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The scarce standard therapeutic protocols for the management of peri-implant diseases results in the empirical application of therapeutic modalities. The objective of this study was to carry out a survey to analyze the therapeutic trends of professionals with different academic backgrounds and levels of expertise.An exploratory cross-sectional internet-based study survey of board-certified members of the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) was conducted. To assess the therapeutic trends, four clinical vignettes representing different scenarios of peri-implant biologic complications were provided to the participants. Differences in practice patterns were determined using chi-square test and Student t test or analysis of variance (ANOVA) test for qualitative variables.A total of 268 members of the AAP and EFP completed the survey. A significant difference in preferred treatment plan was found between EFP and AAP periodontists, resective therapy being the treatment of choice by the majority of the former (41.2%) and regenerative therapy by the latter (48.9%; P.001). Overall, 48.1% of experts did not consider any intervention for the management of mucositis. Antibiotic prescriptions differed among groups, with statistical significance in each clinical case, and the explantation criteria were inconsistent and differed significantly among groups.Substantial variations exist concerning the decision-making to manage peri-implant diseases and conditions.

Objective This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system. Importance Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis. Findings The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy. Conclusions Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.

Purpose of Review Periodontal medicine recognizes a “bidirectional” interaction between periodontitis and systemic conditions. Unfortunately, the facile ability to publish a periodontal-systemic association, regardless of biologic plausibility or rigorous scientific scrutiny, continues without abate. Recent Findings The increasing number of periodontal-systemic associations corrupts the ability of dentists to distinguish which of the associations are spurious and which are valid. Summary The use of a Disease Association Checklist creates a register for rational assessment of current disease associations. However, to diminish the publication of spurious periodontal-systemic observational associations, editors must demand that authors follow Bradford-Hill criteria and the STROBE Statement to ensure a stringent pathway to publication.

Background Individuals with altered passive eruption (APE) are assumed to be more susceptible to periodontal diseases. To date, this hypothesis has not been sufficiently supported by scientific evidence. The aim of this study, using an experimental gingivitis model, was to examine the development and resolution of gingival inflammation in patients with APE when compared to patients with normal gingival anatomy. Methods A localized experimental gingivitis was induced in 9 patients with APE (test group) and 9 patients without APE (control group) in the maxillary right quadrant. After 21 days, patients were instructed to resume proper home oral hygiene procedures. At baseline (day 0) and at days 7, 14, 21, 28, 35, and 42, plaque index (PlI), gingival index (GI), and gingival crevicular fluid volume (GCF) were evaluated for teeth 6 (canine), 7 (lateral incisor) and 8 (central incisor) of test and control groups. Results During the experimental gingivitis phase (days 0 to 21), the rate of change in gingival inflammation (GI) was dramatically different between the APE test group and the control group. On day 21, at the time of maximum plaque accumulation, the GI of the APE test group was a 109% greater than the GI of the test group (P ≤ 0.001) despite similar plaque levels (P = 0.436). During the resolution of inflammation phase (days 22 to 42), the APE test group continued to exhibit statistically higher GI scores than the control group (P = 0.029). Conclusion In the presence of similar amounts of plaque deposits and plaque accumulation rates, APE patients exhibited differences in the development and resolution of plaque-induced gingival inflammation when compared to controls.

AIM The goal of the present investigation was to identify site-level factors that might allow prognostication of individual implants in partially dentate patients with multiple non-splinted restorations. METHODS We analysed clinical and radiographic characteristics of 222 non-splinted single implants in function for at least 5 years in 86 partially dentate individuals at the time of functional loading and at follow-up, with the outcome variable being peri-implantitis. Principal component analysis identified factors contributing to greatest variability and linear discriminant analysis coupled with Random Forest Classifier used to identify risk predictors. RESULTS After controlling for patient-level factors, the following characteristics were associated with significantly increased risk for peri-implantitis: Periodontal disease on adjoining teeth at the time of restoration (Odds Ratio (OR): 8.0), implant placement at a depth of 6 mm or more in relation to the CEJ of adjacent tooth (OR: 8.5), asymmetric prosthesis (OR: 4.3), history of tooth loss due to periodontitis (OR: 2.4) and a mean baseline plaque index of 1.6 or more (OR: 7.9). CONCLUSIONS Our findings suggest that a system that incorporates both subject level and implant-level factors is required to effectively prognosticate the success of individual implants.

Effective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of this study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews.An overview of systematic reviews was conducted to evaluate the efficacy or reported adverse events associated with orally administered medication or medication combinations for relief of acute pain. Reviews were inclusive of all age populations but were limited to those that evaluated medication and medication combinations marketed in the United States and had moderate or high methodological quality according to the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool.Five reviews were found eligible for inclusion. The data identified combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations.The best available data suggested that the use of nonsteroidal medications, with or without acetaminophen, offered the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.

This retrospective study aims to assess compliance to supportive periodontal therapy (SPT) among patients treated with dental implants with different periodontitis histories and the possible influence of their compliance on peri-implant marginal bone level.Dental records of 106 patients treated with at least one dental implant were reviewed. A single operator who did not provide care to the patients recorded the following during the first year of implant function (first year of follow-up), during the first 5 years of follow-up, and during the entire follow-up duration: 1) number of recalls; 2) compliance, calculated from registered attendance; 3) periodontal disease history; 4) peri-implant radiographic bone level from most recent examination; and 5) clinical parameters including probing depth and bleeding on probing. Clinical and radiographic parameters were assessed at site level and analyzed for possible associations among them and with demographic parameters.Collected data were based on 156 implants with an average of 6.5 ± 3.4 years (range: 1 to 13 years) in function. Patients with periodontitis history demonstrated greater compliance than patients without periodontitis history during the two longer follow-up times. Over time, the majority of patients demonstrated partial compliance (71% to 80% of patients). Peri-implant bone level averaged 0.9 ± 1.1 mm, without significant association with compliance level; however, positive periodontitis history and more years in function were significantly associated with greater peri-implant bone loss.Patients with implants partially comply with scheduled SPT, regardless of periodontitis history. Patients who had received periodontal treatment demonstrated better compliance than those without prior periodontal therapy experiences.

Although human gingival fibroblasts (hGFs) and human periodontal ligament fibroblasts (hPDLFs) exhibit numerous phenotypic similarities, it has been suggested that the secretory and behavioral differences, which exist between these cell types, are a result of the membrane protein composition of these cells.Four matched pairs of hGFs and hPDLFs were cultured. Before confluence, membrane-bound and -associated proteins from cells of the fourth passage were extracted. The processed protein samples were evaluated using capillary-liquid chromatography-nanospray tandem mass spectrometry. Global protein identification was performed on an orbitrap mass spectrometer equipped with a microspray source operated in positive ion mode. Proteome software was used to validate protein identifications derived from tandem mass spectrometry sequencing results.Four hundred fifty proteins were common to both hGFs and hPDLFs. Of the proteins identified, 214 were known membrane-bound or -associated proteins, and 165 proteins were known nuclear-associated proteins. Twenty-seven proteins, identified from the 450 proteins, common to both hGFs and hPDLFs, were detected in statistically significant greater quantities in either hGFs or hPDLFs. More specifically, 13 proteins were detected in significantly greater quantities in hGFs, whereas 14 proteins were detected in significantly greater quantities in hPDLFs.Distinct differences in the cellular protein catalog may reflect the dynamic role and high energy requirements of hGFs in extracellular matrix remodeling and response to inflammatory challenge as well as the role of hPDLFs in monitoring mechanical stress and maintaining tissue homeostasis during regeneration and remineralization.

Numerous scientific studies assert the existence of hormone-sensitive periodontal tissues. Tissue specificity of hormone localization, identification of hormone receptors and the metabolism of hormones are evidence that periodontal tissues are targets for sex steroid hormones. Although the etiologies of periodontal endocrinopathies are diverse, periodontal pathologies are primarily the consequence of the actions and interactions of sex steroid hormones on specific cells found in the periodontium. This review provides a broad overview of steroid hormone physiology, evidence for the periodontium being a target tissue for sex steroid hormones and theories regarding the roles of sex steroid hormones in periodontal pathogenesis. Using this information, a teleological argument for the actions of steroid hormones in the periodontium is assessed.

The endocrine system plays a major role in human survival. Endocrine glands secrete chemical messengers or hormones that affect every tissue of the body, including the periodontium, during the life of the individual. As the endocrine system influences a broad assortment of biological activities necessary for life, a general understanding of the principal components and functions of this system is essential. A fundamental assessment of hormone structure, mechanism of action and hormone transport, as well as influence on homeostasis is reviewed. A concise evaluation of the functions of the central endocrine glands, the functions of the major peripheral endocrine glands (other than gonadal tissues) and the known relationships of these hormones to the periodontium is examined.

A preface on the historical background, scope and clinical importance of the effects of reproductive endocrinology on the periodontium is presented. Furthermore, deductive explanations of intuitive observations evaluating the influence of reproductive endocrinology on the periodontium are discussed.

In relation to periodontal diseases associated with sex-steroid hormones, men have been the forgotten sex. It is not surprising that there has been less scrutiny of the effects of sex-steroid hormones in men considering the more striking changes that occur in women during different periods of their life. Despite the gingival inflammatory changes reported in women, men have been reported to have a higher prevalence of destructive periodontal diseases. The information presented in this review will provide a contemporary evaluation of male susceptibility to periodontal diseases.

The male reproductive system consists of the testes, a ductal system and sex accessory organs. Production of sperm by the testes combined with fluids formed by the sex accessory organs (e.g. seminal vesicles, prostate and bulbourethral glands) produce a secretion that supports the survival of spermatozoa and provides a medium through which they can move through the reproductive ducts (e.g. epididymis, vas deferens, ejaculatory duct and urethra) for ejaculation of viable sperm into the female reproductive tract. Summarized herein are the essentials of normal male reproductive physiology, disorders of male sexual differentiation, pharmacological therapy of common diseases of the male genitourinary tract and the impact of drugs of abuse on the male reproductive system.

Background Effective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of this study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews. Types of Studies Reviewed An overview of systematic reviews was conducted to evaluate the efficacy or reported adverse events associated with orally administered medication or medication combinations for relief of acute pain. Reviews were inclusive of all age populations but were limited to those that evaluated medication and medication combinations marketed in the United States and had moderate or high methodological quality according to the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool. Results Five reviews were found eligible for inclusion. The data identified combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations. Practical Implications The best available data suggested that the use of nonsteroidal medications, with or without acetaminophen, offered the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.

Background and Overview In 2005, the American Dental Association (ADA) Council on Scientific Affairs convened an expert panel to develop clinical recommendations for dentists treating patients who are receiving oral bisphosphonate therapy. The Journal of the American Dental Association published the resulting report in 2006. This 2008 advisory statement is the first of projected periodic updates of the 2006 clinical recommendations. Conclusion This 2008 advisory statement concludes, on the basis of a review of the current literature, that for patients receiving bisphosphonate therapy, the risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw apparently remains low. It also newly concludes that current screening and diagnostic tests are unreliable for predicting a patient's risk of developing the condition. This statement updates the 2006 recommendations regarding general dentistry, management of periodontal diseases, implant placement and maintenance, oral and maxillofacial surgery, endodontics, restorative dentistry and prosthodontics, and orthodontics.

Bisphosphonates are important drugs that are increasingly prescribed to reduce the morbidity associated with osteoclast-mediated bone diseases. Shortly after the turn of the century, a variety of case reports described a necrosis of the jaw bone in patients using bisphosphonates. Currently, an exposed area of necrotic jaw bone present for at least eight weeks in patients using bisphosphonates has been defined as a bisphosphonate-associated osteonecrosis (BON) by the American Dental Association. BON may occur spontaneously but is more frequently associated with local trauma to the jaw. At this time, a causal relationship between BON and bisphosphonates has not been demonstrated. This review will evaluate current data related to the occurrence, risk, prevention, treatment, and management of BON.

Background The esthetic replacement of teeth has become an important standard for implant dentistry. While defining this goal has not been difficult, the ability to restore implants esthetically has been fraught with obstacles and sometimes has not been attainable. The purpose of this review is to summarize essential anatomical and surgical considerations for cosmetic implant dentistry. Methods This article provides a summary of the predominant findings from clinical studies and case reports that help develop implant surgical guidelines for better esthetic outcomes. Results Soft- and hard-tissue requirements for placing an implant in an ideal position are defined. The authors discuss the best treatment approaches as well as the limitations associated with esthetic implant placement. They evaluate the available data specifically for the maxillary anterior sextant, since this anatomical region has higher esthetic demands. Conclusions Several parameters and various surgical techniques have been developed to manipulate soft- and hard-tissue contours and to control the esthetic outcome for implant-supported restorations. Clinical Implications It is essential for practitioners to understand the anatomical basis for and limitations of implant dentistry in the esthetic zone.

Assessment of the periodontium has relied exclusively on a variety of physical measurements (e.g., attachment level, probing depth, bone loss, mobility, recession, degree of inflammation, etc.) in relation to various case definitions of periodontal disease. Periodontal health was often an afterthought and was simply defined as the absence of the signs and symptoms of a periodontal disease. Accordingly, these strict and sometimes disparate definitions of periodontal disease have resulted in an idealistic requirement of a pristine periodontium for periodontal health, which makes us all diseased in one way or another. Furthermore, the consequence of not having a realistic definition of health has resulted in potentially questionable recommendations. The aim of this manuscript was to assess the biological, environmental, sociological, economic, educational and psychological relationships that are germane to constructing a paradigm that defines periodontal health using a modified wellness model. The paradigm includes four cardinal characteristics, i.e., 1) a functional dentition, 2) the painless function of a dentition, 3) the stability of the periodontal attachment apparatus, and 4) the psychological and social well-being of the individual. Finally, strategies and policies that advocate periodontal health were appraised. I'm not sick but I'm not well, and it's a sin to live so well. Flagpole Sitta, Harvey Danger

Valuable decision making for periodontal treatment success in situations where there is ambiguous or conflicting information was previously reported using a consensus building method, the Delphi survey, for posterior teeth with chronic periodontitis. This study focuses on outcome measures relevant in assessing therapy of anterior teeth with chronic periodontitis.The Delphi panelists were the same American periodontists who participated in the previous Delphi survey evaluating successful therapy in posterior teeth. In this study, panelists determined the level of importance of attachment level, probing depth, mobility, plaque, inflammation, esthetics, pain, and patient satisfaction following periodontal treatment of a single tooth or multiple anterior teeth in a patient with severe chronic periodontitis. The panelists were questioned concerning the relative importance of each outcome measure, a minimally acceptable level considered necessary for success for each outcome measure, and the length of time required for these outcome measures to remain stable.The 35 panelists considered the control of pain, esthetics, and patient satisfaction to be "extremely important" outcome measures for successful periodontal treatment of single or multiple teeth. Attachment levels, probing depths, plaque levels, degree of inflammation, and mobility (for multiple teeth) were considered to be "very important" outcomes. The minimally acceptable reduction in probing depths following 1 year of treatment was 2 mm; whereas 2 mm of attachment gain was considered necessary for successful treatment. The panel also found a Miller degree I mobility as an acceptable outcome for clinical success. Finally, the panel agreed that the 1-year results of treatment should remain stable for a minimum of 5 years.The Delphi technique proved a practical instrument to transform expert opinion into a group consensus for relevant periodontal outcome measures. Absence of pain, esthetics, and patient satisfaction were outcome measures considered "extremely important" for successful therapy. Although panelists considered attachment loss, probing depths, and mobility somewhat less important outcomes, they wanted an attachment gain of 2 mm and would accept a degree I mobility as long as outcomes remained stable for 5 years. These data suggest that minimal standards for successful therapy of anterior teeth can be established among periodontal practitioners.

Background: A paucity of information exists concerning how estrogen affects cellular function in the gingiva of women. In this study, the behavior of human gingival fibroblasts was examined in the presence of a potent estrogen, estradiol. Methods: Quiescent, premenopausal gingival fibroblasts were incubated in the presence and absence of estradiol (1 nM) and/or raloxifene (100 nM). Cell number was determined and cell cycle analyzed using a flow cytometer. Collagen and non-collagen production in cell cultures grown on various extracellular matrices were determined using a radioactive microassay which measures collagenase-digestible and collagenase-resistant radiolabeled proteins. To ascertain if the gingiva contained specific estrogen-sensitive cell populations, a fluorescence-activated cell sorter was used to detect, sort, and enrich fibroblast populations responsive to estrogen. Results: Cellular proliferation and the number of cells entering the S-phase of the cell cycle were significantly increased in mass cultures of fibroblasts stimulated by estradiol. Raloxifene did not antagonize the action of estradiol on cell proliferation. In regard to protein production, estradiol significantly reduced collagen production on plastic and collagen IV matrices; whereas non-collagen protein production on plastic and collagen I matrices was significantly reduced. Cell sorting of mass fibroblast populations revealed that, on average, 45% of the cells from the resident population selectively accumulated the estrogen probe. These sorted and estrogen-sensitive enriched cell populations proliferated in the presence of 1 nM estradiol, whereas the sorted, estrogen-deficient enriched fibroblast populations did not proliferate when incubated with 1 nM estradiol. Conclusions: These data indicate that estradiol can induce cellular proliferation while depressing protein production in cultures of human, premenopausal gingival fibroblasts. This cellular proliferation appears to be the result of a specific population of cells within the parent culture that responds to physiologic concentrations of estradiol. J Periodontol 2005;76:1391-1397.

Periodontal regeneration has been a relentless goal of the periodontist. Perhaps the oldest and most frequently attempted type of regeneration has involved chemical modification of the root surface. Varying results from histological and clinical studies have created controversy about the clinical effectiveness of root surface decalcification.This systematic review assesses the efficacy of root surface biomodification through the use of citric acid, tetracycline, or ethylenediaminetetraacetic acid (EDTA) in patients with chronic periodontitis.Does the use of chemical root declacification result in effective periodontal regeneration and improved clinical outcomes in patients with chronic periodontitis?The Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effectiveness; Cochrane Central Register of Controlled Trials; American College of Physicians Journal Club, evidence-based MEDLINE journals; and National Center for Biotechnology Information PubMed Journals, as well as Dogpile, Google, and Copernic search engines were screened. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research, and Periodontology 2000. Searches were performed for relevant clinical trials published through September 25, 2002.Histological and clinical studies evaluating the effects of citric acid, tetracycline, or EDTA on root surfaces of patients with chronic periodontitis were considered for inclusion.Studies evaluating extracellular matrix proteins (e.g., fibronectin), enamel matrix proteins (e.g., amelogenins), or other proteins or growth factors applied to the root surface were not included.Primary outcome measures included changes in connective tissue attachment, cementogenesis, clinical attachment levels, probing depths, and gingival recession. Secondary outcome measures included changes in bone level, gingival inflammation, and plaque levels. Results for continuous outcome measures for primary variables (clinical attachment levels, probing depths, and recession) were expressed as mean differences or standardized mean differences. Clinical attachment levels and reduction in probing depth were evaluated using meta-analysis. All papers were rated according to methodological strength of evidence.1. Thirty-four studies incorporating a total patient population of 575 were analyzed: 26 for citric acid, 5 for tetracycline, and 3 for EDTA treatment. 2. Four of 8 human histological studies reported regeneration with the use of citric acid. Only 1 of 18 clinical studies reported attachment gain. 3. Of the 5 studies examined using tetracycline, 1 histological study and 1 clinical study reported attachment gain. 4. No regeneration was reported in the 3 studies evaluating the use of EDTA. 5. Meta-analysis performed on 28 clinical trials did not show any significant effects of acid root treatment on attachment level gains or probing depth.1. Evidence to date suggests that the use of citric acid, tetracycline, or EDTA to modify the root surface provides no benefit of clinical significance to regeneration in patients with chronic periodontitis. 2. The best method for ascertaining the clinical efficacy of acid-treated root regeneration would be to conduct a randomized clinical trial with sufficient statistical power that is supported by quantitative histological evaluation. 3. The majority of the studies that evaluated the regenerative potential of root surface modifiers were observational in nature; therefore, the value of conclusions reached in this manuscript must be carefully considered.

In 2 previous multicenter studies evaluating the efficacy of a novel anesthetic gel (lidocaine 25 mg/g plus prilocaine 25 mg/g), there was a rather small, although statistically significant, overall difference between the active and placebo gels. There were, however, large center variations. At centers where the placebo-treated patients reported high pain scores, the difference between treatments was large, suggesting that the anesthetic gel is most effective in patients who experience the procedure as painful. The present multicenter, double-blind, randomized study evaluated the anesthetic effect of this gel in pain-sensitive patients by using a visual analog scale (VAS) and a verbal rating scale (VRS).One hundred thirteen (113) patients with moderate to severe periodontitis were screened for pain sensitivity upon probing. Eighty-five reported VASor = 30 mm on probing and were included in the treatment phase (43 anesthetic and 42 placebo gel). The periodontal pockets of one quadrant in each patient were treated with gel for 30 to 45 seconds, followed by scaling and/or root planing.The results were similar between centers. The median overall VAS pain score was 11 mm in the anesthetic group and 27 mm in the placebo group. The Hodges-Lehmann point estimate of the treatment difference was 10 mm (P = 0.004). No pain or only mild pain was reported by 70% in the anesthetic group and by 48% in the placebo group (P = 0.003). Two patients in the anesthetic group and 7 patients in the placebo group required rescue anesthesia.This study confirms the favorable anesthetic efficacy of active gel over placebo in selected pain-sensitive patients. It suggests that the gel may be a valuable alternative to conventional injection anesthesia.

The squamous odontogenic tumor (SOT) is a rare, benign, locally infiltrative neoplasm of the jaws that appears to originate from the rests of Malassez. It has been confused with other pathologic entities such as ameloblastomas, carcinomas, and fibromas and clinically may resemble localized periodontal disease. The tumor is often asymptomatic, although it can present with symptoms of pain and tooth mobility. A characteristic radiographic appearance is that of a triangular-shaped or semi-circular lucency associated with the roots of erupted teeth. Histologically, the tumor is characterized by the formation of variably sized nests and cords of uniform, benign-appearing, squamous epithelium with occasional vacuolization and keratinization. Treatment of SOT by conservative surgical excision is normally curative with rare episodes of recurrence reported. Since the clinical presentation of SOT may mimic more common pathologic entities, this case report reinforces the need for careful histologic evaluation of all lesions found in the periodontium.

Oral contraceptives (OC) have historically been considered a risk factor for gingival diseases. We set out to investigate this premise further, given that, over recent years, hormone concentrations in OC have been substantially reduced. Using a prospective, split-mouth, experimental gingivitis model, pre-menopausal women either taking (n = 14) or not taking (n = 16) OC refrained from all oral hygiene practices in one maxillary (test) quadrant while continuing to perform normal oral hygiene activities in the contralateral (control) quadrant. Mean increases in plaque index (PI), gingival index (GI), and gingival crevicular fluid (GCF) volume from days 0 to 21 were significant in test quadrants (P < 0.05) but did not differ regardless of whether subjects received OC (P > 0.05). PI, GI, and GCF volume did not vary in control quadrants over the course of the study (P > 0.05). Analysis of these data suggests that current OC formulations do not affect the inflammatory response of the gingiva to dental plaque.

Background, aims: Sonic toothbrushes are well-established in oral home care for plaque removal; however, the effects of low frequency acoustic (sonic) energy released from sonic toothbrushes to the cells of the periodontium have not been investigated. The purpose of this study was to evaluate the effects of sonic energy on human gingival fibroblast proliferation and protein production in cell culture. Methods: Direct and indirect transfer calibration studies found the fundamental frequency of the Sonicare® sonic toothbrush to be 261 hertz (Hz) with amplitudes ranging from 70 to 104 decibels (dB) in the human periodontium. Using an in vitro delivery system, which coupled a signal-wave generator with a bone transducer to mimic the energy delivered by the Sonicare® toothbrush, the effects of signal, amplitude and duration were evaluated longitudinally using a gingival fibroblast cell culture model. 8 strains of fibroblasts isolated from healthy human gingiva were seeded at 30,000 cells/35 mm culture dish in minimum essential medium supplemented with 10% fetal bovine serum. To ascertain the relationship of the amplitude and the duration of sonic stimulation to cellular proliferation, gingival fibroblasts were subjected 2× daily to 261 Hz sound at various amplitudes (67–97 dB) for 0, 15, 30, 60, and 120 s on days 1, 3, 5, 7, and 10. Results: It was found that either 30 or 120 s of sound exposure for 10 days of treatment had significant effects on cell proliferation in comparison to control cultures. Specifically, at day 10, 87 dB at 261 Hz for 30 s 2× daily resulted in a 25.5% increase in cell number (p

Immediate placement of dental implants into tooth extraction sites is an effective treatment option. When immediate placement procedures are performed with a round implant, a void is often evident between the implant and the orifice of the socket. Previous treatment focused on the use of membranes or special closure techniques to induce bone growth into the void. Anatomically shaped dental implants provide a predictable alternative to previous filling techniques since the anatomical implants decrease or completely fill the void at the socket opening. This article describes a surgical technique developed for the immediate placement of these implants in extraction sites.

Gingival diseases are a diverse family of complex and distinct pathological entities found within the gingiva that are the result of a variety of etiologies. There are several clinical characteristics common to all gingival diseases and these features include clinical signs of inflammation, signs and symptoms that are confined to the gingiva, reversibility of the disease by removing the etiology, the presence of bacterial laden plaque to initiate and/or exacerbate the severity of the disease and a possible role as a precursor for attachment loss around teeth. Defining and classifying gingival diseases has not been an easy task. The tools and methods to identify gingival diseases have varied depending on the criteria used by epidemiologists, researchers, or the practicing clinician. The classification of gingival disease in this review relied upon experimental and/or epidemiological human studies that accurately and reliably assessed an underlying functional derangement that was localized to the gingiva and was reported in a peer-reviewed journal. The classification of gingival diseases that depends on dental plaque to initiate the disease process(es) has been categorized into two groups. The two categories of plaque-induced gingival diseases are those affected by local factors and those that are affected by local factors and modified by specific systemic factors found in the host. In this review, the clinical characteristics of gingival disease associated with plaque, endogenous hormone fluctuations, drugs, systemic diseases, and malnutrition were investigated.

The handpiece of a Florida sleeve probe was modified to create a flange with the capability to detect the cemento-enamel junction (CEJ). This new instrument (the Pressure-controlled, Automated, Standardised Handpiece or Florida PASHA probe) was used to determine whether (a) the CEJ could be reproducibly detected in dried, human skulls and (b) clinical attachment levels could be reliably measured in human subjects. When using the Florida PASHA probe to detect the CEJ at 157 different sites in four dried, human skulls, there were no statistically significant (p > or = 0.15) differences in mean CEJ detection measurements for any of the three participating examiners; either when the CEJ was visualised or obscured. The mean differences between first and second replicates ranged from 0.00 to 0.08 mm. Intraclass correlation coefficients (ICCs) of repeated measures in both conditions ranged from 0.70 to 0.83 for tactile CEJ detection (CEJ obscured), and from 0.95 to 0.96 for visual detection (CEJ visible). In human studies, the Florida PASHA probe was used by two examiners to determine clinical attachment levels (CAL) at 660 sites in 5 human subjects undergoing supportive periodontal therapy. Intra-examiner agreement of replicate measurements recorded by the probe, as measured by calculating ICCs, ranged from 0.79 to 0.85 for the 2 examiners, respectively. A statistically significant inter-examiner difference in mean CAL measurements when using the Florida PASHA probe was found (p

The male reproductive system consists of the testes, a ductal system and sex accessory organs. Production of sperm by the testes combined with fluids formed by the sex accessory organs (e.g. seminal vesicles, prostate and bulbourethral glands) produce a secretion that supports the survival of spermatozoa and provides a medium through which they can move through the reproductive ducts (e.g. epididymis, vas deferens, ejaculatory duct and urethra) for ejaculation of viable sperm into the female reproductive tract. Summarized herein are the essentials of normal male reproductive physiology, disorders of male sexual differentiation, pharmacological therapy of common diseases of the male genitourinary tract and the impact of drugs of abuse on the male reproductive system.

The endocrine system plays a major role in human survival. Endocrine glands secrete chemical messengers or hormones that affect every tissue of the body, including the periodontium, during the life of the individual. As the endocrine system influences a broad assortment of biological activities necessary for life, a general understanding of the principal components and functions of this system is essential. A fundamental assessment of hormone structure, mechanism of action and hormone transport, as well as influence on homeostasis is reviewed. A concise evaluation of the functions of the central endocrine glands, the functions of the major peripheral endocrine glands (other than gonadal tissues) and the known relationships of these hormones to the periodontium is examined.

In relation to periodontal diseases associated with sex-steroid hormones, men have been the forgotten sex. It is not surprising that there has been less scrutiny of the effects of sex-steroid hormones in men considering the more striking changes that occur in women during different periods of their life. Despite the gingival inflammatory changes reported in women, men have been reported to have a higher prevalence of destructive periodontal diseases. The information presented in this review will provide a contemporary evaluation of male susceptibility to periodontal diseases.

Numerous scientific studies assert the existence of hormone-sensitive periodontal tissues. Tissue specificity of hormone localization, identification of hormone receptors and the metabolism of hormones are evidence that periodontal tissues are targets for sex steroid hormones. Although the etiologies of periodontal endocrinopathies are diverse, periodontal pathologies are primarily the consequence of the actions and interactions of sex steroid hormones on specific cells found in the periodontium. This review provides a broad overview of steroid hormone physiology, evidence for the periodontium being a target tissue for sex steroid hormones and theories regarding the roles of sex steroid hormones in periodontal pathogenesis. Using this information, a teleological argument for the actions of steroid hormones in the periodontium is assessed.