no abstract available

The aim of the paper is to present a critical overview, with emphasis on the evidence from human histology, on the different types of bone grafts and bone substitutes used in regenerative periodontal therapy of intraosseous defects. The available evidence indicates that surgical periodontal therapy employing the use of autogenous bone, demineralized freeze dried bone allograft, bovine bone derived xenografts, may result in periodontal regeneration. At present there is no evidence from human histological studies demonstrating predictable periodontal regeneration following the use of alloplastic (synthetic) materials.

Keywords: periodontal regeneration, human histology, controlled clinical studies, bone grafts, bone substitutes, review

This multi-center study evaluated periodontium visibility during natural and forced smile based on a new classification. The study population consisted of 576 patients (364 women and 212 men) aged from 21 to 78 years. All the participants' teeth from first right premolar to first left premolar were present and the periodontium was healthy. Clinical photographs of the participants smiles were taken and the smile line analyzed according to the following 4 classifications: 1) more than 2 mm of marginal gingiva visible or more than 2 mm apical to the cemento-enamel junction visible for the reduced but healthy periodontium; 2) between 0 and 2 mm of marginal gingiva visible or between 0 and 2 mm apical to the cemento-enamel junction visible for the reduced but healthy periodontium; 3) only gingival embrasures visible; and 4) gingival embrasures and cemento-enamel junction not visible. Patients were also classified by age group and gender. With natural smile analysis revealed the following: Class 1, 4.69%; Class 2, 8.16%; Class 3, 44.79%; and Class 4, 42.36%. With forced smile analysis revealed the following: Class 1, 22.22%; Class 2, 21.35%; Class 3, 45.49%; and Class 4, 10.94%. The eriodontium was more visible in the forced smile than in the natural smile. Age and gender influenced the position of the smile line for only the natural smile. Concern was expressed about esthetics by participants in 89.06% of the cases. Examination of periodontium visibility must be performed both for natural and forced smile.

Keywords: smile, smile line, aesthetic, periodontium

Restoring the loss of periodontal soft and hard tissues represents a unique challenge for the dental team. The interdental papillae in the esthetic zone can be a dilemma for both the patient and the therapist. A multidisciplinary approach is critical for the successful treatment of lost papillae. This article reports on the successful long-term papillae reconstruction using a combined approach: Plastic surgery and restorative dentistry in one case and restorative dentistry alone in another case.

Keywords: papilla reconstruction, reduced periodontium, esthetic outcome, bone morphology, gingival morphology

In animal models it has been shown experimentally that psychological stress may negatively affect the outcome of periodontitis. Several studies in various populations have confirmed an association between negative life events, the level of depression and anxiety, as well as personality traits and periodontitis. The aim of the present study was to explore these relationships in a Norwegian adult population. Patients aged 40+ yr were selected on the basis of their periodontitis experience as assessed radiographically, and the participants were grouped in 2 groups: group 1 consisted of periodontally healthy subjects (no detectable bone loss); and group 2 consisted of subjects with >3mm radiographic bone loss in >3 sites. Four different questionnaires were employed to assess the participants' level of anxiety, depression and neuroticism, as well as their Health Locus of Control. Negative life events and smoking habits were also recorded. The results revealed a statistically significant bivariate relationship between periodontitis and negative life events or the degree of anxiety among the selected psychosocial variables. However, these associations did not appear to be significant when smoking was introduced in a linear multiple regression model. One explanation offered is that good access to dental care and a high utilization of oral health services in Norway may have compensated for the possible underlying causal effects of psychosocial stressors on periodontal health. Thus, comparisons of such studies between different populations may not always be feasible.

Keywords: psychological stress, periodontitis, epidemiology

Clinical observations and existing literature suggest that severe periodontal disease near the maxillary sinuses may contribute to sinusitis and subsequently to chronic productive cough. The aim of the present study was to test this hypothesis. Sixty-five individuals with severe periodontitis affecting upper molars and premolars were selected. Clinical and radiographic examinations included gingival bleeding, clinical probing depth, and alveolar bone loss. In addition, two consecutive questionnaires about smoking habits, productive cough and postnasal drip before and after periodontal treatment were used. The test population was compared to a periodontally healthy control group that was stratified and matched for age, gender and smoking habits. The prevalence of productive cough and postnasal drip was 22% in the test group compared to 6% in the control group (p<0.05). Among the patients who were positive for productive cough 29% also suffered from recurrent sinusitis as diagnosed by an otolaryngologist. After periodontal treatment 43% of the cases reported reduced airway symptoms, although smoking habits were unchanged. The findings support a previous study suggesting that periodontitis affecting teeth near the maxillary sinuses may increase the risk for productive cough. The high prevalence of postnasal drip and diagnosed sinusitis suggests chronic secretory sinusitis as a possible link in the dentobronchial syndrome.

Keywords: periodontal disease, respiratory diseases, chronic productive cough, maxillary sinus, clinical study

Gingival recessions induce root denudation with the risk of non-carious and carious cervical lesions. Periodontal plastic surgery may be used as an alternative to restorative dentistry in order to cover the lesion. Among all the surgical techniques, coronally advanced flap procedures produce statically significant improvements in root coverage with good esthetic results and hypersensitivity reduction. However, the nature of the attachment gain is still controversial. The use of an enamel matrix derivative (Emdogain®) in the treatment of intrabony defects is supposed to promote periodontal regeneration and to favor the early healing of periodontal soft tissue wounds. In the case of gingival recessions with cervical lesions which have been previously treated in restorative dentistry, a coronally advanced flap procedure combined with the application of an enamel matrix derivative can be used in order to promote a re-mineralization of the lesion and to enhance the rate of connective tissue attachment. This case report demonstrates good clinical results after 1 year of healing.

Keywords: enamel matrix derivative, gingival recession, cervical lesion, bonded restoration

The present case series study illustrates two different mucogingival techniques for treating gingival recessions associated with deep dental abrasions. The therapeutic strategies depend on the depth of the abrasion measured at the mid most coronal point at the CEJ level (CEJ step). When the CEJ step was <1 mm, a connective tissue graft associated with an extremely positioned coronal flap was performed. In case of a CEJ step >=1 mm, a double connective tissue graft with an extremely positioned coronal flap was used. The dental abrasions and/or CEJ were not mechanically treated in either situation. One year later, the results showed a recession reduction of 97.5%, with complete root coverage obtained in 82% of sites, and dental hypersensitivity reduction obtained in 5 out of the initial 7 sites. There were no new cases of dental hypersensitivity at the end of follow-up period as a consequence of the treatment. This case series report shows that optimal clinical results in terms of complete root coverage of gingival recessions associated with deep cervical abrasions can be achieved by performing an appropriate surgical procedure without removing dental tissue.

Keywords: gingival recession, connective tissue graft, abrasion

The aim of this study was to determine the prevalence of four selected periodontal pathogens in a large population of patients with various periodontal conditions. The study was based on the databank of a commercial laboratory that provides diagnostic testing services. The study population consisted of 10,946 patients, aged 11-85 years (mean age: 46.2 years). Subgingival plaque samples were collected and analyzed for the presence of A. actinomycetemcomitans, P. gingivalis, T. forsythensis (B. forsythus), and T. denticola using oligonucleotide probes. A total of 33,259 samples were included in the final analysis. Within this population, 97% of patients were found to harbor at least one of the four pathogens. T. forsythensis, T. denticola, and P. gingivalis were detected in 82-93% of the patients, whereas A. actinomycetemcomitans was found in only 33% of the patients. A. actinomycetemcomitans showed a skewed distribution with a higher prevalence of infected sites in patients <= 25 years (24-32% of sites). By contrast, the proportion of positive sites for the other pathogens increased with age to reach a maximum in adult populations (>= 74% of sites). The prevalence of T. forsythensis, T. denticola and P. gingivalis increased significantly with increasing probing depth. These results confirm that A. actinomycetemcomitans, P. gingivalis, T. forsythensis, and T. denticola are frequently found in populations of patients with various periodontal conditions, and that the prevalence of A. actinomycetemcomitans is higher in younger patients.

Keywords: periodontal pathogens, gingivitis, periodontitis, age

no abstract available

Keywords: probing, probing attachment level, diagnostic tests, accuracy, reproducibility, bleeding upon probing, influencing factors, pocket depth

Non-surgical therapy, including supra- and subgingival scaling and root planing is one of the most important means of treating periodontitis. The objective of subgingival instrumentation in periodontally diseased sites is to remove the adhering microbial biofilm and calcified deposits and to create a clinically smooth root surface in order to promote a healing response in the gingival tissues. However, total removal of calculus is a difficult task. Following debridement of the periodontally involved root surface, the thoroughness of calculus removal is traditionally evaluated using a periodontal probe. The main failure in periodontal treatment may depend on calculus remaining after therapy. Recently, a novel measurement device has been introduced. The DetectarTM-system is designed for objective subgingival calculus diagnosis. By evaluating the root surfaces with LED light and detecting differences between calculus and the root surface, the endpoint of root surface instrumentation might be assessed more precisely.

Keywords: DetectarTM, subgingival calculus detection, LED light