This document discusses several controversies in the relationship between periodontal disease and pulpal health. It notes that while early studies hypothesized periodontal disease could directly cause pulpal necrosis, more recent histological and clinical studies show this rarely occurs. Periodontal diseases and procedures have a negligible effect on pulpal survival, and communication between the periodontium and pulp through dentinal tubules or lateral canals does not typically result in pulp necrosis. The document also indicates that pulpless teeth are rarely a cause of periodontal disease.
This document discusses various controversies in periodontal therapy. It covers debates around the need for surgical procedures versus non-surgical therapy, the effectiveness of different instrumentation techniques like ultrasonic scaling versus manual scaling, the role of root planing and its aggressiveness, the use of lasers versus mechanical debridement, and the role of local and systemic antimicrobials. It also discusses controversies around the role of trauma from occlusion in causing periodontal disease progression and gingival recession. While some studies have found associations, there is no clear consensus on many of these topics with evidence on both sides of the issues.
This document discusses several controversies in periodontics. It addresses debates around the classification of periodontal diseases, factors involved in periodontal pathogenesis like invasiveness of bacteria and the role of the periodontal epithelium. It also examines controversies in diagnosing periodontal diseases and determining an accurate prognosis. Additionally, it looks at debates around treatments like gingival curettage, tooth mobility and splinting, one stage full-mouth disinfection versus quadrant SRP, and whether results are comparable between non-surgical and surgical periodontal therapy. The document acknowledges that while knowledge has improved, some controversies remain due to limitations in present diagnostic methods and incomplete understanding of periodontal pathology.
This presentation explains the various controversies in different topics in periodontics. Discusses the controversies in Classification of periodontal diseases,
Diagnosis of periodontal diseases,
Prognosis,
Tooth mobility & splinting,
Gingival curettage one stage full-mouth disinfection versus quadrant SRP,
Systemic antimicrobials in periodontal therapy, Non-surgical versus surgical periodontal therapy,
Postsurgical antimicrobial medication,
Periodontal pack,
Periodontal-endodontic relationship,
Periodontal and systemic diseases,
Implant therapy in periodontally compromised patients.
Controversies in periodontics / /certified fixed orthodontic courses by India...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Controversies in periodontics / /certified fixed orthodontic courses by India...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
1. The document discusses desquamative lesions of the gingiva, which describes red, painful, glazed gingiva that may be a manifestation of mucocutaneous conditions like lichen planus.
2. It provides a classification and overview of various diseases that can clinically present as desquamative gingivitis, including lichen planus, pemphigoid, and pemphigus vulgaris.
3. Diagnosis of desquamative gingivitis involves clinical examination, biopsy, microscopy, and immunofluorescence to arrive at a final diagnosis, as desquamative gingivitis is not a
1) The study evaluated the role of antibiotics in preventing postoperative complications after routine periodontal surgery. 45 patients receiving either amoxicillin, doxycycline, or no antibiotics were evaluated.
2) No significant differences were found between groups in postoperative pain, swelling, or infection rates. Properly performed periodontal surgery does not typically result in postoperative infections.
3) While antibiotics are often prescribed following regenerative or implant surgeries, this study found no additional benefit to prescribing antibiotics for routine periodontal surgeries to prevent postoperative infections when performed aseptically. Larger studies are still needed to confirm findings.
This document discusses various controversies in periodontal therapy. It covers debates around the need for surgical procedures versus non-surgical therapy, the effectiveness of different instrumentation techniques like ultrasonic scaling versus manual scaling, the role of root planing and its aggressiveness, the use of lasers versus mechanical debridement, and the role of local and systemic antimicrobials. It also discusses controversies around the role of trauma from occlusion in causing periodontal disease progression and gingival recession. While some studies have found associations, there is no clear consensus on many of these topics with evidence on both sides of the issues.
This document discusses several controversies in periodontics. It addresses debates around the classification of periodontal diseases, factors involved in periodontal pathogenesis like invasiveness of bacteria and the role of the periodontal epithelium. It also examines controversies in diagnosing periodontal diseases and determining an accurate prognosis. Additionally, it looks at debates around treatments like gingival curettage, tooth mobility and splinting, one stage full-mouth disinfection versus quadrant SRP, and whether results are comparable between non-surgical and surgical periodontal therapy. The document acknowledges that while knowledge has improved, some controversies remain due to limitations in present diagnostic methods and incomplete understanding of periodontal pathology.
This presentation explains the various controversies in different topics in periodontics. Discusses the controversies in Classification of periodontal diseases,
Diagnosis of periodontal diseases,
Prognosis,
Tooth mobility & splinting,
Gingival curettage one stage full-mouth disinfection versus quadrant SRP,
Systemic antimicrobials in periodontal therapy, Non-surgical versus surgical periodontal therapy,
Postsurgical antimicrobial medication,
Periodontal pack,
Periodontal-endodontic relationship,
Periodontal and systemic diseases,
Implant therapy in periodontally compromised patients.
Controversies in periodontics / /certified fixed orthodontic courses by India...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Controversies in periodontics / /certified fixed orthodontic courses by India...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
1. The document discusses desquamative lesions of the gingiva, which describes red, painful, glazed gingiva that may be a manifestation of mucocutaneous conditions like lichen planus.
2. It provides a classification and overview of various diseases that can clinically present as desquamative gingivitis, including lichen planus, pemphigoid, and pemphigus vulgaris.
3. Diagnosis of desquamative gingivitis involves clinical examination, biopsy, microscopy, and immunofluorescence to arrive at a final diagnosis, as desquamative gingivitis is not a
1) The study evaluated the role of antibiotics in preventing postoperative complications after routine periodontal surgery. 45 patients receiving either amoxicillin, doxycycline, or no antibiotics were evaluated.
2) No significant differences were found between groups in postoperative pain, swelling, or infection rates. Properly performed periodontal surgery does not typically result in postoperative infections.
3) While antibiotics are often prescribed following regenerative or implant surgeries, this study found no additional benefit to prescribing antibiotics for routine periodontal surgeries to prevent postoperative infections when performed aseptically. Larger studies are still needed to confirm findings.
Refractory periodontitis refers to chronic periodontal disease that responds poorly to conventional treatment such as scaling and root planing. About 10-15% of patients have refractory periodontitis. Several studies examined clinical, microbiological, and immunological parameters to better diagnose and treat refractory periodontitis. One study found that levels of certain bacterial species, percentage of sites with deep pockets, and number of bacterial species with high antibody levels could predict refractory cases. Another study found elevated antibody levels to specific bacteria correlated with refractory cases. Molecular studies identified higher expression of certain genes involved in inflammation and bone resorption in refractory patients. Microarray analysis found refractory patients had persistent pathogenic bacteria after treatment. Combin
Desquamative gingivitis is a clinical manifestation characterized by erythema, desquamation and ulceration of the gingiva that can be indicative of an underlying condition. It is not a specific disease but rather a gingival response associated with various disorders. The document discusses the definition, pathogenesis, clinical presentation and diagnosis of desquamative gingivitis. It also describes three disorders that are commonly associated with desquamative gingivitis: lichen planus, bullous pemphigoid, and pemphigus.
1. Controversies exist in many areas of periodontology including disease diagnosis and classification, microbial aspects, pathogenesis, and various treatment modalities such as periodontal, implant, and mucogingival therapies.
2. Dogmas that were previously held as undisputed truths are now being challenged by new evidence, with debates around issues like the definition of biologic width, need for splinting, and thresholds for peri-implant disease diagnosis.
3. Mapping techniques can help explore controversies through non-controversial elements, literature analysis, review of opinions, networks of relationships, and chronologies to better understand disagreements.
This document discusses refractory periodontitis. It begins by defining refractory periodontitis as a destructive periodontal disease where patients continue to experience attachment loss at sites despite conventional therapy. Several studies are summarized that investigated clinical features and microbial profiles of refractory periodontitis patients. In general, the studies found heterogeneity in clinical presentation and microbial profiles of refractory patients. Certain bacteria like Enterococcus faecalis and Streptococcus species were found at higher levels in refractory patients. The document concludes by discussing treatment considerations for refractory periodontitis, such as using antibiotics and intensified maintenance programs.
Periodontitis and Systemic Diseases- A Broken Two-way MirrorR Viswa Chandra
This document summarizes the relationship between periodontitis and systemic diseases like diabetes and cardiovascular disease. It finds that periodontitis is associated with worse diabetes outcomes and increased cardiovascular risk. There is a two-way relationship between the conditions, with periodontitis potentially worsening diabetes and cardiovascular markers, and treatment of periodontitis linked to improved glycemic control and reduced cardiovascular risk factors. However, knowledge about these links among healthcare providers is still lacking. The data on these relationships is also inconsistent and there are no clear guidelines on screening, treatment and management.
This seminar explains various periodontal risk assessment tools at subject, tooth and site level risk assessment. Also, SPT with adjunct use of antimicrobials by professional and to be used by personals. Maintenance care for the implant patients has also been described with different conditions. The role played by dentist and by patient is being explained in flowcharts. And at last complications during SPT is described with references.
This presentation focusses on definition, history, goals and objectives of SPT, patient compliance, ways to improve patient's compliance, parts of SPT, SPT in daily practice, classification of post treatment patients, AAP Guidelines for periodontist and dentist and studies related to SPT.
Critical issues in periodontal research khushbukhushbu mishra
This document summarizes several critical issues in periodontal research. It discusses epidemiology and prevalence studies showing lower rates of severe periodontitis than previously believed. It also examines the microbiology and etiology of periodontal diseases, questioning which bacterial species are involved and how they relate to disease status. Additionally, it outlines areas of pathogenesis, mechanisms of tissue destruction, issues in diagnosis and therapy, and the need for further research into the host immune response and potential immunization therapies.
Scaling and root planing (SRP) is a non-surgical treatment for periodontitis that aims to remove dental plaque and calculus from tooth surfaces. It involves scaling to remove deposits and root planing to smooth root surfaces. The goals are to eliminate periodontitis by removing irritants and restoring a healthy environment for tissue healing. The long-term effectiveness depends on factors like patient compliance, disease severity, and anatomical challenges. Overhanging restorations can interfere with cleaning and disturb the ecological balance, allowing disease-causing bacteria to proliferate.
Non Surgical Periodontal Therapy by Dr Santosh Martandesantoshmds
Review and Essay Material on Non Surgical Periodontal Therapy. Illustrative Contents for proper presentation on all aspects of NSPT. The Presentation helps in drafting A to Z of NSPT. Readers are encouraged to add newer studies and ideas under each aspect of NSPT.
I read an article about non-surgical periodontal therapy, analyzed the information, and summarized it within a powerpoint. I then presented this presentation to my Dental Hygiene Theory I class. I found it useful for the class to be presented with an article explaining NSPT because this is the topic that was discussed on that particular day of class. With the knowledge provided in this presentation, hygienists can get a brief overview of NSPT.
This document discusses prognosis in periodontics. It begins by defining prognosis and distinguishing it from related terms. It describes different types of prognoses, such as short-term versus long-term, and classifications like good, fair, poor, and hopeless. The document outlines factors that determine prognosis, including overall clinical factors, local anatomic factors, systemic/environmental factors, and restorative factors. Specific examples like age, disease severity, plaque control, smoking, and furcation involvement are provided. The relationship between diagnosis and prognosis is also addressed.
Non-surgical periodontal therapy involves procedures like manual debridement, machine-driven debridement, supra/subgingival irrigation, local drug delivery, lasers, systemic drugs and host modulation therapy to reduce probing depth and bleeding and improve clinical attachment levels. Surgical therapy involves flap procedures to access root surfaces and eliminate deep pockets. Systematic reviews found that both non-surgical and surgical periodontal therapy are effective in treating periodontitis, with no significant differences in clinical outcomes between the two approaches. The choice of treatment depends on the initial probing depth, with non-surgical therapy used for shallower pockets and surgery for deeper pockets above a critical threshold.
Critical issues in periodontal research /certified fixed orthodontic courses...Indian dental academy
This document discusses critical issues in periodontal research over time. It covers the evolution of understanding of epidemiology and prevalence, pathogenesis, microbiology, diagnosis, and treatment of periodontal diseases from the 1950s to present. Key topics include changing views of the prevalence of gingivitis and periodontitis, identification of periodontitis-causing bacteria, the role of host response and risk factors, efforts to better classify and diagnose periodontal diseases, and the development of nonsurgical and surgical treatment approaches.
The document discusses various methods for evaluating periodontal regeneration after therapy, including clinical, radiographic, surgical re-entry, and histologic methods. It also covers principles of bone regeneration including osteogenesis, osteoconduction and osteoinduction. Non-bone graft associated procedures and bone grafting techniques and materials used in periodontal regeneration are described in detail.
This document discusses microsurgery, which refers to surgery performed under magnification using microscopes or loupes. Microsurgery principles include improving motor skills, passive wound closure with exact apposition, and use of microinstruments to reduce tissue trauma. Loupes and operating microscopes provide variable magnification from 1.5x to 20x. Microsurgical instruments are 15cm long with very fine tips to allow precise manipulation. Microsurgery offers advantages like cleaner incisions and reduced hemorrhage compared to conventional surgery. It has clinical applications in periodontal, restorative, and implant procedures. The document concludes that microsurgery can improve results of various procedures and many can now be done minimally invasively.
Refractory periodontitis refers to chronic periodontal disease that responds poorly to conventional treatment such as scaling and root planing. About 10-15% of patients have refractory periodontitis. Several studies examined clinical, microbiological, and immunological parameters to better diagnose and treat refractory periodontitis. One study found that levels of certain bacterial species, percentage of sites with deep pockets, and number of bacterial species with high antibody levels could predict refractory cases. Another study found elevated antibody levels to specific bacteria correlated with refractory cases. Molecular studies identified higher expression of certain genes involved in inflammation and bone resorption in refractory patients. Microarray analysis found refractory patients had persistent pathogenic bacteria after treatment. Combin
Desquamative gingivitis is a clinical manifestation characterized by erythema, desquamation and ulceration of the gingiva that can be indicative of an underlying condition. It is not a specific disease but rather a gingival response associated with various disorders. The document discusses the definition, pathogenesis, clinical presentation and diagnosis of desquamative gingivitis. It also describes three disorders that are commonly associated with desquamative gingivitis: lichen planus, bullous pemphigoid, and pemphigus.
1. Controversies exist in many areas of periodontology including disease diagnosis and classification, microbial aspects, pathogenesis, and various treatment modalities such as periodontal, implant, and mucogingival therapies.
2. Dogmas that were previously held as undisputed truths are now being challenged by new evidence, with debates around issues like the definition of biologic width, need for splinting, and thresholds for peri-implant disease diagnosis.
3. Mapping techniques can help explore controversies through non-controversial elements, literature analysis, review of opinions, networks of relationships, and chronologies to better understand disagreements.
This document discusses refractory periodontitis. It begins by defining refractory periodontitis as a destructive periodontal disease where patients continue to experience attachment loss at sites despite conventional therapy. Several studies are summarized that investigated clinical features and microbial profiles of refractory periodontitis patients. In general, the studies found heterogeneity in clinical presentation and microbial profiles of refractory patients. Certain bacteria like Enterococcus faecalis and Streptococcus species were found at higher levels in refractory patients. The document concludes by discussing treatment considerations for refractory periodontitis, such as using antibiotics and intensified maintenance programs.
Periodontitis and Systemic Diseases- A Broken Two-way MirrorR Viswa Chandra
This document summarizes the relationship between periodontitis and systemic diseases like diabetes and cardiovascular disease. It finds that periodontitis is associated with worse diabetes outcomes and increased cardiovascular risk. There is a two-way relationship between the conditions, with periodontitis potentially worsening diabetes and cardiovascular markers, and treatment of periodontitis linked to improved glycemic control and reduced cardiovascular risk factors. However, knowledge about these links among healthcare providers is still lacking. The data on these relationships is also inconsistent and there are no clear guidelines on screening, treatment and management.
This seminar explains various periodontal risk assessment tools at subject, tooth and site level risk assessment. Also, SPT with adjunct use of antimicrobials by professional and to be used by personals. Maintenance care for the implant patients has also been described with different conditions. The role played by dentist and by patient is being explained in flowcharts. And at last complications during SPT is described with references.
This presentation focusses on definition, history, goals and objectives of SPT, patient compliance, ways to improve patient's compliance, parts of SPT, SPT in daily practice, classification of post treatment patients, AAP Guidelines for periodontist and dentist and studies related to SPT.
Critical issues in periodontal research khushbukhushbu mishra
This document summarizes several critical issues in periodontal research. It discusses epidemiology and prevalence studies showing lower rates of severe periodontitis than previously believed. It also examines the microbiology and etiology of periodontal diseases, questioning which bacterial species are involved and how they relate to disease status. Additionally, it outlines areas of pathogenesis, mechanisms of tissue destruction, issues in diagnosis and therapy, and the need for further research into the host immune response and potential immunization therapies.
Scaling and root planing (SRP) is a non-surgical treatment for periodontitis that aims to remove dental plaque and calculus from tooth surfaces. It involves scaling to remove deposits and root planing to smooth root surfaces. The goals are to eliminate periodontitis by removing irritants and restoring a healthy environment for tissue healing. The long-term effectiveness depends on factors like patient compliance, disease severity, and anatomical challenges. Overhanging restorations can interfere with cleaning and disturb the ecological balance, allowing disease-causing bacteria to proliferate.
Non Surgical Periodontal Therapy by Dr Santosh Martandesantoshmds
Review and Essay Material on Non Surgical Periodontal Therapy. Illustrative Contents for proper presentation on all aspects of NSPT. The Presentation helps in drafting A to Z of NSPT. Readers are encouraged to add newer studies and ideas under each aspect of NSPT.
I read an article about non-surgical periodontal therapy, analyzed the information, and summarized it within a powerpoint. I then presented this presentation to my Dental Hygiene Theory I class. I found it useful for the class to be presented with an article explaining NSPT because this is the topic that was discussed on that particular day of class. With the knowledge provided in this presentation, hygienists can get a brief overview of NSPT.
This document discusses prognosis in periodontics. It begins by defining prognosis and distinguishing it from related terms. It describes different types of prognoses, such as short-term versus long-term, and classifications like good, fair, poor, and hopeless. The document outlines factors that determine prognosis, including overall clinical factors, local anatomic factors, systemic/environmental factors, and restorative factors. Specific examples like age, disease severity, plaque control, smoking, and furcation involvement are provided. The relationship between diagnosis and prognosis is also addressed.
Non-surgical periodontal therapy involves procedures like manual debridement, machine-driven debridement, supra/subgingival irrigation, local drug delivery, lasers, systemic drugs and host modulation therapy to reduce probing depth and bleeding and improve clinical attachment levels. Surgical therapy involves flap procedures to access root surfaces and eliminate deep pockets. Systematic reviews found that both non-surgical and surgical periodontal therapy are effective in treating periodontitis, with no significant differences in clinical outcomes between the two approaches. The choice of treatment depends on the initial probing depth, with non-surgical therapy used for shallower pockets and surgery for deeper pockets above a critical threshold.
Critical issues in periodontal research /certified fixed orthodontic courses...Indian dental academy
This document discusses critical issues in periodontal research over time. It covers the evolution of understanding of epidemiology and prevalence, pathogenesis, microbiology, diagnosis, and treatment of periodontal diseases from the 1950s to present. Key topics include changing views of the prevalence of gingivitis and periodontitis, identification of periodontitis-causing bacteria, the role of host response and risk factors, efforts to better classify and diagnose periodontal diseases, and the development of nonsurgical and surgical treatment approaches.
The document discusses various methods for evaluating periodontal regeneration after therapy, including clinical, radiographic, surgical re-entry, and histologic methods. It also covers principles of bone regeneration including osteogenesis, osteoconduction and osteoinduction. Non-bone graft associated procedures and bone grafting techniques and materials used in periodontal regeneration are described in detail.
This document discusses microsurgery, which refers to surgery performed under magnification using microscopes or loupes. Microsurgery principles include improving motor skills, passive wound closure with exact apposition, and use of microinstruments to reduce tissue trauma. Loupes and operating microscopes provide variable magnification from 1.5x to 20x. Microsurgical instruments are 15cm long with very fine tips to allow precise manipulation. Microsurgery offers advantages like cleaner incisions and reduced hemorrhage compared to conventional surgery. It has clinical applications in periodontal, restorative, and implant procedures. The document concludes that microsurgery can improve results of various procedures and many can now be done minimally invasively.
This document discusses reconstructive osseous surgeries and periodontal regeneration. It begins with definitions of key terms like repair, reattachment, new attachment, and regeneration. It then covers the history of periodontal regeneration research, including experiments demonstrating the regenerative potential of different progenitor cell sources. The document outlines the biology of wound healing and variables that influence periodontal regeneration. It also discusses methods of evaluating new attachment and periodontal reconstruction outcomes, including clinical, radiographic, surgical re-entry, and histological methods. Finally, it covers regenerative techniques like removal of junctional epithelium and root bio-modification to facilitate new attachment.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
El documento describe un procedimiento de regeneración endoperiodontal realizado por el Dr. Latorre Valenzuela. Se llevó a cabo una endodoncia previa realizada por la Dra. Silvia Parra antes de aplicar Emdogain, rellenar con Bio-Oss y colocar una membrana Bio-Gide. El procedimiento finalizó con la sutura y una revisión a los 4 meses postoperatorio.
Recent advances in surgical technology include the development of magnification systems like loupes and microscopes. Loupes provide 2-10x magnification but have limitations like eye strain. Compound loupes provide better magnification and image quality than simple loupes. Prism loupes provide the best magnification and depth of field. Surgical microscopes allow relaxed viewing with no eye strain, provide the highest magnification, and allow for documentation. Periodontal microsurgery uses microscopes and microinstruments to improve root planing, wound closure, and outcomes like reduced pain and faster healing.
Tissue engineering aims to regenerate tissues by combining cells, scaffolds, and signaling molecules. There are two main strategies - in vitro construction of tissues in the lab prior to implantation, and in vivo regeneration of tissues at the implantation site. Successful tissue engineering requires the right cells, scaffolding for cell attachment and growth, and signaling to guide tissue development. Stem cells are promising cell sources due to their ability to differentiate into many cell types.
Recent advances in periodontal surgical technology include the use of magnification systems like surgical microscopes and loupes, as well as lasers. Magnification improves accuracy and visibility for procedures like root planing. Microsurgery allows for less invasive surgery with reduced trauma and faster healing. Lasers can be used for soft tissue procedures and osseous contouring due to their hemostatic and bactericidal properties, but overuse risks thermal damage. Precautions are needed when using lasers to protect eyes and tissues.
Lasers and its application in periodonticsShilpa Shiv
The document discusses different types of lasers used in periodontology, including their properties, mechanisms of interaction with tissue, safety classifications, and clinical applications. It provides details on lasers such as the argon, diode, Nd:YAG, Er:YAG, and CO2 lasers, covering their wavelengths, active mediums, delivery systems, absorption characteristics, and periodontal uses. The document also examines laser tissue interactions, safety considerations, and the theoretical zones of tissue change caused by laser exposure.
This document provides an overview of periodontal wound healing and regeneration following periodontal surgery. It defines regeneration as the reproduction of lost or injured periodontal tissues, including cementum, periodontal ligament, and alveolar bone. Successful regeneration is assessed through probing, radiographs, direct measurements, and histology. The document discusses factors that influence regeneration outcomes, such as the surgical technique and local wound environment. Regenerative therapies aim to fully restore the lost periodontal structure and function.
Tissue engineering is an interdisciplinary field that applies engineering and life science principles toward developing biological substitutes to restore or improve tissue and organ function. It involves harvesting a patient's cells and growing them on a biodegradable scaffold to form new living tissue that can replace damaged tissue or organs. This could help solve the shortage of donor organs by providing alternatives to organ transplantation and eliminate the risk of rejection. While challenges remain in replicating complex organs, tissue engineering has the potential to save lives, heal injuries, and improve quality of life by providing permanent solutions for those suffering from organ defects or failures.
Guided tissue regeneration (GTR) is a technique used in periodontal therapy to regenerate lost periodontal tissues by placing a barrier membrane over periodontal defects. The membrane prevents epithelial and gingival connective tissue cells from repopulating the root surface, allowing periodontal ligament cells to repopulate and regenerate cementum, bone, and periodontal ligament. Classic studies in the 1980s proved that only periodontal ligament cells have the potential for regeneration of periodontal structures. Clinical application of GTR involves placing a physical barrier membrane during periodontal flap surgery to isolate the root surface and allow repopulation with periodontal ligament cells. Membranes can be resorbable or non-resorbable
Types of bone and membrane used in guided tissue regeneration UGDS2014
This document discusses types of membranes and bone used in guided tissue regeneration. It describes how guided tissue regeneration uses membranes or barriers to separate gingival tissue from the periodontal ligament and bone, allowing repopulation of the area by periodontal ligament cells. The document outlines different generations of membranes, including non-resorbable, resorbable, and resorbable membranes containing growth factors. It also discusses various types of bone grafts used in guided tissue regeneration, including their mechanisms of bone growth promotion.
This document provides an overview of lasers and their use in dentistry. It begins with the history and fundamentals of lasers, including how they work and their properties. Commonly used dental lasers such as Nd:YAG, CO2, and diode lasers are then described. The applications of lasers in dentistry are discussed, including procedures on hard and soft tissues. Some advantages of lasers are their precision and reduced pain compared to traditional methods. Protection measures for laser use are also outlined. The document concludes that lasers provide alternatives to conventional surgery and are an effective "new scalpel" in dentistry.
Guided tissue regeneration (GTR) involves placing barriers over defects to separate gingival tissues and allow regeneration of periodontal ligament and bone. Animal and human studies show that excluding epithelium and allowing repopulation of defects by periodontal ligament cells leads to new attachment. Both resorbable and non-resorbable membrane barriers have been used for GTR with the goal of preventing epithelial migration and promoting regeneration. GTR has been shown to be predictable for treating intra-bony defects and grade II furcations.
The document discusses diagnosis and treatment of peri-implant disease. It begins by introducing the history of dental implants and defines peri-implant mucositis and peri-implantitis. The main causes are bacterial infection and biomechanical overload. Treatment involves non-surgical and surgical approaches to arrest disease progression and maintain the implant site. The document then examines the histology and microbiology of healthy and diseased peri-implant tissues.
Rigid internal fixation for mandibular of infected mandibular fracturesLucas Alves Neto
This study evaluated the use of rigid internal fixation for treating 11 patients with infected mandibular fractures. All patients achieved bony union of the fracture without requiring removal of the bone plate. The authors conclude that rigid internal fixation is a viable treatment option for infected mandibular fractures as it allows for immobilization of the fracture segments and bone union despite the presence of infection.
Diagnosis & treatment plan for periimplant desease/ dental implant coursesIndian dental academy
This document discusses diagnosis and treatment of peri-implant disease. It begins by describing the history of dental implants and defines peri-implant mucositis and peri-implantitis. Peri-implant tissue breakdown can result from microbial and mechanical factors. Treatment aims to arrest disease progression and maintain implant sites. Bacterial infection and biomechanical overload are major causes of peri-implant bone loss. Implant shape, surface, and soft tissue attachment can also influence peri-implant health.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an overview of endodontic microbiology. It discusses apical periodontitis as an infectious disease primarily caused by bacterial infection of the root canal system. The document outlines the various routes through which root canal infection can develop, such as through exposed dentin tubules or lateral/apical foramina. It also discusses the historical evidence demonstrating the role of bacteria in endodontic disease and pulpal pathology. Spatial distribution of microbiota within the root canal system and the development of endodontic biofilms are addressed.
The document discusses the endodontic-periodontal interrelationship. It begins by introducing how Simring and Goldberg first described this relationship in 1964. It then discusses the classifications of endodontic and periodontal lesions put forth by various studies. The document covers the anatomical considerations between the pulp and periodontium like apical foramina, lateral canals, and dentinal tubules which allow communication between the two tissues. It also discusses the etiological factors involved like bacteria, fungi, and viruses that can lead to endodontic or periodontal diseases.
Endoscopic Endonasal Excision of Odontoid Processiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontal disease results from a complex interplay between subgingival biofilm and the host immune-inflammatory response. While several bacteria are found in periodontal pockets, no single organism causes the disease. The pathogenesis involves the host response to the bacterial challenge, which can remain at a low, asymptomatic level or progress to tissue destruction if left unchecked. Understanding these disease processes is important for developing improved treatment strategies.
This document provides an overview of the pathogenesis of periodontal disease. It begins with definitions of pathogenesis and periodontitis. Key points include: plaque bacteria initiate inflammatory responses leading to tissue damage; the host immune response determines susceptibility; and the transition from gingivitis to periodontitis involves a shift from localized to widespread inflammation and bone/tissue loss. Histopathological changes are described at each disease stage. The roles of bacterial virulence factors and host inflammatory mediators such as cytokines are discussed.
This document presents a case study of a 21-year-old boy who presented with oroantral communication and sinus symptoms. Radiographs revealed an ectopic third molar tooth located in the maxillary sinus, which was the cause of chronic sinusitis. The patient underwent a Caldwell-Luc procedure to remove the tooth from the sinus and close the oroantral communication. Post-operatively, the patient's sinus symptoms resolved and follow-up radiographs showed a normal maxillary sinus. The case demonstrates that an ectopic tooth in the maxillary sinus can cause oroantral communication and sinusitis if left untreated.
- Periapical wound healing is the host's programmed immunoinflammatory defense mechanism in response to infection or injury. It involves complex overlapping stages including inflammation, proliferation, and remodeling.
- The primary difference between healing after surgery and nonsurgical root canal treatment is that surgery requires blood clot formation and may result in faster healing dynamics. After successful nonsurgical root canal treatment, periapical inflammatory tissues will be eliminated mainly by phagocytic debridement.
- Healing involves osseous healing of trabecular and cortical bone as well as dentoalveolar healing resulting in repair or regeneration of the apical attachment apparatus. Various factors like age, tooth position, and root canal filling material can
This document presents a case study of a 21-year-old male patient who presented with oroantral communication and sinus symptoms. Radiological examination revealed an ectopic third molar tooth located in the patient's maxillary sinus, which was the cause of his chronic sinusitis. The tooth was surgically removed via a Caldwell-Luc procedure. This resolved the patient's sinus symptoms and the oroantral communication was also closed. The case demonstrates an unusual cause of oroantral communication and sinusitis due to an ectopically erupted tooth located in the maxillary sinus.
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Temporary Splinting in secondary trauma from occlusion followed by vestibular...dbpublications
Background: A 27 year old female patient presented with the chief complaint of pain and mobility in mandibular anterior teeth. An extremely shallow vestibule with less width of attached gingiva was observed with marginal gingival recession in 31, 32 and 41. Secondary trauma from occlusion was observed clinically with respect to 31. Methods: After adequate oral prophylaxis, the trauma from occlusion on 31 was relieved by selective grinding. The mobile mandibular anterior teeth were splinted with a temporary splint material (26 gauge stainless steel wire). The mandibular labial vestibule was extended using the lip switch procedure or the Edlan-Mejchar technique. Results: The procedure yielded a considerable gain in the width of the attached gingiva, which maintained itself even 9 months after the surgical procedure. Mobility was reduced with complete resolution of injury to the supporting tissues leading to improved function of the mandibular anterior teeth. Conclusion: Patients presenting with secondary trauma from occlusion and a shallow vestibule, treatment options such as oral prophylaxis, selective grinding, splinting combined with Edlan-Mejchar technique leads to complete resolution of mobility along with maintenance of the width of the attached gingival for a considerable period of time.
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Controversies in periodontics 1 /certified fixed orthodontic courses by Indian dental academy
1. CONTROVERSIES IN
PERIODONTICS
INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
www.indiandentalacademy.com
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2. INTRODUCTION
When a thing caeses to be a matter of controversy, it caeses to be a matter
of interest.
In reviewing past and present concepts and treatment modalities that are
available, it becomes evident that there are no completely accepted
principles and techniques.
On this note, I would like to present my topic for seminar:
CONTROVERSIES IN PERIODONTICS.
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3. VIRAL— BACTERIAL INTERACTIONS IN PERIODONTITIS
Recent studies have demonstrated various human viruses, especially cytomegalo
. viruses and Epstein Barr Viruses type 1, seem to play a part in pathogenesis of
human periodontitis.
Parra and Slotes reported that HCMV was present in 60 % of patients and EBV- IN
30%. Slots examined frequency of HCMV, EBV-2 and herpes simplex Viruses in
subgingival samples.
They reported 89% of samples yielded atleast one of three test viruses from deep
periodontal pockets and 56% yielded from shallow periodontal pockets
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4. Dual virus infection seems to be particularly pathogenic and they may
accentuate bacterial virulence factor.
HCMV resides in monocytes, macrophages, and T cells and EBV in B
cells, which has the potential to impair major defense mechanism of the
periodontium.
Tiny et al. reported that high rate of active HCMV infection in early
localized aggressive periodontitis.
They suggested that puberty is an important for HCMV and EBV primary
infection or reinfection.
Puberty related perturbation of immune system
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5. CMV has been shown to lead decreased Polymorphonuclear Leukocyte
chemotaxis, phagocytosis, oxidative burst and intracellular killing capacity and it
may increase the human susceptibility to bacterial infection.
HCMV infection of monocytes macrophage can induce prostaglandin E
2 production that may result in increased bone resorption and suppressed T
lymphocyte function.
Mac Donald et al. emphasize the possible detrimental role of HCMV and EBV-1 in
periodontal repair.
Bacterial infection and other condition that promote diapedesis of
inflammatory cells in a tissue would increase possibility of initiating an HMCV
infection of the tissue.
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6. Contreras et al. in 1999 conducted a study to examine relation ship between
subgingival herpes virus and periodontal disease and periodontopathogenic
bacteria
The study confirmed positive relationship between subgingival EBV-1, HCMV and
mixed herpes viral infections and clinical severity of periodontitis.
Viral infection promote subgingival pathogenic bacterial infection than vice versa.
Neutrophil dysfunction may serve to potentiate over growth and virulence of P
gingivalis and other microbes.
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7. WIDTH OF THE KERATINIZED GINGIVA
Attached gingiva is firm, resilient and tightly bound to underlying
periosteum of alveolar bone.
Distance between mucogingival junction and projection on external surface
of the bottom of the gingival sulcus
Keratinized gingiva includes marginal gingiva also.
No standard width of keratinized gingiva has been established.
It may be necessary to increase zone of healthy tissue if it is subjected to
trauma of the prosthetic treatment.
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8. For many years the presence of adequate zone of gingiva was considered
critical for maintenance of marginal tissue health and for prevention of
continues loss of connective tissue attachment.
Narrow zone of gingiva --
1) was in sufficient to protect periodontium from injury caused by frictional forces
encountered during mastication and to dissipate the pull on the gingival
margin created by muscles of adjacent alveolar mucosa.
2) it will favor sub gingival plaque formation
3) it will also favor attachment loss and soft tissue recession
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9. Goldman and Cohen outlined a tissue barrier concept
Dense collagenous band of connective tissue retards or obstructs the spread of
.
inflammation better than does the loose fiber arrangement of the alveolar
mucosa.
Limits recession as result of inflammation
This view is indirectly supported by findings of Kennedy et al.after recall
evaluations of u patients from their 6 years longitudinal study of free
autogenous gingival grafts
ADEQUATE WIDTH OF GINGIVA
Some authors suggested that less than 1 mm.
Apicocoronal height ought to exceed 3 mm
Third category of authors stated that adequate zone of gingiva is any dimension of
gingiva which ---
1) is compatible with gingival health or 2) prevents retraction of gingival
margin during movements of the alveolar mucosa.
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10. Lang and Loe conducted a study to evaluate the significance of the gingival zone.
The results showed that despite of the fact that tooth surfaces were free from
plaque, all sites with less than 2 mm exhibited persisting clinical signs of
inflammation..
In contrast teeth possessing least attached tissue s (cuspid and bicuspids) are least
involved periodontally as compared to molars.
Incidence of disease is greater on palatal and lingual surfaces of molars where
amount of keratinized tissue is greatest
Wenstrom and Lindhe have shown that a free gingival unit supported by a loosely
attached alveolar mucosa is not more susceptible to inflammation than a free gingival
unit that is supported by a wide zone of attached gingiva.
.
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11. • Miyasato et al. (1997) ceased oral hygiene for a period of 25 days and
found no difference in development of clinical signs of gingival
inflammation between areas with minimal and those with appreciable
width of gingiva.
• Dorfman et al. examined 96 patients with bilateral side facial tooth
surfaces exhibiting minimal keratinzed tissues, which has been treated
with free gingival graft on one side and un treated control on other side.
• Width of keratinized gingiva on grafted site was increased to 4mm
following the treatment.
• The attachment level at grafted sites and control remained unchanged
through out the years.
• Thus narrow zone of gingiva has the same resistance to continues
attachment loss as wider zone of gingiva.
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12. TRAUMA FROM OCCLUSION
.
What is occlusal trauma?
The international workshop for classification of periodontal disease and conditions in
1999.
Occlusal Trauma - It is injury resulting in tissue changes within attachment
apparatus as a result of occlusal forces.
Primary Occlusal Trauma – Injury resulting in tissue changes from excessive occlusal
forces applied to a tooth or teeth with normal support.
Secondary trauma from occlusion – Injury resulting in tissue changes from normal or
excessive occlusal forces applied to a tooth or teeth with reduced support.
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13. Role of occlusion in pathogenesis of periodontal disease
Occlusal trauma is associated with periodontal disease over 100 years.
In 1901 Karolyi ,in 1917 and 1926 Stillman indicated that excessive occlusal
force was the primary cause of periodontal disease.
These early reports created a background for controversy that continues to this day.
Is there association between excessive occlusal forces and progression of
periodontal disease?
At what point does an occlusal force become excessive.
When should treatment initiated and how should this treatment initiated and how
should this treatment accomplished?
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14. Several early authors felt that occlusal forces were the initiating factor in
periodontal disease and led to ongoing progression of periodontal lesion.
In an attempt to demonstrate this relationship several animal studies on
sheep and monkeys were conducted
Later some investigators state that traumatic occlusion causes changes
in attachment apparatus without involving gingival unit.
They postulated that change in attachment apparatus is mainly due to reduced
blood supply to periodontal ligament
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15. Orban and Weinmann in 1933 using human autopsy material evaluated .
They concluded that there was no relation ship between excessive occlusal force
and periodontal destruction.
Instead they suggested that gingival inflammation extending in to supporting bone
was the cause of periodontal destruction
During the same time Glickman and co workers published studies.
These studies demonstrated a phenomenon described as an altered pathway of
destruction when an excessive occlusal force was present.
Change in orientation of gingival and periodontal fibers
Co destruction.
Vertical osseous defects
Based on this observation, use of occlusal adjustment was advocated as part of the
treatment of existing periodontal disease,
Occlusal adjustment to prevent periodontitis was not advocated
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16. Waertaug evaluated large number of human autopsy specimens to determine
relationship of morphology of osseous defect and excessive occlusal forces.
No relation between excessive occlusal force and vertical bone loss.
Polson and Lindhe conducted studies to evaluate effect of plaque and excessive
occlusal forces in animal models.
These studies agreed removal of plaque and control of inflammation would stop
.
progression of periodontal disease whether or not excessive occlusal forces are
present.
Meitner reported when squirrel monkeys was subjected to repeated mechanical
injury in combination with marginal periodontitis, the connective tissue loss was
not greater than that of specimen in which periodontitis alone was induced.
Thus these appeared to be no co destructive effect on connective tissue
attachment.
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17. PROBLEM IN RELATING FINDING FROM ANIMAL
RESEARCH TO THE HUMAN DENTITION
An ideal model on which to study occlusion is not yet to be found.
If a high crown on tooth of a dog or monkey, the tooth will intrude and
recognize a new position while human tooth gets progressively
mobile.
Parafunctional habit is a major factor in human occlusal trauma,
monkeys and dogs not known to have such persistent habits
Periodontal disease naturally occurs in humans.
In the animals models the lesion of periodontal is induced artificially.
With treatment these artificially treated lesion repair more predictably
than naturally occurring lesions
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•
18. PERIODONTAL – ENDODONTIC CONTROVERSY
• Two questions have been raised and continue to be matters of dispute.
• 1) Is periodontal disease a cause of pulpal necrosis?
• 2) Can a pulpless tooth be cause of periodontal disease?
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19.
The effect of periodontal disease and
procedures on the dental pulp
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20. Periodontal diseases
• Recent publications have suggested that periodontal disease is a direct
cause of Pulpal atrophy and necrosis.
• The pathways for communication and therefore for the extension of
disease from a periodontal pocket to pulp are through patent dentinal
tubules, lateral canals, and apical foramina.
• Many histological and clinical studies suggest, however, that such
relationships rarely, if ever, result in pulp necrosis.
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21. • Kirkham examined 100 periodontally involved teeth and found only 2% had
lateral canals located in a periodontal pocket.
• Tagger & Smukler removed roots from molar teeth so extensively involved
with periodontal disease that root amputation was required, and found that
none of the resected roots showed inflammatory changes.
• Haskell et al also removed roots from maxillary molars with periodontal
involvement and found no inflammatory cells or very few inflammatory cells
present in the pulps of the periodontally involved resected roots.
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22. • Czarnecki & Schilder performed a histological study of intact, caries free
teeth and compared the pulp of teeth, which had periodontal disease.
The pulp of the periodontally involved teeth were all histologically similar to
caries free teeth .
Teeth with extensive decay or extensive restortations showed evidence of
pulpal pathosis.
• Ross & Thompson evaluated the progress of 100 patients with maxillary molar
furcation involvement over a period of 5—24 years.
Of the 387 maxillary molars, 79% had at least 50% or less bone support
around one root prior to periodontal treatment.
Only 4% required root canal treatment subsequent to periodontal therapy. None
were ascribed to the effects of advanced periodontal disease in pulp.
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23. Jaoui et al. studied patients with advanced periodontal disease for 5—14
years after completion of active periodontal treatment .
Of the 571 teeth that did not have root canal treatment at time of completion
of periodontal treatment, only one tooth required root canal treatment over
the 5 to 14 year recall period.
Pulpal insult through patent dentinal tubules or the occasional exposed lateral
canal have relatively insignificant effect on the ability of the dental pulp
tissue to survive.
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24. Periodontal procedures
• The clinical research studies by Ross Thompson, Bergenholtz , Nyman
and Jaoui et al evaluated patients who presented with advanced
periodontal disease, received periodontal treatment.
• They received follow up maintenance for periods ranging from 4 to 24
years. There were 1,623 teeth in the combined studies
• Four percent required root canal treatment subsequent to periodontal
treatment, and follow up periodontal care.
• Cause of pulp necrosis was mainly due to pulpal exposure.
• Extension of periodontal disease to involve the root apices is also cited
as a reason for root canal treatment
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25. • In summary dental pulp is capable of surviving significant insults and
that the effect of periodontal disease as well as periodontal treatment is
on the dental pulp is negligible.
• The weight of evidence in literature shows that clinical significance of
the relationship between periodontal disease and dental pulp has been
exaggerated in historical and much of the current periodontal –
endodontic literature
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26. Effect of endodontically involved teeth on periodontal
health and healing
. Only in recent years the potential effect of a tooth with a necrotic pulp or
a tooth that had root canal treatment was considered as a risk factor in
the initiation of periodontal disease.
• Pulpless tooth with a periapical lesion promotes the initiation of
periodontal pocket formation and interfere with healing of periodontal
lesion after periodontal treatment.
Jansson et al. state that teeth teeth with periapical lesion had lost more
proximal bone .
0.19 mm year vs 0.06mm year for teeth with no periapical lesion or
where there is evidence of reduction in lesion size.
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27. • Sanders et el. reported in 1983 that after the use of freeze – dried bone
allografts 65% of teeth that did not have root canal treatment showed
complete or greater than 50% bone fill in periodontal osseous defects.
• While only 33% of teeth which had root canal treatment prior to
periodontal surgical procedure had complete or greater 50% bone fill.
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28. ROLE OF LYMPHOCYTES IN PERIODONTITIS
• Inflammatory cells, predominantly lymphoid cells and macrophages
thought to be engaged in controlling bacterial challenge.
• Participation of these cells in a major way in process of tissue
destruction had not yet been conceived.
• In 1970 antibodies to cell surface markers became available which
allowed sub categorization of T lymphocytes in to two major subsetsCD4
and CD8.
• CD4 molecules serves as a co receptor for major histocompatibility class
.
two molecules on antigen presenting cells.
• CD8 molecule is a co receptor for MHC class one molecules of the target
cells.
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29. Phenotypic Analysis
• Phenotypic analysis shows that there are no numerical abnormalities of
T helper cells or major cells.
• There may be altered ratios of CD4 to CD8 in periodontal lesions of
aggressive periodontitis patients
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30. Functional studies
• T and B-lymphocytes are present in lesions of early onset periodontitis
patients.
• Two accepted activities of the lymphocytes are.
1) They may provide protection against host from infectious agents.
2) they contribute to host tissue damage.
B cells and their linear descendents secrete immunoglobulins (IgG) that
may inactivate bacterial toxins, prevent bacterial adherence and
promote bacterial phagocytosis by polymorphonuclear leukocytes.
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31. Juvenile periodontitis patients frequently have elevated levels of serum
IgG antibodies against AA antigens.
• But still there has been controversy that whether these antibodies were
protective or not.
• IgG2 antibodies are the predominant sub class presented.
• IgG2 antibodies are not been thought to be effective direct opsonins, or
activators of direct classical pathway.
• IgG2 antibodies can kill AA only when neutrophil has the proper allotypic
form of fc receptor.
• Abnormal lymphocyte function in early onset periodontitis as manifested
by lower than normal levels of non stimulated DNA synthesis in cultured
peripheral blood mononuclear cells.
• This reaction has been called autologous mixed lymphocyte function
(AMLR )
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32. • In some of the studies of periodontal disease patient AMLR returned to
normal after periodontal treatment.
• It is not known how diminished AMLR relates to early onset
periodontitis.It has been suggested that reduced AMLR relate to
improper regulation of B cell responses.
• In 1974 Langer et al. reported that peripheral blood lymphocyte from
juvenile periodontitis patients exhibited reduced blastogenic response
to dental plaque and gram –ve bacteria.
• Several other studies following this early reports found that lymphocytes
from periodontitis patients exhibited more exacerbated than normal
blastogenic response to mitogens and bacterial antigens.
• This phenomenon remains with no strong scientific evidence although it
may be related to reduce AMLR via reduced population of suppressor
inducer T cells.
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33. ROOT - CONDITIONING
• Exposed root surface as result of periodontitis has undergone
substantial alteration and may no longer serve as an appropriate
substrate for cell attachment.
• Loss of collagen fiber insertion, contamination of root surface by
bacteria and alteration in mineral density.
• Root surface also lack chemotactic stimuli for migration of cell capable
of producing periodontal regeneration.
• Apical migration of junctional epithelium along root surface over
connective tissue following surgical therapy also appear to inhibit
regeneration
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34. • Scaling and root planning is effective in removing bacterial deposits as well
as removing endotoxins from exposed root surface.
• How ever it results in formation of smear layer is thought to serve as a
physical barrier between periodontal tissues and root surface and may
inhibit formation of new connective tissue attachment to root surface.
• Root conditioning of these periodontally involved root surface will eliminate
cytotoxic materials, will dematerializes the planed root surface,will also
expose and enlarge opening of dentinal tubules and will dematerializes the
inter tubular dentin.
• Exposed collagen matrix of dentin is chemotactic for PMN, macrophage
and fibroblasts.
• It can also support the attachment and migration of fibroblast.
• Root surface demineralization will also enhance healing
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35. HISTOLOGICAL AND CLINICAL SUTDIES
• College of dentistry --Columbus asses the efficacy of root surface
biomodification through tetracycline citric acid or EDTA in patients with
chronic periodontitis.
• They included all the studies evaluating histological and clinical effects
of citric acid, tetracycline and EDTA.
• They excluded studies evaluating effects of extra cellular matrix protein,
enamel matrix protein or growth factors applied to root surface.
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36. Main results
• Thirty-four studies incorporating total patient population of 575 were
analyzed, 26 for citric acid, 5 for tetracycline and 3 EDTA treatment.
• Four of eight human histological studies represents regeneration with
use of citric acid and only 1 of 18 clinical studies reported attachment
gain.
• Of 5 studies using tetracycline, 1 histological study and 1 clinical study
reported attachment gain.
• No regeneration was reported in the 3 studies evaluating use of EDTA.
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37. Reviewer’s conclusion
• Evidence to data suggests that use of citric acid, tetracycline and EDTA
to modify root surface provides no benefit of clinical significance to
regeneration in patients with chronic periodontitis
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38. Root conditioning delays wound healing?
• Selvig et al. examined wound healing in experimental fenestration
defects following conditioning of defects walls with either saline or citric
acid.
• Following elevation of mucoperiosteal flaps, fenestral defects where
covered with polytetrafluroethylene membrane.
• Post surgically after 14 days healing appears to be delayed in citric
acid treated site as compared to the control.
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39. RESTORATION OR IMPLANT PLACEMENT: A
growing treatment planning quandary
Regardless of the implant system, the placement and functional success of
endosseous implants is greater than 90%.
Is a tooth with questionable prognosis restored or intervened with dental
implant?
Should a tooth with large post and core restoration and failing endodontic
procedure is re treated conventionally or should it be extracted?
Is it better to replace such a tooth with an implant?
If the implants fail to integrate or if restoration is an esthetic failure, would it
have been better to retain the tooth?
Answering such questions is a challenge for clinicians. Clinical and economic
factors should be considered in making such decisions.
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40. Clinical factors
The heavily restored tooth
• These teeth may have been restored multiple times, have minimal
external coronal dentin for an adequate restorative ferrule.
• The post space can be so large that internal dentinal walls of the
preparations are too thin.
• If greater force is to be exerted on a tooth, increase in the resistance
form should be made.
• Crown lengthening can increase resistance but at the expense of
removing bone of adjacent teeth.
• Orthodontic extrusion can also be considered but extrusion adds both
additional financial cost and increased time to treatment.
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41. Immediate implant placement along with single stage surgical placement
limits number of procedures.
Before the acceptance of sinus augmentation procedures, the choice might
have been to retain teeth with root resective and endodontic re
treatment procedures.
Previously it was thought that implants in posterior maxillae or mandible
was less ideal.
.
Decision for implant placement may change if patient is a heavy smoker or
if they are an uncontrolled diabetic, factors which could compromise
implants
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42. The Furcation involvement
• Reducing attachment levels for crown lengthening or for root resective
procedures may have a negative long-term impact.
• Periodontally involved molars are the most common teeth lost.
• Furcation and concavities associated with them make them difficult to
treat.
• Resecting roots can improve debridement acess but literature differs as
to success of root amputations or hemi–sections.
• Reasons for failures were current decay, endodontic failure,root
fractures and less commonly, recurrent periodontal dis
• Resection may require osseous removal to the adjacent teeth, as crown
lengthening does.
• If osteoplasty ostectomy is not performed then plaque – retentive
areas are created
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43. Hemi–section
• Hemi–section, the length of root trunk affects how much bone is
removed to create positive osseous architecture.
• To create a positive osseous architecture a large amount of bone must
be removed on remaining root and adjacent tooth..
• If the patient’s anatomy requires sinus augmentation, then clinician may
reconsider treating tooth with root resection.
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44. Difficult anterior esthetic cases
• The use of dental implants to replace anterior teeth is one of the last
areas to gain acceptance by dental profession.
• The greatest benefit is avoidance of unnecessary preparations of non-
restored teeth adjacent to an implant.
• Professional acceptance of implants in esthetic zone has increased
because they are
• Better pre-surgical planning guidelines.
• More option in diameter of implants fixtures.
• Great variety of abutments.
• Better techniques for preparing edentulous ridge.
• Better prosthetic techniques to produce a high esthetic final restoration.
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45. ECONOMIC FACTORS
• Clinician as well as patients many times elects best economic option
than best treatment option.
• Some still argue that the long-term success rates of implants are not
high enough and that questionable teeth should be maintained until
they become hopeless.
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46. Hand versus Ultrasonic Instrumentation
• Partial removal of cementum became established as a therapeutic
procedure over one century ago.
• Mergenhen and Hampp were the first to demonstrate that plaque –
related gram-negative bacteria produce the complex lipo-polysachride
endotoxins described by Boe in 1941
• Aleo and De Renzius scientifically proved the significance of root
cementum bound endotoxin removal in periodontally diseased teeth.
• In 1974 they showed that cementum of these involved teeth contains
endotoxins and also found that this lipo-polysachride is toxic to cells in
vitro.
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47. Comparison
• Many investigators have compared hand and ultrasonic
instrumentation.
• Nishimine and O’ Leary showed that root planning was more effective
than ultra sonic scaling in removing endotoxins from periodontally
involved root surfaces.
• Two investigations evaluated the smoothness of root surfaces at an
ulrtastructural level following hand and ultrasonic instrumentation.
• One study reported a much smoother root following ultrasonic scaling.
The second study reported opposite results.
• Luiggi and Gian conducted a study to compare efficacy of ultrasonic
and hand instrumentation.
• They found no significant differences between fibroblast growth on
periodontally involved root surfaces treated with hand instruments and
with ultrawww.indiandentalacademy.com
sonic scalers.
48. • Several studies reported on an increased efficiency of subgingival
instrumentation with both sonic and ultra sonic scalers, since manual
instrumentation takes longer to achieve the same clinical results
(Dargoo 1992,Copulos et al. 1993).
• Power driven instruments have been shown to be superior in treatment
of class 2 and class 3 furcations (Leon & Vogel 1987).
• Development of heat at scaler tip when water-cooling is not sufficient.
This increased temperature may cause injury to pulpal and periodontal
tissues.
• Another draw back is formation of pathogenic bacterial aerosols and the
reduced tactile sensation in comparison to hand instruments.
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50. NONSURGICAL
PERIODONTAL THERAPY
• Conventional nonsurgical periodontal therapy consists of mechanical supra and
subgingival tooth debridement
• Reducing the bacterial load and altering the microbial composition towards a
flora more associated with health,which in turn result in lower levels of
inflammation and relative stability in periodontal attachment levels.
• In the past, endotoxin or lipopolysacchairde derived from cells of gram-negative
bacteria was though to be so firmly attached to the root surface.
• More recent studies on extracted teeth indicate that endotoxins are superficially
bound and can be removed by such means as brushing.
• Thus systematic root planing to remove cementum does not seem warranted.
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51. • Furcation opening is often less than 1 mm, too small to be effectively
reached with relatively larger curettes.
• Most of the new ultrasonic tips are approximately 0.50mm in diameter,
which may favor ultrasonics as the instruments of choice for furcation
sites.
• One study on instrumentation of furcations with and without surgical
access indicates that no major differences were observed between use
of curettes or ultrasocics in the closed treatment groups and in wide
furcations.
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52. PERIODONTAL SURGERY
• The following have been proposed as the aims of periodontal surgery:
• Accessibility to previously in accessible root surfaces.
• Production of healthy dento-gingival junction that would enable the
patient to practice a high level of plaque removal.
• Reduction of probing depths to allow - a) effectively delivered
maintenance and home care and b) the monitoring and or diagnosis of
recurrent inflammation and progressive periodontal disease.
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53. COMPARISON OF SURGICAL AND NONSURGICAL
TREATMENT MODALITIES
• An early study employing a split-mouth design was that of knowles et al.
. Three modalities were tested sub-gingival curettage, modified Widman
flap surgery and pocket elimination surgery
• After evaluation for eight years all techniques resulted in favorable
changes in the means of the clinical parameters measured
• The surgical techniques resulted in slightly more pocket reduction in
deep pockets.
• The modified Widman flap resulted in the greatest clinical attachment
gain.
• In studies comparing the effects of root planing and modified Widman
flap surgery over 6 years of observation,.
• The modified Widman flap resulted in more pocket reduction in initially
deep pockets, although mean attachment levels were similar.
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54. In summary, following points may be deduced
from available literature.
• Both non-surgical and surgical therapies have been shown to result
in similar mean improvements of clinical scores.
• Data for the possible adjunctive effect of surgical procedures on
patients/sites unresponsive to initial therapy are scarce.
• Data for the possible adjunctive effect of surgical procedures on
patients believed to be at high risk to ongoing attachment loss are
scarce.
• Other than studies on regenerative techniques data for the
comparable effects of different surgical modalities on furcation areas
are also scarce.
• Data for long-term outcome measures, such as tooth loss and quality
of life issues, are scarce.
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55. PERIODONTITIS –
SYSTEMIC DISEASE
ASSOCIATIONS IN THE
PRESENCE OF SMOKING
– CAUSAL OR
COINCIDENTAL?
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56. • No Current issue in periodontal research is more visible or controversial
than the relationship between periodontitis and systemic diseases.
• Four lines of evidence suggests that the observed periodontitis-systemic
disease associations are in part a result of confounding by smoking
• First, no periodontitis-systemic disease associations have been identified
among neversmokers.
• Second, periodontitis and smoking mimic one another with respect to the
types of diseases with which they are associated (e.g. lung cancer and
Parkinson’s disease).
• Third, only studies with inadequate adjustment for smoking report
significant periodontitis-systemic disease associations.
• Lastly, elimination of dental infection, unlike smoking cessation, does not
reduce coronary heart disease risk.
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57. Smoking, the epidemoiologists’ perspective
• Individuals with periodontitis are more likely to be current or past
cigarette smokers.
• When individuals with and without periodontitis are compared it is to be
expected that individuals with periodonititis will have more smoking-
related diseases, such as coronary heart disease, lung cancer, low-birth
weight babies etc.,..
• Statistical adjustment of control for confounding is possible.
• Such statistical adjustment can be used to eliminate some but not all of
the bias caused by the smokers.
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58. • The imperfect smoking questionnaires,the inability to ask questions or otherwise
obtain information on important characteristics of smoking, all make it virtually
impossible to have perfect statistical adjustment for smoking.
• Wherever past or current smokers are included in the analyses, biased
periodontitis – systematic disease associations will be reported.
• Therefore, primary analyses should be limited to healthy never-smokers both
because smoking is such a strong risk factor and because the magnitude of
smoking cannot be well measured.
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59. Effect of smoking on Periodontitis cannot be
distinguished from the effect of smoking on
systemic diseases
• Periodontitis-systemic disease associations have not been identified
among never-smokers.
• Periodontitis and smoking are associated with similar health risks.
• Conflicting study results can be explained in terms of statistical
adjustment for tobacco smoking.
• Dental infection elimination through complete tooth removal, unlike
smoking cessation, does not reduce health risks.
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60. Periodontitis and chronic obstructive
pulmonary disease (COPD)
• Among past and current smokers, periodontitis significantly increased
the risk for COPD.
• When the analysis included past, current, and never smokers with
adjustment for reported smoking dose and duration, the HR for COPD
decreased by 7%.
• Finally, when the analysis was limited to never-smokers, periodontitis
was associated with a small and insignificant increased risk for COPD.
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61. Periodontitis and lung cancer
• Among past and current smokers, periodontitis significantly increased
the risk for lung cancer
• When the analysis included never, past, or current smokers, with
adjustment for smoking the HR for lung cancer associated with
periodontitis decreased by 49%.
• When the analysis was limited to never-smokers, the opposite
association was present.
• Periodontitis was associated with a decreased risk for lung cancer, not
an increased risk.
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62. Periodontitis and stroke
• Among past and current smokers, periodontitis marginally increased the
risk for stroke.
• When the analysis included never, past or current smokers with
adjustment for smoking, the HR for stroke associated with periodontitis
decreased by 8%.
• Finally, when the analysis was limited to never-smokers, periodontitis
increased the HR for stroke by 11%.
• These findings differ from previously reported results.
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63. Periodontitis and coronary heart disease (CHD)
• Among past and current smokers, periodontitis significantly increased the risk
for CHD by 26%.
• Among past, current and never-smokers the HR for CHD associated with
periodontitis was 1.13.
• Finally, when the analysis was limited to never-smokers, the HR for CHD
associated with periodontitis became insignificant).
• Imperfect adjustment for smoking history is inducing associations between
periodontitis and smoking related diseases.
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64. • There is also hope that periodontal treatments can reverse an
increased CHD risk..
• Findings from the same cohort study indicated that complete
elimination of all dental infections by extraction does not decrease
CHD risk..
• Then why would an incomplete, imperfect and reversible decreasing of
the bacterial load by means of periodontal treatments decrease CHD
risk?
• Some have offered the explanation that the risk, once established, is
not reversible and therefore primary periodontitis prevention trials rather
than secondary prevention should be initiated.
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65. Conflicting study results can be explained in
terms of statistical adjustment for tobacco
smoking
• Study was categorized as having good adjustment for smoking when
the number of cigarettes smoked per day was taken into account in the
analyses.
• When a study did not take into account the number of cigarettes
smoked per day the study was categorized as poorly adjusted.
• There have been a total of nine cohort studies published on the
periodontitis-CHD associations.
• Periodontitis was not significantly associated with CHD among those
studies that provided a good adjustment for smoking dose.
• In contrast, periodontitis was significantly associated with CHD in the
four studies that either did not adjust for smoking or adjusted crudely.
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66. Dental infection elimination through complete
tooth removal does not reduce health risks
• There is certainly hope that secondary prevention of CHD events can
occur through periodontal treatment.
• Current epidemiological evidence does not support the hope that
periodontitis plays a role in secondary heart disease prevention.
• A cohort study in the US population suggests that periodontitis does not
increase the risk for secondary heart disease events.
• Individuals with periodontitis and pre-existing heart disease were found
to be at the same risk for developing a secondary heart disease event
as the individuals with pre-existing heart disease but without
periodontitis.
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67. • There is also hope that periodontal treatments can reverse an
increased CHD risk..
• Findings from the same cohort study indicated that a definitive,
irreversible, and complete elimination of all dental infections by
extraction does not decrease CHD risk.
• Then how incomplete, imperfect and reversible decreasing of the
bacterial load by means of periodontal treatments decrease CHD risk?
• Some have offered the explanation that the risk, once established, is
not reversible and therefore primary periodontitis prevention trials rather
than secondary prevention should be initiated.
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