were significantly higher than those of the control group. The GI of fimA II, IV-positive samples was significantly higher than that of negative samples.ConclusionP. gingivalis carrying fimA II or IV was closely related to orthodontic gingivitis. In addition, proper oral hygiene control could lead to little increase in dental plaque accumulation, and exert a beneficial effect to periodontal tissues.

Protocol for a new concept of no-prep ultrathin ceramic veneers.

No-prep veneers, although ideally considered the best option because of tooth structure maximum preservation, have been frequently criticized for some potential limitations including esthetic outcomes and periodontal complications. A new protocol to optimize no-prep veneers restorations is presented. A key point of the proposed technique is to identify optimal margins' positions: margin is positioned in the point of maximum convexity of teeth, avoiding the over contouring of traditional no-prep veneers. The procedure can be appreciated for the marginal accuracy and the resulting aesthetic stability. The case reports show that properly managed no-prep veneers can have biologically healthy and aesthetically pleasant tooth-restoration transitions and emergence profiles. High-quality no-prep veneers can be more challenging to realize than conventional veneers and the success seems to depend on a combination of good case selection, margins' position, sound adhesive principles, clinical, and laboratory experience.

Consequences of impacted wisdom teeth extraction on the periodontal environment of second molars. A pilot study

Wisdom teeth extraction is a common procedure, generally considered as safe by patients. However, complications are possible, especially periodontal ones. The aim of this study was to evaluate the frequency and the consequences of periodontal complications at the level the 2nd molars after extraction of the wisdom teeth. A single-center retrospective observational multi-operator study was conducted at the university hospital of Besançon-France. The files of all the adult patients who underwent extraction of four impacted wisdom teeth by mean of a standardized surgical technique between November 2012 and November 2014 and who could be followed 1 year postoperatively at least and that precisely mentioned the periodontal status of the surgical sites were included. Postoperative complications, gingival and plaque indexes according to Loë and Silness, periodontal attachment level and periodontal second molar probing were recorded. The main judgment criterion was the occurrence of a periodontal complication in the second molar areas. The files of 20 patients (15 women-5 men), operated on by five different surgeons, met the inclusion criteria. Two patients suffered from dry socket at one of the avulsion sites. No patient had a gingival or plaque index greater than 2. No gingival recession or periodontal pocket over 4mm was found. Extraction of impacted third molars in young healthy adults didn't have any impact on the second molars periodontal environment in our study. Literature suggests that surgical technique greatly influences the occurrence and the extent of periodontal sequelae.

Long-term treatment outcome and influencing factors of teeth receiving modified crown lengthening

Objective: To observe the long-term clinical treatment outcome and the influencing factors of the outcome for the teeth receiving modified crown lengthening surgery combined with root canal treatment and post-core crown restoration. To summarize the clinical guidelines of modified crown lengthening surgery in selection of indications and for mulation of treatment planning. Methods: Fifty-seven patients with a total of 67 teeth receiving modified crown lengthening surgery combined with root canal treatment and post-core crown restoration for at least a 6 months' follow-up period between July 2004 and July 2013 were recruited in this retrospective study by phone call interviews. The patients' clinical outcomes were evaluated by the combination of clinical examination, radiograph and questionnaire regarding patient-reported outcome of the last follow up (≥9 months post modified crown lengthening surgery and ≥6 months after definite crown restorations). All of the treated teeth were classified into two groups, group A (teeth with good clinical treatment outcome) and group B (teeth with poor clinical treatment outcome), based on the defined criteria including patients' satisfaction with the function and esthetics of the teeth and absence of periodontal, endodontic and prosthodontic complications. The potential influencing factors of clinical treatment outcome were also determined by Logistic regression analysis. Results: Vertical root fracture in 1 tooth was found on its periapical film and the tooth was deemed hopeless. Thus, the survival rate is 99% (66/67) for the multidisciplinary treatment approach. Seventy-two percent (48/67) of the teeth achieved good clinical treatment outcome and 28% (19/67) of the teeth developed one or several complications. In group B (teeth with poor clinical treatment), 16 out of teeth exhibited periodontal complications with bleeding on probing (BOP) positive mostly found. Logistic regression analysis demonstrated that plaque control (OR=21.392, P=0.014), edge form (OR=7.610, P=0.011), and smoking experience (OR=7.315, P=0.018) were the risk factors influencing the clinical treatment outcome of modified crown lengthening surgery combined with root canal treatment and post-core restoration. Conclusions: Modified crown lengthening surgery combined with root canal treatment and post-core restoration has a good and stable clinical effect in the observational time of 6-114 months. Plaque control, smoking status and edge form of the tooth appeared to be the influencing factors of this multidisciplinary treatment approach.

Profiling of subgingival plaque biofilm microbiota in adolescents after completion of orthodontic therapy.

BackgroundFixed orthodontic treatment is the most common method for malocclusion but has the potential risk of periodontal complication with unclear outcomes of whether microbiologic and clinical changes could be reversible in adolescents after orthodontic therapy.MethodsTwenty adolescents with orthodontic treatment were enrolled in the study as the case group at end of the therapy, while 19 periodontally healthy adolescents were involved in the control group. At baseline (T0), clinical parameters including gingival index, probing depth and sulcus bleeding index were tested, and subgingival plaque samples were collected from the lower incisors. The counts of A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and total bacteria were determined by real-time PCR. All parameters were reassessed after 1 month (T1) and 3 months (T2) in the case group and compared with that of the controls.ResultsAt baseline (T0), clinical parameters (including GI, PD, SBI) of the test sites in the case group were significantly higher than that of the control group (P<0.05 or P<0.01). At 3 months (T2), no differences were noticed in GI and SBI between two groups. The prevalence and counts of periodontopathogens tend to be normal (P>0.05), while PD and the amount of P.intermedia were still significantly higher compared with that of the control group (P<0.05 or P<0.01).ConclusionAfter removal of appliances, the periodontal changes induced by orthodontic therapy are only partially reversible at 3 months after removal.

Occurrence of Dental Injuries and Periodontal Complications in Tongue-piercing Jewellery Users.

Tongue piercing (TP) has been gaining in popularity, mainly among adolescents and young adults, and there has been a corresponding increase in reports of dental injury and adverse effects on periodontal tissue due to TP jewellery. The purpose of this study was to assess the type and prevalence of dental injury and periodontal complications in a group of Slovenian adolescents and young adults with TP in comparison with a control group. This case-control study included 17 subjects with TP (study group) and 28 subjects without TP (control group). Subjects were clinically examined for dental injuries, as classified according to Andreasen. Periodontal complications were evaluated using an estimation of clinical attachment loss (CAL) and gingival recession (GR). Differences in categorical variables were analyzed using the chi-squared or Fisher's exact test as appropriate. Differences between the groups in numerical variables were analyzed with the Mann-Whitney U-test. A multiple logistic regression model was built to test the association between dental injuries and TP when controlling for cofounders, namely age and gender of study participants. The significance level was set at α = 0.05 (two-tailed). Subjects with TP had 12.2 higher odds of dental injury (CI = 2.2-67.7, p = 0.004) compared with subjects without TP. Enamel fractures were more prevalent in the study group (p = 0.002). Frequencies of other dental injuries in the two groups were similar. GR was significantly associated with TP (p = 0.008), while differences in CAL between the groups were not statistically significant. Subjects with tongue piercing had more dental injuries and gingival recession.

Progressive Spacing of Incisors and Miller’s Class II Gingival Recession with Anterior Tongue Thrust Treated with Proper Alveolar Root Housing and Autogenously Gingival Grafting

Amidst several controversies involving orthodontic treatment and gingival recession, periodontal complications of tongue thrust habit especially in adults have not yet been fully investigated. This case report presents a successful clinical case of progressive spacing of incisors (PSI) with gingival recession treated with proper alveolar root housing and autogenous grafting. A 24 year old girl reporting with mobility in mandibular anterior teeth was diagnosed Miller's class-II gingival recession of 7 mm and grade-II mobility in mandibular central incisors along with anterior tongue thrust habit. Spontaneous decrease in tooth mobility was achieved after correction of habit using fixed habit breaking appliance along with proper root positioning in the alveolar bone with fixed orthodontics. Post-debond, connective tissue gingival graft was performed using pouch and tunnel technique to achieve adequate root coverage. Thus interruption of tongue habit and correction of

Perio-ortho interrelationship: A Review

It is well established that the patients who undergo orthodontic treatment have a high susceptibility to present plaque accumulation on their teeth because of the presence of brackets, wires and/or other orthodontic elements on the teeth surfaces with which the oral hygiene procedures might be more difficult. The considerable variance of the design and the material characteristics of orthodontic elements may also play an important role in this field. The orthodontic treatment is a double-action procedure, regarding the periodontal tissues, which may be sometimes very meaningful in increasing the periodontal health status, and may be sometimes a harmful procedure which can be followed by several types of periodontal complications, namely: gingival recessions, bone dehiscences, gingival invaginations and/or the formation of gingival pockets. A harmonious cooperation of the periodontist and the orthodontist offers great possibilities for the treatment of various orthodontic-periodontal problems. The present discussion focused on the effects of a combined periodontal and orthodontic treatment on the periodontal health and dentofacial aesthetics, and the mode that each field can contribute to optimize treatment of combined orthodontic-periodontal clinical problems

Minimally invasive corticotomy in orthodontics using a three-dimensional printed CAD/CAM surgical guide

The aim of this prospective study was to evaluate the effectiveness of an innovative, minimally invasive, flapless corticotomy procedure in orthodontics. The STROBE guidelines were followed. Ten patients with severe dental crowding and a class I molar relationship were selected to receive orthodontic treatment with clear aligners and corticotomy-facilitated orthodontics. The mean age of these patients was 21 years (range 17–28, standard deviation 6.08 years); the male to female ratio was 2:1. The main outcome was a reduction in the total treatment time to correct dental crowding. The secondary outcomes were periodontal index changes, the degree of root resorption, and patient perceptions of the method used, assessed using the short-form Oral Health Impact Profile (OHIP-14). The occurrence of early surgical complications or unexpected events was also recorded. All patients completed the treatment to correct dental crowding. The average treatment time was reduced by two-thirds. The procedure did not significantly modify the periodontal indices or oral health-related quality of life. No early surgical complications or unexpected events were observed. In short, the results indicate that this new procedure is safe and accelerates tooth movement without periodontal complications or discomfort. However, the efficacy of this procedure must be confirmed in controlled clinical trials.

Effectivity and durability of telescopic dentures on abutment teeth

In a study, the effectivity and durability of telescopic dentures on abutment teeth provided with telescope crowns were investigated. The prognosis for the prosthetic structure and for the abutment teeth were both investigated. The survival rate of 234 telescopic dentures (886 abutment teeth) in 147 patients in a general dental practice were retrospectively evaluated on the basis of a status study. The mean survival rate was calculated. This is the moment when 50% of the telescopic dentures had failed. For telescopic dentures in the maxilla, this was 22.3±2.8 years, which did not represent a statistically significant difference from the mandible (20.9±1.9 years). Of the 886 abutment teeth that were used, 127 (14.3%) were extracted after an average period of 11.7 years. Periodontal complications were the primary reason for extraction. Based on this investigation, one could conclude that telescopic dentures are also a durable and sustainable solution in the long term. Loss of abutment teeth is relatively rare and has limited influence on the survival of the prosthetic structure.

Autophagy Has a Beneficial Role in Relieving Cigarette Smoke-Induced Apoptotic Death in Human Gingival Fibroblasts.

The deleterious role of cigarette smoke has long been documented in various human diseases including periodontal complications. In this report, we examined this adverse effect of cigarette smoke on human gingival fibroblasts (HGFs) which are critical not only in maintaining gingival tissue architecture but also in mediating immune responses. As well documented in other cell types, we also observed that cigarette smoke promoted cellular reactive oxygen species in HGFs. And we found that this cigarette smoke-induced oxidative stress reduced HGF viability through inducing apoptosis. Our results indicated that an increased Bax/Bcl-xL ratio and resulting caspase activation underlie the apoptotic death in HGFs exposed to cigarette smoke. Furthermore, we detected that cigarette smoke also triggered autophagy, an integrated cellular stress response. Interesting, a pharmacological suppression of the cigarette smoke-induced autophagy led to a further reduction in HGF viability while a pharmacological promotion of autophagy increased the viability of HGFs with cigarette smoke exposures. These findings suggest a protective role for autophagy in HGFs stressed with cigarette smoke, highlighting that modulation of autophagy can be a novel therapeutic target in periodontal complications with cigarette smoke.

Nonsurgical Approach in Periodontal Therapy for a Patient with Metabolic Syndrome

ABSTRACT Aim The aim of this article is to describe the effect nonsurgical periodontal therapy can have on the improvement in the glycemic and lipid indices of patients with metabolic syndrome (MS). Background Combination of noncommunicable diseases has become increasingly common among the people at present. Metabolic syndrome is a combination of dyslipidemia, diabetes mellitus (DM), obesity, and hypertension. Periodontal disease (PDD) is also a common entity among many people. The heightened chance of PDD in the diabetic patient is well established. Among the treatment modalities for PDD, nonsurgical therapy plays a major role. Reduction of the major causative factors of PDD can bring about a massive improvement of the disease through this approach. Case description Periodontal management of an adult patient with MS via nonsurgical periodontal therapy alone had shown dramatic improvement of periodontal as well as general health of the patient at the completion of the treatment. Conclusion Improvement of glycemic indices of diabetic patients has been shown with periodontal treatment in conjunction with medical treatment. Clinical Significance Value of a dental professional in diagnosing metabolic diseases through detection of periodontal and other dental complications cannot be underestimated. A well-executed nonsurgical periodontal therapy alone can bring about a massive improvement of the PDD condition as well as other metabolic diseases, such as DM, emphasizing the importance of proper collaboration among the dental surgeons with the medical practitioner. How to cite this article Malwatte US, Jayasinghe VP, Tilakaratne A. Nonsurgical Approach in Periodontal Therapy for a Patient with Metabolic Syndrome. Int J Experiment Dent Sci 2016;5(1):64-68.

Iatrogenic Damage to the Periodontium Caused by Orthodontic Treatment Procedures: An Overview.

In orthodontic treatment, teeth are moved in to new positions and relationships and the soft tissue and underlying bone are altered to accommodate changes in esthetics and function. Function is more important than esthetics. The speciality of orthodontics has in addition to its benefits, complications as well as risks associated with its procedures. However the benefits outweigh the risks & complications in most of the treatment cases. Few of the unwanted side effects associated with treatment are tooth discolorations, enamel decalcification, periodontal complications like open gingival embrasures, root resorption, allergic reactions to nickel & chromium as well as treatment failure in the form of relapse.

Geometrical Salvage of Split Tooth

Aims: Management of vertically fractured mandibular first molar by intra coronal splinting applying the finite centre of rotation effect of Pythagorus theorem. Case Presentations: A 28 year old male patient presented at the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in the lower right back region of the mouth since last the 10 days. Past dental history revealed that affected tooth had root canal treatment done two years ago. History of present illness was that pain was elicited on chewing, and applying pressure on that area, with occasional bleeding from the same region. Intraoral examination revealed that tooth 46 was tender on percussion with vertically fractured crown in Case Study Tripathi et al.; BJMMR, 7(7): 623-629, 2015; Article no.BJMMR.2015.369 624 mesiodistal direction. Periapical Radiograph revealed that tooth was endodontically treated, with radiolucencies at apical and furcal area, and visible fracture line in mesiodistal direction at CEJ level. Technique Used in the Study: The tooth was endodontically retreated and Pythagorus theorem was used to locate the centres of rotation on both buccal and lingual sides of tooth 46 coronally. The technique was followed by drilling a vent at the same position approximating a fibre post (3M, Relyxfibre post). The centres were different both for buccal and lingual aspects which when approximated will provide antirotation. The post was placed in the buccolingual direction and the tooth was restored with posterior composites after which the restoration was checked for any high points. Follow up of the case was done for the period of one year. Discussion: The concept of the estimation of the finite centre of rotation is like the primary objective in tightening a screw joint to generate an optimum preload that will maximize the fatigue life of the screw while offering a reasonable degree of protection against loosening. The major advantage of this approach is that the fragment was stabilized properly and there was healthy development of periodontium over the year. Conclusion: Usually the vertically fractured tooth have poor prognosis and may likely be referred for extraction if not stabilized properly. This case report emphasizes the basic concept of stabilization and preventing rotation around an axis which will give the fractured tooth a better longevity and avoid the vibrations during crown preparation. The combined effect will restore the patient’s own natural tooth back and minimizes the chances of periodontal complication.

Restoring endodontically treated teeth

It is impossible to guarantee success in every case. However, predictably successful endodontic therapy cannot be achieved without properly designing and executing restorations with careful consideration of potential periodontal complications. When prosthetic and periodontal considerations are addressed concurrently with endodontic treatment, patients leave the office with the best possible prognosis for teeth that otherwise have been lost. The information in this article is meant to aid dentists in the restoration of endodontically treated teeth. Practitioners must always use their best professional judgement, taking into account the needs of each individual patient when choosing a restorative plan. The Dental Journal neither expressly nor implicitly warrants any positive results nor expressly nor implicitly warrants against any negative results associated with the application of this information.

Periodontal management in orthognathic surgery: Early screening of periodontal risk and its current management for the optimization of orthodontic and surgical treatments

Orthodontic preparation for orthognathic surgery requires correcting mal-occlusions and coordination of arcades. In addition to improving the aesthetics, these treatments can ensure the achievement and sustainability of prosthetics and/or implants. Nevertheless, periodontal structures are easily damaged. Orthodontic displacement can only be applied in the absence of inflammation or weakened periodontal structure. An early detection of periodontal risk should be achievable by prescribers of a surgical-orthodontic treatment. Simplified periodontal examination, with easily detectable warning signs, will help to identify the periodontal risk. Although periodontal treatment follows current "non invasive" trend, some procedures remain necessary to prevent and/or remedy periodontal defects or diseases, such as mineral periodontal reinforcement corticotomy. It is essential that the patient meets all the practitioners to plan and assess the extent of the constraints necessary to optimize results, before starting orthodontic treatment combined with orthognathic surgery. Any periodontal complication (even minor) will be considered as a failure, regardless of good aesthetic and functional results.

The Multidisciplinary Management of Fused Maxillary Lateral Incisor with a Supernumerary Tooth in Cleft Lip Adolescence

Fusion, an uncommon anomaly of the hard dental tissues, is potentially the cause of clinical problems related to esthetics, tooth spacing, and other periodontal complications. This paper describes a multidisciplinary approach involving surgical, endodontic, restorative, and orthodontic attention for the successful, functional, and esthetic rehabilitation of a maxillary left lateral incisor fused with a supernumerary tooth in unilateral cleft lip adolescence in contralateral side. After clinical and radiographic examinations, a fusion between the left maxillary lateral incisor and a supernumerary tooth was diagnosed in the patient, and a small connection was detected between the pulp systems of the two root canals. The case reported in this paper presents the successful resolution of a fused maxillary lateral incisor with a supernumerary tooth, using endodontic, surgical, restorative, and orthodontic management. The decision made in extracting or retaining the fused tooth depends on the arch discrepancy and esthetic needs. Future studies, with long-term followup, will be helpful in evaluating the long-term efficacy of the different treatment options.

Principles of screw - retained and cement - retained fixed implant prosthesis: A critical review

Dental implants in the past were mainly restricted to completely edentulous patients and to a certain extent in the distal extension situations. In the present scenario with a dramatic increase in the survival rates of the dental implants and their widespread acceptance by the patients, they are often being used in partially edentulous conditions and as well as single tooth replacements. However, longevity of the restoration, both functionally as well as esthetically depends on various factors prevailing in the clinical situation. One such factor of immense importance is the selection of connection between the implant abutment and the final prosthesis. This connection can be screw-retained or cement-retained depending on the clinical situation of the particular case. Although, screw-retained restorations have been successfully used since many years, there has been a shift in paradigm toward cement-retained restorations. This article reviews the various complications associated with screw-retained restorations and subsequently analyzes the various factors associated with the selection of the attachment mechanism in implant dentistry. Clinical Relevance To Interdisciplinary Dentistry The article involves various disciplines of dentistry, particularly Prosthodontics, Periodontics, Oral Surgery and Dental Materials. As specified, in this literature, selection of connection system between implant and the prosthesis plays a significant role in reducing the prevalence of various periodontal (Peri-implantitis, bone loss), prosthetic (screw loosening or fractured prosthesis) and surgical complications associated with implant supported prosthesis. Thus, a thorough knowledge of this aspect, significantly increases the success rate of implant supported prosthesis in partially and completely edentulous patients.

Treatment Strategy for Correction of Periodontal Defects Associated with Tongue Piercing: A Case Report

Intraoral piercing has increased in popularity in the last few years. This type of jewelry has been associated with periodontal and muco-gingival defects such as attachment loss and gingival recession. This case report described a 25-year-old female presented to the clinic of Periodontics at Witten/Herdecke University in Witten, Germany, with a tongue stud placed through the mid-dorsum of her tongue. The lower left central (LL1) and lower right central (LR1) incisors exhibited 6 mm and 5 mm lingual probing depth, 4mm and 3.5mm lingual recession respectively and localized radiographic bone loss in the mid-half of the roots. The treatment strategy consisted of removal of the tongue piercing, professional prophylaxis, oral hygiene instructions and an open-flap surgery of the lingual anterior region of the mandible with the application of enamel matrix derivative (EMD) and bone graft material. Results: At the 1-, 3- and 7-month recall visits, the patient’s oral hygiene has been improved, and the attachment loss appears to have stabilized. It is clear that the tongue piercing might be a risk factor for local periodontal complications.

Role of Periodontal Therapy in Rapid Tooth Movement

Periodontally accelerated osteogenic orthodontics (PAOO) or Wilckodontics is a clinical procedure that combines selective alveolar corticotomy, particulate bone grafting and the application of orthodontic forces. The most important factor in the success of PAOO is proper case selection and careful surgical and orthodontic treatment. An increasing amount of orthodontic patients seeking orthodontic treatment, make them prone to periodontal complications since their teeth are confined to the nonflexible alveolar bone. Interdisciplinary orthodontic treatment along with tissue engineering principles can create rapid orthodontic tooth movement as well as reducing side effects such as root resorption, relapse, inadequate basal bone and infection. Many of these challenging aspects facilitate the necessities of special concepts where PAOO technique opened doors and offered solutions to many limitation in orthodontic treatment. The aim of this article was to provide an overview of the literature including the historical background, indications, contraindication, the biological aspect of PAOO and the surgical technique and modifications of the same.