Search

This is the second article in a two-part series on gingival recession. The first article covered the aetiology and prevalence of gingival recession, while this article focuses on the factors affecting decision making and the management, including treatment of gingival recession alongside the evidence base. With more than half of the population suffering from gingival recession, the clinician should be aware of the different options and treatment modalities available to manage gingival recession. This will enable them to engage with the patient, giving them the necessary and required information to make a patient-centred decision about the most suitable treatment option that will address their concerns. CPD/Clinical Relevance: The clinician should be aware of the different options and treatment modalities available to manage gingival recession. [ABSTRACT FROM AUTHOR]

Gingival recession affects more than half of the population and has a multifactorial aetiology. Despite this, the knowledge and awareness of the factors that predispose sites to recession remains limited, with most people associating it with poor oral hygiene. As patients retain their teeth for longer, the risk of recession is likely to grow, thus increasing the need to establish a greater understanding of this very common condition. This two-part series provides a contemporary overview of the condition with the first article discussing its prevalence, aetiology and classification, and the second covering the different management options. CPD/Clinical Relevance: It is important to establish the aetiology of gingival recession to manage the condition effectively. [ABSTRACT FROM AUTHOR]

Aim: The study aim was to investigate the predictive role of obesity on clinical response following non‐surgical periodontal therapy in individuals with severe periodontitis. Methods: A total of 57 BMI obese and 58 BMI normal non‐smoker adults with periodontitis (defined as probing pocket depths (PPD) of ≥5 mm and alveolar bone loss of >30% with >50% of the teeth affected) received non‐surgical periodontal therapy. Periodontal status was based upon PPD, clinical attachment level (CAL) and full‐mouth bleeding score (FMBS). Mean PPD, percentage sites PPD >4 mm, percentage sites PPD >5 mm and FMBS at 2 and 6 months were outcome variables. Propensity score analysis was used to assess the effect of obesity on outcome variables after adjusting for confounders. Results: Statistically significant higher clinical measures (mean PPD, mean percentage of sites with PPD >4 mm, mean percentage of sites with PPD >5 mm and FMBS) were observed in the obese group than the normal group at baseline, 2 and 6 months after therapy (p <.01). At 2 and 6 months, obesity was associated with worse mean PPD (p <.05), percentage sites with PPD >4 mm (p <.05), percentage sites with PPD > 5mm (p <.05) and FMBS (p <.01), independent of age, gender, ethnicity or plaque levels. Conclusions: Obesity compared to normal BMI status was an independent predictor of poorer response following non‐surgical periodontal therapy. [ABSTRACT FROM AUTHOR]

Background: While leukocytosis is a common feature of severe periodontitis, a smaller amount of evidence has been produced on erythrocytes counts in periodontitis, suggesting a possible tendency to anemia. The aim of this study was to investigate the associations between periodontitis and circulating leukocytes, erythrocytes, and platelets.Methods: The study included 471 patients with periodontitis (including aggressive periodontitis [AgP], and chronic periodontitis [CP]) and periodontal health. A separate sample of 333 patients from a previous study (127 AgP and 206 periodontally healthy) was used as replication. Periodontal clinical data were collected and a blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes and platelets.Results: Adjusted linear regression analyses revealed associations between periodontitis and total leukocytes counts (p < 0.001), neutrophil counts (P <0.001) and hematocrit (HCT) levels (P = 0.045). Sub-analysis revealed no statistically significant differences between AgP and CP. Disease severity was correlated with total leukocyte and neutrophil counts and HCT (P <0.001, P <0.001 and P = 0.004, respectively). In the replication sample, adjusted linear regression analysis revealed associations between periodontitis and decreased hemoglobin (HB) (P = 0.009), mean corpuscular hemoglobin (MCH) (P = 0.023), and MCH concentration (P <0.001). A subset of patients included in these studies (14% to 15.7% of periodontitis versus 8.4% to 10.2% of healthy, respectively, in the two cohorts) were anemic based on the World Health Organization criteria.Conclusion: This paper, reporting results of periodontal examination and blood sampling in over 800 patients, suggest that not just leukocytosis but also tendency to "anemia of inflammation" are typical features of periodontitis. [ABSTRACT FROM AUTHOR]

Specialty registrar training in restorative dentistry is intended to develop mono-specialty knowledge and clinical competence to ensure optimal treatment outcomes and improved quality of life in complex cases. There have been a number of changes to the training programme in recent years, with the introduction of structured curricula and increased emphasis on learning outcomes, assessed via mono-specialty examinations (MSEs). However, the views of trainers and trainees on these changes, the relevance of MSEs to training and their impact on development and future employment prospects are not clear. [ABSTRACT FROM AUTHOR]

This is the second paper in this two-part series. Paper one provided an overview of managing gingival tissue excess and paper two will focus on increasing clinical crown height to facilitate restorative treatment. Crown lengthening is a surgical procedure aimed at the removal of gingival tissue with or without adjunctive bone removal. The different types of procedure undertaken will be discussed over the two papers. In order to provide predictable restorations, care must be taken to ensure the integrity of the margins. If this is not taken into account it can lead to an impingement on the biologic width, which may in turn lead to chronic inflammation resulting in recession or the development of periodontal problems which can be hard to manage. Clinical Relevance: This paper aims to reinforce the need for thorough diagnosis and treatment planning and provides an overview of the various procedures that can be undertaken. [ABSTRACT FROM AUTHOR]

This is the first article in a two-part series which aims to provide an overview of the different techniques used to increase clinical crown height. In the first paper, the focus will be on the management of patients who present with gingival tissue excess. The different aetiologies are discussed and illustrated with clinical cases, following which a range of procedures that may be employed in the management of these patients are presented. With an increasingly ageing population, more patients are taking regular medications prescribed from their general medical practitioner, and so having a working knowledge of the specific drugs that may cause gingival enlargement is essential. Clinical Relevance: When patients with gingival tissue excess present in primary or secondary care, a clinician must have a good knowledge of the possible causes of the condition, as well as an idea of how the patient may be managed. [ABSTRACT FROM AUTHOR]

The article presents a discussion of the role of dental nurses in dental implantation, adapted from the book "Advanced Dental Nursing," edited by Robert Ireland.

Background: Enamel matrix-derived proteins have been shown to regenerate periodontal tissues lost as a result of disease in humans. Emdogain®, a commercial preparation of porcine enamel matrix derivative (EMD), has been shown to induce new cementum, periodontal ligament and bone formation in human periodontal defects. Although a number of studies have reported successful outcomes, local adverse effects have so far not been reported in the literature. This case report describes two examples of external inflammatory resorption following surgical root surface debridement and the use of Emdogain®. Treatment: The treatment in both cases involved raising a full-thickness flap following completion of non-surgical therapy. The granulation tissue from the defect was removed and the root surfaces debrided. Emdogain® was applied following the manufacturers' instructions and involved conditioning the root surfaces with Pref-Gel and applying the Emdogain® to the defect. The flaps were sutured and the site reviewed regularly. Radiographs were taken before the treatment was undertaken and also at 6 months to assess the healing of the defect. Results: External inflammatory root resorption was observed on the treated teeth 6–24 months after therapy. Conclusion: External inflammatory root resorption may be an unusual adverse event following Emdogain® treatment. [ABSTRACT FROM AUTHOR]