no abstract available

Change has occurred in dentistry and periodontics where improved methods to accurately assess risk for periodontal disease and quantify periodontal disease status would benefit all stakeholders of oral health care. This paper focuses on a new technology that provides these measurements. The Periodontal Assessment Tool (PAT) is an integral component of the Oral Health Information Suite™ (OHIS). Using only data gathered during a traditional periodontal examination, PAT accurately assesses the risk and quantifies severity and extent for periodontal disease, reporting them as a risk score and disease score, respectively. The risk score is expressed on a scale of 1 (lowest risk) to 5 (highest risk) and the disease score on a scale of 1 (healthy) to 100 (generalised severe periodontitis). The risk score has been shown to be valid and accurate where the study population was observed for 15 years. The extent of agreement between calculated disease scores and actual severity measured as mean alveolar bone height using digitised radiographs was strong (r = 0.735). Furthermore, there was strong agreement between the disease score and the diagnostic opinions of periodontists, general dentists and dental hygienists. Both risk and disease scores are objective, precise, and sensitive to minor changes, either improvement or deterioration. These novel scores provide a powerful new tool for monitoring periodontal status, quantifying therapeutic outcomes, and for communication with patients, third party payers and other health professionals.

Keywords: disease severity and extent, periodontal disease, risk assessment, therapeutic outcomes

A clinically validated, computer-based tool for the calculation of periodontal disease risk has become commercially available. In addition to risk analysis, the tool provides the general dentist, periodontist or orthodontist with an individualised description of disease severity and extent, rendered textually and as a numeric score in easy to understand clinical and patient reports. The tool utilises less data than collected during a standard periodontal examination, is easy and inexpensive to use, and the reports generated by the system are well received by patients. Evidence-based therapeutic recommendations are offered to the clinician for consideration in treatment planning, determined by current or changing risk and severity scoring. The widespread use of the tool has broad implications for stakeholders in oral health care. This commentary examines the reported effects of the use of the system, and conjectures on possible future effects resulting from system usage.

Keywords: PreViser, risk calculator

Anatomical links exist between the dental pulp and the periodontium and these include dentinal tubules, accessory canals and the apical foramina. The presence of these structures has led to the assumption that both periodontal disease and periodontal treatment can have a very negative effect on the dental pulp. Examination of the literature produces convincing evidence that the vital pulp is likely to be in danger only if periodontal disease is severe and extends to involve the apical tissues. Epidemiological research demonstrates that very few patients experience such severe disease and thus the effects of periodontal disease and its treatment on the dental pulp have been greatly exaggerated.

Keywords: dental pulp, endodontic disease, periodontal disease

This review presents the various techniques, the indications and contraindications for surgical lengthening of the clinical crown. Based on the concept of biologic width of the dento-gingival complex, the aim of surgical modifications in this region is to create a distance of approximately 3 mm between the foreseeable marginal area of a reconstruction and the crest of the alveolar bone. Studies on wound healing suggest that stability of the soft tissues following such surgical procedures is obtained after a healing period of 6 months. In order to obtain optimal aesthetic treatment outcomes of restorations, the duration of the healing period should be respected.

Keywords: crown lengthening, surgery

Halitosis is so common among any adult population group, that some believe this distressing breath condition to be within a range of normal breath odours. However, as halitosis often interferes with social relationships it has rapidly brought awareness among the general population. Assuming that the cause of halitosis is in the oral cavity, many rightly seek therapy from dentists. It therefore becomes necessary for dentists to have an understanding of the oral as well as the systemic factors that cause halitosis. This article aims to address some misconceptions, and reviews the current information on the aetiology, diagnosis and management of various types of halitosis, with an emphasis on halitosis originating in the oral cavity.

Keywords: halimeter, gas chromatography, organoleptic, substrates, volatile sulphur, compounds

Hemisection surgery involves the premeditated amputation of one or more roots and its overlying coronal structure to facilitate partial tooth retention. This can be carried out in cases where a multirooted tooth may have its furcation area, or one or more of its roots severely affected by periodontal disease, caries or a periodontal-endodontic lesion. With appropriate case selection and pre-operative planning it is possible to attain good aesthetics, a friendly environment for the periodontium and a good long-term prognosis. This report outlines a technique whereby a hemisected tooth may be restored without compromising its positional relationship to its abutments and by minimising occlusal loading.

Keywords: hemisection, laboratory stages, restoration

Gingival overgrowth induced by cyclosporin is frequently treated surgically. A case report of gingival overgrowth induced by cyclosporin associated with severe chronic periodontitis is described. This clinical case report describes an impressively positive treatment response following non-surgical periodontal therapy. A 47-year-old male, with a generalised gingival overgrowth associated with tooth migration, large overjet and tooth mobility was treated. The medical history revealed a renal transplant, hypertensive state, and a family history of periodontitis. The patient was under a regimen of 200 mg cyclosporin and 100 mg captopril daily. The diagnosis was severe chronic periodontitis. Probing pocket depths of >= 8 mm were found in all teeth present. Treatment consisted in non-surgical therapy and reduction of the cyclosporin dosage. After 6 months of non-surgical treatment, clinical parameters demonstrated a great improvement with 90% of sites with 1-3 mm and 6% with 4-5 mm of probing depth, and absence of bleeding on probing. Tooth realignment and overjet reduction occurred spontaneously and the patient was totally satisfied with the treatment. Surgical corrections were not considered necessary. Supportive periodontal care was given every 3 months. A cause-related approach working closely with the nephrologist could be adequate for treatment of cyclosporin-associated gingival overgrowth and periodontitis and should precede surgical treatment. The reduction in cyclosporin dosage may account for at least part of the obtained clinical results.

Keywords: cyclosporin, dental plaque, gingival overgrowth, non-surgical periodontal therapy, periodontitis

Several reasons contribute to the loss of interdental papillae and establishment of 'black triangles' between teeth. Several non-surgical and surgical techniques have been proposed to treat soft tissue deformities and manage the interproximal space. Non-surgical approaches (orthodontic, prosthetic and restorative procedures) modify the interproximal space, thereby inducing modifications to the soft tissues. The surgical techniques aim to re-contour, preserve and reconstruct the soft tissue between the teeth. This case report demonstrates complete reconstruction of the papilla following a semilunar coronally repositioned papilla technique with 6 months follow-up.

Keywords: black triangle, connective tissue graft, papilla reconstruction