no abstract available

When obtaining good clinical results using connective tissue submerged grafts, the vast majority of authors place great emphasis on the surgical techniques carried out. However, few studies have shown the complications that may arise during such interventions. Although complications may not be frequent and are not life-threatening, these complications do exist. These complications generate anxiety for practitioners. Those that are regarded with most apprehension are peri- and post-operative haemorrhage, and this occurs due to the physiological vascularisation density of the palatal mucosa.
Through a study of the human anatomy, the authors verified the correlations that could exist between the morphology of the hard palate and the distribution of the greater palatine pedicle and, furthermore, if they were determining factors in choosing therapeutic options.
This study comprises two sections relating to applied anatomy: osteology (part 1) and dissection (part 2). Part 1 involved 30 maxillas presenting various forms and edentitions. Observations were carried out to compare the relationship between the line of the greater palatine pedicle, the morphology of the palate, and the effects of osseous remodelling associated with extractions and the installation of removable prosthesis. Part 2 was carried out on 12 fresh human cadaver maxillas. After injection of the arterial system with coloured latex, the specimens were dissected to observe the distribution of the greater palatine pedicle of the palate.
Anatomical surgery was carried out on two palates with different morphologies and different tissue harvesting techniques were performed. This allowed the authors to first specify the vascular distribution pattern of the palate, and to evaluate the relation between the sample zones and the branches of the greater palatine pedicle, to finally establish rules to help prevent haemorrhage from occurring.

Keywords: connective tissue graft, haemorrhagic risk, human hard palate, palatine artery

In the past few decades, there has been an increase in public awareness about overall beauty and a pleasant smile. As a consequence, a harmonious gingival profile has gained extreme importance in the overall success of the implant restoration. This article presents a technique and case of an immediate implantation and provisionalisation to maintain pre-implant soft tissue profiles. More importantly, the surgical treatment plan for aesthetic cases, including indications and contraindications, is also outlined.

Keywords: aesthetics, implants, papillae, provisional

Aim: The aim of the present study was to investigate the association between clinical periodontal indices and stages of HIV disease as expressed by CD4 cell counts.
Materials and methods: A total of 60 individuals, both males and females, above the age of 18 years who were previously confirmed as HIV-positive were recruited and a detailed medical history was taken. To evaluate periodontal disease, a full-mouth examination was undertaken and, plaque index (PI), gingival index (GI), probing pocket depth and clinical attachment level were recorded. These HIV-positive individuals were classified into three different groups consisting of 20 individuals/group, according to their CD4 count: group A, individuals with CD4 count >=500 cells/µl (mild immunosuppression); group B, individuals with CD4 count from 200 to 499 cells/µl (moderate immunosuppression); and group C, individuals with CD4 count <200 cells/µl (severe immunosuppression). Associations between the above indices and CD4 counts were examined.
Results: The mean plaque index of group B individuals were higher than the mean plaque index of group C which was statistically significant. The mean gingival index of group A, group B and group C did not show any statistically significant difference. The mean probing pocket depth and mean clinical attachment level in group A and group B individuals were higher when compared with group C individuals, which was statistically significant. However, no statistically significant difference was detected between group A and group B.
Conclusion: The individuals with severe immunosuppression (CD4 cell count <200 cells/µl) showed less periodontal disease progression than expected.

Keywords: cell count, gingivitis/epidemiology, HIV infections, periodontal diseases/complications, periodontal diseases/epidemiology, periodontal index

Background and aim: Aggressive periodontitis is a critical disease with a poor prognosis for long-term tooth preservation. Extractions of several 'hopeless teeth' are often necessary with subsequent extensive prosthetic reconstruction. The authors aimed to determine whether or not the preservation of 'hopeless teeth' can stabilise periodontal conditions over time.
Case report: A 32-year-old female was first examined in the authors' department in 1993 with the diagnosis of generalised severe aggressive periodontitis. Her external treatment plan included several tooth extractions, bone augmentations, implants, and an extensive prosthetic reconstruction. In accordance with the patient's choice, all hopeless teeth were preserved. Non-surgical treatment was performed on all teeth, surgical treatment was performed on teeth without regenerative potential and with pockets over 6 mm, and surgical regenerative treatment with non-bioresorbable expanded polytetrafluoroethylene (ePTFE) membranes was performed on sites with regenerative potential. After surgical therapy, supportive treatment was carried out four times a year to date. Due to the teeth preservation treatments, no prosthetic treatment was necessary, but a gingiva mask was used for the wide exposed roots of the maxillary anterior teeth.
Results and conclusions: This case shows that periodontal stabilisation and long-term preservation of even hopeless teeth is possible. The radiographic re-evaluation in 2007 showed bone gain at sites treated with ePTFE membranes and small bone gain or stabilisation of the bone level in all other treated sites. The treatment increased the bone level of the hopeless teeth and these teeth have been preserved for 14 years.

Keywords: aggressive periodontitis, hopeless tooth, tooth preservation

Chronic periodontitis is a bacteria-induced inflammatory process that results in signs of inflammation, including bleeding-on-probing and deepening probing depths. Treatment usually consists of oral hygiene instruction, root planing and possibly surgery. The present two case reports illustrate the use of the antibiotic azithromycin in the treatment of chronic periodontitis that persisted after scaling and root planing. In these cases, after re-evaluation at the completion of scaling and root planing, the patients elected not to have surgery, and instead decided to receive a course of azithromycin. The data demonstrated improvements in the signs of periodontal inflammation, and these improvements remained during several cycles of maintenance.

Keywords: antibiotics, non-surgical periodontal therapy, periodontitis

Xeroderma pigmentosum (XP) is a very rare skin disorder where a person is highly sensitive to sunlight (photosensitive), has premature skin aging and is prone to developing skin cancers. Only Type B (XP, Cockayne syndrome) is associated with dental findings, which are namely dental caries, delayed eruption of teeth and malocclusion. To date, no case of XP with periodontal findings has been reported. Here we present a rare case of XP with oral and periodontal findings. The authors further hypothesised that periodontal destruction in XP patients is due to immune defects present in such patients.

Keywords: bone loss, immunologic abnormalities, periodontitis, xeroderma pigmentosum

Background: Open flap debridement (OFD) with flap repositioning may result in significant gingival recession. In the present case series, patients with periodontal pockets were treated with subepithelial connective tissue grafts (SCTG) in combination with OFD for the prevention of postoperative gingival recession.
Study design: Ten patients (60 teeth) with periodontal pockets in the anterior dentition underwent OFD combined with SCTG. Probing pocket depth (PPD), relative attachment level (RAL), and relative gingival margin level (RGML) were recorded at baseline and at 6 months post-operatively.
Results: Mean PPD at baseline was 4.2mm, and 1.8mm at 6 months (P<0.05), RAL at baseline was 12.2mm and 10.7mm at 6 months (P<0.05), while RGML at baseline was 8mm and 8.9mm at 6 months post-operatively.
Conclusion: Results indicated that use of SCTG underneath the flap when combined with OFD was an effective method to minimize post-operative gingival recession.

Keywords: subepithelial connective tissue graft, post-operative gingival recession

Background: Class II furcation defects indicate a specific common clinical problem and the need for effective therapy. Connective tissue grafts have been used as a barrier in a limited number of previous reports for protecting and stabilising wounds of furcation sites during the healing period, so as to support bone regeneration when closing mandibular Class II furcation defects. The present case report series was carried out to compare the effectiveness of connective tissue grafts (CTGs) as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans.
Study design: Twenty chronic periodontitis patients with a single Class II furcation defect on a buccal or lingual surface of mandibular teeth were included in the study. Vertical probing pocket depth (V-PPD), vertical relative attachment level (V-RAL) and relative gingival margin level (RGML) were recorded at baseline and 6 months post-surgery.
Results: After 6 months, the mean V-PPD reductions observed in the test group (2.43±0.46mm) and control group (2.21±0.61mm) were statistically significant. However, the difference was not statistically significant between the test group and the control group. In both the test and the control group, the mean RAL gains at 6 months were statistically significant, compared with the baseline data. At 6 months, the mean V-RAL gains in the test group (2.08±0.67) were greater than the control group (1.73±1.15), but the difference was not statistically significant (P=0.06). Complete closure of furcation was achieved at one site in the test group compared with no sites in the control group.
Conclusion: It can be concluded that 6 months after surgery, both connective tissue graft as a barrier, and resorbable collagen membrane resulted in improvement in terms of V-RAL gains and reduction in V-PPD and horizontal probing depth.

Keywords: Class II furcation, collagen membrane, subepithelial connective tissue graft

Ultrasound is used in both the diagnosis and treatment of various diseases of the human body. Ultrasonography uses sound waves that reflect as echoes to produce images of structures within the body. It also has several applications in dentistry and in periodontics it is used to treat and maintain periodontal health. Through the cavitational effect and acoustic micro-streaming produced by oscillatory movements of ultrasonic inserts, mechanical debridement can be completed in a short time. The recent introduction of micro-ultrasonics and linear oscillating devices has improved mechanical debridement resulting in minimally invasive instrumentation. Ultrasonography plays a significant role in osteotomies and sinus lift procedures by its piezoelectric ultrasonic vibrations. Periodontal ultrasonography provides a non-invasive diagnostic method for measuring pocket depth and the assessment of periodontal health. In addition, low intensity pulsed ultrasound appears to be effective in periodontal healing and demonstrates the potential for periodontal regeneration.

Keywords: osteoinduction, piezosurgery, sonochemicals, ultrasonics

One explanation for the conflicting results about the effects of supragingival plaque control on the subgingival microflora is that professional and personal plaque control is not strictly limited to the supragingival environment. When aimed at treating periodontal diseases, these procedures are correctly applied. However, for research purposes, in order to prevent misinterpretation, it is necessary to provide a better explanation about the materials and methods that were used to avoid changes in the subgingival microbiota, both in professional and in home-care supragingival plaque control.

Keywords: microbiology, non-surgical periodontal therapy, plaque control, tooth brushing

This literature review and clinical report presents a case of a 14-year-old boy with gingival ulceration and associated recession. The patient had been diagnosed with juvenile idiopathic arthritis and was medicated with methotrexate and non-steroidal anti-inflammatory drugs. The patient reported that his oral ulceration became significantly worse after beginning medical treatment for the condition. Once the dose of his medication was adjusted, the patient did not suffer from further gingival ulceration and remained orally and periodontally stable. This report summarises the mechanisms of action of methotrexate, its side effects and describes the potential for the occurrence of methotrexate-induced gingival ulceration and recession.

Keywords: juvenile idiopathic arthritis, methotrexate, oral ulceration, periodontology, recession

Background: Research into immediate-loading protocols has shown encouraging results. The evaluation of an immediate-loading technique would require a quantitative method for the measurement of implant stability. Resonance frequency analysis (RFA) is emerging as a non-invasive tool for the clinician to assess primary stability of the newly placed implant. Nonetheless, so far, little evidence is available in the literature and no gold standard for the evaluation of implant stability exists that could be used for comparison.
Objective: To evaluate the evidence available in the literature regarding resonance frequency analysis for the determination of primary stability with regard to its utility in decision-making in immediateloading protocols.
Materials and methods: An initial electronic database search (PubMed) was performed to identify articles related to resonance frequency analysis published or accepted for publication from 1996 to April 2007. Next, a manual search was performed throughout the most relevant journals that specialise in implant dentistry. Finally, an additional search was made through the references of the selected articles. The selection of articles, extraction of data, and assessment of validity were made independently by two reviewers.
Results: A total of 37 articles were selected for data extraction. Data regarding advantages and limitations of RFA and factors influencing primary stability was extracted from each paper. No randomised controlled trials were found in the literature; thus, all study designs were accepted. Due to the heterogeneous methodology, a meta-analysis could not be performed.
Conclusions: RFA may help the clinician to choose among various loading protocols and to selectively monitor implants during the healing phase. However, the biological parameters that may be represented by the implant stability quotient value are still not fully understood. There is a lack of consistency in the evidence analysed, thus drawing attention to the need for more methodologically acceptable studies.

Keywords: dental implants, immediate loading, resonance frequency analysis, review