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PubMed2002

Effect of different EGTA concentrations on dentin microhardness.

The effect of 1%, 3% and 5% EGTA (ethylene glycol-bis-(beta-amino-ethyl ether) N,N,N',N'-tetra-acetic acid) on the microhardness of root dentin of the cervical third of human teeth was studied. Five newly extracted maxillary incisors were sectioned transversely at the cementoenamel junction, and the crowns were discarded. The roots were embedded in blocks of high-speed polymerized acrylic resin and cut transversely into 1-mm sections. The second section of the cervical third of the root of each tooth was sectioned and divided into four parts. Each part was placed on an acrylic disc that was used as a base for microhardness measurement. Fifty microliters of 1% EGTA, 3% EGTA, or 5% EGTA were applied to the dentin surface. Deionized and distilled water was used as control. Dentin microhardness was then measured with a load of 50 g for 15 s. Statistical analysis showed that the three concentrations of the chelating solution EGTA significantly reduced dentin microhardness when compared with water (ANOVA, p < 0.01), and that there was a statistically significant difference among the three solutions (Tukey test, p < 0.05).

Analysis of Variance↗

PubMed2005

Influence of cervical preflaring on determination of apical file size in maxillary premolars: SEM analysis.

The purpose of this study was to investigate the influence of cervical preflaring on the determination of the first file that binds at working length (WL) in buccal roots of maxillary premolars. Five groups (n=10) were formed at random and, after standard access cavities, the WL was determined 1 mm short from the apex. In group 1, the initial apical file was inserted without preflaring of cervical and middle thirds of the root canals. In groups 2 to 5, the cervical and middle thirds were enlarged with sizes 90 and 110 Gates-Glidden drills, K(3) Orifice Opener instruments, ProTaper instruments and LA Axxess burs, respectively. Canals were sized manually with K-files, starting with No. 08 K-files inserted passively up to the WL. File sizes were increased until a binding sensation was felt at the WL and the size of the instrument was recorded. Transversal sections of the WL regions were examined under scanning electron microscopy and the discrepancies between the canal diameter and first file to bind at the WL were assessed. Significant differences (p<0.001) were found between the groups. The major discrepancy was found without preflaring (mean 157.8 microm). LA Axxess burs produced the smallest discrepancy (mean 0.8 microm). Gates-Glidden drills and K(3) Orifice Opener instruments showed no significant differences (p>0.05) between their results (83.2 microm and 73.6 microm, respectively). The discrepancy for ProTaper instruments was 35.4 microm on average. In conclusion, the instrument binding technique for determination of the anatomical diameter at the WL was not precise. Preflaring of the cervical and middle thirds improved the determination of the anatomical diameter at the WL, and the type of instrument played a major role. Canals preflared with LA Axxess burs showed a more accurate binding of the files to anatomical diameter.

Analysis of Variance↗

PubMed2002

Cervical root resorption in two patients with unilateral complete cleft of the lip and palate.

OBJECTIVE: Case reports on cervical root resorption in patients with complete cleft of the lip and palate are scarce. Moreover, cervical root resorption is sometimes diagnosed several years after a combined orthodontic and surgical therapy in patients with cleft. In this article a review of the literature is presented, and a description and the management of the cervical lesion is provided. An additional objective of this report is to advocate for alveolar bone grafting before the age of 12 years while the vulnerable cervical region of the teeth adjacent to the cleft defect is still protected by a thick layer of bone.

Adult↗

PubMed1996

Comparison of 2 desensitizing dentifrices with a commercially available fluoride dentifrice in alleviating cervical dentine sensitivity.

Previous studies have demonstrated efficacy of desensitizing dentifrices containing strontium acetate/sodium fluoride (SrAc2F) and potassium chloride/sodium monofluorophosphate (KCl/MFP) in alleviating discomfort arising from cervical dentine sensitivity (CDS). The aim of this investigation, therefore, was to determine efficacy of a SrAc2F dentifrice compared with KCl/MFP and a commercially available fluoride dentifrice containing sodium fluoride/sodium monofluorophosphate (NaMFP). Fifty-six patients participated in a 2-center double-blind, 3-way comparative parallel 6-week clinical study. Patients were evaluated at 0, 2, and 6 weeks for tactile (Yeaple probe), air sensitivity (dental air syringe), and subjective perception of pain (VAS scores). Results for Yeaple probe scores (Wilcoxon tests) between 2 weeks and baseline were highly significant for KCl/MFP, significant for NaMFP and nonsignificant for SrAc2F; scores between 6 weeks and baseline were, however, highly significant for all groups. Subjective Yeaple probe VAS scores (paired t-tests) between 6 weeks and baseline were significant for all groups; significance was demonstrated in the KCl/MFP group between 2 weeks and baseline. Subjective air visual analogue scores (paired t-tests) between 2 weeks and baseline were highly significant for all groups. There were no significant differences between groups at any time point. The results of the study demonstrated that the commercially available fluoride-containing dentifrice was as effective as the 2 desensitizing dentifrices in alleviating CDS over time.

Acetates↗

PubMed1997

Guided tissue regeneration using a bioabsorbable membrane in the treatment of human buccal recession. A re-entry study.

A surgical technique involving a bioabsorbable membrane was used to treat localized buccal recession defects of between 2 and 5 mm on 17 sites in 13 patients. A conventional flap for coronal repositioning was raised consisting of a trapezoid flap with de-epithelialization of papillae, and the root surface planed back to reduce its convexity. The polylactate membrane with internal spacer bars was placed over the root surface with its coronal edge as near to the cemento-enamel junction (CEJ) as possible. This was held in place by a bioabsorbable retaining suture around the root, and the flap was coronally repositioned to cover the membrane. The patients were prescribed tetracycline for 2 weeks postsurgically, the sutures removed after 4 weeks, and cleaning procedures in the area reinstated after 6 weeks. Measurements were made using a custom made stent, and subjected to a Wilcoxon signed ranked analysis. These were clinical recession, clinical attachment level, probing depth, width of attached gingiva and the level of the buccal alveolar crest. The healing was monitored for a minimum of 1 year, and a surgical re-entry procedure was performed on 11 sites. The new buccal alveolar crest position was measured. This procedure resulted in a clinical and statistically significant reduction in clinical recession of 2.4 +/- 0.2 mm, a gain in attachment level of 2.7 +/- 0.2 mm, a gain in root coverage of 76 +/- 6% (P < 0.002), and a regeneration of buccal bone in all cases, with an average of 2.0 +/- 0.1 mm (P < 0.0023). This study shows that the use of a bioabsorbable membrane will predictably and significantly increase root coverage and regenerate buccal bone when used to treat localized buccal recession defects.

Absorption↗

PubMed1997

Experimental peri-implantitis in consecutively placed, loaded root-form and plate-form implants in adult Macaca mulatta monkeys.

This study is part of an on-going project describing the character of round- and plate-form implants placed in a primate model. In this paper 20 loaded plate-form and 23 root-form implants were connected to prostheses and experimental peri-implantitis was induced by ceasing scaling procedures and placing braided silk ligature around the implants. Twenty-four prostheses utilizing natural teeth were studied for comparison. Clinical measurements were carried out monthly for 6 months and radiographic measurements at 3 and 6 months post-ligature placement and cessation of scaling. Both root-form implants and plate-form implants showed a significant loss of crestal bone height at 3 and 6 months after ligature placement (P < .001 after 6 months). The difference in bone loss between plate- and root-form implants, however, was not significant.

Alveolar Bone Loss↗

PubMed1997

Comparison of manual and automated probing in an untreated periodontitis population.

Diagnosis of periodontal disease progression involves recording two probing attachment level measurements over an adequate time interval. A diagnostic instrument which exhibits less measurement variability allows for increased sensitivity and earlier disease detection. Traditionally, a manual probe with an occlusal stent of the cementoenamel junction (CEJ) as a reference landmark has been the method of choice. Automated probes that use an occlusal disk as the reference landmark have been developed as an alternative means of measure. The aim of this study was to compare the variability of these two probing methods. Four hundred eleven (411) interproximal sites in 46 untreated periodontitis patients were monitored by a single examiner over a 6-month period. Each site was measured on a monthly basis, first with an automated probe (AP) followed by a manual probe (MP) in combination with a custom-fabricated acrylic stent. Measurement variability of the two probing methods was also compared over a 7-day interval. The AP measurements were significantly more variable than the MP measurements (P < 0.001) when considering the variability between two passes at the same visit. Over the 6-month period, the MP measurements demonstrated significantly more variability than the AP measurements (P < 0.001). It was also noted that MP measurements exhibited more variability at sites with frequent bleeding during the 6 months of the study (P = 0.006). The results of this study demonstrate that AP may have less variability of attachment level measurements over a 6-month period and may be less influenced by local inflammatory changes. However, future comparison studies should include multiple examiners to reduce examiner bias and should alternate the probing method to reduce bias created by local tissue changes from multiple probings.

Adult↗

PubMed1997

Recurrent peripheral giant cell granuloma associated with cervical resorption.

A case of recurrent peripheral giant cell granuloma in a 38-year-old man is reported. The lesion was localized on the attached gingiva of the lower left second premolar (tooth #35). The surgical excision of the lesion revealed a superficial resorption of the cervical region of the involved tooth. The resorption was smoothed out, and there was no sign of recurrence or further resorption after 14 months. Root resorption, although extremely rare, may be associated with peripheral giant cell granuloma.

Adult↗

PubMed1997

Reproducibility of bone height measurements made on serial radiographs.

The objective of this study was to determine the reproducibility of alveolar bone height measurements made on digitized images of serial radiographs using 3 different alignment systems for taking serial radiographs: 1) XCP Rinn System, 2) XCP Rinn System modified to include an alignment pin, and 3) I/EGAD system (impression based-electronically guided alignment device). Eighty duplicate films taken 1 hour apart of randomly selected anterior or posterior sites for alignment systems 1 and 2 were taken on 40 subjects. Thirty-eight duplicate films were taken of posterior and anterior sites on 19 subjects with alignment system 3. Cemento-enamel junction alveolar crest measurements were made on digital images using the side-by-side technique. Image pairs of serial radiographs were dichotomized into well-matched and poorly matched groups based on subjective evaluation of the geometric likeness. Of those taken with system 1, 47% were well matched; with system 2, 62%; and with system 3, 98%. The measurement error of change in radiographic bone height, defined as twice the standard deviation of difference (mm), was determined. This varied between 1.03 mm for poorly matched radiographic pairs taken with alignment system 1 and 0.52 mm for all radiographic pairs taken with alignment system 3. These results can be used together with power calculations to select an alignment system for a particular study. For example, power calculations indicate that detecting a bone change of 0.5 mm using the I/EGAD system would require one-third of the subjects needed when using the XCP Rinn method.

Adult↗

PubMed1998

Effects of expanded polytetrafluoroethylene and polylactic acid barriers on healthy sites.

The configuration of the barrier devices to treat interproximal defects by guided tissue regeneration (GTR) necessitates inclusion of healthy adjacent teeth to secure the barriers in place. The purpose of this study was to evaluate the effects of expanded polytetrafluoroethylene (ePTFE) and polylactic acid (PLA) barrier devices on probing depth (PD), clinical attachment level (CAL), and crestal bone height in healthy sites. The study included 30 patients who were in an earlier study which compared the effects of GTR utilizing an ePTFE or a PLA barrier in intrabony defects. Thirty defects were randomly assigned to receive either a PLA (test) or an ePTFE barrier (control) after open flap debridement. The sites in this investigation included those healthy sites in the immediately adjacent non-affected teeth covered by the barriers. CAL and PD were measured at baseline and 12 months. Intrasurgical crestal bone height was recorded at the time of barrier placement and at a 12-month re-entry. Two-sample t-test comparisons of PD and CAL measurements between barrier device covered sites at baseline (PD: ePTFE, 2.32+/-0.51; PLA, 2.59+/-0.74; CAL: ePTFE, 2.71+/-0.66; PLA, 2.59+/-0.65 mm), and at one year (PD: ePTFE, 2.14+/-0.37; PLA, 2.07+/-0.56; CAL: ePTFE, 3.14+/-1.05; PLA, 2.75+/-0.73 mm) were not statistically different (P > 0.05). Paired t-test was utilized to compare changes in PD, CAL, and crestal bone height from baseline to 12 months. A statistically significant reduction in PD was found in the PLA group (delta = -0.52, P = 0.01) while no significant change was found in the ePTFE group (delta = -0.18, P = 0.18). Change in CAL was statistically significant in the ePTFE group (delta = 0.43, P = 0.02) while no significant change was found in the PLA group (delta = 0.16, P = 0.39). Crestal bone height changes from baseline to 12 months were statistically different for both groups (ePTFE, delta = 0.8 mm, P = 0.001; PLA, delta = 0.6 mm, P = 0.001). These resorptive changes, when compared between treatment groups were not statistically different (P > 0.05). In conclusion, the placement of ePTFE or PLA barriers on healthy sites resulted in probing depth reductions and loss of attachment of 0.5 mm or less. Additionally, both groups exhibited less than 1.0 mm of crestal bone resorption.

Adult↗

PubMed1998

A classification system for loss of papillary height.

A classification system for loss of papillary height is proposed. It uses readily identifiable anatomical landmarks for reference, and sorts the degree of loss into 3 classes. The 3 broad categories allow for a quick descriptive assessment. In addition to the basic classification, it is suggested that additional and incremental description may be included to further define the defects.

Disease Progression↗

PubMed1998

Impact of endodontic conditions on marginal bone loss.

This study was undertaken to examine the extent to which the marginal alveolar bone may be influenced by the condition of the dental pulp. A total of 115 pairs of contralateral teeth were observed in 87 patients (25 to 45 years old) in which the test tooth, but not the control tooth, was either endodontically treated or not treated but with a periapical radiolucency. The distance from the cemento-enamel junction to the marginal bone level was measured using intraoral radiographs. The condition of the endodontic filling, the periapical status, and the presence of root canal post were also assessed. With clinical parameters similar between teeth in the two groups in terms of visible plaque, bleeding on probing, probing depth, and attachment level, the results showed a somewhat (mean value 0.1 mm; SD 0.7) larger reduction of the alveolar bone support in test than control teeth. This difference was not statistically significant on a patient level. Hence, this study failed to demonstrate a correlation between a reduced marginal bone support and endodontic status.

Adult↗

PubMed1998

Inflammatory cervical root resorption following segmental orthognathic surgery. A case report.

An unusual case of bilateral inflammatory external/internal root resorption developed in the maxillae of a 28 year-old female approximately 4 years following routine segmental orthognathic surgery. The patient experienced dental pain in a tooth adjacent to a segmental osteotomy cut 8 months postsurgery, however, the tooth later became asymptomatic. A definitive diagnosis of inflammatory cervical root resorption was not established until nearly 4 years later on routine dental examination. The external/internal resorptive lesions were located 4 to 6 mm apical to the connective tissue attachment on 3 of the 4 tooth roots adjacent to osteotomy cuts. Two of the affected teeth required non-surgical root canal therapy due to pulpal communication with the resorptive defects. The lesions were accessed by flap surgery, thoroughly debrided, and obturated with an intermediate restorative material until definitive restorative therapy could be completed. All sites healed uneventfully and the patient has been closely observed for approximately 2 years without symptoms or recurrence of the resorptive lesions. Dental health care providers should be alert to the possible occurrence of inflammatory root resorption in sites adjacent to osteotomy cuts over extended periods of time. Routine radiographic examination may be beneficial in the postoperative management of the segmental orthognathic surgery patient.

Adult↗

PubMed1998

Horizontal alveolar bone loss and vertical bone defects in an adult patient population.

The objectives of the present investigation were to analyze intraoral radiographs and to study 1) the distribution of the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL) and 2) the prevalence and severity of vertical defects, and furcation lesions in 416 individuals seeking dental care. Full mouth radiographs were enlarged 7.5 times and the mesial and distal distances between CEJ and bone level were measured. The extent of interradicular molar radiolucencies was also measured. Images of 10,282 teeth were studied. Subjects were between 15 to 94 years (mean age: 47.2, S.D.+/-15.2). On average they had 24.8 teeth (S.D.+/-5.5). The mean distance CEJ-BL increased significantly up to age 45 (r2=0.07; beta=0.29; P < 0.0001) and remained stable thereafter r2=0.09, beta=-0.02, N.S.). The mean distance CEJ-bone level was 1.4 mm (S.D.+/-0.7) in the 15 to 24 age group; 3.0 (S.D.+/-1.5) in the 45 to 54 age group; and 3.02 (S.D.+/-1.4) in the 75 to 94 age group. No vertical defects were found in 163 participants (39.3%); vertical defects > or = 3.0 mm were found in 30.2% (126). Mesial defects were significantly more common that distal defects (P < 0.001). The extent of horizontal bone loss was correlated to extent of vertical defects (r2=0.88; P < 0.0001). The number of remaining teeth was not associated with horizontal or vertical bone loss. In conclusion, the study indicated that few of the individuals had extensive horizontal bone loss. Vertical defects suitable for guided tissue regeneration procedures however, were found in many patients.

Adolescent↗

PubMed1998

Cervical root resorption associated with guided tissue regeneration: a case report.

Root surface resorption, ankylosis (replacement resorption) and alveolar bone resorption are not uncommon sequelae to periodontal healing in both animal and human trials whether the treatment objective is regenerative, preventive, or conservative. The present report describes a case with progressive cervical root resorption in a patient who received periodontal regenerative treatment with guided tissue regeneration (GTR). A 46-year-old woman was referred for treatment of severe periodontitis. Remaining radiographic attachment was less than 50%. Following a period of 18 months, during which non-surgical and surgical therapies were performed, angular defects were diagnosed on radiographs and recurrent bleeding periodontal pockets (6 mm) were found in the proximal areas of 24 and 25. Root caries was not present. Periodontal surgery with GTR was performed in this area. No immediate postsurgical complications were noted. Two years later, clinical and radiographic examinations revealed gingival recession with bleeding periodontal pockets (6 mm) which had partly uncovered severe proximal cervical resorptions in 25. Root surface caries was not present. Following surgical inspection, the root of 25 was removed. The root was subsequently prepared for histological analysis. Resorption cavities covered almost the entire cervical proximal surface of the root above intact infracrestal cementum and were covered by numerous CD68+, both mononuclear and multinucleated cells. In a central area as indicated on the radiographs, the cavities penetrated into the root canal. There was no evidence of root caries.

Antigens, CD↗

PubMed1998

Alveolar bone levels in AIDS and HIV seropositive patients and in control subjects.

Alveolar bone levels were studied from intraoral radiographs of 24 non-hospitalized patients with AIDS, 17 HIV seropositive subjects, and 39 matched control subjects. The AIDS/HIV subjects were seeking dental care in a faculty practice. The matched control subjects came from those non-HIV-infected patients seeking dental care at the University of Washington. Magnified intraoral radiographs were used to assess the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL). The extent of vertical defects and furcation invasions was also assessed. The mean age of the AIDS, HIV, and control subjects was 38.9 +/- 6.6 years, 37.1 +/- 7.6, and 39.9 +/- 5.6, respectively, and was not statistically different. Among the AIDS patients, 75% were smokers, while 88.2% of the HIV subjects were cigarette smokers. Therefore, the matched control subjects were also smokers to the same extent. The mean difference in distance CEJ-BL was 0.1 mm (mesial) and 0.3 mm (distal) and greater in the HIV/AIDS group than in the control group, but not statistically different. No vertical defects > or = 3.0 mm were found in 69.2% of the control subjects and in 58.5% of the combined HIV/AIDS group. None of the HIV/AIDS subjects had more than 5 defects > 3.0 mm, while 7.6% of the control subjects had such defects. Significant associations were found between smoking and extent of alveolar bone loss (distance) (P < 0.001) as well as the number and extent of vertical defects (P < 0.01), but were not associated with HIV status. The extent of furcation invasions, as read radiographically, did not differ between groups. In conclusion, smoking but not HIV status was the primary factor for alveolar bone loss.

Acquired Immunodeficiency Syndrome↗

PubMed1999

The accuracy of radiographic methods in assessing the outcome of periodontal regenerative therapy.

BACKGROUND: The study of regenerative therapy in the periodontal intrabony defect has relied upon surgical re-entry as the gold standard of outcome assessment. The search for a non-invasive method has led to the application of various radiographic techniques in evaluating post-treatment bone fill. METHODS: The purpose of this study was to determine the ability of 2 forms of radiographic analyses (linear measurement and computer assisted densitometric image analysis, CADIA) to assess postsurgical bone fill as measured at a re-entry procedure. A method that incorporates linear measurements and CADIA (linear-CADIA) was developed and tested as well. Forty-five intrabony defects in 15 patients were treated with open flap debridement, demineralized freeze-dried bone allograft (DFDBA), or a combination of DFDBA and tetracycline. Standardized radiographs were obtained at baseline and at 1-year postsurgery. RESULTS: A 12-month surgical re-entry provided clinical measurements for post-treatment bone fill. All radiographs were digitally scanned and analyzed on a computer. Fifty-three percent of the defects were excluded from the study due to poor standardization or poor defect quality. Forty percent of all pairs of radiographs were judged to have poor standardization. In the first analysis, standardized images were subtracted and quantitatively analyzed utilizing CADIA. It was found that CADIA had the highest correlation with clinical bone fill when a region of interest (ROI) was examined in the middle portion of the defect. This quantitative evaluation provided very little clinically relevant information regarding actual bone fill. For the second analysis, pre- and post-treatment linear radiographic measurements were obtained. In only 43% of the sites, did linear radiographic measurements determine post-treatment bone fill within 1.0 mm of the clinical measurements. Overall, linear measurements underestimated bone fill by 0.96 mm (+/-1.2). These differences were statistically significant (paired Student t-test, P = 0.0023). A method, which incorporates the use of both CADIA and linear radiographic measurements (linear-CADIA), was tested. The linear-CADIA method underestimated bone fill by 0.26 mm (+/-1.4), but these differences were not statistically significant (paired Student t-test, P = 0.41). CONCLUSION: Linear radiographic measurements significantly underestimate post-treatment bone fill when compared to re-entry data. The linear-CADIA method provided the highest level of accuracy of the 3 methods tested. This study also emphasizes the importance of developing a consistent method of radiographic standardization.

Adult↗

PubMed1999

Long-term results of a minimally invasive surgical approach for bone grafting.

A retrospective analysis of the results obtained from regenerative surgery performed utilizing a minimally invasive surgical approach was performed. Bone grafting procedures were performed at 194 sites in 87 patients using small incisions and minimal flap reflection. There were 44 females with a mean age of 52.7 years and 43 males with a mean age of 54.9 years. The mean healing time at which data were collected was 21.7 months. Postsurgical data were collected at the time of routinely scheduled supportive periodontal therapy (SPT) appointments by 2 evaluators. Mean changes in probing depth and attachment levels were evaluated utilizing a Wilcoxon sign rank test. Mean improvement in probing depth was 4.58 mm (P <0.0001) and attachment level was 4.87 mm (P <0.0001). These improvements were seen for all levels of initial prognosis (good to poor) and appeared to be stable over time. The postsurgical gingival margin was at or within 1 mm of the cemento-enamel junction (CEJ) for 58% of the sites treated. This was interpreted to indicate good retention of soft tissue height postsurgically. It was concluded that the minimally invasive approach for bone grafting yielded results that were equivalent to more traditional surgical approaches utilizing longer incisions and greater reflection.

Bone Transplantation↗