[Report of the General Secretary of the Hungarian Dentists' Association at the Delegates' Meeting of May 12th, 2006].
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Congresses as Topic↗
Biomedical subjects
István Gera
Publications and source records attributed to István Gera.
Healing of intra-bony defects following treatment with a composite bovine-derived xenograft (Bio-Oss Collagen) in combination with a collagen membrane (Bio-Gide PERIO).
AIM: The purpose of the present study was to compare clinically the treatment of deep intra-bony defects with a combination of a composite bovine-derived xenograft (BDX Coll) and a bioresorbable collagen membrane [guided tissue regeneration (GTR)] to access flap surgery only. METHODS: Thirty-two patients, each of whom displayed one intra-bony defect, were treated either with BDX Coll+GTR (test) or with access flap surgery (control). The results were evaluated at 1 year following therapy. RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the test group showed a reduction in the mean probing depth (PD) from 8.3+/-1.5 to 2.9+/-1.3 mm (p<0.001) and a change in the mean clinical attachment level (CAL) from 9.4+/-1.3 to 5.3+/-1.5 mm (p<0.0001). In the control group, the mean PD was reduced from 8.0+/-1.2 to 4.4+/-1.7 mm (p<0.001) and the mean CAL changed from 9.6+/-1.3 to 7.9+/-1.6 mm (p<0.01). The test treatment resulted in statistically higher PD reductions (p< or =0.05) and CAL gains (p<0.001) than the control one. In the test group, all sites (100%) gained at least 3 mm of CAL. In this group, a CAL gain of 3 or 4 mm was measured at 10 sites (62%), whereas at six sites (38%), the CAL gain was 5 or 6 mm. In the control group, no CAL gain occurred at three sites (19%), whereas at 10 sites (62%), the CAL gain was only 1 or 2 mm. A CAL gain of 3 mm was measured in three defects (19%). CONCLUSIONS: Within the limits of the present study, it can be concluded that the combination of BDX Coll+GTR resulted in significantly higher CAL gains than treatment with access flap surgery alone, and thus appears to be a suitable alternative for treating intra-bony periodontal defects.
Alveolar Bone Loss↗
Clinical evaluation of an enamel matrix protein derivative combined with either a natural bone mineral or beta-tricalcium phosphate.
BACKGROUND: The purpose of the present study was to compare the healing of deep intrabony defects following treatment with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or beta-tricalcium phosphate (beta-TCP). METHODS: Twenty-four patients with advanced periodontal disease, each of whom displayed one intrabony defect, were randomly treated with a combination of either EMD + NBM or EMD + beta-TCP. Clinical evaluation was performed at baseline and 1 year following therapy. RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with EMD + NBM showed a reduction in mean probing depth (PD) from 7.9 +/- 1.0 mm to 3.2 +/- 0.6 mm and a change in mean clinical attachment level (CAL) from 8.8 +/- 1.1 mm to 4.5 +/- 0.6 mm (P < 0.001). In the group treated with EMD + beta-TCP, the mean PD was reduced from 7.8 +/- 1.2 mm to 3.2 +/- 0.9 mm, and the mean CAL changed from 8.8 +/- 1.2 mm to 4.7 +/- 1.2 mm (P < 0.001). In both groups, all sites gained at least 3 mm of CAL. CAL gains of 4 or 5 mm were measured in the majority of the cases (75%), irrespective of treatment modality. No statistically significant differences in terms of PD reductions and CAL gains were observed between the two groups. CONCLUSION: Within the limits of the present study, both therapies resulted in significant PD reductions and CAL gains 1 year after surgery.
Adult↗
Clinical and histologic evaluation of an enamel matrix protein derivative combined with a bioactive glass for the treatment of intrabony periodontal defects in humans.
The present study clinically and histologically evaluated healing of human intrabony defects following treatment with a combination of enamel matrix derivative (EMD) and bioactive glass (BG) or BG alone. Six patients displaying either combined one- and two-walled (five patients) or three-walled (one patient) intrabony defects around teeth scheduled for extraction were included. A notch was placed at the most apical extent of the calculus on the root surface to serve as a reference. Six months after surgery, the teeth or roots were extracted, together with some of their surrounding soft and hard tissues, and processed for histologic evaluation; a gain of clinical attachment was found in all cases. Healing in all three defects treated with EMD + BG was mainly characterized by new cementum with inserting collagen fibers and new periodontal ligament; most graft particles were surrounded by bone-like tissue, indicating ongoing mineralization. Treatment with BG resulted in epithelial down-growth and connective tissue encapsulation of the graft material in all three specimens. Reformation of cementum and periodontal ligament was observed in one of the specimens, limited to the most apical part of the defect. Formation of bone-like tissue around the graft particles was observed in only one of the three specimens treated with BG. Direct contact between the BG particles and root surface (cementum or dentin) was not observed in any of the six specimens. BG alone has low potential to facilitate periodontal regeneration. However, EMD + BG resulted in formation of new cementum with an associated periodontal ligament, as well as enhanced mineralization around the BG particles.
Bone Substitutes↗
[Organ transplant patients' complex periodontal treatment].
The number of organ transplant patients has increased in recent years. The Cyclosporin-A (CsA) has been used at least for 20 years to control graft rejections. As many organ transplant patients also take Ca channel blocking medication this might potentiate the CsA associated gingival hyperplasia. The outcome of the comprehensive periodontal treatment was evaluated in 14 kidney and liver transplant patients. If gingival overgrowth showed no marked reduction after thorough professional supra and subgingival plaque control either gingivectomy or flap surgery were indicated. The average age of the organ transplant patients was 38 years. 10 was man and 4 female. The daily dose of CsA ranged between 150-200 mg, and each patient took also Ca channel blocking drugs, 5-20 mg/day. S/RP alone was successful in two cases. Gingivectomy was performed in 10 cases and flap operation was indicated in two cases. Among patients with high compliance and excellent individual oral hygiene no recurrence occurred, while two patients with very low level of oral hygiene showed immediate gingival overgrowth after surgery. It is supposed that dental plaque is an important contributing factor in the development of drug induced gingival overgrowth and meticulous plaque control should be one of the most important treatment modalities in controlling drug-induced gingival changes.
Adult↗
[Report from the commemoration of the 50th anniversary of the founding of the School of Dentistry at Semmelweis University].
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Faculty, Dental↗
[Necrotizing sialometaplasia].
Necrotizing sialometaplasia is a non-neoplastic self-limiting inflammatory-ulcerous condition of the minor salivary glands. It is reported to appear in the oral cavity at every area where minor salivary glands exist, particularly those of the palate. Necrotizing sialometaplasia is a very rare disease that spontaneously develops with fearsome features. It is thought to be due to infarction of minor salivary glands, and heals in a few weeks, without any treatment. The clinical and histopathological features of necrotizing sialometaplasia often simulate those of such malignancies as squamosus cell carcinoma or mucoepidermoid carcinoma. Familiarity with necrotizing sialometaplasia and correct differential diagnosis are paramount in avoiding misdiagnosis and inappropriate treatment.
Adult↗
[Risk factors for destructive periodontitis. I. Behavioral and acquired factors (literature review)].
Dental plaque is a necessary but not sufficient etiologic factor of the destructive periodontal disease. The manifestation of periodontal destruction is influenced by a wide variety of risk factors and determinants. In the introduction the terminology of different etiologic and risk factors are discussed in general. Than the risk factors and determinants of destructive periodontitis are overviewed. In the first part the acquired and behavioral factors and determinates are discussed. Among the local factors the role of the individual oral hygiene, the specificity of subgingival dental plaque the plaque retentive factors and occlusal traumatism are discussed. The hormonal, the acquired immunological factors, osteoporosis and the age are discussed as systemic risk factors and determinants. Among the behavioral factors smoking, psychological stress and socio-economic factors are covered. The second part is going to cover the genetic predisposing factors.
Age Factors↗
[Risk factors and risk indicators of destructive periodontitis. II. Genetic risk factors (literature review)].
After the latest advances in genetic research and basic genetic terminology having been briefly discussed in the second part of the paper, the chromosomal, monogenic as well as polygenic inherited disorders affecting normal PMN leukocyte functions are overviewed. From Down's syndrome to the Papillon-LeFevre syndrome, the different leukocyte adherence deficiencies and also certain inherited metabolic bone diseases, like hypophosphatasia are discussed. Than the recent advances in the research of the role of genetic polymorphisms of lymphokines and certain white blood cell's Fc receptor polymorphism in the development and progression of periodontitis are discussed in details. Finally the role of the ethnic modifying factors in the aetiology of destructive periodontal disease are discussed.
Chromosome Aberrations↗
[The stages of comprehensive periodontal therapy--diagnosis-driven treatment planning].
The rationale and the stages of the comprehensive periodontal treatment are overviewed. The consecutive phases are logically following each other. Basically three major therapeutical categories can be established, such as: 1. absolutely healthy from periodontal point of view, 2. gingivitis, 3. periodontitis. Within the periodontitis group the basic principles and strategies are totally different for the management of chronic and aggressive periodontitis cases. Principally the comprehensive periodontal therapy can be divided into four main phases: phase I. initial or cause related therapy, phase II. surgical therapy, phase III. periodontal reconstruction, and phase IV. periodontal maintenance. The classic non-surgical and surgical techniques can cure inflammation, arrest the progression of periodontal destruction and restore gingival-periodontal health, and the outcome is quite predictable for gingivitis and chronic periodontitis. The long-lasting results are dependent on the patients' motivation and maintenance. The late therapeutical results and the maintenance of aggressive periodontitis cases are less predictable. Technically the vertical component of the bone loss can be fully corrected by regenerative surgical techniques. So far the horizontal bone loss should be considered as an irreversible feature as no periodontal regenerative techniques are available to restore the lost alveolar crest and interdental septa.
Chronic Disease↗
[Periodontal treatment needs in Central and Eastern Europe].
The aim of the present review is to evaluate the periodontal conditions and treatment needs in Central and Eastern European countries joining the European Union and to compare these data to the epidemiological data from the industrialised and developing countries. The recent prevalence and severity data provided by national surveys based on the CPITN methods are summarised. The periodontal conditions in the age groups 15-19 and 35-44 are discussed in details. The CPITN data show no major differences in the extent and severity of destructive periodontal disease in the different countries. In the age group 15-19 just a few European surveys reported "score 4 sextant" and the prevalence of "score 3 sextants" was also below 10% in each survey. However calculus formation and bleeding on probing were very frequent findings both in Western and Eastern Europe. In the age group 35-44 the average prevalence of "score 4 sextant" in Western and Eastern Europe were comparable while the proportion of periodontally absolutely healthy individuals was lower in Eastern Europe than in the Western part of the Continent. Five to twenty per cent of the populations are affected by destructive periodontitis at the age of 40. This indicates the magnitude of the disease as a public health problem both in the industrialised West and the Eastern European countries. The some 10-15% prevalence rate of destructive periodontitis imposes a great challenge to the health authorities of these post-communist countries amid social and economic transition, because the nation-wide preventive and basic periodontal therapeutic measures should be managed and financed from a substantially lower GDP than in the industrialised West.
Adolescent↗
Histologic evaluation of human intrabony defects following non-surgical periodontal therapy with and without application of an enamel matrix protein derivative.
BACKGROUND: Surgical periodontal treatment with enamel matrix protein derivative (EMD) has been shown to promote periodontal regeneration. However, it is not known whether nonsurgical periodontal therapy with additional subgingival application of EMD may also enhance periodontal regeneration. The purpose of this study was to clinically and histologically evaluate healing of human intrabony defects following non-surgical periodontal treatment with and without application of EMD. METHODS: Sixteen patients, each of whom displayed one advanced intrabony defect around teeth or roots scheduled for extraction, were included in the study. The defects were treated as follows: 1) scaling and root planing with hand instruments and application of EMD; 2) scaling with an ultrasonic instrument and application of EMD; or 3) scaling with an ultrasonic instrument alone. Healing was uneventful in all cases. Six months after surgery, the teeth or roots were extracted together with some of their surrounding soft and hard tissues and processed for histologic evaluation. RESULTS: Clinical examination revealed a probing depth reduction and a gain of clinical attachment after all 3 treatment modalities. The histological evaluation, however, revealed that healing in all 3 procedures was predominantly characterized by formation of a long junctional epithelium along the instrumented root surface and no predictable regeneration of attachment apparatus. CONCLUSION: Within its limits, the present study failed to show periodontal regeneration in advanced human intrabony defects following non-surgical treatment with subgingival application of EMD.
Alveolar Bone Loss↗
Clinical and histologic evaluation of human intrabony defects treated with an enamel matrix protein derivative combined with a bovine-derived xenograft.
The purpose of the present case report study was to clinically and histologically evaluate the healing of deep intrabony defects following treatment with either a combination of an enamel matrix protein derivative (EMD) and a bovine-derived xenograft (BDX) or with BDX alone. Three female patients with generalized marginal periodontitis and presenting one advanced intrabony defect each were treated with either a combination of EMD + BDX (two defects) or with BDX alone (one defect). The postoperative healing was uneventful in all three cases. Six months after surgery, a gain of clinical attachment was measured at all treated sites. The histologic examination revealed that all three defects healed with a new connective tissue attachment (ie, new cellular cementum with inserting collagen fibers) and new bone. Most of the BDX particles were surrounded by a bone-like tissue. No direct contact between BDX particles and the root surface (cementum or dentin) was observed. Within their limits, the present data indicate that treatment with either EMD + BDX or with BDX alone may enhance the formation of new connective tissue attachment and new bone in human intrabony defects.
Alveolar Bone Loss↗
[Classification of periodontal diseases].
During the past centuries the basic understanding of periodontal disease and the concepts of etiopathogenesis have evolved and substantially changed. The changes in paradigm has always been followed by the conceptual changes in the classification of periodontal disease. The earliest entirely descriptive classifications were based on the clinical signs and symptoms of periodontal disease. These were followed by a classification system based on the classical pathology paradigm established by Orban and Gottlieb. This was replaced by the next classification reflecting the infection/host response paradigm during the late '60s started with the pioneering works by Loe and coworkers. It is because many data indicated that the host response (determined by genetics, immunology and behavioral factors) was at least as important in the clinical manifestation of periodontal destruction than the bacterial biofilm this classification had been also updated. The AAP published its latest official classification system in 1999. Nevertheless this new system is far from perfect and should evolve as soon as enough data are collected by periodontal research to answer many controversy still existing to day.
Atrophy↗
Comparison of clinical, radiographic, and histometric measurements following treatment with guided tissue regeneration or enamel matrix proteins in human periodontal defects.
BACKGROUND: The purpose of this study was to compare the clinical and radiographic parameters with the histometric findings following 2 different regenerative procedures in humans. METHODS: Fourteen advanced intrabony defects at teeth scheduled for extraction were randomly treated as follows: 8 with guided tissue regeneration (GTR) using bioabsorbable barriers and 6 with an enamel matrix protein derivative (EMD). Standardized radiographs, probing depths (PD), and attachment levels (CAL) at baseline and 6 months after therapy were evaluated and compared to the histometric measurements made following the removal of teeth and surrounding tissues 6 months after the surgery. RESULTS: Significant PD reductions (GTR: -5.62 mm; EMD: -5.00 mm) and CAL gains (GTR: 3.87 mm; EMD: 2.67 mm) were observed in both groups. Six months after surgery, minor resorptions of the alveolar crest (AC) (GTR: 0.40 mm; EMD: 0.33 mm) and bony gain at the bottom of the defects (GTR: 0.47 mm; EMD: 1.05 mm) were observed radiographically. No statistically significant differences in the change of clinical and radiographic parameters between the GTR and EMD groups were found. Histometrically, significant amounts of new connective tissue attachment (i.e., cementum with inserting collagen fibers) were observed in both groups (GTR: 2.29 mm; EMD: 1.81 mm). Bone regeneration was found to be significant only in the GTR group (GTR: 1.93 mm; EMD: 0.78 mm). However, the study lacked statistical power for determining equivalence between the groups. CONCLUSIONS: Within the limitations of the present study, it may be concluded that at 6 months after GTR or enamel matrix protein derivative therapy, formation of new cementum and bone may be histometrically demonstrated. Except for the formation of new bone, no statistically significant differences between both therapies could be seen for clinical, radiographic, and histometric results 6 months after surgery.
Absorbable Implants↗
[Treatment of periodontitis associated with cyclosporin-induced severe gingival hyperplasia with regular mechanical plaque removal in a patient with renal transplantation (Case report)].
A clinical case of a middle-aged kidney transplanted woman is presented. The woman has been taking Cyclosporin-A for over 13 years and has had advanced periodontitis and severe gingival swellings and gingival inflammation. The kidney transplant patient was treated and followed up for approx. four years. The treatment protocol included very thorough mechanical scaling and root planing, oral hygienic instructions and the regular professional maintenance program resulted in complete remission of the gingival overgrowth and stabilization of the periodontal condition. The gingival and periodontal conditions showed a continuing improvement over the time despite of the continuous CSA administration.
Cyclosporine↗
[Osteoporosis: a risk factor for periodontal disease (literature review)].
Osteoporosis is a major public health problem all over the world. Caucasian women have the highest risk. Osteoporosis affects about 10% of the total population but the prevalence among postmenopausal women is more than 30%. It had long been stated that general osteoporosis played no role in the etiology of destructive periodontitis with inflammatory nature. Nevertheless a substantial number of publications in recent years indicated just an opposite relationship. It has been shown that total body calcium and bone density was closely associated with mandibular bone density and several studies have demonstrated close relationship between edentulism and systemic osteopenia. Certain data showed clear relationship between osteoporosis and periodontal disease, and osteoporosis is considered as one of the risk factors for periodontal bone loss. Both osteoporosis and periodontal disease are chronic multifactorial diseases with many genetic and behavioral risk factors and determinants. Both diseases can be successfully controlled by eliminating several risk factors. Estrogen replacement therapy can be protective against both postmenopausal osteoporosis and severe periodontitis in postmenopausal women. Tobacco smoking and diet are also important risk factors for both diseases and genetic factors have also been identified as important risk factors in the etiology of both diseases. Recent epidemiological and clinical data provides limited but convincing evidence suggesting an association between osteoporosis and periodontal disease, and many common risk factors could have been detected in the etiology of both diseases.
Bone Density↗
Clinical evaluation of an enamel matrix protein derivative (Emdogain) combined with a bovine-derived xenograft (Bio-Oss) for the treatment of intrabony periodontal defects in humans.
The purpose of the present study was to compare the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative (EMD; Emdogain) and a bovine-derived xenograft (BDX; Bio-Oss) to BDX alone. Twenty-four healthy patients, each of whom displayed one intrabony defect, were randomly treated with a combination of EMD + BDX (test) or with BDX alone (control). Soft tissue measurements were made at baseline and 1 year following the therapy No differences in any of the investigated parameters were observed at baseline between the two groups. No adverse healing response was observed in any of the patients. At 1 year after therapy, the sites treated with EMD + BDX showed a reduction in probing pocket depth (PPD) from 10.0 +/- 1.5 mm to 4.3 +/- 1.4 mm and a change in clinical attachment level (CAL) from 10.9 +/- 2.0 mm to 6.2 +/- 1.9 mm (P <.0001). In the group treated with BDX, the PPD was reduced from 9.7 +/- 2.4 mm to 3.2 +/- 0.7 mm and the CAL changed from 10.1 +/- 2.3 mm to 5.2 +/- 1.2 mm (P <.0001). Hard tissue fill was observed radiographically in all defects. Both treatments resulted in significant improvements of PPD and CAL. However, no statistically significant differences in any of the investigated parameters were observed between the test and control groups. Both therapies led to significant improvements of the investigated clinical parameters.
Alveolar Bone Loss↗