Periodontology - Science topic

look at biomarkers associated with different forms of periodontitis

you can have a look at this

Yes it is, may be TFO alone is not that obvious and not always causing apparent destruction in periodontal tissue, this is what is refered to as adaptive capacity of the periodontium to accommodate changes in occlusal forces and this capacity vary according to patients factors bone factor, type and direction of the traumatic force, tooth factor and other factors. However, with margonal periodontitis the effect of TFO on periodontium and periodontal tissue destruction is more obvious and rapid.

Thank you Dr. Alhabil for the reply, i also wanted to know how do you differentiate if the melanin has been removed in non contact mode, how long does it take for the results to be evident?

This is not my area of expertise

 Experimental induction of periodontitis in rats 

Anesthetic agents whether it is Lidocaine, Prilocaine, Mepivacaine solution with vasoconstrictor can be used safely in hypertensive patients attending dental clinic. However It is of utmost importance that dental clinicians need to select anesthetic solution in hypertensive patients considering their cardiovascular effect in order to provide comfort to the patients and knowing safety

As result of the aggressive nature of these conditions and lack of response to conventional periodontal therapy

The condition is managed by

Non-surgical (initial phase I/II) therapy

Revaluation

Surgical therapy

Supportive periodontal therapy

Orthodontic treatment

 Systemic antibiotics – to complement non-surgical therapy as the undisturbed subgingival plaque is protected by the biofilm effect

Tetracycline 250 mg qds for 14 days

Metronidazole 250 mg and Augmentin 375 mg (amoxicillin 250 mg) tds for seven days

Revaluation

Sites of active destruction as demonstrated by bleeding on probing and deep periodontal pockets are indications for surgical intervention

 Surgical therapy

Modified Widman Flap

Total elimination of pocket lining which is invaded by causative periopathogens

Accessibility for proper debridement of the osseous defects

 Supportive periodontal therapy

As result of the aggressive nature of the condition, the patient recall should NOT exceed three months intervals

Maintenance recall will prevent the recurrence of the disease and detect any “new” development of periodontal lesions

 Orthodontic treatment

To improve aesthetic problem when required (complete resolution of the condition)

Six months following therapy?

I concur with the response of John S Mamoun in relation to the basics but related to social change, poverty, literacy level and national policy are factors to reckon with in addressing chronic diseases.

Dear Ramachandra SS 

Dear Khady. What do you mean by pooling? Why are you pooling if they are from different sites. I smell something wrong with this!

Dear Dr. Eckert,

I totally agree with the all the factors that your stressed out. I would like to highlight also the fact that primary stability is still regarded as a crucial factor to achieve biologic stability. On the counterpart, it is interesting the number of recent reports showing that high insertion torque may have a detrimental effect of crestal bone stability as well as upon osseointegration. For instance, Cha et al. (JDR 2015) demonstrated in a multiscale analysis that high IT more than doubles this zone of dead and dying osteocytes. As a result, peri-implant bone develops micro-fractures, bone resorption is increased, and bone formation is decreased. Likewise, Simons (COIR 2014) showed that the thicker the cortical bone layer was at implant placement (and thus, higher IT), the greater the marginal bone resorption was. Therefore, I would consider further inadequate implant drilling protocol along with high bone density (and not quality since these from these reports might be extracted that poorer bone might be biologically better - richer vascularity compared with denser bone) might play important roles on implant failure. Interestingly, the recent reports by Derks (JDR 2015,2016) showed twice as much peri-implantitis and implant failure in areas of denser bone (mandible) compared to the maxilla.

Best,

Alberto

Edison - not necessarily.  I haven't worked with oral flora, but have experience with staphylococci and P. aeruginosa on this platform.  In general, healthy well-suspended organisms will tend to adhere to the polystyrene or polycarbonate that the pin plate is typically made of.  There is a difference between simple adhesion and actual biofilm formation, so adherent organisms will need some time to develop full biofilms.  A couple of important points to consider are these:

1) The plankonic organisms not adhering to your pins will generally grow much faster than biofilm incorporate pins.  This will tend to exhaust nutrients and oxygen in your wells.  After a brief exposure to allow adherence, we replaced the media to allow the pin-adherent organisms to have a chance to compete.  We 're-fed' plates that way every 12-24 hours to be sure that nonadherent organisms weren't swamping the system.

2) Unlike 'real world' biofilms, especially such as those related to dental enamel, there is no 'formal' adhesion between the biofilm and the pin.  This means, at least for the first couple of days, that you'll need to be very gentle when removing and replacing the pins to avoid accidental sloughing of the biofilm matrix.

3) A method we considered, but never employed, was roughening the surface with a very fine sand paper to produce an irregular surface to allow easy adhesion and persistent growth on the pin.

4) Lastly, remember that in a typical 96-well type chamber with actively metabolizing cells, the partial pressure of oxygen falls sharply as one descends through the depth of the well.  As a result, in your pin system the biofilm will probably be the thickest and most developed right at the fluid meniscus.  Look for your effect there, not deep in the well at the tip of the pin.

Good luck!  John

Hi Mohammed. I use the closed tray technique in the following clinical situations:

1. Single implants. 2. two non splinted implants (eg lower overdenture). 3.Limited mouth opening or implants located at the back of the mouth where long screws will not fit. 4. relatively parallel implants (no more than 2 though) and implants with their long axis parallel to the path of removal of the custom tray.

I use the open tray technique in the following clinical situations:

1. two or more splinted implants.2. implants with 15 degrees of divergence or more. 3.  immediate loading protocol.

Hope i answered your question sufficiently.Best regards.

Yes, please contact me directly,  or through  The POSEIDO Academy (Periodontology, Oral Surgery, Esthetic & Implant Dentistry Open Academy) is an international on-line learning platform dedicated to the diffusion of clinical teaching, user-friendly scientific knowledge and global community information. The POSEIDO Academy is managed directly by the SIREN Professors, an international network of renowned clinicians and researchers members of the POSEIDO SIREN (Scientific International Research & Education Network). As convenors of this Academy, their duty is to diffuse their clinical and scientific knowledge and experience, to organize the themes of discussions, and to promote exchanges and debates through our Community, in the respect of the POSEIDO Academy Charter of Ethics. The Charter mostly implies for all SIREN Professors to remain independent from commercial considerations and advertisement in their teachings and comments, even if they can present freely their works with the implants or materials they are using in their daily practice. http://www.poseido.net/network/poseido-academy.html

Best Regards 

Nelson

I do agree with Martin and African Americans are more prone for this and risk may vary from individual to individual.

I have had extensive experience conducting clinical trials in which we had to teach toothbrushing and/or flossing to the subjects--(this includes manual and powered toothbrushes).  The best way to standardize instruction is through the use of video.  We use a professionally produced video to teach straightforward brushing and flossing (manual or powered).  Usually the straightforward brushing and flossing is for a control group.  For toothbrushes or interdental cleaning aids that are the subject of the clinical trial, we produce a video that incorporates the manufacturer's instructions.  Additionally, we give each subject (control and experimental group) a set of written instructions with photographs that contain the exact information that is in the video.  Teaching subjects in this manner has saved us a great deal of time.  There are a number of videos that are available that teach straighforward brushing (Modified Bass Method) and flossing.  The American Dental Hygienist's Association has them as does the the American Dental Association as well as a number of other professional organizations.  Hope this helps! 

Manoj,

The answer to your question and can be found in the classic 3 part Bowers HENA studies.

 

 J Periodontol. 1989 Dec;60(12):664-74.

Histologic evaluation of new attachment apparatus formation in humans. Part I.

Bowers GM1, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E.

Abstract

Part I of this three-part human study evaluated the formation of a new attachment apparatus (bone, cementum, and periodontal ligament) on pathologically exposed root surfaces in an open and closed environment. The most apical level of calculus on the root served as a histologic reference point to measure regeneration on root surfaces exposed to the oral environment. Attempts were made to initiate the formation of a new attachment apparatus by flap curettage, root planing, coronectomy, and submersion of vital roots beneath the mucosa. Nonsubmerged defects were treated by the same surgical technique and served as controls. Biopsies were obtained at 6 months and regeneration was evaluated histometrically by two investigators who were unaware of the treatment performed. Data from 9 patients with 25 submerged and 22 nonsubmerged defects were submitted for statistical analysis. Results indicate that a new attachment apparatus did not form in any of the 22 nonsubmerged teeth; a new attachment apparatus did form in a submerged environment (0.75 mm); significantly more new attachment apparatus (P less than 0.05), new cementum (P less than 0.01), new connective tissue (P less than 0.05), and new bone (P less than 0.02) formed in submerged defects; new cementum was cellular in nature and formed equally well on old cementum and dentin. Greater percent positive regeneration of the attachment apparatus and all component tissues occurred in submerged defects and no extensive root resorption, ankylosis, or pulp death was observed on submerged or nonsubmerged roots.

 

J Periodontol. 1989 Dec;60(12):675-82.

Histologic evaluation of new attachment apparatus formation in humans. Part II.

Bowers GM1, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E.

Abstract

There is conflicting evidence regarding the value of graft materials in enhancing the formation of new bone, cementum, and periodontal ligament (new attachment apparatus). Part II of this study compared the healing of intrabony defects with and without the placement of decalcified freeze-dried bone allograft (DFDBA) in a submerged environment. The most apical level of calculus on the root served as a histologic reference point to measure regeneration on root surfaces exposed to the oral environment. Biopsies were obtained at 6-months and evaluated histometrically by two investigators unaware of the treatment performed. Data from 9 patients with 30 grafted defects and 13 nongrafted defects were submitted for statistical analysis. Results indicate that in a submerged environment significantly more new attachment apparatus (P less than .05) and new bone (P less than .05) formed in grafted than nongrafted sites. Significantly greater loss of alveolar crest height occurred in nongrafted than grafted defects (P less than .05); regeneration of new attachment apparatus, new bone, and new cementum occurred more frequently in grafted than nongrafted defects. There was a greater chance for the regeneration of a connective tissue attachment in nongrafted intrabony defects than in grafted defects; new cellular cementum formed equally well on old cementum, dentin, or both old cementum and dentin in the same defect. The periodontal ligament was oriented parallel, perpendicular, or both parallel and perpendicular in the same defect; and, no extensive root resorption, ankylosis, or pulp death was observed in grafted or nongrafted defects.

 

J Periodontol. 1989 Dec;60(12):683-93.

Histologic evaluation of new attachment apparatus formation in humans. Part III.

Bowers GM1, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E.

Abstract

There is still controversy as to the role of bone grafting materials in the formation of a new attachment apparatus and component tissues (bone, cementum, and periodontal ligament). The purpose of this study was to compare the healing of intrabony defects with and without the placement of decalcified freeze-dried bone allograft (DFDBA) in a nonsubmerged environment in humans. The most apical level of calculus on the root served as a histologic reference point to delineate root surfaces exposed to the oral environment and to measure new attachment apparatus and new component tissue formation. Free gingival grafts were placed over grafted and nongrafted defects to retard epithelial migration. Biopsies were obtained at 6 months and regeneration was evaluated histometrically. Data from 12 patients with 32 grafted and 25 nongrafted defects were submitted for statistical analysis. Results indicate that in nongrafted defects, a long junctional epithelium formed along the entire length of exposed root surfaces and often extended apical to the calculus reference notch. Free gingival grafts did not enhance regeneration of a new attachment apparatus, new cementum, new connective tissue, or new bone in nongrafted defects. The formation of a new attachment apparatus was observed when intrabony defects were grafted with DFDBA (x1.21 mm); significantly more new attachment apparatus (P less than .005), new cementum (P less than .005), new connective tissue (P less than .05), and new bone (P less than .0001) formed in intrabony defects grafted with DFDBA than in nongrafted defects. There was a greater chance for regeneration of a new attachment apparatus and component tissues in grafted defects than in nongrafted defects. New cellular cementum formed on old cementum and dentin but more often formed over both in the same defect). The periodontal ligament was more frequently oriented perpendicular to the root; there was greater loss in alveolar crest height in nongrafted than grafted defects (P less than .05); and extensive root resorption, ankylosis, and pulp death were not observed in grafted or nongrafted defects.

 

Absolutely.... PRF can be obtained as a membrane which can be used in such cases along with CAF or say LDF or BF etc.. its autologous, reduced donor sit morbidity and also facilitates regeneration by delivering an intricate complex of various growth factors like VEGF, TGF, IGF, FGF etc..

Upon that it has been proved to be effective in such cases in various evidence based studies...

Sasha Jankovic et al... AR Pradeep et al, Del Corso et al.. Anil Kumar et al... and lot more.... Systematic reviews DelFabbro et al... Plackova et al. Saurav et al.... etc prove its definative efficacy in periodontal regeneration.

Optimize the slurry viscosity to coat on the substrate

I think , Pedicle graft is the most suitable for the treatment of Class II gingival recession if the condition is suitable. since pedicle graft has connected to blood vessel and gives predictable result, compared to free gingival graft and others ( It has plasmatic circulation, and it needs more technique sensitive, need graft stabilisation)

Dear Antonius Bronckers, Thank you for your so kind advice in detail ! I'm itching to try the classical TRAP staining method in periodontal tissue. Could you give me a TRAP protocol for parraffin-embedding jaw from mice, since very few articles have descripted this condition in detail? Your suggestions on distinguishing macrophage from osteoclast in periodontal tissue is noticeable and very useful. But I wonder if the TRAP kit will stain any cells other than macrophage and osteoclast, e.g., if any, mast cell or plasma cell? As you said, osteoclast is multicleated (>3 nuleus could be seen as a threshold ) which might be excluded to count macrophage in periodontal tissue? Strictly speaking, there are no specific but more representative markers for macrophage, such as F4/80 and CD68, with which I would try. According to your experience, how many macrophages-like cells could be stained in subepithelial connective tissue?

Yes platelet rich fibrin and platelet rich plasma have been extensively used in periodontal regeneration and excellent results have been achieved.The newer of the two, that is PRF has tremendous potential as it harbours lot of growth factors and are used even by oral surgeons in dental defects.Hence it makes a lot of sense to use them in regeneration procedures n dentistry.

Dear Rodrigo Guabiraba,

Thanks for your answer. I completely agree with you. But what perplexes me is that every day new reports of association of new systemic disease from Alziemers to diabetes mellitus with periodontitis is being published. But, we see these systemic disease in edentulous patients also where periodontitis does not exist. This provoked a thought in my mind that if we are able to develop an animal model where we can establish a direct link between systemic disease and periodontitis, this should add more authenticity to the already existing results. What is your opinion?

Hi Kritika,

In some cases The Old-time methods are very useful. I am not a specialist in this topic, but I used to work with someone who is - try to contact with Dr. Kussovski, V.:

https://www.researchgate.net/profile/Vesselin_Kussovski/ and his collaborators.

Best regards!

P.S. Old but ....

Ozonated olive oil enhance regeneration and resolution of inflammation in osseous defects and periodontal abscesses. Proves to be a good local drug delivery system effective in reduction of pocket depth and gain in clinical attachment

Dr Peter Abrahamsson, Halmstad, Sweden. Peter has a disputation about osmotic tissue expanders. You can fint Peter on Research Gate:)

During the initial tipping phase (approximately 24hrs), significant compression and the associated ischemia and inflammation initiate the recruitment of chemo-kines and cytokines. Then there is a lag phase during which not much movement occurs, allowing for these to arrive at the site where bone resorption will occur (and the subsequent movement of the tooth thru the bone). There is not a continual state of severe compression or ischemia associated with the low forces used in modern orthodontics, in order to limit undesired side effects of root resorption. For additional information, you can access our chapter on "Neural Modulation of Orthodontic Tooth Movement" in the textbook "Principles in Contemporary Orthodontics". Hope this helps.

http://www.intechopen.com/books/principles-in-contemporary-orthodontics/neural-modulation-of-orthodontic-tooth-movement

Hello Amit,

Ciprofloxacin + metronidazole can be used as an alternative in patients allergic to amoxicillin. The Journal of Periodontology 2004 AAP Position Paper - Systemic Antibiotics in Periodontics* is a good review of the topic.

Tom

Although CBCT is not an exact way to measure the root surface areas of severe endo-perio lesion for a tooth, it might be useful for comparing the root surface areas between the experimental groups.