[American dentistry in the year 2000].
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Biomedical subjects
Publications and source records attributed to M O Schmid.
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Clinical research has shown beyond doubt that maintenance of oral health in restored or periodontally treated dentitions depends only to a relatively small degree on the therapeutic appliances and techniques used. It is the combination of periodic professional tooth debridement and fluoridation by the dental team, detailed and uncompromising instruction of individualized home care techniques, and ensuing optimal daily plaque control by a well-informed, trained, and motivated patient that determines, almost exclusively, the long-term success of dental therapy. It is, therefore, imperative that dental restorations and periodontal procedures be compatible with the requirements for effective maintenance care.
A surgical technique to establish wide zones of attached mucosa was performed in 28 patients presenting with inadequate amounts of attached gingiva. The clinical results of the procedure were monitored over a period of 2 years. Biometric assessment of 112 mucogingival units immediately before and at 1, 3, 6, and 24 months after surgery revealed that the mean width of attached gingiva changed from 1.1 mm to 5.3 mm of attached tissue (gingiva plus vestibular mucosa). A surgically produced increase of 4.9 mm in width (P less than 0.001) and subsequent shrinkage of 0.7 mm or 14% (P less than 0.001) resulted in a total average gain of 4.2 mm of attached mucosa 2 years after surgery (P less than 0.001). A begin/end analysis of the coronal level of clinical periodontal attachment and the extent of gingival recession showed no clinically significant changes. The mean width of keratinized gingiva increased 0.8 mm during the 2-year postoperative period. The subperiosteal vestibule extension is recommended as an alternative to the free autogenous mucosa graft for establishing wide bands of attached mucosa in areas where loss of attached gingiva is associated with mechanical or microbial irritation of the marginal periodontium.
An intracoronal technique for semipermanent splinting of mobile or migrating teeth is described and clinically evaluated. Circumferential grooves of 1 to 1.5 mm depth were cut into the enamel in the occlusal third of the teeth to be splinted. The teeth were splinted by placing a polyester ligature in two or more figure-8 loops along the grooves, and sealing the grooves and interproximal contact areas with an acid-etch composite resin system. A total of 51 splints involving 183 teeth and 132 interproximal contact areas were placed in 34 patients. One year after insertion, 46 splints were found intact. Five splints presented with one fractured interdental element, each. Average mobility of the splinted teeth was 51% below the preoperative level. Splinting improved the masticatory comfort. The esthetic results were satisfactory.
The attitude of 1085 Swiss military recruits towards the dentist and dental care, their knowledge of periodontal disease and its prevention, the incidence of smoking and the frequency of eating sweets as well as interest in their own teeth in general was determined by use of a questionnaire. The results showed a positive attitude on the part of the participants towards their own teeth and a definite motivation for good oral health. The oral hygiene habits of only a minority could be classified as sufficient, the knowledge of periodontal disease and its prevention were limited. Smoking and eating sweets were found to be widespread. It can be stated, therfore, that hygiene instruction for improvement of oral health by the dental profession as well as motivational efforts towards general health education at home and at school were unfortunately unsatisfactory.
The ability of three different oral hygiene devices to remove 2-day-old bacterial deposits was evaluated on 21 young adults with healthy periodontia. On buccal tooth surfaces, the cleaning effect of a multitufted nylon brush was superior to that of a wooden toothpick or unwaxed dental floss. On lingual surfaces, the toothpick was as effective as the brush. On the visible portions of proximal surfaces, all three devices were equally efficient. A combined cleaning exercise with all three instruments together yielded significantly better results than did the use of each single device. Eight subjects were able to remove all disclosable deposits.
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The capillary blood circulation of free gingival autografts during healing was studied by means of 45 fluorescein angiographs taken over a postoperative period of 14 days in 10 female patients, 21 to 36 years old. The surgical technique commonly used for transplanting gingiva was slightly modified in that no surgical dressings and, in 3 cases, not even sutures were employed to immobilize the grafts. During the first 3 postoperative days, fluorescent plasmatic diffusion of increasing intensity was observed. In one case, fluorescing capillary circulation was detected as early as 24 hours after surgery, fluorescent capillaries became evident in all graft sites and increased steadily in number. Between 9 and 14 days after surgery, an even capillary loop pattern was established.
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