kein Abstract verfügbar

There is a wide range of indications for orthodontic tooth movements aimed at improving the prognosis of malpositioned teeth in the mixed dentition and of teeth affected with periodontal disease. New regenerative periodontal treatment procedures (membrane technique, application of enamel matrix derivates) have provided greater opportunities for gaining new attachment and have improved the preorthodontic conditions for moving teeth into infrabony defects or for vertical movements of teeth with reduced bone support. The benefits and problems of a combined periodontal/orthodontic treatment approach are discussed with respect to preorthodontic mucosal grafting, guided tissue regeneration, loss of interdental gingiva, correction of crowding, reorienting of migrated and flared incisors, and gaining new abutment teeth by distalizing free-end premolars.

Schlagwörter: adult orthodontics, GTR technique, crowding, molar uprighting, pathologic tooth migration, premolar distalization

In patients with advanced bone loss, it is desirable to use a treatment strategy that conserves critical teeth, to avoid complications during prosthetic restoration. Part 1 discussed treatment options for teeth with horizontal bone loss down to the apical third of the root, vertical bone defects with poor defect morphology, furcations with a large defect height and combined periodontal and endodontic inflammation. If a treatment strategy is followed in which critical teeth are extracted in cases of advanced attachment loss, seating a prosthetic restoration on periodontally compromised abutments cannot be avoided. In addition to periodontal treatment of the remaining dentition, this strategy should focus on periodontal risk assessment and the avoidance of biomechanical and technical complications when seating dental restorations. A case presentation of Generalized Aggressive Periodontitis followed for 11 years demonstrates the implementation of periodontal treatment and prosthetic restoration.

Schlagwörter: treatment strategy, periodontitis, bone loss, dental restorations, tooth mobility

A long-term retrospective analysis of clinical and radiographic data was carried out to determine the interest and value of splint therapy for stabilizing clinical conditions after periodontal treatment. The study population was composed of 51 patients enrolled in periodontal maintenance. Patients were selected for splint therapy (splints or combined splint-fixed partial dentures) because of residual tooth mobility in the anterior area following completion of periodontal treatment. The follow-up period comprised between 2 to15 years. During the observation period, 2 out of the 308 abutment teeth were lost and a small number of complications (3 pulpal incidents, 9 debondings) occurred. The mean percentage of bone loss calculated on periapical radiographs was 0.27% in the group 5-10 years after splinting and 0.40% in the group 10-15 years after splinting. The results of this study demonstrate that when modern adhesive techniques are applied, resinbonded splints and fixed partial denture splints can be viable alternatives to conventional complete coverage prostheses in the treatment and maintenance of patients with periodontal diseases.

Schlagwörter: periodontitis, resin-bonded splints, periodontal maintenance

The aim of the present case report is to present the four-year results following open flap surgery and additional application of an enamel matrix protein derivative for the treatment of intrabony defects caused by peri-implantitis. Three patients (one female and two males) diagnosed with late peri-implantitis and presenting deep crater like intrabony defects, were treated with open flap debridement (OFD), implant surface decontamination with EDTA and application of an enamel-matrix-protein derivative (EMD). One year after therapy a substantial reduction of probing depth (PD), clinical attachment level (CAL) gain and radiographic bone fill were observed in all three cases. The obtained results were maintained at a stable level for all 3 patients over a period of 4 years. The results of the present case report study indicate that OFD followed by decontamination of the implant surface with EDTA and subsequent application of EMD may result in positive clinical and radiographic results that can be maintained over a period of 4 years.

Schlagwörter: peri-implantitis, surgical therapy, enamel matrix protein derivative, case reports

Guided tissue regeneration (GTR) with biodegradable polylactide/polyglycolide acid (PLA/PGA) membranes was compared to open curettage and scaling and root planing (SRP) and reevaluated after 6 months and 5 years. Wound healing up to the sixth week postoperatively is considered to be important for the regenerative effect. The purpose of the study was to determine whether GTR is superior to open curettage and SRP. Thirty-six teeth in 20 patients (8 females/12 males) with an average age of 44.6 years (17-64 years) were treated with GTR, applying resorbable PLA/PGA membranes. Either open curettage or SRP was carried out on contralateral teeth. After 2, 4 and 6 weeks, wound healing was assessed. After intraindividual comparison to conventionally treated reference teeth, the difference of the clinical attachment level (!CAL), furcation involvement, and PPD was measured 6 months and 5 years postoperatively. The statistical significance was tested with the Mann-Whitney U-test. Disturbed wound healing was only seen after the GTR procedure (8 membrane exposures after 2 weeks, 1 after 4 weeks, none after 6 weeks). After 6 months, !CAL measured 1.5 mm (3.9 mm/2.4 mm) in comparison to open curettage and 0.9 mm (3.3 mm/2.3 mm) compared to SRP. Five years after GTR, there was a mean attachment gain of 3.8 mm. Our study shows that GTR with resorbable membranes is superior to open curettage and SRP in the treatment of vertical bone defects.

Schlagwörter: resorbable PLA/PGA membranes, furcation involvement, vertical bony defects, guided tissue regeneration, GTR

In patients with multiband appliances, the effectiveness of an herbal extract containing mouthrinse (Parodontax©) was tested for possible reduction of plaque and gingivitis. A total of 40 patients (mean age: 16 ± 2.3 years) with mild to moderate gingivitis participated in this prospective randomized, double-blind clinical study. At baseline (Group 1: Parodontax©, n = 20, mean age: 15.8 ± 2.2 years, Group 2: control, placebo solution, n = 20, mean age: 16.1 ± 2.3 years) caries frequency (DMF-T) and approximal plaque index (API), plaque index (PI), sulcular bleeding index (SBI), papillary bleeding index (PBI) and gingival index (GI) were assessed for the Ramfjord teeth. All subjects were examined at 4-week intervals for a period of 3 months, and all plaque and gingival index scores were reevaluated. At the end of the study, the patients in Group 1 (Parodontax©) showed significantly lower parameters indicative of inflammation than those in the control group. The SBI value in Group 1 was reduced from initially 39% to 8%, the PBI value from 1.07 to 0.17, and the GI value from 1.73 to 0.58. The plaque indices, however, showed no significant differences between the two groups (Group 1: API: 87%, initial value, and 78%, final value; PI: 1.99, initial value, and 1.66, final value; Group 2: API: 91%, initial value, and 83%, final value; PI: 2.66, initial value, and 2.11, final value). This double-blind study showed that usage of an herbal extract containing mouthrinse as an adjunct to mechanical oral hygiene measures seems to be beneficial in gingivitis therapy in patients wearing fixed orthodontic appliances.

Schlagwörter: multiband appliance, compliance, gingivitis, prophylaxis, herbal extract containing mouthwash

A 46-year-old woman presented at the Department of Periodontology, University of Giessen, with mild chronic periodontitis and multiple gingival recessions in the upper jaw. Examination revealed poorly contoured metal ceramic restorations. Resulting soft tissue contours were also less than ideal from an aesthetic perspective. Oral hygiene instructions, scaling, and root planing were performed to reduce periodontal inflammation. Subsequently, periodontal plastic surgery was conducted, applying various root coverage procedures and aesthetic crown lengthening. New metal ceramic restorations and bridges were inserted. Long-term stability was achieved by effective plaque control and periodic recalls.

Schlagwörter: aesthetics, gingival recession, connective tissue graft

The DentalView DV2 Perioscopy SystemTM (DentalView Inc., Lake Forest, CA, USA) was designed to visualize the subgingival environment for diagnosis and to aid the treatment of periodontitis. This instrument consists of a 0.5 mm diameter fiber-optic strand. This strand is inserted into a sheath, which provides a sterile barrier between the patient's tissue and the perioscope. The sheath is connected to a peristaltic pump, which conducts a flow of water around the strand to the strand's end to irrigate the working field. The end of the sheath has a sapphire lens that ocuses on the tooth's surface and sends the image back through the fiber-optic strand to a video sensing chip camera (CCD). The image is then displayed on an active matrix LCD-TFT monitor. Using the perioscope, clinicians are able to visually explore the gingival pocket, finding the precise location of the biofilm, root deposits, granulation tissue, caries and root fractures.

Schlagwörter: perioscopy, dental endoscopy, scaling and root planing