David E. Deas

Response of chronic and aggressive periodontitis to treatment.

Patients with aggressive periodontitis can be both rewarding and frustrating to treat in clinical practice. Interindividual variation in response to therapy can be widespread, and we do not clearly understand the reasons for this variable response. It is possible that new research into the resolution of inflammation may reveal basic differences between patients with chronic periodontitis and those with aggressive disease. In addition, future research involving modulation of host inflammatory responses may clarify the reasons for the differences in clinical outcomes between patients. We think it likely that this research could result in further alterations to the classification of periodontal diseases, as with more knowledge of the mechanisms of disease it is possible that patients currently classified as having aggressive periodontitis may be found not to represent a single diagnostic entity. Better understanding of the true nature of patients currently identified as having aggressive periodontitis may therefore lead to more effective treatment approaches.

Scaling and root planing vs. conservative surgery in the treatment of chronic periodontitis.

A renewed interest in conservative surgical techniques has been fueled by new technology, changes in referral patterns to periodontists and a desire to achieve periodontal health in the least invasive, most cost-efficient manner possible. Trends suggest that an increasing amount of periodontal care is being provided in the offices of general dentists. If true, it is likely that patients receiving care in these offices will be offered simpler surgical treatment modalities that do not require an extensive armamentarium. The purpose of this article was to review the effectiveness of six relatively simple surgical techniques - gingivectomy, flap debridement, modified Widman flap, excisional new attachment procedure, modified excisional new attachment procedure and laser-assisted new attachment procedure - and to compare the results obtained using these procedures with the well-known clinical benefits of scaling and root planing. The intent was to determine whether the benefits of surgical procedures in the hands of most general dentists extend beyond those of conventional nonsurgical therapy.

Periodontal wound healing with and without platelet-rich plasma: histologic observations and assessment of flap tensile strength.

BACKGROUND Platelet-rich plasma (PRP) has been promoted as a surgical adjunct to enhance hard and soft tissue wound healing. Although anecdotally reported to be of value, the results of controlled studies examining the added effects of PRP on surgical procedures have been mixed. The purpose of this study was to test the effect of PRP on flap strength at various post-surgical time points in a minipig animal model. METHODS Twelve Yucatan minipigs provided four sites per animal. PRP was prepared from each animal at the time of surgery. Following reflection of a mucoperiosteal flap in each quadrant, subgingival plaque and calculus were removed. Each surgical site was irrigated with sterile saline; prior to suturing, one randomly selected test quadrant in each arch was treated with PRP. Four animals were euthanized at day 14, and two animals were euthanized at 2, 7, 10, and 28 days. The flap strength in each quadrant was tested by attaching to a loop of 3-0 silk suture through the tissue; the force required to separate the flap from the tooth/bone interface was recorded for each site. A separate portion of each flap site was prepared for descriptive histologic examination, including inflammation, hemorrhage, and new bone growth. RESULTS Flap strength was significantly less on day 2 compared to later time points, and there were no significant differences between the test and control groups. No histologic differences in healing between test and control sites were seen at any time point. CONCLUSIONS PRP did not seem to contribute to greater flap strength at any post-surgical time point, nor was it associated with any histologic differences in wound healing in this Yucatan minipig model. The time points chosen for observation post-surgery, as well as the variability in the PRP platelet count, may have contributed to the lack of positive findings in this study.

Removal of an Amalgam Tattoo Using a Subepithelial Connective Tissue Graft and Laser Deepithelialization

BACKGROUND A 56-year-old female presented for periodontal treatment with a large amalgam tattoo located in alveolar mucosa on the facial aspect of her maxillary central incisors. The lesion had been present for 42 years since having endodontic surgery at teeth #8 and #9 after a traumatic childhood incident. METHODS A two-stage surgical approach was used to eliminate the lesion, beginning with a subepithelial connective tissue graft to increase tissue thickness subjacent to the amalgam tattoo. After 6 weeks of healing, the overlying pigmented tissue was removed using laser surgery to expose the underlying grafted connective tissue. RESULTS After 2 months of healing following laser surgery, the amalgam pigmentation was completely removed, with good color match and an increased width of keratinized tissue at the surgical site. CONCLUSION A relatively large amalgam tattoo in the esthetic zone can be adequately removed by a two-stage procedure using grafted palatal connective tissue and laser deepithelialization.

Case Report: Diagnosis and Treatment of a Botryoid Odontogenic Cyst Found in the Maxillary Anterior Region

INTRODUCTION The botryoid odontogenic cyst (BOC) is a multicompartmentalized variant of the lateral periodontal cyst (LPC) that is typically found in the premolar-canine region of the mandible. METHODS A 60-year old man was referred for evaluation of a radiolucent lesion discovered on a routine examination. Radiographs revealed a unilocular radiolucency between the roots of teeth #10 and #11. Clinically, the site appeared normal with minimal probing depths, and there were no signs of swelling, bleeding, or mobility of the adjacent teeth. The pulps of both teeth responded to cold without lingering. After patient consent, the lesion was accessed by a mucoperiosteal flap, curetted from its bony cavity, and submitted for biopsy. The site was then treated with a bone allograft and a collagen membrane. RESULTS The diagnosis of a BOC was made based on location and the histopathological findings of multiple cystic spaces lined by nonkeratinized stratified squamous epithelium. The 22-month follow-up revealed a normal clinical appearance with evidence of radiographic bone fill at the site of the lesion. CONCLUSION This case shows an unusual presentation of a BOC in both location and radiographic appearance and emphasizes the importance of a microscopic examination of unilocular lesions when associated with teeth having normal responding vital pulps. The relatively high recurrence rate for the BOC warrants periodic follow-up.

Crown lengthening in the maxillary anterior region: a 6-month prospective clinical study.

The purpose of this study was to assess osseous parameters and stability of maxillary anterior teeth following crown lengthening surgery. Thirty-six patients requiring facial crown lengthening of 277 maxillary anterior and first premolar teeth were included. Presurgical and intraoperative clinical measurements were recorded at baseline and 1, 3, and 6 months postsurgery at midfacial, mesiofacial, and distofacial line angles. The data presented here suggest that when crown lengthening anterior maxillary teeth, the distance between the desired gingival margin and alveolar crest is usually insufficient to allow for biologic width. In addition, there is significant tissue rebound that may stabilize by 6 months. Tissue rebound appears related to flap position relative to the alveolar crest at suturing. These findings suggest that clinicians should establish proper anterior crown length with osseous resection.This case report examined crestal bone level maintenance surrounding a platform-switched implant that was retrieved due to prosthetic difficulty. The retrieved platform-switched implant threads demonstrated tight contact with the surrounding bone and demonstrated both radiographic and histologic features that were indicative of successful osseointegration. Very high bone-to-implant contact (BIC) without epithelial downgrowth to the implant thread was noted. The BIC consisted of a combination of newly formed bone and native bone. The buccal and lingual bone levels coincided with the original platform position noted at the time of the surgery, and did not appear to resorb at all. The result of the present investigation confirms the maintenance of the crestal bone level for platform-switched implants.