Yu-Hsiang Chou

An Interdisciplinary Treatment Approach Combining Orthodontic Forced Eruption with Immediate Implant Placement to Achieve a Satisfactory Treatment Outcome: A Case Report

BACKGROUND Periodontal disease often results in severely bony defects around the teeth and leads to eventual extraction. Remaining bone morphology often compromises ideally restoration-driven positions and deteriorates the success rates for dental implants. PURPOSE The present investigation illustrates the clinical outcome of immediately installing an implant following orthodontic forced eruption and atraumatic extraction. MATERIAL AND METHODS The subject of this study is a 40-year-old Asian female with a right mandibular first molar that had a deep probing depth on the mesial side and mobility. Via the aid of radiographic examination, the tooth that had an angular bony defect and apical lesion was diagnosed as having deep caries and chronic periodontitis with a poor prognosis. After consultation with the patient, we developed a treatment plan incorporating a forced eruption with immediate implantation, intended to augment the alveolar bone volume and increase the width of keratinized gingivae, in a nonsurgical manner. RESULTS Following 12 months of orthodontic treatment, the tooth was successfully moved occlusally in conjunction with an 8 mm vertical interdental bone augmentation. Because of sufficient volume of bone and satisfactory gingival dimensions, the implant showed adequate initial stability in the correct position to facilitate physiological and aesthetic prerequisites. After 6 months of osteointegration, a customized impression coping was utilized to transfer the established emergence profile to a definitive cast for the fabrication of a customized abutment. The final prosthesis was made using a customized metal abutment and ceramometal crown. CONCLUSION In the face of difficult clinical challenges, meticulous inspection and a comprehensive treatment plan were crucial. Interdisciplinary treatment through the careful integration of multiple specialists suggests the possibility of optimal results with high predictability.

Antipsychotic medications and dental caries in newly diagnosed schizophrenia: A nationwide cohort study.

We investigated the association between antipsychotic medications and the risk of dental caries in patients with schizophrenia. We enroled a nationwide cohort of patients with newly diagnosed schizophrenia within 1 year of dental caries development. Exposure to antipsychotics and other medications was categorised according to their type and duration, and the association between exposure and dental caries was assessed through logistic regressions. Of the 3610 patients with newly diagnosed schizophrenia, 2149 (59.5%) exhibited an incidence of treated dental caries. Logistic regression analysis identified a younger age, female sex, high income, a 2-year history of dental caries, and exposure to first-generation antipsychotics, and antihypertensives as independent risk factors for treated dental caries in patients with schizophrenia. Hyposalivation, the adverse effect of first-generation antipsychotics and antihypertensives, was associated with an increased risk of treated dental caries. However, hypersalivation from first-generation antipsychotics for dental caries was associated with a protective factor. These findings suggest that clinicians should pay attention to the aforementioned risk factors for dental caries in patients with schizophrenia, particularly while prescribing first-generation antipsychotics and antihypertensives to such patients.

Clinical Case Report on Treatment of Generalized Aggressive Periodontitis: 5-Year Follow-up.

Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease associated with considerably more rapid periodontal tissue destruction than chronic periodontitis. This study presents the 5-year follow-up of a patient with GAgP. A 29-year-old man reported experiencing increasing gingival recession. He was treated using cause-related therapy, provisional splints, and flap surgery combined with allograft grafting and was followed up for 5 years. This case study shows that elimination of infectious microorganisms and meticulous long-term maintenance provide an effective treatment modality for aggressive periodontitis cases. This treatment modality can restore the masticatory function and provide the GAgP patient with improved quality of life.

New Classification of Crown Forms and Gingival Characteristics in Taiwanese

Objectives: The aim of the investigation was to examine the forms of the crowns in the maxillary anterior tooth segment and corresponding gingival characteristics among healthy Taiwanese subjects. Materials and Methods: The crown width at the apical third (CW), length (CL), gingival angle (GA) and the interdental papilla height were assessed from the diagnostic stone model using a calibrated periodontal caliper. A CW/CL-ratio was calculated for each tooth and averaged for each tooth region. Gingival thickness (GT) and width of keratinized gingiva (WG) were measured clinically. Results: The cluster analysis revealed 3 classifications of crown forms: narrow (N), compound (C) and square (S) types. There was a significant difference among the 3 classifications with respect to CW/CL-ratio, GT, and WG (p < 0.0001). Conclusions: The results demonstrated varied crown forms and corresponding gingival characteristics in Caucasian and Taiwanese. The new classifications hinted that there was a polymorphism in different races and could be a valuable esthetic guideline and reference for anterior tooth rehabilitation, including various periodontal and restorative treatments and anterior implant placement procedures in Taiwanese.

Association between the eruption of the third molar and caries and periodontitis distal to the second molars in elderly patients

The objective of this study was to verify whether caries and periodontal diseases, when present on the distal surface of the second molars (M2s), are associated with the eruption of the third molars (M3s). In this split‐mouth study, we evaluated 70 elderly patients with unilateral maxillary or mandibular M3s who presented to the outpatient clinics of two hospitals. Patients underwent comprehensive oral examinations and radiographical measurements, and we assessed the outcomes of periodontal disease and caries. Periodontal measurements included plaque index, bleeding on probing, and periodontal probing pocket depth (PD). Moreover, caries were assessed through visual–tactile examination and radiography. We performed the χ2 test to determine factors associated with M3 and non‐M3 outcomes. Eighty‐one unilateral erupted M3s were observed in the study patients. Both the distobuccal region (p < 0.0001) and the distolingual region (p = 0.006) had a higher PD on the nonextraction side than the extraction side, and the caries rate was significantly higher on the nonextraction side than on the extraction side (p <0.0001 on M2 with caries and p = 0.003 on M2 with distal caries). M3 eruption, at the same or different occlusal plane levels of M2, is a risk factor for periodontal diseases and caries in M2s in elderly patients. M3s may continue to negatively impact dental health well into later life.

Association of vitamin D receptor gene polymorphisms and periodontitis in a Taiwanese Han population

Background/purpose : Genetic polymorphisms in the vitamin D receptor (VDR) gene are related to the immune response and bone metabolism, both of which are implicated in the pathogenesis of periodontitis. This study was to investigate the association between VDR-gene polymorphisms and periodontitis among a Taiwanese Han ethnic population. Materials and methods Ninety-two aggressive periodontitis (AgP), 385 chronic periodontitis (CP) and 163 healthy controls (HC) were recruited from dental clinics. Demographic characteristics and possible confounding factors were obtained using a self-reported questionnaire. The VDR rs731236 (TaqI), rs7975232 (ApaI), rs1544410 (BsmI), and rs2228570 (FokI) polymorphisms were genotyped using PCR-RFLP methods. Statistical analyses were applied to determine the associations. Results The individual VDR polymorphisms were not associated with risk of AgP and CP. The f allele of rs2228570 was related to decreased risk for AgP. Subjects with TAbF (adjusted OR = 7.2, 95% CI = 3.2–7.2, p < 0.0001) or TAbf (adjusted OR = 0.17, 95% CI = 0.05–0.48, p = 0.002) combined polymorphisms were significantly associated with AgP. Subjects with Tabf (adjusted OR = 2.6, 95% CI = 1.8–3.8, p < 0.0001), TAbF (adjusted OR = 4.4, 95% CI = 2.6–8.1, p < 0.0001), TabF (adjusted OR = 0.36, 95% CI = 0.2–0.5, p < 0.0001), or TAbf (adjusted OR = 0.45, 95% CI = 0.3–0.7, p = 0.001) combined polymorphisms were significantly associated with CP. Conclusion The study indicates that VDR gene polymorphisms are associated with AgP and CP in a Taiwanese Han population.

Compliance with Supportive Periodontal Treatment in Patients with Dental Implants.

PURPOSE The need for dental implants is increasing, and supportive periodontal treatment can achieve long-term success and prevent peri-implantitis. Contributing factors to noncompliance with long-term scheduled supportive periodontal treatment remain unclear. To investigate whether demographic and clinical characteristics are associated with noncompliance, the authors analyzed data for patients who had received dental implants. MATERIALS AND METHODS The authors recruited patients participating in a supportive periodontal treatment program after receiving permanent prostheses on implants placed from 2005 to 2013. Demographic data and dental treatment histories were collected. Compliance was defined as a record of participation in a standard supportive periodontal treatment program for at least 1 year. The chi-square test, log-rank test, Kaplan-Meier survival curve, and Cox proportional hazards model were used for statistical analysis. RESULTS The study included 120 patients (259 implants, 60% compliance). The two groups (compliant and noncompliant) differed significantly in frequency distributions for sex (P = .0017), educational level (P = .0325), and histories of substance use (P = .0016), periodontitis (P = .0005), and root planing or flap surgery (P = .0002). The Kaplan-Meier survival curves and log-rank test showed that increases in cumulative continuation rates were significantly associated with male sex (P = .0025); body mass index ≥ 24 kg/m² (P = .0093); and a history of periodontitis (P < .0001), root planing or flap surgery (P < .0001), and substance use (P = .0026). Multivariate Cox proportional hazards model for supportive periodontal treatment noncompliance showed significantly higher compliance in patients who had received root planing or flap surgery (hazard ratio = 0.26, 95% confidence interval = 0.12 to 0.53, P = .0002). CONCLUSION These results suggest that in patients who received a permanent prosthesis on implant placement, root planing or flap surgery was the crucial factor in determining compliance with supportive periodontal treatment. However, well-designed large-scale studies with a larger sample size are needed to confirm the findings of this study.

Oral and General Health-Related Quality of Life (OHRQoL) among Patients Undergoing Periodontal Treatment and Regular Supportive Periodontal Treatment (SPT)

Periodontitis often affects the quality of life (QoL) of patients. This study investigated the oral health-related quality of life (OHRQoL) and health-related quality of life (HRQoL) of three categories of participants. These were, firstly, follow-up patients (FU), specifically periodontitis treated patients, who had undergone periodontal treatment and supportive periodontal treatment (SPT). Secondly, new patients, specifically patients being treated for periodontitis for the first time (NP). Thirdly, periodontally healthy patients or patients with only mild gingivitis (HG). Materials and Methods: In total 129 participants were recruited during this study; these consisted of 32 patients in the FU group, 62 patients in the NP group and 35 patients in the HG group. Each participant had accepted a periodontal examination and then completed a questionnaire that included demographic data and the various QoL instruments, these were the Oral Health Impact Profile (OHIP), the Oral Impacts on Daily Performance (OIDP), and World Health Organization Quality of Life-BREF (WHOQOL-BREF). Chi-square tests, ANOVA, and multivariable analysis were used to compare the difference among the three groups. Results: Among participants with ≥ 24 teeth, the OHIP scores of the NP group (30.38 ± 2.52) were significantly higher than those of the FU group (20.13 ± 3.60; p = .0142). When the OIDP results were considered, the score for the NP group (7.57 ± 1.43) was significantly higher than that for FU group (1.40 ± 2.04) (p = .0306). By way of contrast, among participants with ＜ 24 teeth, the OHIP scores of both the NP group (39.96 ± 3.52) and the FU group (32.69 ± 4.54) were significantly higher than those in HG group (4.21 ± 7.03; p = .0004). Conclusions: The outcome revealed that the OHRQoL of FU patients who possessed more than 24 teeth is superior to that of the NP group. Clinical Relevance: Periodontitis patients should receive treatment in order to preserve sufficient healthy teeth and SPT is likely to enhance their OHRQoL. (J Taiwan Periodontol, 21(1):12-22, 2016)