Richard M Palmer

King's College London | KCL · Department of Restorative Dentistry

Periodontal screening is an important tool in dental practice, and the BPE system is recommended. Clinically, visual examination should identify inflammatory change, recession and enlargement. However, detailed periodontal charting is required in all patients with significant levels of disease. In addition, radiographic examination is important to...

Supragingival plaque control on a daily basis should resolve gingivitis and is fundamental to the management of periodontitis. Subgingival plaque control has been termed subgingival scaling, root planing, root surface debridement and professional mechanical plaque removal (PMPR). Most cases of periodontitis should respond well to this treatment. An...

Periodontal assessment of multirooted teeth can be difficult because the entrances of the furcations may be inaccessible. Furcation involvement is graded according to the distance to which the furcation can be probed in a horizontal direction from each of the entrances. Treatment options are conceptually consistent with those for single-rooted teet...

The lateral periodontal abscess is normally associated with a deep pocket on a vital tooth. The first line of treatment is drainage via the pocket and root surface debridement under local anaesthesia. Combined periodontal/endodontic lesions are diagnosed where a deep pocket extends to a pulpal communication (apical, lateral or furcation) in a non-v...

Periodontal screening is an important tool in dental practice, and the BPE system is recommended. Clinically, visual examination should identify inflammatory change, recession and enlargement. However, detailed periodontal charting is required in all patients with significant levels of disease. In addition, radiographic examination is important to...

The most common diagnostic categories are chronic gingivitis and periodontitis. Many other conditions affect the periodontal tissues, including systemic conditions that have an oral involvement. Prognosis is a prediction of the probable outcome of a disease based on the patient’s present condition and the usual course of the disease as seen in simi...

This chapter is devoted to providing straightforward explanations of periodontal conditions for the patient. It includes pertinent illustrations, clinical photos and diagrams to support the text which is written in lay terms.

Drifted anterior teeth may be a sign of severe periodontitis. Management may include periodontal treatment, orthodontics, splinting and supportive care. Crown lengthening surgery is one of the commonest pre-restorative periodontal procedures. Simple soft tissue resection may not be possible. A flap procedure with the removal of crestal bone allows...

Surgical techniques for the regeneration of the periodontal ligament include the use of membranes and grafts, and the application of biological agents and growth factors. Surgical treatment of gingival recession can be achieved by coverage of exposed root surfaces with soft tissue and by the creation of new keratinised and attached gingiva.

Surgery may be indicated where deep pockets persist after extensive root surface debridement and there is good plaque control by the patient. Surgical methods can be divided into resective, open access and regenerative techniques although there may be some overlap between the categories. Periodontal flap surgery is used to gain access to previously...

The establishment of periodontal health should be a primary aim in all treatment plans. The methods by which this can be achieved have been dealt with in previous chapters, but there are a number of situations where integration of these treatment methods with other dental disciplines needs to be clarified. To simplify matters this chapter will cons...

Regeneration of the lost tissues of the periodontium is an ideal therapeutic goal and has been the subject of much research and ingenious clinical techniques. Reconstructive or regenerative techniques are used either singly or in combination for three main purposes: (1) to regain lost periodontal ligament attachment, (2) to provide a wider zone of...

An appreciation of dental plaque and the host response provides an essential basis from which to understand the disease process and treatment rationale. This information will help the reader to understand not only the way that plaque may have an impact on oral tissues but also why regular effective cleaning may improve periodontal health and why so...

Background: Maxillary sinus septa are barriers of cortical bone that divide the maxillary sinus floor into multiple compartments, known as recesses. Aim/Hypothesis: To gain further insights and resolve conflicting results in the literature regarding prevalence, predominant location and morphologic variability of maxillary sinus septa. Material and...

Purpose: An international Delphi study was undertaken to determine by consensus an agreed approach to the management of children with dental manifestations of ectodermal dysplasia, including the use of dental implants. This was done using a questionnaire developed by an interdisciplinary team. Materials and methods: The Delphi study questionnair...

Background: Calcium phosphate-based materials have been widely used as bone substitutes and more recently are being exploited together with growth factors as bone tissue engineering scaffolds regulating cell behavior. The aim of this study is to evaluate the in vitro and in vivo response to a newly developed calcium metaphosphate (CMP) bone graft,...

To review the systemic impact of smoking on bone healing as evidenced within the orthopaedic literature. A protocol was established and studies were sourced from five electronic databases. Screening, data abstraction and quality assessment was conducted by two review authors. Prospective and retrospective clinical studies were included. The primary...

Purpose: The crestal bone level around a dental implant may influence its strength characteristics by offering protection against mechanical failures. Therefore, the present study investigated the effect of simulated bone loss on modes, loads, and cycles to failure in an in vitro model. Materials and methods: Different amounts of bone loss were...

Background and aimIn cases with limited bone height, short implants could be a good alternative to augmentation procedures. The aim of this randomized controlled trial was to compare the clinical performance of implants of 6mm or 11mm in length in the posterior region. Materials and methodsIn this multicenter trial (six study sites), 95 subjects we...

To gain further insights and resolve conflicting results in the literature regarding prevalence, predominant location and morphologic variability of maxillary sinus septa. Electronic and hand searching of English literature identified 33 investigations published from 1995 to 2011. Septa were defined as at least 2-4 mm in height. Septa were present...

SGP1T , a strain belonging to a lineage of the phylum Synergistetes with no previously cultivated representatives was subjected to a comprehensive range of phenotypic and genotypic tests. The strain was dependent for good growth on co-culture with, or extracts from, selected other oral bacteria. Phylogenetic analysis of the full-length 16S rRNA gen...

Objective: To compare the diagnostic accuracy of conventional periapical radiography and cone beam computed tomography (CBCT) at detecting peri-implant bone defects. Materials and methods: Implants were placed in fresh bovine ribs in osteotomy sites of varying diameter (five with no peri-implant space, five with a 0.35 mm space, five with a 0.67...

Objectives: To assess whether the use of a graft and/or membrane post-tooth extraction improves healing of the site dimensionally, radiographically, and/or histologically. Materials and methods: MEDLINE and EMBASE and the Cochrane Central register of controlled trials (CENTRAL) were searched up until August 2011. Randomized controlled trials tha...

The objective of this working group was to assess and make specific recommendations to improve the quality of reporting of clinical research in implant dentistry and discuss ways to reach a consensus on choice of outcomes. Discussions were informed by three systematic reviews on quality of reporting of observational studies (case series, case-contr...

Moazzez R, Thompson H, Palmer RM, Wilson RF, Proctor GB, Wade WG. Effect of rinsing with ethanol-containing mouthrinses on the production of salivary acetaldehyde. Eur J Oral Sci 2011; 119: 441–446. © 2011 Eur J Oral Sci It has been suggested that the use of alcohol-containing mouthrinses could lead to the presence of acetaldehyde in saliva. In thi...

Little is known about maxillary sinus compliance, i.e., the intrinsic potential of the sinus membrane to resume its homeostatic status after the surgical trauma caused by sinus floor elevation. The aim of the present study is to investigate the effect of maxillary sinus floor augmentation on sinus membrane thickness. Within-patient comparison of co...

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Immediate placement of implants into infected sites: a systematic review of the literature. Waasdorp JA, Evian CI, Mandracchia M. J Periodontol 2010;81:801-8. REVIEWER: Richard Palmer, PhD, BDS, FDS RCS PURPOSE/QUESTION: Do implants placed into sites compromised by endodontic or periodontal infection hav...

The effect of smoking on soft tissues after periodontal treatment has been extensively studied. However, little focus has been placed on the impact of smoking on bone regeneration after treatment. The aim of this review is to systematically assess the effect of smoking on bone regeneration after periodontal treatment. A protocol was established and...

To evaluate the use of a single Astra Tech implant to support a two-unit cantilever fixed dental prosthesis. Twenty-nine subjects with an edentulous space (at least equivalent to two bicuspid units) in the premolar/molar segments of the maxilla or mandible with opposing natural teeth or a fixed/removable prosthesis were treated. They were provided...

Patients have high expectations of dental implants in terms of appearance, function and longevity. It is essential that these expectations are realistically managed and that treatment of the highest standard is provided. This involves very careful evaluation, including clinical and radiographic, and presentation of the pros and cons of treatment al...

Molecular ecology methods are now well established for the culture-independent characterization of complex bacterial communities associated with various environmental and animal habitats and are revealing the extent of their diversity. By comparison, it has become clear that only a small minority of microorganisms are readily cultivated in vitro, w...

Tissue engineering is emerging as a new therapeutic alternative in dentistry, particularly in the reconstruction of alveolar ridge or sinus augmentation to enable dental implant placement. Bone morphogenic protein 7 (BMP-7) is an osteoinductive molecule that regulates bone formation and is currently being exploited for dental applications. In this...

To assess the accuracy of measuring the cortical bone thickness adjacent to dental implants using two cone beam computed tomography (CBCT) systems. Ten 4 x 11 mm Astra Tech implants were placed at varying distances from the cortical bone in two prepared bovine ribs. Both ribs were scanned in a reproducible position using two different CBCT scanners...

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A Novel Decision-Making Process for Tooth Retention or Extraction J Periodontol 2009;80:476-491. Avila G, Galindo-Moreno P, Soehren S, Misch CE, Morelli T, Wang H-L. REVIEWER: Richard M. Palmer, PhD, BDS, FDS RCS PURPOSE/QUESTION: Is it possible to devise a system to help in the decision-making process o...

Subgingival plaque samples obtained from human subjects with periodontitis, shown to include previously uncultivable members of the phylum Synergistetes, were used to inoculate Cooked Meat Medium (CMM). The presence of Cluster A (uncultivable) Synergistetes was monitored by fluorescent in situ hybridization (FISH) and quantitative PCR (Q-PCR). Clus...

Background: Bone-containing vascularized grafts have been used successfully to reconstruct post-cancer surgical defects. Dental implants can be placed in these bone-containing grafts to allow implant-supported prosthodontic reconstruction of these patients. Purpose: The aim of this study was to evaluate the survival of dental implants used in th...

A number of studies have suggested that implant failure and associated bone loss is greater in subjects with a history of periodontitis. To evaluate the risk for marginal bone loss around implants and implant failure in subjects with a history of periodontitis compared with periodontally healthy subjects in studies with a minimum 3-year follow-up....

Members of the phylum “Synergistetes” have frequently been detected in the human oral cavity at sites of dental disease, but they have rarely been detected in studies of oral health. Only two oral “Synergistetes” taxa are cultivable. The aims of this study were to investigate the diversity of “Synergistetes” in the oral cavity, to establish whether...

The aim of this study was to assess oral health-related beliefs and attitudes, health behaviour of smokers in relation to the Transtheoretical Model (TTM) of behaviour change, willingness to have smoking cessation provided together with periodontal treatment. Postal questionnaire was sent to 500 referred patients. Part 1 looked at attitudes and bel...

OBJECTIVE: This study was undertaken in order to test the hypothesis that the consequences of tobacco smoking may include increased synthesis of toxic volatile sulphur compounds in diseased periodontal pockets. DESIGN: A cross‐sectional, parallel study comparing groups of smokers and non‐smokers with periodontitis and the level of volatile sulphur...

Aim: To review the scientific preclinical background and clinical studies of current methods of periodontal regeneration in the treatment of infrabony defects and soft tissue deficiencies Method: Five commissioned review papers including two systematic reviews were scrutinized by a group of experts in order to derive consensus conclusions, clinical...

OBJECTIVES: The cells of the junctional epithelium (JE) provide and maintain the epithelial attachment, and remain morphologically and phenotypically distinct from oral sulcular (OSE) and external oral epithelia (EOE), from which they may be regenerated de novo. Expression of cytokeratins (CK) in human epithelia has been shown to be highly site‐spe...

There have been rapid developments in dental implant treatment protocols to reduce the time between implant placement and restoration. Implants may be placed immediately following tooth extraction or following a period of healing to allow resolution of residual infection or sufficient bone and soft tissue healing. Early restoration and loading of i...

Article Title and Bibliographic Information The Efficacy of Various Bone Augmentation Procedures for Dental Implants: A Cochrane Systematic Review of Randomized Controlled Clinical Trials Esposito M, Grusovin MG, Coulthard P, Worthington HV. Int J Oral Maxillofac Implants 2006;21(5):696-710 Level of Evidence 1 Purpose/Question Review efficacy and...

Neutrophils leave the bone marrow as terminally differentiated cells, yet little is known of the influence of nicotine or other tobacco smoke components on neutrophil differentiation. Therefore, promyelocytic HL-60 cells were differentiated into neutrophils using dimethylsulfoxide in the presence and absence of nicotine (3-(1-methyl-2-pyrrolidinyl)...

SPEC; DOI:10.1186/1471-2121/9/19; ;

To investigate the orthodontic management of patients with developmentally absent maxillary lateral incisors. A questionnaire was mailed to all orthodontists on the specialist list held by the British Orthodontic Society. The questionnaires (57.3% response) were analysed in two groups: Group 1 consisted of orthodontists who worked only in an orthod...

The aim of this study was to investigate the transfer of bacterial doxycycline resistance between oral bacteria in subjects receiving systemic doxycycline for the treatment of periodontitis. Streptococci were cultured before and after treatment from the subgingival plaque of two patients with periodontitis, genotyped and investigated for the presen...

Article Title and Bibliographic Information Fixed partial prostheses supported by 2 or 3 implants: a retrospective study up to 18 years. Eliasson A, Eriksson T, et al. Int J Oral Maxillofac Implants 2006;21(4):567-74. Level of Evidence 2B Purpose/Question How does the long-term success and complication rate of 2- and 3-implant supported fixed par...

The aim was to investigate the relationship between bone mineral density (BMD) of the jaws (mandible and maxilla) and other skeletal sites. In addition, the influence of gender, smoking and the number of years without natural teeth were examined. 18 edentulous patients (9 females, 9 males) with a mean age of 67.1 (sd 12.6) years had DXA scans to as...

To investigate patient centred outcomes, soft tissue morphology, and bone levels. Sixty-six subjects, who had completed treatment for a single implant restoration at least l year previously. Appearance was recorded photographically and bone levels and interdental contact points measured from intra-oral radiographs using a x 7 scale loupe. Subjects...

The "Synergistes" group of organisms are a phylogenetic cluster of Gram-negative anaerobes related to Synergistes jonesii, sufficiently distinct from all other phyla to be considered a distinct phylum or Division. They are widely distributed in nature although normally only a minor constituent of the bacterial community in each habitat. They have e...

To assess the management of patients who are current smokers in dental practice. A postal questionnaire to the 243 periodontists on the UK specialist register and 239 randomly selected hygienists on the General Dental Council register. Eighty per cent of both groups responded. There were significant demographic differences between the two groups of...

Background: The soft tissues around single tooth implants differ fundamentally from the gingiva around natural teeth. There are very limited data comparing soft tissues around different implant systems. Aim: To assess whether the design characteristics of dental implants, particularly the implant-abutment junction, may affect the dimensions and hea...

The aim of this in vitro study was to compare the resistance to separation (breakaway force) of flat (Magfit-IP-BF) and domed (Magfit-IP-BD) implant magnet attachments subjected to non-axial forces. The separating forces were applied by an Instron Universal Testing Instrument to single magnet attachments at angles of 0 degrees, 2 degrees, 5 degrees...

Article Title and Bibliographic Information: The Importance of Implant Surface Characteristics in the Replacement of Failed Implants. Alsaadi G, Quirynen M, vanSteenberghe D. Int J Oral Maxillofac Implants 2006;21(2):270-4. Level of Evidence: 3b. Purpose/Question: Following failure of an implant does the type of surface of the replacement implant a...

Article Title and Bibliographic Information: Early loading of Osseotite implants 2 months after placement in the maxilla and mandible: a 5-year report. Sullivan D, Vincenzi G, Feldman S. Int J Oral Maxillofac Implants 2005;20(6):905-12. Level of Evidence: 3b. Purpose/Question: Would a reduced healing time of 2 months affect the success rates of Oss...

Previous work has suggested that tobacco smoking has a local as well as a systemic effect on the severity of periodontal disease. Objective: To test the hypothesis that smokers have more disease in the upper anterior region. A retrospective stratified random sample of 49 non-smokers and 39 heavy smokers (>or=20 cigarettes/day) was obtained from a t...

Unlabelled: There have been rapid developments in dental implant treatment protocols to reduce the time between implant placement and restoration. Implants may be placed immediately following tooth extraction or following a period of healing to allow resolution of residual infection or sufficient bone and soft tissue healing. Early restoration and...

Unlabelled: Implant-retained prostheses need to be re-evaluated on a regular basis. This should include review of the effectiveness of oral hygiene procedures to maintain soft tissue health, evaluation of the integrity and function of the prosthetic superstructure and comparison of radiographic bone levels at appropriate intervals. Clinical relev...

Molecular ecological analysis based on 16S rRNA gene sequence analysis is well established for the characterisation of complex bacterial communities. However, 'universal' PCR primers can introduce biases into the analysis of the species composition of clone libraries because of mismatches between the primer and target organism sequences. In this st...

The human 60 kDa and microbial 65 kDa heat shock proteins (HSP) have been implicated in the pathogenesis of chronic periodontitis (P) and coronary heart disease (CHD). We have studied four male non-smoking cohorts of 81 subjects, matched for age. Group (a) consisted of a healthy group with minimal gingivitis (n = 18), group (b) were patients with P...

Palmer RM. Should quit smoking interventions be the first part of initial periodontal therapy? J Clin Periodontal 2005; 32: 867–868. doi:10.1111/j.1600-051X.2005. 00808.x.© Blackwell Munksgaard, 2005.

Background: Connecting teeth and osseointegrated implants in fixed reconstructions is not generally recommended because of differences in their response to loading. Aim: The aim of the present study was to assess the clinical and radiographic performance of the teeth and implants used to support three unit fixed bridges subjected to normal funct...

Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity of adult heavy smokers and never-smokers referred for assessment and treatment of chronic periodontitis. A random sample of patients with at least 20 teeth, stratified for smoking and age (5-year blocks, 35...

To determine the influence of vitamin C supplementation (500 mg, bd, 14 days) on the circulating concentrations of soluble ICAM-1 (a marker of endothelial activation), neopterin (a marker of monocyte activation), and neutrophil elastase (a marker of neutrophil activation) in smokers and non-smokers in a randomised, double-blind, placebo-controlled...

To review the potential biological mechanisms underlying the effects of tobacco smoking on periodontitis. Smoking has major effects on the host response, but there are also a number of studies that show some microbiological differences between smokers and non-smokers. Smoking has a long-term chronic effect on many important aspects of the inflammat...

In the search for an accurate periodontal probe which does not frequently penetrate the pocket base, a new tip has been designed which is flattened, and of 1 mm width and 0.45 mm thickness. This study aimed to evaluate the physico-mechanical and clinical properties of this probe (test) in comparison to a conventional 0.5 mm circular probe (control)...

Subjects. There were 308 subjects (55% women), aged 15 to 95 years, treated between October 1993 and May 2000 at the Mayo Clinic, Rochester, MN. The posterior mandible was the most frequently treated area (124 patients) followed by anterior maxilla (70 patients), posterior maxilla (64 patients), and anterior mandible (50) patients. Therapy. 674 imp...

To measure the effect of three special liquid proportions and five forming temperatures on the length of superplastically formed titanium dental implant superstructures made using Rematitan dental casting investment. Rematitan dental casting investment was used to make models that contained two implant abutment analogues 8 mm apart. The investment...

Gingival inflammation associated with plaque accumulation is delayed or impaired in smokers. Anecdotal evidence suggests that smokers who quit experience an increase in gingival bleeding. A group of 27 subjects on a Quit-smoking programme were examined for changes in gingival health over a 4-6-week period. The bleeding on probing with a constant fo...

The accuracy of an implant fixture-level impression is affected by the type of impression tray used. The purpose of this in vitro study was to investigate the accuracy of open tray implant impressions comparing polycarbonate stock impression trays and rigid custom-made impression trays to make implant fixture-level impressions. Gold cylinder pairs,...

The aims of this study were (i). to assess the morphological features of osteo-blast-like, osteosarcoma cells (cell line SaOS-2) cultured on implant surfaces of varying alloys and (ii). to evaluate the biological activity of these cells, following their adhesion onto these surfaces. SaOS-2 cells (6 x 104) were grown on titanium discs (diameter 30 m...

pi alpha 1-Antitrypsin deficiency is a genetically determined condition resulting in predisposition to certain inflammatory diseases due to a protease: antiprotease imbalance that is exacerbated by tobacco smoking. Limited evidence suggests that there may be a significant enrichment of mild alpha 1-antitrypsin deficiency phenotypes in subjects with...

Soluble ICAM-1 (sICAM-1; sCD54), sCD44v5 and sCD44v6 are circulating adhesion molecules, with immunomodulatory potential, that have been frequently attributed diagnostic, prognostic and aetiological significance in a number of inflammatory and malignant diseases. We have previously shown that systemic concentrations of these molecules are increased...

To investigate the clinical and psychological outcomes with ball attachment supported mandibular overdentures on Branemark implants placed in a single stage surgical approach. MATERIAL AND METHODS Sixteen edentulous patients aged 32-74, with atrophic (flat) mandibular residual alveolar ridges, and a history of having difficulty coping with technica...

Abstract Background IGF-1 and the major serum IGF-1 binding protein, IGFBP-3, are under extensive investigation as potential prognostic markers of specific malignancies and vascular diseases. However, there is conflicting evidence that tobacco smoking may influence systemic concentrations of IGF-1 and IGFBP-3. Subjects and methods Serum concentrati...

Sequential interactions between several adhesion molecules and their ligands regulate lymphocyte circulation and leukocyte recruitment to inflammatory foci. Adhesion molecules are, therefore, central and critical components of the immune and inflammatory system. We review the evidence that tobacco smoking dysregulates specific components of the adh...

IGF-1 and the major serum IGF-1 binding protein, IGFBP-3, are under extensive investigation as potential prognostic markers of specific malignancies and vascular diseases. However, there is conflicting evidence that tobacco smoking may influence systemic concentrations of IGF-1 and IGFBP-3. Serum concentrations of IGF-1 and IGFBP-3 were measured in...

Tobacco smoking affects systemic concentrations of soluble intercellular adhesion molecule (ICAM)-1, but its effect on local expression of adhesion molecules in gingival tissue has not been studied previously. E-selectin and ICAM-1 expression on small blood vessel endothelia in gingival biopsies obtained from smokers (n=17) and non-smokers (n=17) w...

Abstract Sequential interactions between several adhesion molecules and their ligands regulate lymphocyte circulation and leukocyte recruitment to inflammatory foci. Adhesion molecules are, therefore, central and critical components of the immune and inflammatory system. We review the evidence that tobacco smoking dysregulates specific components o...

Tobacco smoking is an accepted risk factor for periodontal disease. Most studies in the periodontal literature rely on reported smoking habits which can be unreliable. This review specifically addresses this problem. Methods of assessing tobacco smoke exposure, variation in individual smoking habits, classification of former/ex-smokers, and validat...

To determine whether the reduced inflammation and bleeding and increased fibrosis reported in tobacco smokers affect the validity of clinical probing measurements by altering probe tip penetration. A constant force probe was used to measure probing depths and sound bone levels at six sites on 64 molar teeth (384 sites) in 20 smoking and 20 non-smok...

Raised serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) in smokers could have immunomodulatory effects in periodontitis. The aim of this study was to compare serum and gingival crevicular fluid (GCF) concentrations of sICAM-1 in smokers and non-smokers with periodontal disease. sICAM-1 in serum and GCF collected from age- and gen...

In assessing the link between tobacco smoking and disease, it is important to determine longterm, cumulative exposure to tobacco smoke as accurately as possible. Conventional methods of assessing exposure to tobacco smoke each have intrinsic limitations. Self-reporting of tobacco use, and the conversion of this data to pack-years, can be prone to e...

The study examined the setting and thermal expansions of seven dental casting investments intended for use in the superplastic forming (SPF) of Ti6A14V for dental implant superstructures. The total expansion is compared with the coefficient of thermal expansion of the alloy. The unrestricted setting expansion of the investment was measured at room...

This is the fourth article in a series written by a selection of experts who willl be speaking at this year's National Dental Conference: Best Practice 2001. In this issue, Professor R. M. Palmer explores what we should be telling our patients about long-term periodontal problems.

This study was undertaken in order to test the hypothesis that the consequences of tobacco smoking may include increased synthesis of toxic volatile sulphur compounds in diseased periodontal pockets. A cross-sectional, parallel study comparing groups of smokers and non-smokers with periodontitis and the level of volatile sulphur compounds in the gi...