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Objectives: To demonstrate the potential application of mixed reality (MR) holographic imaging technology in subgingival scaling and root planing (SRP) for patient with advanced periodontitis., Methods: This case series comprised the analysis of 1566 sites from 261 teeth of 10 patients with advanced periodontitis. Digital CBCT scans and intraoral scans of the patients were digitally acquired preoperatively and aligned to create a three-dimensional periodontal visualization model. Through rendering, interactive holographic images were displayed using MR. The surgeon first used MR images to communicate with the patients, and then facilitated SRP under their guidance. Probing pocket depth (PPD), clinical attachment loss (CAL), Plaque index (PI), and bleeding on probing (BOP) parameters were recorded at baseline and at 8-week postoperatively. Patient-reported outcome indicator questionnaires on self-efficacy were also collected., Results: PPD, CAL, PI, and BOP significantly decreased at 8-week following MR hologram-assisted SRP (p<0.001). For sites with PPD≥4 mm, PPD and CAL declined by 2.33±1.23 mm and 0.69±1.07 mm, respectively. PI significantly decreased from 1.94±0.61 to 0.82±0.58 (p < 0.001) and BOP sites decreased significantly from 84.11% to 40.25%. After receiving MR holograms for condition communication, most patients had a better perception of the effectiveness of SRP treatment and the benefits it brings. 80% of the subjects expressed their willingness to undergo MR-assisted periodontal treatment in the future., Conclusion: These results provide preliminary support for MR hologram-assisted digital SRP. With this technology, images of the gingiva and alveolar bone can be displayed in real time, accurately and three-dimensionally. This improves SRP effectiveness, diminishes complications, and enhances patients' confidence in the treatment., Clinical Significance: MR holographic imaging-based digital SRP is a clinically feasible and promising adjunctive periodontal treatment option. It may contribute to improved non-surgical treatment efficacy in patients with severe periodontitis., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The purpose of this randomized clinical study was to clinically evaluate and compare the efficiencies of platelet-rich fibrin (PRF), concentrated growth factor (CGF) and autogenous bone graft (ABG) in the treatment of intrabony pockets and to assess the alveolar bone gain (AB gain) radiographically (panoramic and CBCT images)., Methods: Eighty intrabony pockets were divided into four groups: ojnly open flap debridement (OFD), OFD+PRF, OFD+CGF and OFD+ABG; each group consisted of 20 defects. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and tooth mobility (TM) by using Periotest M device were evaluated. Radiographic images were also taken to evaluate the AB gain. PRF was produced using a protocol of 2,700 RPM for 12 min and the relative centrifugal force (RCF) was evaluated. CGF was prepared as follows: 2 min 2700 rpm, 4 min 2400 rpm, 4 min 2700 rpm, 3 min 3000 rpm., Results: The study results revealed a similar improvement in PI and GI values in all groups (p > 0.05). There was a statistically significant decrease in PD and CAL in favor of ABG group at day 180 in comparison with other groups (p = 0.001). There was also a statistically significant decrease in TM and alveolar bone height loss (ABHL), whereby the AB gain gradually increased among the groups with the best group being ABG, followed by CGF, PRF, and control groups, respectively (p = 0.001)., Conclusions: The study results support the treatment of periodontal intrabony pockets using OFD in combination with ABG, CGF, and PRF, as ABG showed the best results followed by CGF and PRF., (© 2023 American Academy of Periodontology.)

Objective: To determine the capacity of ultrasonographic image-based measurements of gingival height and alveolar bone level for monitoring periodontal health and disease., Methods: Sixteen subjects were recruited from patients scheduled to receive dental care and classified as periodontally healthy ( n = 10) or diseased ( n = 6) according to clinical guidelines. A 40-MHz ultrasound system was used to measure gingival recession, gingival height, alveolar bone level, and gingival thickness from 66 teeth for comparison to probing measurements of pocket depth and clinical attachment level. Interexaminer variability and comparison between ultrasound measurements and probing measurements was performed via Bland-Altman analysis., Results: Gingival recession and its risk in non-recessed patients could be determined via measurement of the supra- and subgingival cementoenamel junction relative to the gingival margin. Interexaminer bias for ultrasound image analysis was negligible (<0.10 mm) for imaged gingival height (iGH) and 0.45 mm for imaged alveolar bone level (iABL). Diseased subjects had significantly higher imaging measurements (iGH, iABL) and clinical measurements (probing pocket depth, clinical attachment level) than healthy subjects ( p < 0.05). Subtraction of the average biologic width from iGH resulted in 83% agreement (≤1 mm difference) between iGH and probing pocket depth measurements., Conclusions: Ultrasonography has an equivalent diagnostic capacity as gold-standard physical probing for periodontal metrics while offering more detailed anatomical information.

The aim of the study was to compare the supra-alveolar gingival dimension (GD) and the clinical pocket probing depth (PD) by combining data from an intraoral scanner (IOS) and cone-beam computed tomography (CBCT) and identify the clinical features affecting the clinical PD. 1,071 sites from 11 patients were selected for whom CBCT, IOS images, and periodontal charts were recorded at the same visit. CBCT and IOS data were superimposed. GD was measured on cross-sectional images of the probed sites. The level of agreement and correlation between GD and PD were assessed for the entire population and within groups (treated vs untreated, bleeding on probing [BOP] vs no BOP, and PDs of 0-3 mm vs 4-5 mm vs ≥ 6 mm). The mean [± SD] difference between GD and PD was 0.82 [± 0.69] mm, and they were positively correlated (r = 0.790, p < 0.001). The correlations between GD and PD were stronger for untreated sites, sites with BOP, and sites with a larger PD. Within the limitations of this study, the similarity between GD and PD may suggest a possible tendency of overestimation when recording PD., (© 2022. The Author(s).)

Background: The concentration and persisting time of antimicrobial agents in the periodontal pockets are important factors for their antimicrobial efficacy. Increased clearance time in the periodontal pocket is a significant criterion for the selection of intrapocket irrigants. The aim of this study was to estimate the clearance time of a cationic agent from the periodontal pocket., Methods: Thallium-201(Tl-201) was chosen as a tracer to simulate the clearance of cationic substance because of its electrical activity. Twenty patients with periodontitis and probing depths 6 to 9 mm were included in this study. In each patient, 3 Mega Becquerel (MBq) of Tl-201 were inserted into the periodontal pocket. Dynamic imaging was performed and clearance of radioactivity was measured., Results: Clearance of radioactivity was 67.1 ± 16.9, 83.1 ± 13.9, 90.4 ± 10.4, 93.39 ± 8.0% at 30, 60, 90 and 120 min, respectively. Half-life of wash-out was determined as 20.3 ± 10.2 min., Conclusion: The results of this study demonstrate that the half-life of the cationic solution applied subgingivally was approximately 20 min and labelling of oral irrigants with radiotracers may be used to determine their clearance in further research.

Deepened periodontal pockets exert a significant pathological burden on the host and its immune system, particularly in a patient with generalized moderate to severe periodontitis. This burden is extensive and longitudinal, occurring over decades of disease development. Considerable diagnostic and prognostic successes in this regard have come from efforts to measure the depths of the pockets and their contents, including level of inflammatory mediators, cellular exudates and microbes; however, the current standard of care for measuring these pockets, periodontal probing, is an analog technology in a digital age. Measurements obtained by probing are variable, operator dependent and influenced by site-specific factors. Despite these limitations, manual probing is still the standard of care for periodontal diagnostics globally. However, it is becoming increasingly clear that this technology needs to be updated to be compatible with the digital technologies currently being used to image other orofacial structures, such as maxillary sinuses, alveolar bone, nerve foramina and endodontic canals in 3 dimensions. This review aims to summarize the existing technology, as well as new imaging strategies that could be utilized for accurate evaluation of periodontal pocket dimensions., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: Diagnosis is a crucial step in periodontal treatment. The aim of this study was to evaluate the effectiveness of optical coherence tomography (OCT) for observation and determination of periodontal tissue profiles in vivo., Material and Methods: In experiment 1, refractive indices of purified water, porcine gingiva and human gingiva at 1330 nm were determined for the analysis of OCT images of periodontal tissues. In experiment 2, OCT examination was performed in the midlabial apico-coronal plane of mandibular anteriors in 30 Asian volunteers with healthy gingiva. Sulcus depth was measured on intra-oral photographs taken during probing. In the OCT images, the gingival, epithelial and connective tissue thickness, and the position of alveolar bone crest were determined and finally, the biologic width was measured., Results: Refractive indices of purified water, porcine gingiva and human gingiva were 1.335, 1.393 and 1.397, respectively. Cross-sectional images of gingival epithelium, connective tissue and alveolar bone were depicted in real-time. The sulcular and junctional epithelium could be visualized occasionally. Laser penetration and reflection were limited to a certain depth with an approximate maximal imaging depth capability of 1.5 mm and OCT images of the periodontal structure were not clear in some cases. The average maximal thickness of gingiva and epithelium and biologic width at the mandibular anteriors were 1.06 ± 0.21, 0.49 ± 0.15 and 2.09 ± 0.60 mm, respectively., Conclusion: OCT has promise for non-invasive observation of the periodontal tissue profile in detail and measurement of internal periodontal structures including biologic width in the anterior region., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Approximately 10 9 bacteria can be harbored within periodontal pockets (PP) along with inflammatory byproducts implicated in the pathophysiology of systemic diseases linked to periodontitis (PD). Calculation of this inflammatory burden has involved estimation of total pocket surface area using analog data from conventional periodontal probing which is unable to determine the three-dimensional (3-D) nature of PP. The goals of this study are to determine the radiopacity, biocompatibility, and antimicrobial activity of transient micro-particle fillers in vitro and demonstrate their capability for 3-D imaging of artificial PP (U.S. Patent publication number: 9814791 B2)., Methods: Relative radiopacity values of various metal oxide fillers were obtained from conventional radiography and micro-computed tomography (μCT) using in vitro models. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays were used to measure the biocompatibility of calcium tungstate (CaWO 4 ) particles by determination of viable keratinocytes percentage (%) after exposure. After introducing an antibacterial compound (K21) to the radiopaque agent, antimicrobial tests were conducted using Porphyromonas gingivalis (P. gingivalis) and Streptococcus gordonii (S. gordonii) strains and blood agar plates., Results: CaWO 4 micro-particle-bearing fillers exhibited an X-ray radiopacity distinct from tooth structures that enabled 3-D visualization of an artificial periodontal pocket created around a human tooth. MTT assays indicated that CaWO 4 micro-particles are highly biocompatible (increasing the viability of exposed keratinocytes). Radiopaque micro-particle fillers combined with K21 showed significant antimicrobial activity for P. gingivalis and S. gordonii., Significance: The plausibility of visualizing PP with 3-D radiographic imaging using new radiopaque, biocompatible, transient fillers was demonstrated in vitro. Antibacterial (or other) agents added to this formula could provide beneficial therapeutic features along with the diagnostic utility., (Published by Elsevier Ltd.)

Background: Periodontitis is an infectious/inflammatory disease most often diagnosed by deepening of the gingival sulcus, which leads to periodontal pockets (PPs) conventional manual periodontal probing does not provide detailed information on the three-dimensional (3-D) nature of PPs., Objectives: To determine whether accurate 3-D analyses of the depths and volumes of calibrated PP analogues (PPAs) can be obtained by conventional cone beam computed tomography (CBCT) coupled with novel radiopaque micro-particle fillers (described in the companion paper) injected into the PPAs., Methods: Two PPA models were employed: (1) a human skull model with artificial gingiva applied to teeth with alveolar bone loss and calibrated PPAs, and (2) a pig jaw model with alveolar bone loss and surgically-induced PPAs The PPAs were filled with controlled amounts of radiopaque micro-particle filler using volumetric pipetting Inter-method and intra-method agreement tests were then used to compare the PPA depths and volumes obtained from CBCT images with values obtained by masked examiners using calibrated manual methods., Results: Significant inter-method agreement (0.938-0.991) and intra-method agreement (0.94-0.99) were obtained when comparing analog manual data to digital CBCT measurements enabled by the radiopaque filler., Significance: CBCT imaging with radiopaque micro-particle fillers is a plausible means of visualizing and digitally assessing the depths, volumes, and 3-D shapes of PPs This approach could transform the diagnosis and treatment planning of periodontal disease, with particular initial utility in complex cases Efforts to confirm the clinical practicality of these fillers are currently in progress., (Published by Elsevier Ltd.)

Background and Objective: The aim of the present study was to compare clinical periodontal parameters and to assess the release of C-telopeptides pyridinoline cross-links (ICTP) and C-terminal crosslinked telopeptide (CTX) from gingival collagen of naswar (NW) and non-naswar (control) dippers., Material and Methods: Eighty-seven individuals (42 individuals consuming NW and 45 controls) were included. Clinical (plaque index, bleeding on probing, probing depth and clinical attachment loss) and radiographic (marginal bone loss) periodontal parameters were compared among NW and control groups. Gingival specimens were taken from subjects in NW and control groups, assessed for ICTP and CTX levels (using ELISA) and analyzed using micro-Raman spectroscopy. The significance of differences in periodontal parameters between the groups was determined using Kruskal-Wallis and Mann-Whitney U tests. The percent loss of dry mass over exposure time and the rate of release of ICTP and CTX from all groups were compared using the paired t-test to examine the effects of exposure time., Results: Clinical and radiographic periodontal parameters were significantly higher in the NW group than the control group (P < .01). In the Raman spectrum, the strongest and sharpest band occurred at 1260 cm -1 amongst NW users. A Raman band at Amide I was observed with slight shifts in wave numbers. The rate of ICTP and CTX release was significantly higher in subjects from the NW group compared with those from the control group (P < .05). Both factors, the type of groups and time, had a significant effect on release of ICTP and CTX (P < .05)., Conclusion: Within the limits of the present study, it may be concluded that clinical and radiographic periodontal parameters were worse among subjects in the NW group than in those of the control group. There is a higher degree of collagen breakdown in the connective tissue of subjects in the NW group as a result of naswar usage., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The periodontal probe is the gold standard tool for periodontal examinations, including probing depth measurements, but is limited by systematic and random errors. Here, we used photoacoustic ultrasound for high-spatial resolution imaging of probing depths. Specific contrast from dental pockets was achieved with food-grade cuttlefish ink as a contrast medium. Here, 39 porcine teeth (12 teeth with artificially deeper pockets) were treated with the contrast agent, and the probing depths were measured with novel photoacoustic imaging and a Williams periodontal probe. There were statistically significant differences between the 2 measurement approaches for distal, lingual, and buccal sites but not mesial. Bland-Altman analysis revealed that all bias values were < ±0.25 mm, and the coefficients of variation for 5 replicates were <11%. The photoacoustic imaging approach also offered 0.01-mm precision and could cover the entire pocket, as opposed to the probe-based approach, which is limited to only a few sites. This report is the first to use photoacoustic imaging for probing depth measurements with potential implications to the dental field, including tools for automated dental examinations or noninvasive examinations.

Here, we report a case of gingival fenestration requiring periodontal plastic surgery. The patient was a 32-year-old man presenting with the chief complaint of esthetic impairment and gingival twitching due to gingival fenestration. Baseline examination revealed localized periodontal breakdown, including gingival fenestration in the lower right central incisor (#41). Periodontal examination revealed 3% of sites with a probing depth of ≥4 mm and 8.9% with bleeding on probing. Radiographic examination revealed vertical bone loss in #15 and 36, together with buccal fenestration in #41. Based on a clinical diagnosis of chronic periodontitis with gingival fenestration, initial periodontal therapy comprised plaque control and scaling and root planing. Following suppression of inflammation, occlusal adjustment was performed in the anterior teeth. As plastic surgery, combined use of an elevated flap and a connective tissue graft was applied at #41. Following reevaluation, the patient was placed on maintenance care. The patient's periodontal condition has remained stable over a 6-month period.

The clinical effects of treatment with 808- and 980-nm diode lasers as an adjunct to a uniform and consistent nonsurgical periodontal treatment protocol (NSPTP) for initial probing pockets ≥ 6 mm with a 10-year follow-up were evaluated. In total, 24 patients (16 test cases and 8 control cases) were treated with the NSPTP. The control group (CG) was treated only with nonsurgical conventional therapy, while the test group (TG) received treatment with thermal diode lasers (wavelength of 808 or 980 nm). All patients had recall visits every 3 months and were reevaluated at 1 year after NSPTP. Following the 1-year follow-up, patients were monitored at 4-month intervals for the remaining 9 years. In total, 646 teeth (433 in TG [124 multirooted teeth and 309 single-rooted teeth] and 213 in CG [64 multirooted teeth and 149 single-rooted teeth]) were included. The initial probing pocket depth (PPD) in single-rooted teeth from TG patients decreased from an average of 6.7 mm to 3.3 mm after 1 year, and to 2.3 mm after 10 years. The mean increase in clinical attachment level (CAL) was 3.8 mm. The initial PPD of single-rooted teeth in CG patients decreased from an average of 6.4 mm at baseline to 4 mm after 1 year and 3.3 mm after 10 years. The mean increase in CAL was 2.5 mm in CG. In the TG, the PPDs of multirooted teeth decreased from 6.2 mm to 3.3 mm after 1 year, where they remained stable for 10 years. The mean increase in CAL was 2.2 mm in this group. In the CG, the PPDs for multirooted teeth decreased from 7 mm to 5.8 mm after 1 year and were 5.1 mm after 10 years. The mean increase in CAL was 1.9 mm. The TG had significantly better clinical parameters than the CG, including reduced tooth loss. Compared to conventional debridement alone, the use of thermal diode lasers with NSPTP improves PPD and increases CAL in periodontal pockets ≥ 6 mm over the long term.

Background: Clinical outcomes from videoscope assisted minimally invasive surgery (VMIS) at 36 to 58 months are reported., Methods: Fourteen patients having sites with residual probing depth (PD) of at least 5 mm and 2 mm loss of clinical attachment level (CAL) after initial non-surgical therapy were treated with VMIS., Results: At 36 months or greater post-surgery there was a statistically significant improvement (P <0.001) in mean PD and CAL (PD: 3.80 ± 1.18 mm, CAL: 4.16 ± 1.18 mm) in all surgical sites compared with baseline. There was a mean improvement in soft tissue height (0.36 ± 0.64 mm, P = 0.03). In most cases, patients reported no postoperative discomfort., Conclusions: Improvements from VMIS appear to be favorable when compared with previously reported results of periodontal regenerative surgery. All improvements were stable over time. The lack of post-surgical recession after VMIS has not been reported with traditional regenerative surgery.

Introduction: The purpose of this study was to evaluate the changes of the marginal periodontium 1 year after apical surgery., Methods: Clinical and radiographic (cone-beam computed tomographic) examinations of 54 teeth treated with buccal access flaps for apical surgery were performed at baseline and after 1 year. Clinical assessment included measurements of probing pocket depth, the level of gingival margin (GM), and the width of keratinized tissue. Subsequently, the clinical attachment level (CAL) and the width of the attached gingiva were calculated. On bucco-oral cone-beam computed tomographic sections, the height and thickness of the crestal bone and the thickness of the alveolar bone were measured at different levels., Results: In general, the calculated mean changes of periodontal tissue and crestal/alveolar bone were only minimal. Significant mean changes included only GM and CAL on midoral aspects and the distance from the cementoenamel junction or restoration margin on midbuccal sites. CAL was further correlated with the thickness of the alveolar bone at 3 mm below the cementoenamel junction or restoration margin. None of the clinically and radiographically calculated mean changes were correlated with sex, biotype, or incision techniques. With regard to age, older patients showed significantly more gingival recession on the buccal aspect compared with younger individuals. Furthermore, mean changes of the midbuccal width of the attached gingiva were positively correlated with the healing outcome, whereas mean changes of the midoral GM and CAL were negatively correlated with the healing outcome., Conclusions: Within an observation period of 1 year, the marginal periodontium and its underlying bone structures did not suffer from significant changes after apical surgery., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The autogenous tooth transplantation approach to replace missing teeth has been in use for a long time. Different surgical techniques have been developed to improve prognosis and longevity of transplanted teeth with complete root formation. Many factors reportedly affected short- and long-term success of the procedure: complications such as ankylosis and root resorption up to the tooth exfoliation have occurred frequently. Several studies have appeared on this issue over the years. However, outcomes of transplantations have not yet been conclusively determined as no randomized clinical trials have been published on this issue, and their effectiveness has been evaluated only in observational studies. On the other hand, interesting information from specific experimental studies on the healing pattern of the interface between the root surface and alveolar bone in the replantation/transplantation model, and from non-related studies dealing with mechanically induced periodontal trauma, has been available and potentially useful since the 1970s to 1980s. However, this information has not been incorporated into clinical literature regarding tooth autotransplantation. This commentary aims to show how information from related and unrelated experimental models was translated to a clinical setting and led to a novel approach, successfully applied, in the autotransplantation of a multirooted tooth with completed root formation.

The aim of the study was to analyze research methods for periodontitis severity and elaborate the most effective diagnostic combination. Twenty patients with moderate periodontal disease were included in the study. In addition to conventional diagnostic methods depth of periodontal pockets (PP) was measured by means of endoscopic system and cone bean CT. Differences in PP depth estimated by probing and endoscopic evaluation was 1.2±0.4 mm proving endoscopic method to be useful and most precise tool for periodontal diagnostics.

Objectives: In contrast to two-dimensional planar images, a measuring point is hardly repeatedly determined in a CBCT image when alveolar bone loss is assessed. Thus, the aim of the present study was to propose a six-site measuring method, which is closely related to anatomical structure, for the evaluation of alveolar bone loss in CBCT images., Methods: 150 measuring points in 11 molars and 14 premolars from 6 patients (2 males and 4 females) were included. CBCT images of the teeth were acquired prior to periodontal surgery. Four observers measured the distances between cemento-enamel junctions and the apical bases of the periodontal bone defect at the mesio-buccal, mid-buccal, disto-buccal, mesio-lingual/palatal, mid-lingual/palatal and disto-lingual/palatal sites in CBCT images. Direct measurements of the six sites were correspondingly obtained in the subsequent periodontal surgeries. Differences between the distances measured in the CBCT images and during the surgery were analysed. Interobserver and intraobserver variances were tested., Results: No statistically significant difference was found between the surgical and CBCT measurements (p = 0.84). Diagnostic coincidence rates of four observers were 86.7%, 87.3%, 88.7% and 88.0%, respectively. The interobserver (p = 0.95) and intraobserver (p = 0.30) variances were not significant., Conclusions: The six-site measuring method validated in the present study may be a useful three-dimensional measuring method for the evaluation of periodontal disease.

Aim: This study aimed to determine the degree of discrepancy between clinical measurement of furcation involvement (FI) and cone beam computed tomography image analysis of multirooted teeth., Methods: FI measurements obtained from clinical records were compared to CBCT images of the same teeth to determine the degree of discrepancy between CBCT FI grading and clinical FI grading., Results: Of the hundred and fifty-four sites analysed, 22% of FI measurements from probing and CBCT were in agreement. Fifty-eight percent of clinical FI recordings were overestimated, and 20% were underestimated when compared to CBCT analysis., Conclusion: Clinical recording of FI is both over and underestimated compared to CBCT analysis. This was highest for probing recording grade I furcation involvement where it was highly overestimated. The occurrence of over and under estimation of FI will affect the assignment of prognosis to multirooted teeth, which can influence treatment planning for periodontal therapy and may result in inappropriate treatment., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Periodontitis is a multifactorial and infectious disease that may result in significant debilitation. The aim of this study is to exploit two optical coherence tomography (OCT) systems operating in the Fourier domain at different wavelengths, 930 and 1,325 nm, for structural analysis of periodontal tissue in porcine jaws., Methods: Five fresh porcine jaws were sectioned and stored in formalin before OCT analysis. Two- and three-dimensional OCT images of the tooth/gingiva interface were performed, and measurements of the gingival structures were obtained. The 930-nm OCT system operates in the spectral domain, whereas the 1,325-nm system is a swept-source model. Stereomicroscope images, the gold standard, were used for direct comparison., Results: Through image analysis, it is possible to identify the free gingiva and the attached gingiva, the calculus deposition over tooth surfaces, and the subgingival calculus that enables the enlargement of the gingival sulcus. In addition, the gingival thickness and the gingival sulcus depth can be non-invasively measured, varying from 0.8 to 4 mm., Conclusions: Regarding the ability of the two OCT systems to visualize periodontal structures, the system operating at 1,325 nm shows a better performance, owing to a longer central wavelength that allows deeper tissue penetration. The results with the system at 930 nm can also be used, but some features could not be observed due to its lower penetration depth in the tissue.

Aim: To present 10-year cone beam CT (CBCT) data on the fate of buccal bone at single-tooth implants placed early, delayed, or late after tooth extraction., Material and Methods: Sixty-three of 72 patients, originally randomly allocated to three equal-size groups, received a single-tooth implant on average 10 days (Ea; N = 22), 3 months (De; N = 22), or 1.5 years (La; N = 19) after tooth extraction. Healing abutments were mounted after a 3-month period of submerged healing and metalceramic crowns were cemented after one additional month. At the second stage surgery, presence of buccal bone defects (dehiscences or intrabony) and their dimensions were registered. CBCT scans recorded with a Scanora(®) 3D unit and standardized periapical (PA) radiographs of the implants were obtained at the 10-year control. Interproximal bone levels (i.e., the distance from the implant platform to the first bone-to-implant contact; BIC) measured in CBCT image sections and PA were compared, and the buccal bone level was determined in the CBCT images., Results: Two Ea and one De implants failed to osseointegrate. Forty-nine patients attended the 10-year control and due to poor quality of 5 CBCT scans, useful CBCT images were available from 44 patients (Ea:12, De:17, La:15). No significant differences between CBCT and PA images in measurements of the interproximal bone levels were observed. Ten years after implant placement, BIC at the buccal aspect was located on average 2 mm apically to the implant platform (2.39 ± 1.06 mm [median = 2.36] for Ea, 2.22 ± 0.99 mm [median = 2.16] for De, and 1.85 ± 0.65 mm [median = 1.95] for La implants) with no significant difference among the groups (P = 0.20). Mean buccal bone level (bBL) for implants with an intrabony or a dehiscence defect at second stage surgery was 2.51 ± 1.12 mm [median = 2.70] and 2.84 ± 0.70 mm [median = 2.79], respectively, while 1.78 ± 0.74 mm [median = 1.93] for the implants with no defect. The difference in bBL between the implants without a defect and those with a dehiscence was significant at 10 years (P = 0.0005)., Conclusion: Time of placement of single-tooth implants after tooth extraction did not significantly influence the peri-implant buccal bone level, while presence of a buccal bone dehiscence at second stage surgery resulted in significantly more apically located BIC buccally at 10 years., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried out 1973-2003. In 1973, 1983, 1993, 2003, and 2013 random samples of 1,000; 1,104; 1,078; 987; and 1,010 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80o years. Eighty-year-olds were not included in 1973. All subjects were inhabitants of the city of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment. The frequency of edentulous individuals aged 40-70 years was 16, 12, 8, 1, and 0.3% in 1973, 1983, 1993, 2003, and 2013, respectively. No complete denture weareryounger than 80-years old was found in 2013. During the 40-year period, the mean number of teeth in the age groups 30-80 years increased. In 2013, the 60-year-olds had nearly complete dentitions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36 in 2013. This was higher than earlier surveys, 4 in 1993, and 18 in 2003. The percentage of children and adults without caries and restorations increased during the 40-year period. It was found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013. In the age groups 10-20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013, 43% of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5-60 years, DFS was lower in 2013 compared to the earlier examinations.There was no major change in DFS between 2003 and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40-year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percentage of crowned teeth in the age groups 40 and 50-year-olds. The percentage of endodontically treated teeth decreased between 1973 and 2013 in all age groups. In age groups 10-30-year-olds a major reduction from about 30% to 15% in mean plaque score was seen between 1973-2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older, a decrease in the percentage of surfaces with plaque was observed between 2003-2013. The percentage of tooth sites with gingivitis was for 20 years and older about 40% in 1973. In 2013, the percentage was about 15%. The frequency of sites with gingivitis was generally lower in 2013 compared with the otheryears,1973-1993. The percentage of individuals with probing pocket depths > 4mm increased with age. Between 2003-2013 a clear reduction was seen in all age groups in frequency of individuals with probing pocket depth > 4mm. Over the 40-year period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects with moderate alveolar bone loss were seen. The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the provision of dental helath care and dental delivery system in the near future.

Objective: To evaluate and compare the efficacy of platelet-rich fibrin (PRF) with enamel matrix derivative (EMD; Emdogain) in the treatment of periodontal intrabony defects in patients with chronic periodontitis, six months after surgery., Methods: Forty-four (44) intrabony defects in 30 patients (15 males) were randomly allocated into two treatment groups: EMD (n = 22) and PRF (n = 22). Measurement of the defects was done using clinical and cone beam computed tomography at baseline and 6 months. Clinical and radiographic parameters such as probing depth, clinical attachment level, intrabony defect depth and defect angle, were recorded at baseline and 6 months post-operatively. Within group change was evaluated using the Wilcoxon signed rank test. Intergroup comparisons were made using the Mann-Whitney U test., Results: Postsurgical measurements revealed that there was an equal reduction in probing depth and a greater but statistically non-significant attachment gain for the Emdogain group when compared to the platelet-rich fibrin group. The Emdogain group presented with significantly greater percentage defect resolution (43.07% ± 12.21) than did the platelet-rich fibrin group (32.41% ± 14.61). Post-operatively the changes in defect width and defect angle were significant in both groups, but upon intergroup comparison they were found to be statistically non-significantly different., Conclusion: Both Emdogain and platelet-rich fibrin were effective in the regeneration of intrabony defects. Emdogain was significantly superior in terms of percentage defect resolution.

Aim: The aim of this study was to investigate the accuracy of cone-beam computed tomography (CBCT) in assessing maxillary molar furcation involvement (FI)., Materials and Methods: Fifteen patients with generalized chronic periodontitis after initial therapy were recruited. CBCT was performed in maxillary molars with probing pocket depths of ≥6 mm and advanced FI, and CBCT images were analysed. Furcation surgery was performed in 20 maxillary molars. Lastly, intra-surgical FI assessments were compared with CBCT-based data., Results: Intra-surgical findings confirmed 82.4% of the CBCT data, with a weighted kappa of 0.917. The agreement between both assessments was the highest in buccal furcation entrances, followed by distopalatal and mesiopalatal furcation entrances. Of the four parameters tested of detailed root anatomy and furcation morphology, the mean length of the root trunk and the width of the furcation entrance revealed by CBCT were consistent with their respective intra-surgical values (p > 0.05). Horizontal bone loss and vertical bone loss were underestimated by CBCT relative to their respective intra-surgical classifications (p ≤ 0.05)., Conclusions: Cone-beam computed tomography images demonstrate a high accuracy in assessing the loss of periodontal tissue of the FI and root morphologies in maxillary molars., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

In general, periodontal tissues are clinically assessed using calibrated periodontal probes and radiographs. Due to technical developments and the availability of cone-beam computed tomography (CBCT), 3-D imaging has become feasible and offers some advantages and potential for the evaluation of complex anatomical structures. The present pilot study illustrates and validates the possibility of radiographically visualizing and metrically assessing hard and soft tissue. Artificial periodontal pockets were created in porcine mandibles and measured by clinical (i.e. pocket probing) and radiographic means (CBCT). For the latter method, pockets were filled with a radiopaque material allowing visualization by CBCT. Clinically simulated pocket depth probing and CBCT measurements were compared. The results showed no statistically significant differences between the two methods. Thus, the CBCT visualization approach points towards the development of a new and promising radiographic all- in-one evaluation system of the periodontal status. However, more research and development is required.

SUMMARY There is lack of consensus with respect to the preferred surgical procedure for the treatment of palatally impacted maxillary canines. The aim of this study was to evaluate post-treatment periodontal status of palatally impacted canines treated by open technique with free eruption and closed flap technique and compare it with naturally erupted canines. The subjects comprised 43 patients treated for unilateral palatally impacted maxillary canines and examined 4.19±1.44 months (3-6 months) after removal of the fixed appliance. The group 1 comprised subjects treated by open technique with free eruption (n = 22) and group 2 by closed technique (n = 21). Post-treatment examination comprised periodontal and radiographic examination. There were no significant intergroup differences with respect to periodontal pocket depth or bone support. However, compared with contralateral quadrants with normally erupted canines, quadrants with impacted canines exhibited significant bone loss at the distal contact point of the lateral incisor and the mesial contact point of the canine. The duration of treatment was 28.41±4.96 months for group 1 and 32.19±11.73 months for group 2 (P > 0.05). The mean treatment time required to achieve eruption/extrusion of the impacted canine was 3.05±1.07 months for group 1 and 6.86±4.53 months (P < 0.01) for group 2. It is concluded that choice of surgical method is not associated with any significant differences in post-treatment periodontal status of palatally impacted canines and adjacent teeth.

The goal of this study was to evaluate the effectiveness of demineralized bone matrix (DBM) putty, consisting of demineralized human bone allograft matrix in a carrier of bovine collagen and alginate, for the treatment of periodontal defects in humans. Twenty subjects with at least one site having a probing depth ≥ 6 mm and radiographic evidence of bony defect depth > 3 mm were included. The infrabony defects were grafted with DBM putty bone graft. The following clinical parameters were assessed at baseline and 6 months posttreatment: probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Bone fill was evaluated using transgingival probing and standardized radiographs taken at baseline and 6 months posttreatment. The 6-month evaluation showed a significant PD reduction of 3.27 ± 1.67 mm and clinical attachment gain of 2.27 ± 1.74 mm. Bone sounding measurements showed a mean clinical bone defect fill of 2.93 ± 1.87 mm and a mean radiographic bone fill of 2.55 ± 2.31 mm. The use of DBM putty was effective for treatment of periodontal bony defects in humans. Significant improvement in CAL, PD, and bone fill was observed at 6 months compared to baseline.

Background: The aim of this randomized clinical trial was to evaluate the efficacy of Apically Positioned Flap with Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) to treat periodontal pockets associated with infrabony defect ≤3 mm at posterior natural teeth., Material and Methods: Thirty patients with chronic periodontitis showing persistent periodontal pockets after cause-related therapy were enrolled; 15 patients were randomly assigned to FibReORS (test group) and 15 to ORS (control group). Measurements were performed by a blind and calibrated examiner. Outcome measures included intra-operative and post-operative morbidity and root sensitivity, 1-year probing depth (PD), gingival recession (Rec) and radiographic bone changes., Results: No differences in clinical and bone defect parameters were observed at baseline. Marginal bone resection was reduced by 0.9-1.6 mm in the FibReORS group. ORS was associated with patient perception of greater surgical hardship (p = 0.0264), higher 1-week pain experience (p = 0.0001) and greater dental hypersensitivity (p = 0.0002). After 1 year, shallow, maintainable PD with no difference between the two procedures (p = 0.3707) was obtained. FibReORS was associated with less final Rec (p < 0.0001) and less radiographic bone loss (p < 0.0001) than ORS. Dental hypersensitivity remained significantly higher in the ORS group (p = 0.0024)., Conclusion: FibReORS was similarly effective as ORS for PD reduction with less final Rec and patient morbidity., (© 2012 John Wiley & Sons A/S.)

Objectives: To investigate the frequency, position, number and morphology of enamel pearls (EPs) using micro-CT (µCT) and to report a case of an EP mimicking an endodontic-periodontic lesion., Methods: Cone beam CT (CBCT) was performed in a patient to evaluate a radio-opaque nodule observed on the left maxillary first molar during the radiographic examination. Additionally, 23 EPs were evaluated regarding frequency, position, number and morphology by means of µCT. The results were statistically compared using the Student's t-test for independent samples., Results: 1 pearl was presented in 13 specimens, while 5 specimens presented 2 pearls. The most frequent location of the EPs was the furcation between the disto-buccal and the palatal roots of the maxillary molars. Overall, the mean major diameter, volume and surface area were 1.98 ± 0.85 mm, 1.76 ± 1.36 mm³ and 11.40 ± 7.59 mm², respectively, with no statistical difference between maxillary second and third molars (p > 0.05). In the case report, CBCT revealed an EP between the disto-buccal and the palatal roots of the maxillary first left molar associated with advanced localized periodontitis. The tooth was referred for extraction., Conclusions: EPs, located generally in the furcation area, were observed in 0.74% of the sample. The majority was an enamel-dentin pearl type and no difference was found in maxillary second and third molars regarding diameter, volume and surface area of the pearls. In this report, the EP mimicked an endodontic-periodontic lesion and was a secondary aetiological factor in the periodontal breakdown.

The aim of this study was to radiographically analyse long-term changes in (i) overeruption of unopposed molars and (ii) tipping of molars with a mesial edentulous space, and whether there is an interaction between the two events. A further aim was to analyse if loss of alveolar bone height might influence overeruption and tipping. The sample consisted of panoramic radiographs taken at an interval of 12 years of 292 subjects from a prospective population study of women. The panoramic radiographs were scanned and analysed. Changes in tipping, overeruption and alveolar bone height of molars and control teeth were measured. The results showed that unopposed molars were more commonly found in the upper jaw and that unopposed molars showed 4·9 times higher risk of overeruption of ≥2 mm (95% CI 1·5-15·3) than opposed molars during the 12-year observation period. The average overeruption for the unopposed molars was 4·5% (s.d. 7·6), which corresponds to approximately 0·9 mm. The degree of overeruption increased with decreased bone support. Molars with a mesial edentulous space were most prevalent in the lower jaw, but neither an edentulous space nor alveolar bone level/bone level change were found to have a significant effect on tipping of the molars. The average mesial tipping was 0·8° (s.d. 5·6). In conclusion, unopposed molars showed a significantly increased risk for overeruption. Molars facing a mesial edentulous space showed a low risk for mesial tipping, but a significant interaction between overeruption and tipping was identified., (© 2011 Blackwell Publishing Ltd.)

Aim: The aim of the present study was to examine how deleterious current smoking and the use of Swedish moist snuff (snus) is for periodontal health compared with non-tobacco users., Materials and Methods: The studies comprised three epidemiological cross-sectional studies, in 1983, 1993 and 2003, of stratified random samples aged 20, 30, 40, 50, 60 and 70 years. The numbers of dentate participants were 550, 552 and 523, respectively. The participants were examined clinically and radiographically. Diagnostic criteria were the number of teeth, plaque, gingival status, probing pocket depth (PPD) ≥ 4 mm, height of the alveolar bone level and classification by periodontal disease experience. In addition, participants were asked about their tobacco habits., Results: Multiple logistic regression shows, after adjusting for age, gender and sociodemographic variables, that relative to non-tobacco users, cigarette smokers had statistically significant less gingivitis, a higher frequency of PPD ≥ 4 mm and a higher incidence of severe periodontitis. There was no significant association between gingivitis, frequency of PPD ≥ 4 mm and periodontal disease experience and snus use., Conclusions: Cigarette smokers were found to have a statistically significant higher risk of severe periodontitis than non-tobacco users and users of snus. Using snus did not seem to be a risk factor for periodontitis., (© 2011 John Wiley & Sons A/S.)

Introduction: Vertical root fractures of teeth (VRFs) often pose a diagnostic dilemma because of the difficulty in detection of these in intraoral radiographs except in certain cases with very distinct clinical findings. This often leads to unwarranted extraction of the tooth. Cone-beam computed tomography (CBCT) produces three-dimensional images and allows precise visualization and evaluation of VRFs or cracks in extracted teeth, as reported previously. This clinical pilot study was designed to determine the diagnostic accuracy of noninvasive CBCT for detection of suspected VRFs in endodontically treated teeth by using exploratory surgery to confirm the presence or absence of a fracture., Methods: Thirty-two teeth in 29 patients with clinical signs and symptoms suggestive of VRF were included in the study after informed consent was obtained. They underwent a limited area CBCT evaluation. All CBCT studies were blinded, and 2 board-certified oral and maxillofacial radiologists assessed the presence or absence of VRF through sequential evaluation of the three-dimensional volume. Subjects underwent surgical exploration as part of treatment, which helped establish the presence or absence of VRF., Results: Pearson correlation coefficient by using surgical finding to confirm presence/absence of fracture was 0.602, positive predictive value was 91%, and negative predictive value was 67%. The sensitivity was 88%, and specificity was 75%., Conclusions: This study revealed the superior diagnostic accuracy of CBCT for detection of VRF., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To present the successful endodontic and periodontal management of a two rooted maxillary lateral incisor tooth with a complex radicular lingual groove and severe periodontal destruction using spiral computed tomography as a diagnostic aid., Summary: A 30-year-old male patient presented with a chief complaint of mobility and discharge of pus in an upper front tooth. Clinical examination revealed a sinus tract on the labial gingival surface and a 10-mm-deep periodontal pocket associated with maxillary left lateral incisor tooth. On the lingual side, a groove emerging from cingulum, continuing mesioapically down the lingual aspect of tooth was found. Intraoral periapical radiographs demonstrated a lateral periodontal defect around the mesial aspect and a diffuse radiolucency at the apex of maxillary left lateral incisor tooth. The sinus tract was traced with gutta-percha to the maxillary left lateral incisor that showed an accessory root surrounded by a large radiolucent area. A spiral computed tomographic scan for better understanding of the complicated root canal morphology of the tooth was performed. Based on the clinical, radiographic and spiral computed tomographic findings, a diagnosis of an endo-perio lesion in tooth 22 was made. Management consisted of conventional root canal treatment, radiculoplasty, root resection of accessory root and surgical curettage of the periodontal defect. Follow-up with radiographic examination at 3 months and 1 year was performed. At 1-year recall, the patient was asymptomatic, there was no evidence of the sinus tract and a 3-mm nonbleeding pocket was present in relation to tooth 22. Progression of hard tissue healing was observed in the periapical radiograph taken 1 year postoperatively., Key Learning Points: The key to achieving favourable results in this particular type of developmental anomaly is accurate diagnosis and treatment planning. The health of the periapical osseous tissues appears to be the provital factor for tooth retention. A favourable outcome can only be achieved with a comprehensive treatment approach that effectively manages all local factors that are contributing to the disease process., (© 2011 International Endodontic Journal.)

The aim of the thesis was to study orthodontic tooth movement in relation to edentulous areas and infrabony pockets as well as the physiological movement of teeth facing an edentulous area. A dog model was used in Studies I and II. Teeth were orthodontically moved into and out from inflamed, infrabony periodontal pockets (Study I) and into areas of reduced bone height (Study II). Clinical, radiographic and histometric analyses were made with respect to changes in tooth-supporting tissues. Study III involved clinical, radiographic and 3D model assessments of changes in periodontal conditions and alveolar ridge dimensions in adult patients subjected to tooth movement into areas with reduced ridge dimensions. In Study IV, panoramic radiographs of 292 subjects, taken at an interval of 12 years, were analyzed with regard to changes in the elongation of unopposed molars and tipping of molars facing a mesial edentulous space. In the animal study orthodontic bodily movement of teeth with inflamed, infrabony pockets caused an enhanced rate of progression of the periodontal lesion (Study 1), particularly when the tooth movement was directed towards the infrabony defect. Teeth with healthy periodontium that were orthodontically moved into areas of markedly reduced bone height maintained their periodontal tissue support (Study II). Corresponding orthodontic tooth movement in humans (Study III) resulted in minor dimensional alterations of the periodontal tissues and an increased bucco-lingual width of the alveolar ridge in the area into which the tooth had been moved, whereas a decreased width of the newly established edentulous area was noted. All teeth that were moved showed lateral root resorption at the level of the bone crest on the pressure side, but signs of repair were noticed 1-year post-treatment. In the 12-year radiographic study (Study IV) unopposed molars showed a significant increase in elongation over the 12 years of follow-up. The degree of elongation increased with decreased bone support. Neither edentulous space nor alveolar bone level were found to have a significant effect on tipping. In the presence of both conditions, unopposed molars and molars facing a mesial edentulous space, an increase in elongation was associated with tipping.

Radiographic outcomes are important for the diagnosis and treatment of periodontal diseases. However, the assessment of radiographic measurements is affected by many factors, and it is therefore difficult to ascertain changes in radiographic outcomes. In this study, we proposed a latent variable approach to correct for the distortion in the radiographic measurements in pairs of periapical radiographs taken before and after periodontal treatment. Clinical data from 123 patients treated with non-surgical periodontal therapy was used to illustrate the latent variable approach in assessing radiographic changes in infrabony defect depth. Results were compared with a correction factor method. Computer simulations were also undertaken to evaluate the performance of these two methods compared with uncorrected, raw measurements by calculating their intraclass correlation coefficients (ICCs). The example data set showed that the latent variable method (LVM) and the correction factor method (CFM) were comparable. Simulations showed that both methods achieved very high ICCs in different scenarios, whilst uncorrected raw measurements had relatively low ICCs. This study suggests that correction for errors in radiographic measurements is required for routine radiographs. Whilst both LVM and CFM achieve excellent results, LVM is more flexible in handling missing values, and may provide better results when treatment effects are large., (© 2010 Eur J Oral Sci.)

Background: The failure of the host tissue to establish or maintain osseointegration around dental implants is due to either occlusal or parafunctional forces, premature loading, ill-directed stress, or microbial infection. The long-term failure rate of dental implants is generally 5-10%. Although a variety of etiologies of early peri-implant bone loss (from implant placement to 1-year post-loading) have been proposed, factors associated with late implant failures are less well understood but are probably related to both the peri-implant microbial environment and host factors. Discriminating between causes of implant failure is of importance for instituting a successful implant therapy., Purpose: The objective of this cross-sectional split-mouth study was to identify clinical, radiographic, and bacterial characteristics of peri-implant disease sites., Materials and Methods: Fifteen patients with bilateral implants (Brånemark, Nobel Biocare AB, Göteborg, Sweden; and 3i implant systems, Implant Innovations Inc., Palm Beach Gardens, FL, USA) participated in the study. Sites with peri-implant (radiographic bone loss beyond the third implant thread) and peri-implant healthy tissues (radiographic bone level above the first implant thread) were identified in periapical radiographs using a long-cone paralleling projection technique. Microbiological identification was carried out using established anaerobic culture techniques. A descriptive statistics based on means and standard deviations was reported., Results: Peri-implant bone loss was associated with the absence of radiographic crestal lamina dura, peri-implant pocket depth, pain on chewing, and the submucosal presence of the putative periodontopathogens Tannerella forsythia, Campylobacter species, and Peptostreptococcus micros. Pain was associated with P. micros, Fusobacterium species, and Eubacterium species., Discussion and Conclusion: The absence of radiographic crestal lamina dura and the presence of suspected major periodontal pathogens seem to be associated to peri-implantitis.

Background: Previous studies demonstrated significant variability in the histologic biologic width in periodontal health and mild periodontitis. The purpose of this study was to determine whether the previously established dimensions of the biologic width applied to subjects with severe, generalized, chronic periodontitis., Methods: Twenty-eight subjects, aged 29 to 45 years, with severe, generalized, chronic periodontitis were included in the study. There were 18 males and 10 females, and 19 (68%) of the patients were smokers. Clinical and radiographic measures were taken by calibrated examiners. The clinical biologic width was determined from the most coronal level of clinical attachment to the crest of the alveolar bone for proximal surfaces only and compared to the histologic biologic width previously reported., Results: The clinical biologic width in subjects with severe, generalized periodontitis was significantly greater than previously reported (P <0.001). For all evaluable proximal sites, the mean clinical biologic width was 3.95 mm versus the mean histologic biologic width of 2.04 mm. The greatest clinical biologic widths were seen with pockets <2 mm (5.02 +/- 2.48 mm; range: 1.60 to 9.00 mm) and 2 to 4 mm (4.16 +/- 1.32 mm; range: 0.20 to 6.40 mm)., Conclusions: The mean clinical biologic width in subjects with severe, generalized, chronic periodontitis seemed to be significantly greater than the histologic biologic width previously reported for subjects not demonstrating significant periodontal pathology. In addition, sites with shallow probing depths demonstrated the greatest biologic width, suggesting that these sites may be at increased risk for losing clinically significant attachment during surgical procedures.

Background: Scaling and root planing of diseased periodontal pockets is fundamental to the treatment of periodontal disease. Although various clinical parameters have been used to assess the efficacy of this therapy, radiographic analysis of changes in bone density following scaling and root planing has not been extensively researched. In this study, digital subtraction radiography was used to analyze changes that occurred in the periodontal hard tissues following scaling and root planing., Methods: Thirteen subjects with a total of 39 sites that presented with >3 mm of vertical bone loss were included in this study. Clinical examinations were performed and radiographs were taken prior to treatment and were repeated 6 months following scaling and root planing. Radiographic analysis was performed with computer-assisted radiographic evaluation software. Three regions of interest (ROI) were defined as the most coronal, middle, and apical portions of each defect. A fourth ROI was used for each site as a control region and was placed at a distant, untreated area. Statistical analysis was carried out to evaluate changes in the mean gray level at the coronal, middle, and apical region of each treated defect., Results: Digital subtraction radiography revealed an increase in radiographic density in 101 of the 117 test regions (83.3%). A 256 gray level was used, and a value >128 was assumed to represent a density gain in the ROI. The average gray level increase was 18.65. Although the coronal, middle, and apical regions displayed increases in bone density throughout this study, the bone density of the apical ROI (gray level = 151.27 +/- 20.62) increased significantly more than the bone density of the coronal ROI (gray level = 139.19 +/- 21.78). A significant increase in bone density was seen in probing depths >5 mm compared to those <5 mm in depth. No significant difference was found with regard to bone-density changes surrounding single- versus multiple-rooted teeth., Conclusion: Scaling and root planing of diseased periodontal pockets can significantly increase radiographic alveolar bone density as demonstrated through the use of digital subtraction radiography.

Background: The Aims of this retrospective study were: (i) to describe the applicability of Fibre Retention Osseous Resective Surgery (FibReORS) to infrabony defects with different radiographic depths and (ii) to identify significant anatomical elements associated with the decision of tooth extraction or application of FibReORS in the context of a treatment approach aimed at pocket elimination., Material and Methods: Baseline radiographs with detectable infrabony defects were collected from 68 periodontal patients. Selected teeth with radiographic evidence of infrabony defects had probing depths (PD) >4 mm at revaluation following non-surgical periodontal therapy. Teeth were then surgically treated with FibReORS or extracted on the basis of the decision making of an experienced periodontist and in the context of the overall treatment plan. The total root length and the defect depth were quantified for each selected tooth using radiographic reference points., Results: A total of 324 teeth with infrabony defects were identified. Fifty-three (16%) teeth with a mean radiographic infrabony defect of 8.5+/-1.7 mm (range 6-12 mm) were extracted; 271 (84%) teeth with a mean infrabony defect of 3.0+/-1.4 mm (1-8 mm) were surgically treated, achieving PD < or =3 mm in all sites at 6-month follow-up. Surgically treated teeth showed baseline radiographic infrabony defects < or =4 mm in 86% of the cases. Logistic multilevel modelling indicated that the probability of extraction was influenced by root length (p=0.0230) and by the radiographic defect depth (p=0.0112)., Conclusion: FibReORS is applicable in the treatment of shallow to moderate bony defects and deeper defects associated with longer roots.

Aim: The aim of the study was to test whether a slim Ultrasonic Tip reaches a more apical position when penetrating a periodontal pocket compared with the working blade of a conventional Gracey Curette in both untreated periodontitis and periodontal maintenance patients., Material and Methods: Twenty untreated and 15 periodontal maintenance patients were selected based on the presence of at least one site a pocket of > or =5 mm in each quadrant. Recordings were made at the four approximal sites of four experimental teeth in each patient. First, the probing pocket depth was measured with the Jonker Probe. Second in randomized order, the penetration depth was assessed with an EMS PS Ultrasonic Tip and a Gracey Curette., Results: In the periodontitis group, the Ultrasonic Tip penetrated significantly deeper than the Jonker Probe and the Gracey Curette. In the maintenance group, no differences were observed. Comparing the penetration of the instruments between groups, as related to the Jonker Probe measurements, only in the periodontitis group did the Ultrasonic Tip reach a significantly more apical level., Conclusion: The results of the present study show that in untreated periodontitis patients, the Ultrasonic Tip penetrated the pocket deeper than the pressure-controlled probe and the Gracey Curette.

Introduction: Prophylactic adnexectomy is widely used for cancer risk reduction in women with BRCA1 gene mutations. Adnexectomy significantly reduces ovarian/ salpinx/peritoneum cancer risk to 5% and breast cancer risk to 30-40%. The aim of the study was evaluation of influence of prophylactic adnexectomy in BRCAI gene female mutation carriers on stomatognathic system., Material and Methods: Thirty BRCA1 gene female mutation carriers aged 43-56 years, patients of the Hereditary Cancer Center in Szczecin, one year after prophylactic adnexectomy have been studied. The control group consisted the same patients, but had been studied before adnexectomy. Females with BRCA1 gene mutations have not received any hormone replacement therapy since the adnexectomy. They were divided into 2 subgroups: Y--women before menopause and Z--women aftermenopause. The complete dental exam was performed in all patients. Additionally, panoramic radiograms were performed., Results: Patients after prophylactic oophorectomy revealed higher rates of periodontal pockets 4-5 mm deep and increase of complaints such as: gingival bleeding following brushing, oral dryness and burning., Conclusions: In conclusion, especially premenopausal women with BRCA1 gene mutations after surgical menopause should use short-term hormone replacement therapy to alleviate oral discomfort. Short-term hormone replacement therapy use does not negate the protective effect of prophylactic adnexectomy on breast cancer risk reduction in BRCA1 gene mutation carriers.

Objectives: To study the 5-year outcome of combined use of guided tissue regeneration (GTR) barriers and bovine bone in advanced periodontal defects., Material and Methods: In each of 24 patients, one defect was surgically exposed, debrided, filled with bovine bone, and covered with a bioresorbable barrier. Re-examinations were made after 1, 3, and 5 years., Results: Average full-mouth plaque scores (FMPS) were 14.5% at baseline and 10.7%, 9.8%, and 18.9% after 1, 3, and 5 years, respectively. Mean probing pocket depth (PPD) was 10.0 mm at baseline. Mean PPD reduction was 5.2 mm after 1 year, 5.6 mm after 3 years, and 5.3 mm after 5 years. Mean gingival recession was 1.0 mm after 1 year, 1.6 mm after 3 years, and 1.3 mm after 5 years. Mean gain in clinical attachment level (CAL) was 4.2 mm at the 1-year, 4.1 mm at the 3-year, and 4.3 mm at the 5-year examination. Smoking significantly influenced CAL change at all re-examinations. FMPS were significantly correlated with radiographic defect depth at the 5-year examination and CAL with smoking and FMPS at the 3-year examination., Conclusion: Advanced periodontal defects can be successfully treated with the combined use of GTR barriers and bovine bone to substantially reduce PPD and achieve a stable, long-term gain of CAL.

Objective: To evaluate the effectiveness of demineralized bone matrix (DMBM), an osteoconductive and osteoinductive graft material, as a bone graft for the treatment of osseous defects, both clinically and radiographically., Materials and Methods: The effectiveness of DMBM was assessed at 40 sites in 30 patients who had infrabony defects. Grafted test sites were compared with control sites treated with open-flap debridement., Results: Significant improvement in all variables was found, including reduction of probing depth, and gain in clinical attachment level and bone fill for test and control sites at 3 months and 6 months postoperatively. For test sites, reduction of probing depth was 2.80 mm at 3 months and 4.05 mm at 6 months, and for control sites, 1.75 mm at 3 months and 2.65 mm at 6 months. Gain in the level of clinical attachment for test sites was 2.80 mm at 3 months and 4.00 mm at 6 months; for control sites, this gain was 1.75 mm at 3 months and 2.60 mm at 6 months. The mean amount of defect resolution was 2.02 mm and 3.27 mm for test sites and 0.82 mm and 1.17 mm for control sites, at 3 months and 6 months, respectively. The mean percentage of defect resolution was 37.1% and 56.5% for test sites compared with 20.5% and 28.6% for control sites, at3 months and 6 months, respectively., Conclusions: DMBM improves healing outcomes, namely, reduction of probing depth, resolution of osseous defects and gain in clinical attachment, compared with open flap debridement.

Purpose: The present study was designed to develop a new periodontal risk assessment model based on the periodontal risk assessment (PRA) model by Lang and Tonetti, and to evaluate the risk assessment capability of the proposed model., Materials and Methods: Twenty-six patients diagnosed with chronic periodontitis were selected randomly and a thorough examination and charting of the periodontal status was performed. An intra-oral periapical radiograph of the area with the deepest probing depth was also taken. The following parameters were recorded: percentage of sites with BOP, number of sites with pocket depths > or = 5mm, number of teeth lost, bone loss/age ratio, attachment loss/age ratio, diabetic and smoking status, dental status, other systemic factors and risk determinants. Using Microsoft Excel, the parameters were plotted on the radar chart as per the original and the proposed model., Results: Of the cases identified by the original model, 42.3% were high-risk cases and 30.8% of the cases were low-risk cases. In the proposed model, 46.2% of high-risk cases and 46.2% of low-risk cases were identified. Only 7.7% of the cases identified with the new model were moderate-risk cases. Statistical analysis demonstrated that there was no significant difference between the risk scores of the two models., Conclusions: The results suggest that risk assessment by this model does not vary significantly as compared to the original model, and both are equally adept at detecting potential risk groups.

The current study used advanced three-dimensional (3-D) images with quantitative information to show the bottom of an intrabony defect. The 3-D data were corrected by means of a compact computerized tomography unit for dental use using a cone-beam method (3DX, Morita). 3-D images at the bottom of the intrabony defect in which the distance between the surface of the tooth and bone reached 0.5 mm were combined to provide a reconstructed image of the entire defect. Advanced 3-D images with quantitative information to show the bottom of an intrabony defect can display visually and in three dimensions the depth of an intrabony defect all around a tooth. Moreover, the distance between the cementoenamel junction and the bottom of an intrabony defect can be measured automatically using this technique.

Background: In 1988, an implant manufacturer offered a new dental implant system, with a wide choice of hollow cylinder (HC) and hollow screw (HS) implants. The purpose of this retrospective study of HS and HC implants was to evaluate clinical and radiographic parameters of peri-implant tissue and to analyze surgical and prosthetic aftercare., Methods: A total of 89 HS and 26 HC implants in 38 edentulous patients were available for complete evaluation. The patients were treated with overdentures stabilized by two or four implants. The follow-up period was 10 years., Results: The results of the clinical evaluation showed a mean sulcus probing depth of 3.3+/-1.3 mm (range=2 to 10 mm). The mean radiographic bone loss was 2.2+/-2.1 mm (range=0.1 to 12.2 mm). One implant (HS) was removed during the osseointegration period. Three other implants (two HS and one HC) in three patients had to be removed after 10 years. The survival rate of the HS implant (96.6%) was comparable to the HC implant (96.1%). The success rate of the HS implant (93.3%) was slightly more favorable compared to the HC implant (88.5%). The HS and HC implants met the Albrektsson criteria of success., Conclusions: HS and HC implants provide a stable base for long-term support of a mandibular overdenture. Furthermore, it is important to monitor peri-implant bone level by taking annual radiographs and measuring probing depth, especially after prolonged service.

Unlabelled: This article presents general principles and a sample case of application of digital subtraction of x-rays for objective evaluation of results of treatment in dentistry., Purpose: Evaluation of the results of surgical periodontal treatment by means of digital subtraction of radiographic images taken before and 12 month after surgery., Material and Methods: For evaluation of the results of guided tissue regeneration treatment of deep bony defects digital periapical x-rays were taken before and 12 months after surgery. Pairs of images obtained during treatment were calibrated to equalize vertical x-ray beam angulation followed by calibration to radiological contrast and density. Next the comparison of images taken before and after treatment was performed by means of special computer software designed to subtract content of given images., Results: Digital subtraction showed that the radiological density in regions where surgery was performed has decreased over a period of 12 months meaning that the mineral content which is responsible for absorbing x-ray photons has increased. Some local foci of subsurface hypomineralization were found on subtractions images. These foci couldn't be detected clinically because hypomineralization was taken place within bone., Conclusions: Digital subtraction of x-rays taken before and after surgery treatment is detailed and objective method of evaluating results particularly when changes of surface and subsurface bone mineralization around teeth must be examined.

This article is an initial clinical evaluation of the use of Puros, a specially processed allogeneic bone graft substitute, for treatment of periodontal osseous defects. Nine patients with chronic periodontitis contributed 1 osseous defect each. Clinical and surgical measurements were taken at the time of the initial grafting and 6 months later at the time of a surgical re-entry. On average, probing depth improved by 3 mm, and there was 2.5 mm bone fill. Resorption of the alveolar crest was minimal. All cases healed satisfactorily, and at the time of re-entry only 1 case required re-treatment. Puros appears to be a useful and beneficial material for the treatment of proximal type human periodontal defects.