Biomedical subjects

Dimitris N Tatakis

Publications and source records attributed to Dimitris N Tatakis.

29 records · Page 2Linked to original sources

PubMed2004

Cementodentinal tear: a case report with 7-year follow-up.

BACKGROUND: Cemental tears are an uncommon form of root fracture that can lead to rapid localized attachment loss. Typically, the separation of the fragment occurs at the cementodentinal junction. In this report, we present a case of periodontal involvement associated with a cemental tear-like fragment that proved to be a cementodentinal tear. We also review the literature on the clinical presentation of cemental tear associated periodontal lesions. METHODS: A 52-year-old male presented with acute pain on the maxillary right second premolar. Clinically, probing depth of 7 mm and inflammation were noted on the distal aspect of tooth #4. Radiographic examination revealed separation of cervical root structure on the distal aspect of the tooth, involving two-thirds of the root length. The root fragment was removed, and the localized defect was treated by open flap debridement along with scaling and root planing. The patient was then placed on a regular periodontal maintenance schedule. RESULTS: A postoperative probing depth of 2 mm with 1 mm recession was recorded at 3 months, and maintained for 7 years. Histological examination indicated that the detached root fragment contained dentin with overlying acellular cementum and associated periodontal ligament tissue. The fragment was estimated to represent as much as 20% of the total root surface area. CONCLUSION: Moderate to severe periodontal attachment loss associated with cemental or cementodentinal tears, even ones constituting a significant portion of the root surface, can be successfully treated with conventional periodontal surgical procedures and maintained long term with a proper maintenance regimen.

Bicuspid↗

PubMed2004

Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft.

BACKGROUND: Various surgical techniques have been proposed for treating gingival recession. This randomized clinical trial compared the coronally positioned flap (CPF) alone or in conjunction with a subepithelial connective tissue graft (SCTG) in the treatment of gingival recession. METHODS: Eleven non-smoking subjects with bilateral and comparable Miller Class I recession defects were selected. The defects, at least 3.0 mm deep, were randomly assigned to the test (CPF + SCTG) or control group (CPF alone). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), and gingival/mucosal thickness (GT) were assessed at baseline and 6 months postoperatively. RESULTS: Recession depth was significantly reduced 6 months postoperatively (P<0.05) for both groups. Mean root coverage was 75% and 69% in the test and control groups, respectively. There were no significant differences between the two groups in RD, PD, or CAL, either at baseline or at 6 months postoperatively. However, at 6 months postoperatively, the test group showed a statistically significant increase in KT and GT compared to the control group (P<0.05). CONCLUSIONS: The results indicate that both surgical approaches are effective in addressing root coverage. However, when an increase in gingival dimensions (keratinized tissue width, gingival/mucosal thickness) is a desired outcome, then the combined technique (CPF + SCTG) should be used.

Adolescent↗

PubMed2004

Traumatic lesions of the gingiva: a case series.

BACKGROUND: The most recent classification of periodontal diseases includes a new section on traumatic gingival lesions. Traumatic lesions of the gingiva are thought to be highly prevalent, yet the periodontal literature contains few references on the topic. The purpose of this article is to present a broad spectrum of traumatic gingival lesions of iatrogenic, accidental, and factitious origin. METHODS: Twelve clinical cases were selected to document chemical (due to aspirin, snuff, and peroxide), physical (due to malocclusion, flossing, removable partial denture, oral piercing, and self-inflicted trauma), and thermal (due to overheated ultrasonic scaler, hot food, and ice) injury to the gingiva. RESULTS: Chemical, physical, and thermal gingival injuries of iatrogenic, accidental, or factitious origin can have a variety of presentations with overlapping clinical features. Although the appearance and associated symptoms of a gingival lesion may be suggestive of a particular traumatic etiology, useful or confirmatory diagnostic information is often discovered through careful history-taking. The management of gingival injuries typically requires elimination of the insult and symptomatic therapy. If permanent gingival defects resulted from the injury, periodontal plastic surgery may be necessary. CONCLUSIONS: A variety of chemical, physical, and thermal injuries may involve the gingiva. Accidental and iatrogenic injuries are often acute and self-limiting, while factitious injuries tend to be more chronic in nature.

Adult↗

PubMed2004

Undifferentiated malignant neoplasm involving the interdental gingiva: a case report.

BACKGROUND: Metastases to the gingiva are uncommon. They can be a diagnostic challenge clinically because of their rarity and tendency to mimic benign lesions. In this report, we present a case of an undifferentiated malignant neoplasm of unknown origin presenting as benign inflammatory gingival lesions and we review the literature on metastases to the gingiva. METHODS: A 44-year-old female patient was referred by a local periodontist for evaluation of multiple painless gingival lesions that clinically resembled pyogenic granulomas or periodontal abscesses, but with an uncharacteristic multifocal presentation in the background of good oral hygiene. Her medical history was unremarkable except for recent weight loss. Periapical radiographs were obtained, as well as two incisional biopsies, one placed in formalin for routine histology and immunohistochemistry, the other in phosphate buffered saline for flow cytometry. RESULTS: Radiographic findings were non-contributory for hard tissue pathoses. Histopathological findings were consistent with a poorly differentiated malignancy, suggestive of metastatic disease. Immunohistochemical studies and flow cytometry were unsupportive in delineating any tumor differentiation. The patient subsequently developed multiple tumors throughout the body with similar histopathological findings, yet no primary tumor was identified and a definitive diagnosis could not be rendered. She was discharged one month later in poor condition with the principal diagnosis of hemorrhage/ pancytopenia, and a secondary diagnosis of metastatic head and neck cancer. CONCLUSION: This case of malignant metastatic tumor of unknown origin presenting as benign gingival lesions illustrates the importance of thorough patient evaluation, which should include a biopsy when necessary for definitive diagnosis.

Adult↗

PubMed2003

Periodontal repair in dogs: a bioabsorbable calcium carbonate coral implant enhances space provision for alveolar bone regeneration in conjunction with guided tissue regeneration.

BACKGROUND: Collapse or compression of a barrier device into a periodontal defect or onto the root surface compromises outcomes following guided tissue regeneration (GTR). Bone biomaterials have been suggested to support regeneration of alveolar bone and to improve space provision with GTR devices. The objective of this study was to evaluate space provision, alveolar bone, and cementum regeneration following use of a bioabsorbable, calcium carbonate biomaterial in conjunction with GTR. METHODS: Routine, critical size, 5 to 6 mm, supraalveolar, periodontal defects were created in 5 young adult beagle dogs. Alternate jaw quadrants in consecutive animals received GTR and the coral biomaterial (cGTR) or GTR alone. The animals were euthanized 4 weeks postsurgery and tissue blocks processed for histometric analysis. RESULTS: The coral implant particles were surrounded by newly-formed bone or immersed in connective tissue and appeared to resorb and be replaced by bone. There was limited, if any, appreciable cementum regeneration. Space provision was enhanced in cGTR compared to GTR sites (6.1 +/- 1.6 versus 2.4 +/- 0.8 mm2; P<0.05). Bone regeneration (height) was significantly increased in cGTR compared to GTR sites averaging 1.9 +/- 0.6 and 1.2 +/- 0.6 mm, respectively (P<0.05). Bone regeneration (area) was 2-fold greater in cGTR sites compared to the GTR control (3.3 +/- 1.8 versus 1.4 +/- 0.5 mm2), however the difference was not statistically significant (P>0.05). CONCLUSIONS: The coral implant significantly enhanced space provision for GTR while alveolar bone formation appeared to be enhanced by its use. Increased healing intervals are needed to fully understand the biologic value of the coral implant as an adjunct to GTR.

Absorbable Implants↗

PubMed2002

Peri-implant bone regeneration using recombinant human bone morphogenetic protein-2 in a canine model: a dose-response study.

The objective of this study was to evaluate the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) dose on alveolar ridge augmentation and dental implant osseointegration. Bilateral, 5 mm supraalveolar, peri-implant defects were surgically created in 6 beagle dogs. rhBMP-2 (0.05, 0.1 or 0.2 mg/ml) in an absorbable collagen sponge (ACS) carrier was molded around the fixtures and wounds were closed. Treatment variations were alternated between animals (incomplete block design). Animals were sacrificed at week 8 postsurgery. Nine of twelve jaw quadrants healed uneventfully. Two jaw quadrants exhibited wound failure by week 4 and one by week 8 postsurgery. Radiographic bone regeneration was observed in defects without wound failure from week 4 postsurgery. Radiolucent voids of variable size and shape were observed and regressed over time. In weeks 6 through 8, there was an apparent increase in bone density and trabecular structure, while bone height and volume decreased. Histometric analysis revealed limited differences in bone regeneration between experimental conditions. Bone regeneration area averaged (+/- SD) 1.0 +/- 0.5, 3.5 +/- 1.4 and 2.3 +/- 0.4 mm2 for the 0.05, 0.1 and 0.2 mg/ml dose, respectively. There were no significant differences in osseointegration. Osseointegration in newly formed bone averaged 19 +/- 4%, 18 +/- 10% and 21 +/- 6% for the 0.05, 0.1 and 0.2 mg/ml rhBMP-2 sites, respectively. Collectively, the data suggest that there are no dramatic differences in bone induction and osseointegration within the selected dose and observation interval.

Absorbable Implants↗

PubMed2002

Tongue piercing: impact of time and barbell stem length on lingual gingival recession and tooth chipping.

BACKGROUND: The increasing popularity of tongue piercing has prompted several case reports documenting oral complications of this practice. However, there are no studies assessing potentially significant parameters. The purpose of this study was to evaluate the effect of time (years of wear) and tongue barbell size (stem length) on gingival recession and tooth chipping. METHODS: Fifty-two adults (mean age 22) with tongue piercings were examined for gingival recession on the lingual aspect of the 12 anterior teeth and for tooth chipping anywhere in the mouth. Subjects were grouped according to years of wear (0 to 2, 2 to 4, and 4+ years) and barbell stem length (long > or =1.59 cm, or short <1.59 cm). Data analysis was based on binomial test and non-parametric tests. RESULTS: No subject with a tongue piercing <2 years (group 0-2) exhibited lingual recession or tooth chipping. Lingual recession was found on mandibular central incisors in 50% of subjects wearing long barbells for 2 or more years. Tooth chipping was found on molars and premolars in 47% of subjects with a tongue piercing for 4+ years. CONCLUSIONS: Tongue piercing is associated with lingual recession of mandibular anterior teeth and chipping of posterior teeth. Long-term use of a tongue barbell increases the prevalence of these complications. Barbell stem length appears to differentially affect prevalence of recession and chipping. Since the overwhelming majority of subjects with tongue piercings are young adults, cessation efforts are needed to target this population.

Adolescent↗

PubMed2002

A method to assess the clinical outcome of ridge augmentation procedures.

BACKGROUND: Alveolar ridge augmentation procedures are often needed prior to implant placement or prosthetic rehabilitation. The purpose of this study was to develop a quantitative method to assess the clinical outcome of such procedures. METHODS: Two volumetric methods, based on the volume difference between the pre- and postoperative ridge, were developed. Either a transparent vacuum stent material (method A) or a silicone impression material in a custom acrylic tray (method B) was used to make an impression of the postoperative stone cast. This impression was then filled with polyvinylsiloxane bite registration material (PBRM) and placed on the preoperative cast. The volume of PBRM at the site of the augmented ridge (corresponding to the achieved ridge volume increase, in ml) was measured gravimetrically. Two independent examiners used both methods, in random order, to assess the outcome of 6 diverse clinical cases. Triplicate measurements were made (method precision). Method accuracy was assessed by fabrication of metal castings (known volumes) applied on a preoperative cast to simulate an augmentation procedure. RESULTS: Intra- and inter-examiner reproducibility was high (intraclass correlation coefficients > or =0.84) for both methods. The volumetric measurements obtained by method B showed excellent correlation with the predetermined augmentation volumes (r2 = 0.99; y = 0.94x + 0.12), in contrast to the measurements obtained by method A (r2 = 0.46; y = 0.43x + 1.37). CONCLUSIONS: The developed volumetric method (method B) is both precise and accurate in assessing the outcome of ridge augmentation. This simple, cost-effective, and easy to implement method should be helpful in clinical studies of ridge augmentation procedures.

Alveolar Ridge Augmentation↗

PubMed2002

Accelerated alveolar bone loss in HLA-b27 transgenic rats: an adult onset condition.

OBJECTIVE: Patients with arthritis and Crohn's disease may be more susceptible to periodontitis associated alveolar bone loss (ABL). HLA-B27 transgenic (TG) rats spontaneously develop arthritis and colitis. Based on the hypothesis that TG rats would also be susceptible to ABL, we compared the naturally occurring ABL in TG and Fischer 344 wild-type (WT) rats. METHODS: Eighteen TG and 18 WT virgin female rats were used. Pairs (I TG, I WT) were housed in suspended wire cages. At age 2.6, 6, and 11 months, 8, 5, and 5 pairs were sacrificed, respectively. ABL was measured as exposed molar root surface area (mm2). Western blotting was used for analysis of serum reactivity against bacteria associated with arthritis, colitis, and periodontitis development. RESULTS: At 2.6 months of age, there was no difference in ABL between TG and WT rats. At 6 and 11 months ABL was significantly greater in TG animals by 28% and 53%, respectively. For TG rats, ABL was significantly different between the 3 age groups. For WT rats, ABL was not significantly different between 6 and 11 months. Western blotting revealed distinct TG serum reactivity against extracts of Bacteroides vulgatus, B. fragilis, Prevotella intermedia, and to a lesser extent against extracts of B. forsythus. CONCLUSION: The accelerated ABL in HLA-B27 TG rats is an adult onset condition, independent of husbandry conditions or parity status. HLA-B27 rats exhibit strong immunoreactivity against bacteria implicated in arthritis, colitis, and periodontitis.

Alveolar Bone Loss↗

PubMedDate not supplied

Radiographic and clinical evaluation of single-tooth Biolok implants: a 5-year study.

PURPOSE: The purpose of this prospective clinical and radiographic study was to evaluate Biolok implants used for single-tooth replacement during 5 years of function. MATERIALS AND METHODS: Thirty-nine patients received Biolok implants for single-tooth replacement. Clinical and radiographic recordings were made at baseline (placement of restoration) and at 1, 3, and 5 years. Plaque Index (PI), Gingival Index (GI), and clinical attachment level were the clinical parameters recorded. Clinical attachment level was measured using a customized probing template and a standard pressure electronic probe. Bone level changes were measured from standardized radiographs. Clinical attachment level and bone level were recorded to the nearest 0.1 mm. Correlations between clinical attachment level, bone level, PI, and GI were evaluated. RESULTS: The cumulative survival rate was 97.4% (38 of 39 implants). The mean clinical attachment level change over 5 years was a loss of 0.17+/-0.23 mm. Significant correlations between clinical attachment level change and PI were found at 3 and 5 years (P < .015). Significant correlations between clinical attachment level change and GI were not found (P >.05). Mean bone loss was 0.83+/-0.03 mm from baseline to 1 year, 0.26+/-0.03 mm from 1 year to 3 years, and 0.14+/-0.04 mm from 3 to 5 years. Significant correlations between bone level changes and PI or GI were not found (P > .05). DISCUSSION: Over a 5-year evaluation period, the bone levels and clinical attachment levels were stable. These results were consistent with other studies of single-tooth implants. CONCLUSIONS: After 5 years of function, the results suggest that Biolok implants can be successfully used for single-tooth replacement.

Adult↗

PubMedDate not supplied

Clinical parameters associated with success and failure of single-tooth titanium plasma-sprayed cylindric implants under stricter criteria: a 5-year retrospective study.

PURPOSE: The purpose of this study was to determine the clinical parameters associated with long-term success and failure of single-tooth titanium plasma-sprayed (TPS) cylindric implants. MATERIALS AND METHODS: Thirty-nine implants in 39 subjects were followed for 5 years. The following data were collected: subject age and gender, implant length, implant location, bone density, and implant position in relation to crestal bone. Assessments made at recall intervals included: Gingival Index (GI), probing depth, relative attachment level, and standardized radiographs. Failure was defined as a mean annual attachment loss rate (ALR) of > or = 0.25 mm after the first year of implant function. Between-group differences were assessed nonparametrically using the Mann-Whitney and chi-square tests. RESULTS: Nineteen implants were considered successes and 20 were considered failures with respective mean ALRs of 0.12 +/- 0.07 mm and 0.42 +/- 0.19 mm. The following factors were associated with success: longer implants (P < .001), lower GI (P < .001), higher bone density (P < .0001), and implant position at the crest or supracrestally (P <.0001). Age, gender, probing depth, and implant location were not related to outcome. CONCLUSIONS: A model using attachment loss as a parameter for success and failure has not been previously utilized. Longer implants, lower GI, higher bone density, and implant position at the crest or supracrestally were clinical factors associated with long-term success of single-tooth TPS cylindric implants in this patient population.

Adult↗