This case report describes progressive root resorption that occurred after treatment of a deep gingival recession using scaling and root planing, tetracycline root conditioning, and connective tissue grafting. At 20 months post-operatively, external root resorption was observed without symptoms. Root resorption is an uncommon complication that can occur despite initially achieving the desired outcome of treating recession and creating healthy periodontal tissues. Tetracycline root conditioning may cause late root resorption, so this risk should be considered when developing treatment plans.
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoec...Shilpa Shiv
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoectomy andRoot-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure
journal club on Combined Surgical Resective and Regenerative Therapy forAdva...Shilpa Shiv
JC on Combined Surgical Resective and Regenerative Therapy forAdvanced Peri-implantitis with Concomitant Soft Tissue Volume Augmentation: A Case Report. IJPRD 2014.
Journal club on Connective tissue graft associated or not with low laser ther...Shilpa Shiv
Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial, Fernandes-Dias SB, de Marco AC, Santamaria Junior M et al.
JCP 2015.
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoec...Shilpa Shiv
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoectomy andRoot-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure
journal club on Combined Surgical Resective and Regenerative Therapy forAdva...Shilpa Shiv
JC on Combined Surgical Resective and Regenerative Therapy forAdvanced Peri-implantitis with Concomitant Soft Tissue Volume Augmentation: A Case Report. IJPRD 2014.
Journal club on Connective tissue graft associated or not with low laser ther...Shilpa Shiv
Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial, Fernandes-Dias SB, de Marco AC, Santamaria Junior M et al.
JCP 2015.
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case P...Shilpa Shiv
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case Presentations of a Novel Approach to Immediate Implant Placement at Multirooted Molar Sites, IJPRD 2013.
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) base...Shilpa Shiv
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile, JCP 2015
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Root Resection – A Dark Horse in Management Offurcation Involved Maxillary Mo...iosrjce
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.
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
JOURNAL CLUB ON CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH ...Shilpa Shiv
CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH A CONNECTIVE TISSUE GRAFT TO TREAT MILLER'S CLASS I GINGIVAL RECESSION, JCP 2014;41(4):387-395.
L-PRF for increasing the width of keratinized mucosa around implants: A split...MD Abdul Haleem
Journal Club Presentation: L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.
jornal club on Tissue Engineering for Lateral Ridge Augmentation withRecombi...Shilpa Shiv
JC on Tissue Engineering for Lateral Ridge Augmentation withRecombinant Human Bone Morphogenetic Protein 2Combination Therapy: A Case Report. IJPRD 2015.
Treatment of Endodontic –Periodontic lesion with combination therapy: PRF and...iosrjce
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.
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case P...Shilpa Shiv
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case Presentations of a Novel Approach to Immediate Implant Placement at Multirooted Molar Sites, IJPRD 2013.
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) base...Shilpa Shiv
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile, JCP 2015
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Root Resection – A Dark Horse in Management Offurcation Involved Maxillary Mo...iosrjce
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.
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
JOURNAL CLUB ON CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH ...Shilpa Shiv
CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH A CONNECTIVE TISSUE GRAFT TO TREAT MILLER'S CLASS I GINGIVAL RECESSION, JCP 2014;41(4):387-395.
L-PRF for increasing the width of keratinized mucosa around implants: A split...MD Abdul Haleem
Journal Club Presentation: L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.
jornal club on Tissue Engineering for Lateral Ridge Augmentation withRecombi...Shilpa Shiv
JC on Tissue Engineering for Lateral Ridge Augmentation withRecombinant Human Bone Morphogenetic Protein 2Combination Therapy: A Case Report. IJPRD 2015.
Treatment of Endodontic –Periodontic lesion with combination therapy: PRF and...iosrjce
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.
A presentation on what is a Medical Journal Club and its value in clinical and academic training with the headings necessary for inclusion in a PowerPoint presentation.
Also contains Hyperlinks to useful CAT sites.
Periodontal disease susceptible group present advanced periodontal breakdown even though they achieve a high standard of oral hygiene. Various destructive enzymes and inflammatory mediators are involved in destruction. These are elevated in case of periodontal destruction. Host modulation aims at bringing these enzymes and mediators to normal level.
This ppt aims in highlighting the various host modulatory agents that can be put to use in periodontal therapy.
Peri implantitis treatment with regenerative approachajayashreep
This study evaluates the clinical results and compare reentry hard tissue measurements following regenerative surgery after strict implant decontamination peri-implantitis cases.
Comparative study of DFDBA and FDBA block grafts.pptxDr. B.V.Parvathy
To evaluate and compare the effectiveness of demineralized freeze dried block graft and freeze dried block graft with chorion membrane as barrier membrane clinically and radiographically for the treatment of residual deep intra bony defects.
All furcation defects need to be classified and their possible prognosis should be defined. The treatment of the furcation defects should be carried out accordingly. Treatment include
Osteoplasty, Odontoplasty, Tunnel preparation, Root resection, Hemisection
The future of dentistry and periodontics lies in regeneration. The goals of periodontal therapy lies in not only the arrest of periodontal disease progression but also regeneration of the lost periodontal structures. This presentation provides a review of the current understanding of the regeneration of the periodontium and the procedures involved to restore the periodontal tissues around the teeth.
Reconstructive periodontal surgery aims to treat deep pockets which have not be reduced after non surgical periodontal therapy. periodontal regenerative procedures mainly include the use of modified flap techniques , use of bone grafts and newer gene therapies. Biologic mediators play key role in the regeneration process. Guided tissue regeneration and Guided Bone regeneration are commonly used methods for periodontal regeneration. Minimally invasive surgical techniques are preferred surgical methods for treating deep infrabony pockets
Entire papilla preservation technique in the regenerative treatment of deep i...MD Abdul Haleem
Journal Club Presentation - Department of Periodontology and oral implantology - Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-Year results
Reconstructive periodontal therapy
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
Interproximal tunneling with a customized connective tissue graft a microsurg...MD Abdul Haleem
Journal Club Presentation - Interproximal Tunneling with a Customized Connective Tissue Graft A Microsurgical Technique for Interdental Papilla Reconstruction.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Colonic and anorectal physiology with surgical implications
journal club on Progressive Root Resorption Associatedwith the Treatment of Deep GingivalRecession.
1.
2. Progressive Root Resorption Associated
with the Treatment of Deep Gingival
Recession. A Clinical Case
Norma Cizza, Dario Migues, IJPRD 2013;30:619–25.
Shilpa Shivanand
III MDS
3. INTRODUCTION
• Gingival recession is a common pathology causing esthetic
problems, sensitivity, root caries in the cementum, and must
be treated with mucogingival surgical procedures to improve
esthetics, reduce recession progress, and avoid
hypersensitivity.
• The subepithelial connective tissue technique is well
documented and extremely predictive for solving esthetic
problems and reestablishing the gingival tissues around a
recession via long junctional epithelium formation or
periodontal tissue regeneration.
Langer B, Langer L 1985, Harris RJ et al.
4. • Restored root surfaces should also be included in the surface
to be covered by the connective tissue graft, since eliminating
the restoration allows adjunct periodontum to rebuild after
the restoration’s removal.
McGuire MK et al 1996.
• Root surface conditioning with chemical agents, citric acid,
and tetracycline is used to improve biologic compatibility of
the root with periodontal cells and enhance connective tissue
grafting, although the results are controversial.
Ben-Yehouda et al 1997.
5. AIM
• The aim of this report is to present a patient with a buccal
recession treated by scaling and root planing, tetracycline root
conditioning, and connective tissue grafting.
• Results were satisfactory, though root resorption appeared as
a late complication 20 months postoperatative.
6. CASE REPORT
• The patient was a 52-year-old woman who was a healthy
nonsmoker and attended the authors’ dental office because
of gingival recession at the maxillary left canine and an
overhanging restoration.
• Preoperative clinical and radio graphic images were taken.
Preoperative
clinical and
radio graphic
images showing
a buccal
recession and an
overcontoured
Class V
restoration.
7. • After periodontal examination, generalized chronic adult
periodontitis was diagnosed.
• Oral hygiene instructions were given to the patient, the
restoration at the canine site was polished, and scaling and
root planing were performed.
• One month after the initial therapy, a clinical reevaluation was
carried out.
8. • Considering the mesial and distal gingival tissue lost and the
recession depth, the recession was classified as Miller Class III,
which predicts partial root coverage.
• The proposed treatment consisted of subepithelial connective
tissue grafting and root conditioning with a tetracycline
solution.
Clinical reevaluation 1
month
after the initial therapy. A
Miller Class III
recession was
determined.
9. • Before surgery, baseline data were registered.
• The buccal aspect of the recession height at the canine was 7
mm, the width of the keratinized tissue was 0.5 mm, and the
probing depth was 2 mm.
Baseline data were
obtained
before the surgical
procedure.
10. • The Class V restoration was removed under local anesthesia
up to the cementoenamel junction by scaling and root
planing.
• This procedure was performed before flap raising, both
smooth and supragingival, to preserve any existing connective
tissue attachment.
• The recession area was treated topically with a 100 mg
tetracycline/mL saline solution for 3 minutes, rinsed, and then
dried.
11. • A trapezoidal partial-thickness double-pedicle flap was raised,
passing through the mucogingival junction.
• Pedicles were joined with 4.0 sutures (Ethicon).
Double-pedicle
graft and
subepithelial
connective tissue
grafting.
12. • A 2.5-mmwide subepithelial connective tissue graft was
harvested from the palate without epithelium removal and
was sutured over the recession defect.
• The flap was sutured without stress over the graft, leaving the
epithelium collar uncovered.
• Gingivoplasty at the mesial and distal papillae related to the
defect was performed to prepare a recipient bed.
Flap repositioning and suturing
was completed without stress over
the connective tissue graft. The
exposed epithelium graft and
sutured mesial and distal papillae
can be seen.
13. Post-op instructions
• Postoperative care consisted of 0.12% chlorhexidine rinses
twice a day for 3 weeks; amoxicillin was also prescribed (1.5 g
a day for 5 days).
• Sutures were removed 10 days later.
• Healing was uneventful.
14. • After 6 months, new parameters showed 2 mm of recession
measured at the level of the cementoenamel junction, 3.5
mm of keratinized tissue, and a probing depth of 2 mm.
After 6 months, new
parameters
showed 5 mm of
recession coverage and
3.5 mm of keratinized
tissue.
15. • Twelve months later, an additional 1.5-mm recession was
observed, most likely a result of aggressive brushing at the
affected site.
• New oral hygiene instructions were given and all other
parameters remained stable.
12 month
follow-up
showed
1.5-mm
increase in
recession
height at
canine as well
as at the other
teeth, most
likely a result
of aggressive
brushing.
16. • Twenty months postsurgery, external root resorption was
noted without any symptoms.
• Tooth extraction and implant placement were proposed to the
patient, but she decided to wait.
Root resorption
seen via
transparent
gingiva at 20
months.
17. • Four months later (2 years postsurgery), resorption evolution
was appreciated both clinically and through radiography.
Clinical photograph
and radiograph
showing the
posttreatment
recession at 22 and
24 months,
respectively.
18. • Before extraction and guided bone regeneration, a flap was
raised to observe the resorption.
Exploratory flap raised prior to
tooth extraction and guided
bone regeneration.
Root resorption is evident at
the buccal, mesial, and distal
aspects of the affected tooth.
19. DISCUSSION
• After a satisfactory result in a Miller Class III patient treated
with a connective tissue graft and tetracycline solution,
external root resorption occured 20 months posttreatment.
• Resorption after regeneration treatment is an uncommon
complication that can occur in spite of having achieved the
desired goal of treating the recession and creating good
health conditions for the periodontal tissues.
• It is difficult to predict, diagnose, and treat.
Heithersay GS
20. • An explanation for this unusual outcome is that the epithelial
cells could have migrated in an apical direction.
• Therefore, the epithelium acts as a protective barrier against
resorption.
Karring T, Nyman S, Lindhe J 1984
• Resorption occurs in an environment where different
periodontal tissues compete for marginal healing.
• Cell mechanisms for identifying dental tissues as foreign
structures are unknown, and they induce resorptive cell
activation.
Carnio J et al 2003
21. • There is enough published information claiming connective
tissue grafts as a reliable and predictable technique to obtain
healthy compatible gingival tissues.
• This is why it is believed that the graft material is not related
to root resorption.
• Several publications have reported that root conditioning is
not beneficial since results do not improve the clinical
outcome.
Caffesse et al 2000, Nagata et al 2005.
22. • Cervical resorption can be produced by epithelial cervical
attachment damage from a chemical agent.
Ne R et al 1999
• There are few reports available on resorption cases related to
regeneration techniques for periodontal defects and gingival
recessions resulting from root conditioning with tetracycline
solution or citric acid.
23. • A periodontal defect treated only with tetracycline showed
resorption after 3 years, as reported by Ben-Yehouda.
• Cury et al recently reported on a clinical case of root
resorption 2 years after periodontal defect treatment with a
bioabsorbable membrane and tetracycline.
• Carnio et al published a report on a patient treated with a
connective tissue graft and citric acid that presented
resorption 2 years later.
24. CONCLUSION
• The buccal recession reported here was treated with a
connective tissue graft and tetracycline solution. The
resorption appeared 20 months after treatment.
• Analysis of the published studies in the literature demonstrate
that resorption is a late complication, generally 1 year
posttreatment, and therefore time is an important factor to
be considered.
• It is suggested that tetracycline root conditioning probably
causes root resorption in long-term evaluations.
• Therefore, this must be considered by the practitioner when
developing the treatment plan.
26. I. External root resorption following partial thickness
connective tissue graft placement: a case report.
Hokett SD et al, JOP 2002.
• We report an unusual case of external root resorption (ERR)
that developed in a 37yearold black male approximately 1
year following routine partial thickness connective tissue graft
surgery.
• The lesion was accessed via flap surgery, thoroughly root
planed, and the mucoperiosteal flap replaced.
• The site healed uneventfully and the patient has been closely
observed for over 1 year without symptoms or recurrence of
the resorptive lesion and the affected tooth remained vital.
27. • Clinicians performing partial thickness connective tissue grafts
should be alert to the possible occurrence of root resorption
over extended periods of time.
• The authors speculate that retention of the donor periosteum
with placement on the recipient dentin and root
biomodification may limit the resorptive response following
connective tissue graft procedures to treat tooth root
recession.
28. II. Potentials for root resorption during periodontal
wound healing.
Karring T, Nyman S, Lindhe J, Sirirat M, JCP 1984.
• The present study was undertaken to examine whether
(1) the process of resorption, which invariably affects
periodontitis involved reimplanted roots facing bone or
gingival connective tissue during healing, is a transient
phenomenon and,
(2) root resorption can be prevented by permitting
downgrowth of epithelium along the root surface.
29. • A total of 24 teeth in 2 monkeys was subjected to
experimental periodontal tissue breakdown by the placement
of elastic ligatures around the teeth.
• The ligatures were left in situ until about 50% of the
supporting tissues had been lost.
• Following removal of the ligatures, the teeth were extracted
and the denuded portions of the roots were scaled and
planed.
30. • The crowns of the teeth were resected and the root canals
filled with guttapercha.
• The roots were subsequently implanted into sockets prepared
in the jaw bone in such a way that each root was embedded
in bone except for a portion which was in contact with gingival
connective tissue.
• 1 month prior to sacrifice of the animals, the cut surface of
the coronal part of the roots was exposed by removal of the
covering soft tissue. The epithelium was thereby allowed to
migrate into the wound.
31. • Implantation of the roots was scheduled to provide healing
periods of 1, 2, 3, 4, 8, 12, 16, 20 and 24 weeks before
exposure of the roots.
• The histologic examination of the implant specimens
disclosed that replacement resorption was a progressive
process which eventually resulted in the elimination of the
transplanted roots.
• It was possible to prevent root resorption in this model by
permitting apical downgrowth of epithelium along the root
surface during the initial phase of healing.
32.
33. Introduced by Waienberg in 1964
Modified by Cohen and Ross,1968
Indications
When interdental papilla adjacent to receded area is sufficient wide
AG on approximating teeth is insufficient to cause lateral displacement
Advantages
Risk of loss of bone is less as interdental bone is more resistant
Papilla usually supply greater width of AG
Reasons for failure
Inadequate suturing
Double papillae Laterally positioned flap
34.
35. Harvesting the graft from the donor
site
• Two parallel incisions,
perpendicular to the long axis of
the teeth, are made in the palate,
close to the CEJ (Langer & Langer
1985).
• Two vertical releasing incisions
help dissect the superficial flap
and free the subepithelial
connective tissue graft .
• Once the graft is harvested, the
success rate of the procedure
does not appear to be influenced
by removing the epithelial collar
from the graft (Bouchard et al.
1994).
SCTG
The trapdoor enabling the
retrieval of the connective tissue
graft.
36. Primary incision. Make a horizontal incision with a
partial-thickness flap 3-5 mm apical to the gingival
margin in the palate (preparation of primary flap).
Secondary incision. Make a secondary incision 1-2 mm
coronal to the primary horizontal incision line. This incision,
which is perpendicular to the surface of the gingiva, should
extend to the bone.
Make a vertical incision mesiodistally approximating the width
and length of the necessary graft.
Prepare a primary partial-thickness flap (1.5-mm thick) toward
the center of the palate, parallel to the palatal gingiva. Expose the
underlying connective tissue.
Subepithelial connective tissue graft
37. Root Biomodification
• The application of bio-chemical agent to the root surface
directs the movement of specific biomodulators, triggering
variety of responses from cellular component of healing site,
which could play essential role in regeneration….. (Terranova
et al 1995)
Root Conditioning –
• Urist, Frank et al, Register & Burdick (1971- 1980)…. root
conditioning is demineralization and detoxification of root
surface.
38. Purpose of Root surface
biomodification – (Lindhe)
• To remove smear layer following mechanical debridement.
• Demineralization of the root surface (citric acid)
• Selective removal of hydroxyapatite and exposure of the
collagenous matrix of the root surface. (EDTA)
• Local delivery of antimicrobial compound. (tetracycline HCL )
39. Purpose of Root surface
biomodification – (Lindhe)
• Inhibition of collagenolytic activity. (tetracycline HCL)
• Enhancing cellular response. (migration and attachment of
cells)
• Preventing epithelial down growth Improving retention of
different biomolecules to exposed collagen.
• Expressing a cementoblast phenotype for colonizing cells.
40. Materials for root conditioning
• Physical methods include root conditioning by lasers.
• Chemical methods include use of various chemicals like bile
salts, citric acid (ph 1 , disadv: acidic ph) , tetracycline 0.5%
solution at a PH of 3.2 100mg/ml, EDTA 24 %
Ethylenediaminetetracetic acid PH 6.7 for 15 seconds (Biora),
detergents, phosphoric acid and glycoproteins like fibronectin.
41. • Citric acid…. enhances new attachment or
reattachment and regeneration by
– Removal of smear layer (Polson et al, 1984)
– Root detoxification (Aloe et al, 1975)
– Exposure of root collagen and opening of dentinal
tubules (Polson et al, 1984)
– Demineralization prior to cementogenesis (Register,
1975)
– Initial clot stabilization (Wikesjo et al, 1991)
Citric acid
42. – Enhanced fibroblast growth and stability (Boyko etal,
1980)
– Attachment by direct linkage (Stahl and Tarnow, 1985)
with or without cementogenesis.
– Prevention of epithelial migration along the denuded
roots (Polson et al 1983)
– Accelerated healing and new cementum formation after
surgical detachment of the gingival tissues and
demineralization of the root surface by means of citric
acid. (Register & Burdick)
Citric acid
43. • Time of application. (1min & 4min) tried Trombelli et al
1995...
• 1 min.... Smooth surface with many tubule openings
partially occluded by debris
• 4 min .... Three dimensional network of intertubular and
peritubular collagen fibrils.
Root conditioning with tetracycline
44. Mode of application
• Burnish with cotton pellets saturated with solution of
tetracycline HCL.
• Quantity of tetracycline HCL. (10mg/ ml, 100, 400,) 100
mg/ml should be preferred.
• Shorter application times should be preferred. (Seymour et al
1995)
• Tetracycline of HCL + Fibronectin. No additional benefit was
observed. (Alger et al 1990).
45. Mode of application
• It can be used as a 0.5% solution at a PH of 3.2 and is
applied for 5 minutes.
• One study showed >100 mg/ml may enhance fibroblast
attachment. (dose dependent)
• In another in vitro study Trombelli et al 1995 showed longer
application should be preferred.
• Results are inconsistent.
46. EDTA
• EDTA etching has been found to provide a surface more
suitable for periodontal healing compared to root planing only
or following root planing and etching with citric acid or
phosphoric acid
• 24 % Ethylenediaminetetracetic acid PH 6.7 for 15 seconds
(Biora)
• Usually provided with Emdogain.
• It removes smear layer and facilitates adherence of Emdogain
47. HEALING PATTERNS OF PERIODONTAL WOUND
The downgrowth of epithelial cells (EC) results in long junctional
epithelium.
The proliferation of connective tissue (CT) may result in
connective tissue adhesion and root resorption.
The predominance of bone cells (BC), may result into root
resorption, ankylosis though this is relatively uncommon in
humans when compared with animal models, or both.
With the ingress of periodontal ligament (PDL) and perivascular
cells from the bone, a regenerated periodontium with new
cementum develop.
There are 4 healing patterns of periodontal wound ( the four
possible cell types that predominate the wound site)
48. SOME IMPORTANT DEFINITIONS
Healing of a wound by tissue that does not fully restore
the architecture or function of the part. (AAP, Glossary of
periodontal terms,).
Repair simply restores the continuity of the diseased
marginal gingiva and reestablishes a normal gingival sulcus
at the same level on the root as the base of the
preexistent periodontal pocket.
This process called healing by scar, arrests bone
destruction without necessarily increasing bone height.
REPAIR
49. Regeneration :
Continuous physiologic process
Is the growth and differentiation of new cells and
intercellular substances to form new tissues or parts.
Regeneration takes place by growth from the same type of
tissue that has been destroyed or from it’s precursor. This
is termed as wear and tear repair.
50. Reattachment :
The term has been used in past to refer to the
restoration of the marginal periodontium.
Reunion of epithelial and connective tissues with
root surfaces and bone from which they have been
removed in the course of treatment, such as occur after
an incision or injury. It should not be confused with new
attachment.
51. New attachment
It is the embedding of new periodontal ligament fibers into
new cementum and the attachment of the gingival epithelium
to a tooth surface previously denuded by disease.
Reattachment; Repair in the areas of the roots
not previously exposed to the pocket