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Background: Guided tissue regeneration (GTR) is a common treatment modality for correcting vertical or bony defects in furcations. Multiple materials are used in GTR with allografts and xenografts being the most widely used. Each material has distinctive properties affecting the regenerative potential. A new bone graft combination of xenogeneic/allogeneic may improve the outcome of GTR by providing space maintenance (Xenograft) and osteoinductive potential (Allograft). The aim of this case report is to evaluate the efficacy of the new combined xenogeneic/allogeneic material based on clinical and radiographic outcomes. Methods: A 34‐year‐old healthy male presented with vertical bone loss interproximally between #'s 9 and 10. Clinical exam revealed 8 mm probing depth without mobility. The radiographic exam revealed a wide and deep vertical bony defect of 30%–50% bone loss. The defect was treated using a layering technique with xenogeneic/allogeneic bone graft and collagen membrane. Results: The 6‐ and 12‐month follow‐ups revealed a significant reduction in probing depths and radiographic bone fill. Conclusions: GTR using a layering technique of xenogeneic/allogeneic bone graft and collagen membrane showed proper correction of a deep and wide vertical bony defect. The 12‐month follow‐up revealed healthy periodontium with normal probing depths and bone level. [ABSTRACT FROM AUTHOR]

Introduction: Alveolar bone deficiency is a common postextraction sequela that adversely affects implant placement. Therefore, ridge augmentation is often required to obtain proper bone quantity and quality for restoratively driven implant placement. This case series describes the successful horizontal and vertical alveolar ridge augmentation using custom‐fabricated allogeneic block bone grafts. Case Series: Two healthy partially edentulous patients presented to private practice seeking dental implant treatment. Initial clinical examination and cone‐beam computed tomography (CBCT) radiographic analysis showed moderate to large horizontal ridge defects. Treatment options were discussed for alveolar ridge augmentation and the patients elected to undergo the custom allogeneic block graft procedure to regenerate the atrophied alveolar ridges. The CBCT scan in conjunction with computer‐aided design/computer‐aided manufacturing (CAD/CAM) technology was used to fabricate customized allogeneic block grafts based on alveolar ridge topography. The custom allogeneic block graft allowed less surgical time and decreased postoperative morbidity. The grafted area was allowed 6 months of healing time. Follow‐up radiographs showed the stability of the graft followed by dental implant placement. The dental implants were functionally loaded, and successful implant esthetics and function achieved. Conclusion: Custom allogeneic block grafts could provide a promising innovative method for optimal ridge augmentation. Why are these cases new information?Less invasive procedure as an alternative conventional two‐stage block augmentation.More predictable outcome due to customized block graft. What are the keys to successful management of these cases?It is important determining the type of bone defect.Vertical and horizontal bone loss.Primary closure. What are the primary limitations to success in these cases?Limited data from prospective clinical trials documenting the effectiveness of custom allogeneic block grafts.Limited data are available to confirm accuracy of the CAD/CAM process.Passive flap closure is needed. [ABSTRACT FROM AUTHOR]

Background: Immediate implant placement (IIP) into fresh extraction socket is a favorable treatment option. If successfully managed, it reduces the overall treatment time, and increases patient's satisfaction. Surgical and restorative factors affect IIP success rates. In this systematic review we evaluate the effect of guided bone regeneration (GBR) at the time of IIP on crestal bone level (CBL) changes after at least 12-months of functional loading.Methods: Reviewers conducted an independent search of the National Center for Biotechnology Information PubMed, Medline, and the Cochrane Collaboration Library from 1966 to January 2017 following the inclusion criteria. A hand search of bibliographies of reviews and clinical trials related to IIP was also performed. This study looked into CBL changes around IIP primarily and further extracted the data to conduct three meta-analysis of "IIP using GBR versus IIP without GBR", "IIP using bone graft alone versus IIP using bone graft with membrane" and "IIP using GBR versus conventional implant placement" which were further subdivided to provide more detailed information for each. Four reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms.Results: The electronic search identified 714 potential studies and the hand search retrieved 55 studies. Crestal bone level (CBL) changes were determined in three meta-analyses. The results revealed a mean difference in CBL changes of 0.175 ± 0.180 mm  in favor of IIP without GBR when compared with implant with GBR. However, IIP with bone graft and membrane showed better results when compared with IIP with bone graft alone [CBL changes of 0.532 ± 0.572 mm]. CBL preservation was noted in IIP with GBR versus conventional implant placement [CBL changes of - 0.001 ± 0.049 mm].Conclusions: Meta-analyses showed minimal difference in CBL around IIP with bone graft versus without bone graft and with IIP with GBR compared with conventional implant placement. However, IIP with bone graft and membrane reported better CBL preservation compared with IIP with bone graft alone. Nonetheless, these results should be interpreted with caution because of moderate heterogeneity between studies. [ABSTRACT FROM AUTHOR]

Introduction: Dermatomyositis is an uncommon inflammatory disease marked by muscle and joint weakness with skin rash. Dermatomyositis affects adults and children, with higher prevalence for females aged 40 to 60 years. Most common oral lesions include mucosal edema, erythema, and telangiectasia. Case Presentation: A 51‐year‐old white female with an unremarkable medical history presented for periodontal evaluation in 2010. She reported a 6‐month history of gingival inflammation and skin irritation on her hands and a rash on the center of her chest and forehead. Other complaints included fatigue, hot flashes, decreased appetite, and weight loss. Periodontal examination revealed generalized acute marginal erythema, with localized slight incipient bone loss. Oral hygiene was deemed good to fair. Oral hygiene instructions were reviewed and a prescription for chlorhexidine gluconate was given. The patient was then referred to an allergist and dermatologist where a diagnosis of dermatomyositis was made. After the initial diagnosis, localized scaling and root planing was performed using local anesthetic. The patient was managed medically using prednisone, mycophenolate mofetil, and methotrexate and a 3‐month periodontal maintenance recall interval. The patient remained stable over an 8‐year period. Conclusions: Dermatomyositis is an uncommon inflammatory disease that requires medical and dental teams for proper diagnosis and management. Although the condition is chronic in nature with no definitive cure, signs, and symptoms can be managed with steroids and immunosuppressants to delay progression of the disease and improve quality of life for the patient. [ABSTRACT FROM AUTHOR]

Cannabis, also known as marijuana, is one of the most commonly used substances for medical and recreational purposes globally. With the trend of global legalization of medical use of cannabis and even the recreational use, the prevalence of recreational use of cannabis has increased markedly over the past few years. Correspondingly, the potential health concerns related to cannabis consumption have also increased. Therefore, it is necessary for oral healthcare providers to understand the effects of cannabis use on oral health. This review briefly summarizes the components of cannabis, biologic activities on tissues, and mechanisms of action in human cells and tissues. Oral tissue expression of cannabinoid receptors and the potential association of cannabis to oral diseases are also examined. The goals of this review are to (1) elaborate the basic biology and physiology of cannabis in human oral tissues, and (2) provide a better understanding the effects of its use and abuse on oral health. Due to insufficient information, more well‐designed studies should be conducted. It is urgent to include cannabis usage into dental patient health records. [ABSTRACT FROM AUTHOR]

Introduction: The inflammation associated with peri‐implantitis lesions can be difficult to manage and regeneration of lost bone is unpredictable. Unfortunately, opinions vary on the best method(s) for elimination of inflammation and restoration of residual osseous defects. This report describes the successful surgical management of a peri‐implantitis lesion with reduction of inflammation and maintenance of nearly completely regenerated horizontal and vertical bone over 5 years. Case Presentation: A 55‐year‐old healthy, non‐smoking, African‐American female presented in 2013 with inflammation and >25% bone loss at implant site #18. Probing depths ranged from 6 to 13 mm with bleeding on probing (BOP). She was diagnosed with peri‐implantitis. She reported a history of routine scaling every 6 months since implant and crown placement 3 years earlier (2010). Initial periodontal treatment consisted of non‐surgical scaling and implant debridement. Deep pockets and BOP persisted at re‐evaluation. Surgical treatment consisted of full thickness flap, soft tissue curettage with titanium curets, and detoxification of the implant surface with a doxycycline and sterile saline slurry using a titanium brush. Mineralized freeze‐dried bone allograft and demineralized freeze‐dried bone allograft in a 50:50 ratio was placed and covered with a resorbable collagen membrane. All postoperative visits were uneventful. Maximum probing depths around the treated implant at the 5+‐year follow‐up (2019) were 4 mm with no BOP and nearly complete bone fill. Conclusions: This case illustrates that it is possible to successfully eliminate clinical inflammation associated with peri‐implantitis, regenerate bone, and maintain health for >5 years. [ABSTRACT FROM AUTHOR]

Introduction: Implants that lack keratinized tissue (KT) have been associated with increased plaque accumulation, gingival inflammation or hue of metal showing through the tissue. Free gingival grafts (FGGs) are a predictable treatment for minimal or lack of KT. FGGs can increase the zone of KT around teeth and implants alike. Despite predictability of FGGs, stabilizing the graft around implants can be challenging, but is critical for success. Little information is available regarding ways to stabilize FGGs around implants. Acrylic or composite stents are a viable option for obtaining graft stability and support during the healing process. Case Presentation: This case report highlights the practicality of using acrylic or composite stents for FGG stabilization with successful outcomes. Two patients presented with dental implants, with minimal or lack of KT requiring soft tissue augmentation. FGGs were harvested from the palate and fitted around implant carriers allowing stabilization and adequate suturing. Custom‐made acrylic or composite stabilization stents were fabricated to fit around implant carriers, which were screwed into the implant platform, and hollowed out internally to provide space for the graft. Postoperative visits showed healthy, stable zones of KT in both cases. Conclusion: The customized acrylic or composite stents allowed stabilization of the FGGs with successful outcome. [ABSTRACT FROM AUTHOR]

Introduction: Gingival recession (GR) is an unhealthy root exposure that could result in sensitivity, abrasion, root caries and higher chance of plaque collection. The prevalence of GR is higher on the facial surfaces but could also affect the lingual tooth surfaces. Despite the etiology and location of GR, treatment is warranted to improve the long‐term periodontal stability around the affected teeth. This case report describes the use of partly deepithelialized free gingival graft (PE‐FGG) to augment lingual GR post orthodontic treatment. Case Presentation: The current report evaluates the results of PG‐FGG to correct lingual recession in a 21‐year‐old female. The patient presented with 5 mm lingual recession on a previously orthodontically rotated tooth (#21). The recession was treated using a PE‐FGG to increase keratinized gingiva (KG) and reduce root exposure. Follow‐up at 24 months showed adequate root coverage and KG. Conclusion: The use of PE‐FGG can be used to enhance KG for lingual recession with adequate root coverage. [ABSTRACT FROM AUTHOR]

This is the first study to our knowledge to report a novel mutation in the interferon regulatory factor 8 gene (IRF8G388S) associated with multiple idiopathic tooth root resorption, a form of periodontal disease. The IRF8G388S variant in the highly conserved C‐terminal motif is predicted to alter the protein structure, likely impairing IRF8 function. Functional assays demonstrated that the IRF8G388S mutant promoted osteoclastogenesis and failed to inhibit NFATc1‐dependent transcriptional activation when compared with IRF8WT control. Further, similar to subjects with heterozygous IRF8G388S mutation, Irf8+/– mice exhibited increased osteoclast activity in the mandibular alveolar bone surrounding molar teeth. Immunohistochemistry illustrated increased NFATc1 expression in the dentoalveolar region of Irf8–/– and Irf8+/– mice when compared with Irf8+/+ controls. Genomewide analyses revealed that IRF8 constitutively bound to regulatory regions of several thousand genes in osteoclast precursors, and genetic aberration of IRF8 significantly enhanced many osteoclast‐specific transcripts. Collectively, this study delineates the critical role of IRF8 in defining osteoclast lineage and osteoclast transcriptional program, which may help in better understanding of various osteoclast‐mediated disorders, including periodontal disease. © 2019 American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Introduction: Many mucocutaneous conditions affect the skin and oral cavity. Common conditions include lichen planus, pemphigus, and pemphigoid. This case report shows an atypical presentation of a mucocutaneous condition wherein histopathology was required for definitive diagnosis and treatment. Case Presentation: A 51‐year‐old African American male self‐reported to a private periodontal practice with a chief complaint of sporadic painful oral lesions of about 2 months duration. The patient also reported painful throat lesions. He had been previously treated for a sore throat followed by unspecified inflammation of the epiglottis. Clinical examination revealed diffuse bilateral eye redness, numerous intraoral ulcerations on soft and hard palate and floor of the mouth with trouble swallowing. Oral and ocular presentation suggested a differential diagnosis of cicatricial pemphigoid. Pemphigoid and lichen planus were also considered. Ophthalmologic exam revealed only allergies and no other abnormality. Soft tissue biopsies showed intraepithelial separation between the spinous layer and basement membrane. Direct and indirect immunofluorescence showed strong immunoglobulin G and moderate C3 reactivity confirming a diagnosis of pemphigus vulgaris (PV). A rheumatologist initially treated the patient with a daily combination regimen of methylprednisolone and mycophenolate mofetil. Lesions improved after a few weeks on the regimen. Reduction of medications resulted in return of oral and throat lesions. Resumption of the regimen resulted in lesion remission. Azathioprine replaced the mycophenolate mofetil, and then was gradually stopped after methylprednisolone cessation. Lesions have not reappeared for 1 year. Conclusion: This case illustrates that early diagnosis of mucocutaneous lesions leads to proper treatment and possible remission. [ABSTRACT FROM AUTHOR]

Introduction: Excessive gingival display (EGD) is an esthetic concern for patients with a gummy smile. With the increase in the esthetic expectations of patients, EGD could have an adverse emotional and psychosocial impact. The extent and etiology of gingival display dictate which treatment is indicated. For patients with EGD and a short or hypermobile upper lip, surgical lip repositioning (LRP) is a viable treatment alternative to other more invasive procedures such as orthognathic surgery. The procedure was first introduced in 1973 and resulted in reduced morbidity compared with orthognathic surgery while resulting in predictable improvement. LRP reduces gingival display by restricting the pull of elevator lip muscles and shortening the vestibule, thereby decreasing the range of motion of the lips and decreasing the amount of gingival display. Case Presentation: The current report evaluates the esthetic results of LRP surgery on identical 27‐year‐old twin sisters exhibiting severe vertical maxillary excess (VME) and hypermobile upper lip. Both patients were given the option of orthognathic surgery to correct their VME or LRP to reduce their gummy smile and improve esthetics. Both elected LRP to address their gummy smile and avoid higher morbidity and costs associated with orthognathic surgery. Conclusion: Both patients achieved acceptable esthetic results that were stable at 12 and 24 months. [ABSTRACT FROM AUTHOR]

Introduction: Peri‐implant infections can occur any time postloading. Although management of peri‐implant infections has been described extensively in the literature, no consensus exists on the best approach to its treatment. Infections and bone loss can also occur around implants prior to loading, leading to early implant loss. Little has been reported on the management of peri‐implant infections occurring prior to loading. This report describes the identification as well as the surgical and restorative management of infection and bone loss around a preloaded dental implant. Case Presentation: A 52‐year‐old systemically healthy, non‐smoking white female had severe inflammation with bleeding on probing and bone loss around implant #28 (Universal Numbering System) 7 weeks after placement and augmentation with autogenous and deproteinized bovine bone and a resorbable collagen membrane (RCM). Surgical exposure revealed a deep bony crater around the entire implant. The implant was cleaned for 4 to 5 minutes with a tetracycline and saline slurry. Guided bone regeneration was performed with demineralized freeze‐dried bone allograft and an RCM. Azithromycin, ibuprofen 800 mg three times daily, and 0.12% chlorhexidine gluconate rinse were given post‐surgery. Postoperative healing was uneventful. Nearly complete bone fill was noted at 1 year of observation when implants were permanently restored. A combination of screw‐ and cement‐retained restorations were placed. Tissues remained healthy 5.5 years postloading with maximum 3‐mm probing depth and no changes in bone levels. Conclusions: This case shows that it is possible to arrest early peri‐implant infection, regenerate bone, and maintain health over 5.5 years postloading. Early detection and multidisciplinary care resulted in long‐term success. [ABSTRACT FROM AUTHOR]

Background: Immediate implant placement (IIP) is predictable but can lead to esthetic challenges, including midfacial recession (MFR) and papillary height (PH) loss. The aim of this systematic review is to examine the effect of IIP on MFR and PH after at least 12 months of functional loading.Methods: Literature review of the Cochrane and MEDLINE electronic databases and hand search up to January 2016 identified eligible studies. Four reviewers independently assessed data quality and methodology.Results: A total of 106 articles satisfied the inclusion criteria. Twelve studies qualified for three meta-analyses. MFR was slightly less in conventional implant placement (CIP) than in IIP, but the result was not statistically significant (mean difference [MD] -0.064 mm; P = 0.687). Similarly, there was better PH maintenance in CIPs, with statistical significance for distal PH (DPH) only (cumulative PH: MD -0.396, P = 0.010; DPH: MD -0.765, P <0.001; mesial PH [MPH]: MD -0.285, P = 0.256). MFR was slightly less in IIP with thick versus thin biotypes, but not statistically significantly different (MD -0.373, P = 0.243). Pooled data showed statistically significantly less MFR and better PH maintenance in IIP with thick biotype (MFR: MD -0.478, P <0.001; cumulative PH: MD -0.287, P <0.001; MPH: MD -0.288, P <0.001; DPH: MD -0.310, P <0.001). Non-significantly less MFR (MD 0.253, P = 0.384) and significantly better PH maintenance were found in IIP with immediate provisionalization versus conventional restoration (MD -0.519, P = 0.028).Conclusions: IIP in thick biotype and with immediate provisionalization had less MFR and better PH than IIP in thin biotype or with delayed restoration. However, these findings should be interpreted with caution due to high heterogeneity, which was calculated using comprehensive meta-analysis statistical software that took into account sample size and different treatment groups, and limited qualified studies. [ABSTRACT FROM AUTHOR]

Background: Multiple idiopathic cervical root resorption (MICRR) is a rare entity distinct from pathologic root resorption that occurs as a result of several local and systemic factors.Methods: This report describes a familial pattern of MICRR, including a recently identified case and a 30-year follow-up on previously described cases.Results: The previously reported father (aged 95 years) and son (aged 64 years), and the recently affected daughter (aged 61 years) recounted non-contributory medical history. The resorptive lesions were asymptomatic, unassociated with any predisposing factors, and first identified during the fourth to sixth decades of life. All tooth types were affected, with posterior teeth being affected earlier and with greater frequency; however, distal root surfaces were never affected. The resorptive lesions were progressive in nature, with additional teeth becoming involved as the condition was followed over time. In many instances, surrounding alveolar bone extended into the existing resorptive defects, but without clinical evidence of ankylosis. Gingival tissues, periodontal probing, and tooth mobility were within normal limits. Microcomputed tomography of extracted teeth demonstrated that the lesions were more extensive than clinically evident and rarely invaded the pulp chamber. Histologically, many resorptive lesions were noted along the cementum surface, with evidence of isolated cemental repair. Management of MICRR focused on restoring damaged root surfaces and extracting teeth with extensive root resorption.Conclusions: MICRR is a challenging entity with unknown etiology and a lack of well-established preventive and management strategies. The familial pattern noted in this report necessitates future studies to investigate the role of genetic components in MICRR development. [ABSTRACT FROM AUTHOR]

Background: Immediate implant placement (IIP) is a successful treatment and has the advantages of reducing time and increasing patient satisfaction. However, achieving predictable esthetic results with IIP presents a challenge because of naturally occurring bone loss postextraction. Therefore, the focused question of this systematic review is: What is the effect of IIP on crestal bone level (CBL) changes after at least 12 months of functional loading? Methods: Extensive literature review of the Cochrane and MEDLINE electronic databases and a manual search up to November 2012 identified eligible studies. Two reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms. Results: Electronic and manual searches identified 648 relevant publications. A total of 57 articles satisfied the inclusion criteria. Sixteen studies had test and control groups; therefore, meta-analyses could be performed. The results demonstrated better CBL preservation around IIP compared with implant placement in healed/native bone at 12 months [CBL difference of -0.242 (95% confidence interval [Cl], -0.403 to -0.080; P= 0.003)]. Similarly, platform switching around IIP showed better results compared with non-platform switching (CBL difference of -0.770 [95% Cl, -1.153 to -0.387; P<0.001]). There was no difference in mean CBL changes with regard to one-stage or two-stage IIP protocol (-0.017 [95% Cl, -0.249 to 0.216; P = 0.85]) or the use of immediate or delayed immediate implant loading (0.002 [95% Cl, -0.269 to 0.272; P= 0.99]). Conclusions: Meta-analyses showed less CBL loss around IIP compared with implant placement in healed bone. Platform-switched implants showed greater crestal bone preservation than non-platform-switched implants. There was no significant difference in CBL with one- versus two-stage placement or use of immediate versus delayed IIP loading. Although there were statistically significant differences favoring IIP, the small differences may not be clinically relevant. Although IIP showed favorable outcomes for CBL changes, these results should be interpreted with caution because of high heterogeneity among studies. [ABSTRACT FROM AUTHOR]

Background: Predictable regeneration of lost periodontal tissues in furcations is difficult to achieve. This paper investigates the efficacy of different treatment modalities for Class II molar furcations. Methods: Publications in English were searched using PubMed, Medline, and Cochrane Library databases combined with hand searching from January 1, 1966 to October 1, 2007. The search included randomized controlled human trials in molar Class II furcations with over 6 months of surgical reentry follow-up. Changes in vertical probing depths, vertical attachment levels, and vertical and horizontal bone levels were compared. Results: The search identified 801 articles of which 34 of 108 randomized clinical trials met the criteria. Thirteen trials had test and control arms allowing three meta-analyses: 1) five comparing non-resorbable versus resorbable membranes, 2) five comparing non-resorbable membranes versus open flap debridement and 3) three comparing resorbable membranes versus open flap debridement. There was significant improvement for resorbable versus non-resorbable membranes mainly in vertical bone fill (0.77 ± 0.33 mm; [95% CI; 0.13, 1.41]). Non-resorbable membranes showed significant improvement in vertical probing reduction (0.75 ± 0.31 mm; [95% CI; 0.14, 1.35]), attachment gain (1.41 ± 0.46 mm; [95% CI; 0.50, 2.31]), horizontal bone fill (1.16 ± 0.29 mm; [95% CI; 0.59, 1.73]), and vertical bone fill (0.58 ± 0.11 mm; [95% CI; 0.35, 0.80]) over open flap debridement. Resorbable membranes showed significant improvement in vertical probing reduction (0.73 ± 0.16 mm; [95% CI; 0.42, 1.05]), attachment gain (0.88 ± 0.16 mm; [95% CI; 0.55, 1.20]), horizontal bone fill (0.98 ± 0.12 mm; [95% CI; 0.74, 1.21]) and vertical bone fill (0.78 ± 0.19 mm; [95% CI; 0.42, 1.15]) over open flap debridement. Conclusions: Guided tissue regeneration with the use of resorbable membranes was superior to non-resorbable membranes in vertical bone fill. Both types of membranes were more effective than open flap debridement in reducing vertical probing depths and gaining vertical attachment levels and in gaining vertical and horizontal bone. J Periodontol 2011;82:413-428. [ABSTRACT FROM AUTHOR]

Implant placement in fresh extraction sockets in conjunction with appropriate guided bone regeneration is well documented. The decision to extract teeth and replace them with immediate implants is determined by many factors, which ultimately affect the total treatment plan. The goal of this article is to review some of the important clinical considerations when selecting patients for immediate implant placement, and to discuss the advantages and disadvantages of this mode of therapy. [ABSTRACT FROM AUTHOR]

Background: The etiology of idiopathic cervical root resorption has not been elucidated clearly. However, the process has been linked to trauma, intracanal bleaching, and partial thickness connective tissue grafts. Methods: This study describes a familial pattern of multiple idiopathic cervical root resorption in a father and son. Results: The father was a healthy 63-year-old white male who presented with the first resorption lesion in 1983. Twenty-seven additional lesions were identified on 16 teeth over 22 years. Five teeth were lost as a result of extensive resorption. The son was a healthy 43-year-old when a resorption lesion was identified in 1993. A lesion identified on another tooth 12 years later resulted in extraction. Conclusions: Close relatives of those affected by multiple idiopathic cervical root resorption should be examined carefully for cervical resorption. This study also showed that early treatment can prevent or delay the need for extraction. J Periodontol 2007; 78:387-371. [ABSTRACT FROM AUTHOR]

Neely AL, Holford TR, Löe H, Ånerud Å, Boysen H. The natural history of periodontal disease in humans: risk factors for tooth loss in caries-free subjects receiving no oral health care. J Clin Periodontol 2005; doi: 10.1111/j.1600-051X.2005.00797.x. © Blackwell Munksgaard, 2005. No long-term studies have reported on risk factors for tooth loss in subjects without home or professional dental care. The purpose of this report is to identify potential risk factors for tooth loss among male Sri Lankan tea labourers who participated in a 20-year investigation of the natural history of periodontal disease. Data for this report were obtained from the 455 subjects who participated in multiple examinations over the 20-year period from 1970 to 1990. Analyses included data from interim examinations in 1971, 1973, 1977, 1982 and 1985. Oral health assessments included the following: (1) attachment levels in millimetres on all mesial and mesio-buccal surfaces, excluding third molars; (2) plaque index; (3) gingival index; (4) calculus index; (5) caries index; and (6) missing teeth. Other variables included age, history of smoking and betel nut use. Statistical analyses included descriptive statistics and multivariate repeated-measures modelling with generalized estimating equations. Tooth loss was significantly dependent upon interactions between the mean attachment loss and betel nut use ( Z=3.40; p=0.0007) and history of missing teeth ( Z=−3.70; p=0.0002). The effect of attachment loss on tooth loss was increased in the presence of betel nut and diminished when teeth were already missing at baseline. History of missing teeth, betel nut use and increasing attachment loss were significant predictors of tooth loss over time. Betel nut use increased the effect of attachment loss on loss of teeth, while history of missing teeth diminished the effect of attachment loss on tooth loss. [ABSTRACT FROM AUTHOR]

Background: Few investigations have reported on risk factors for periodontal attachment loss over time in subjects with no home or professional dental care. The purpose of this report was to identify potential risk factors for progression of periodontal attachment loss among male Sri Lankan tea laborers who participated in a 20-year investigation of the natural history of periodontal disease. Methods: Data for this report were obtained from the 154 subjects who participated in the 1970 baseline and the final 1990 examinations and included data from their interim examinations performed in 1971, 1973, 1977, 1982, and 1935. Oral health assessments included: 1) attachment levels in millimeters on mesial and mesio-buccal surfaces of all but third molar teeth; 2) plaque index (PI); 3) gingival index (GI); 4) calculus index (CI); 5) caries index (DMFS); and 6) presence or absence of teeth. Other variables included age, history of smoking, and/or use of betel nul. Statistical analyses used multivariate repeated measures analysis of variance (ANOVA). Results: The final adjusted model indicated that attachment loss increased significantly with age (X² = 74.0; df = 1), GI (X² = 45.5; df = 1), CI (X² = 52.7; df = 1) and follow-up time (X² = 219.8; df = 6, P <0.0001 for all variables). Conclusions: Age, GI, CI, and time were significantly associated with mean attachment loss over 20 years. Neither PI, history of smoking, or history of betel nut use were significantly associated with attachment loss over time. [ABSTRACT FROM AUTHOR]

A cross-sectional radiographic screening was performed on bite-wing pairs (BW) from 1872 10-12 year old schoolchildren in the Greater Worcester, Massachusetts area to assess the prevalence of juvenile periodontitis (JP). The 3-stage screening process entailed: (1) visual identification of possible cases based upon a visual assessment of BW for interproximal crestal bone levels &ges; 2 mm from the cemento-enamel junction (CEJ) on &ges; 1 permanent first molar; (2) identification of probable cases based upon BW from possible cases measured with a transparent ruler calibrated in millimeters; (3) finally, clinical confirmation of JP in consenting probable cases. A total of 1038 subjects were eligible to be included in the study &ges; 3 mesial sites readable). Of the 1038 eligible subjects, 117 possible and 103 probable cases were identified in stage 1 and stage 2, respectively. A total of 99 probable cases could be contacted and 43 were examined clinically. Two cases of JP were confirmed clinically in stage 3, yielding a prevalence rate of 4.6/1000. Specifically, this report defines a rate of JP in 10-12 year-old schoolchildren for the first time. In addition, these results indicate that BW can be used to identify children with JP from large data sets. However, further studies including complete clinical and radiographic examinations are necessary to determine whether this method is adequate for large epidemiologic studies. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Key points Encountering a retained root tip post‐extraction and prior to implant placement is a possible clinical complication. There are numerous approaches for removing retained roots that may be traumatic or atraumatic. Regardless of the approach, careful treatment planning is important to minimize complications, reduce morbidity, and preserve bony structures. The aim of the current case study is to introduce a technique and digitally generated device used for identifying and atraumatically removing a retained root tip and simultaneously placing a stable dental implant.A 63‐year‐old female with a history of myocardial infarction, hypertension, and acute pancreatitis presented for implant placement at site #5. Clinical examination revealed adequate interocclusal, mesiodistal, and buccolingual dimensions for implant placement. Radiographic examination using cone beam computed tomography revealed that retained root #5 interfered with implant placement. Digital planning was used to extract the root tip with minimal trauma to maintain adequate bone for simultaneous implant placement with good primary stability.The follow‐ups at 1, 3, and 6 weeks and 4, 8, and 10 months revealed good bone preservation with an osseointegrated implant.Employment of digital planning to create a palatal window allowed excellent accuracy in removing the retained root while maintaining the bony foundation for a well osseointegrated dental implant. Pre‐planning using cone beam computed tomography scan merged with an intraoral digital scan is necessary for precise location of a retained root and correct implant placement with excellent primary stability. A digitally planned 3D surgical guide is a useful method for extracting retained roots during implant placement to minimize bone damage. Digital planning provides a precise and minimally invasive implant surgery. [ABSTRACT FROM AUTHOR]