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Stabilization of maxillary segments and dental arch after puberty, in cleft lip and palate cases.

To overcome the high tendency to relapse after orthodontic treatment in patients with cleft lip and palate, efficient stabilisation of the dental arch is essential. In patients with an alveolar defect, extended bridges are most suitable, because there is no need for further retention appliances, the functional and cosmetic results are acceptable and extensive prosthetic reconstruction can be avoided, regardless of the patients age.

Adolescent↗

Tooth-implant connection: some biomechanical aspects based on finite element analyses.

This study investigated, with the use of two- and three-dimensional finite element analysis, the peri-implant stress that occurred during loading of a tooth that was rigidly connected to a distally placed implant. A fixed bond between the bone and the implant was assumed, while the periodontal ligament was represented by means of three-dimensional nonlinear visco-elastic spring elements. Two different loading conditions were compared in the study: i) an axially directed static load of 50 kg that was applied to the tooth for 10 s, and ii) a transitional load of 50 kg that was applied for 5 milliseconds. Load duration appeared to have a greater influence than load intensity on the stress distribution in the bone around an implant and a rigidly connected tooth. Static load is, therefore, potentially more harmful for peri-implant bone than transitional load. The periodontal ligament seems to play a key role in the stress distribution between a tooth and a rigidly connected implant.

Alveolar Process↗

A multilevel analysis of factors affecting pocket probing depth in patients responding differently to periodontal treatment.

3 distinct levels are involved in the periodontal inflammatory process: site, tooth, and individual. By focusing attention on the levels in the population, multilevel or hierarchical modelling (MLM) enables the researcher to understand where and how the effects at the levels involved are occurring. The aim of this paper is therefore to analyse the progression of periodontal disease using analytical models that consider the level hierarchy. 22 patients with periodontitis, in previous reports described as either non-responsive or responsive to periodontal treatment, were investigated. In the multilevel modelling method (MLM), the site pocket probing depth (PPD) is summarised in 3 parameters: the overall mean, the between-individual variance, and the within-individual, between-site variance. The model can readily be extended to include independent variables for sites, teeth and individuals. If these variables are important determinants of PPD, their inclusion in the model will lead to a reduction in residual variances between sites, teeth and individuals. The PPDs were used for construction of a PPD change variable (cPPD). This variable, together with the final registrations of PPD (fPPD) alone, were used as dependent variables in the MLM. Independent predictor variables, 12 on site-level, 3 on tooth-level, and 19 on individual-level, were constructed. The total number of sites assessed was 2236 distributed on 559 teeth in 22 subjects. Initially, a fixed, fully unconditional model (models A and E) was assessed, where no predictor variables were specified at any level. Different random-intercept models (B-D, F-H) were then calculated where the independent variables were inserted in blocks relating to each level. The variance components at all 3 levels were significantly larger than zero. This indicates that MLM is recommended for analysing the present data. The inserted predictors showed 100% sensitivity relating to the subject-level variance. Subsequent testing of the patient with disease or at high risk of disease would have to focus on diagnostic tests aimed at the individual teeth and sites. These tests would need to have a balance of sensitivity and specificity. Thus, by using multilevel modelling, the theoretical understanding of important factors in the pathogenesis of periodontitis is stimulated.

Adult↗

Explanatory models for clinical and subjective indicators of periodontal disease in an adult population.

BACKGROUND: The aim of this study was to analyze indicators of periodontal disease using: (1) community periodontal index of treatment needs (CPITN), (2) subjectively reported change of front teeth position, and 3) subjectively reported gingival bleeding. METHOD: These 3 indicators were used in models with explanatory variables from 4 domains: (A) socio-economic attributes, (B) general health and health-related lifestyle, (C) dental attitudes and behaviors, and (D) dental status expressed as (number of teeth and DFT) for the clinically-determined dependent variables. In 1992, the study was carried out cross-sectionally in all 50-year olds in 2 Swedish counties using a questionnaire (n=6343) and clinical investigation of a 20 % sub-sample (n= 1040). RESULTS: Multiple and logistic regression analysis showed that explanatory patterns varied for the clinical and subjective indicators. Use of tobacco had strong effects in all models as did high care utilization. There were few associations with socio-economic attributes. The 2 subjective indicators "changed front position" and "gingival bleeding" associated with attitudes, behaviors and subjective health. Number of teeth and DFT covaried with clinical indicators. CONCLUSIONS: The main conclusions from this study are: (1) that it is possible to find multivariate models with acceptable goodness of fit for prediction of occurrence of periodontal indicators, and (2) that the lack of relation between social attributes and the disease gives arguments for a biological provenance of periodontitis.

Attitude to Health↗

Relationship of dental status, sociodemographic status, and oral symptoms to perceived need for dental care.

OBJECTIVE: Previous studies have noted a discrepancy between clinically determined oral health status (normative need), patients' perceptions, and perceived significance of dental signs and symptoms. Our objective was to quantify the relationships between normative need and self-reports to improve our understanding of the factors that contribute to perceived need for care. METHODS: Clinical examination and questionnaire data were derived from the Florida Dental Care Study, a study of oral health and dental care, in a representative sample of community-dwelling adults aged > or = 45 years. The questionnaire provided information about presence of signs and symptoms, self-ratings of oral health, perceived need for dental care, and sociodemographic status (SDS). Perceived need was measured on a 4-point nominal scale. RESULTS: Self-reported broken filling, broken denture, cavities, loose tooth, teeth that look bad, and toothache were strongly associated with self-reported perceived need for dental care. Satisfaction with dental health was also associated with perceived need, but self-rated oral health was not. Most measures of SDS were associated with perceived need. However, in a single multiple regression, with self-reported signs and symptoms accounted for, race, age group, sex, and educational attainment were not significantly associated with a currently perceived dental problem. CONCLUSIONS: Certain dental signs and symptoms were significantly associated with perceived need for dental care, as were certain aspects of SDS; even once differences in dental signs and symptoms had been taken into account. Disaggregating measurement of perceived need from a single dichotomous ('yes/no') scale to a 4-point nominal scale was elucidative.

Aged↗

Evaluation of physiological tooth movements within clinically normal periodontal tissues by means of periodontal pulsation measurements.

The three-dimensional physiological tooth movement synchronized with heartbeat, periodontal pulsation, has already been demonstrated by previous researchers. The purpose of this study was to estimate physiological tooth movements within clinically normal periodontal tissues, thus establishing periodontal pulsation standards. The measuring device consisted of an amorphous sensor and a small magnet, which could detect tooth displacement without coming into contact with the tooth surface. The samples consisted of the left maxillary central incisors of 23 adult subjects. Three points on the labial surface were used as reference points to measure the labial-lingual movement range, and a point on the incisal edge was used for measuring the incisal-apical movement range. Periodontal pulsation and electrocardiogram measurements were recorded simultaneously for six minutes. The results showed that the mean amplitude of periodontal pulsation concerning the labial-lingual movement range was equal at the three labial points (0.59 microm) and tended to be smaller than that of the incisal-apical movement range (0.87 microm). There were no significant differences in the mean amplitude of periodontal pulsation at any of the four reference points. Significant correlations of the amplitude of periodontal pulsation existed among the three labial points. Though most teeth pulsated uniformly to the labial direction, some teeth moved in a complex manner including rotation with an axis among the three labial points. These results suggest that the values of periodontal pulsation amplitude which were recorded employing the amorphous sensor device are reliable standards of periodontal pulsation within clinically normal periodontal tissues.

Adult↗

Clinical response to experimental forces and non-surgical therapy of teeth with various alveolar bone loss.

Firm lateral force is necessary for the thorough removal of calculus during scaling and root planning (SRP) with hand instruments. However, this firm lateral force should be applied to root surfaces without considering the tooth's loss of supporting tissues. The purpose of the present study was two-fold: firstly, to evaluate the initial pain response of periodontally diseased non-molar teeth with two different levels of alveolar bone loss (ABL) to experimental lateral and vertical pull forces; and secondly, to examine the clinical response of these teeth to non-surgical therapy. Twenty patients with chronic periodontitis were specifically selected in two groups according to the level of ABL at non-molar teeth. Group I consisted of 10 patients who have 141 non-molar teeth with a radiographic evidence of 40-65% ABL. Group II consisted of 10 patients who have 132 non-molar teeth with a radiographic evidence of > or =70% ABL. All patients were systemically healthy, free of pain, and reported no current medication usage. Starting from 0 and gradually increasing an experimental lateral force with digital force gauge, and also an experimental vertical pull force with mechanical force gauge were applied to each tooth and measured. As a result of a single experimental force applied to each non-molar tooth, the initial pain response emerged in the patients was determined by means of electronic bell system used by patients themselves. Each patient was treated with SRP using specific hand instruments under local anesthesia. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and periotest values (PV scores) were compared in both groups at initial and at month 3. A mean experimental lateral force of 24.6 N and a mean experimental vertical pull force of 48.3 N caused initial pain response in group I. Initial pain response occurred with a mean experimental lateral force of 5.3 N and a mean experimental vertical pull force of 19.4 N in group II. Only group I showed statistically significant decrease in PI, GI, PD and a significant attachment gain at month 3 (P < 0.05). There was a decrease of 6 PV in group I at month 3 (P < 0.05), whereas an increase of 4 PV was observed in group II (P > 0.05). This study showed that lateral and vertical forces required for effective SRP do not cause any problem in the group with 40-65% ABL. However, they may cause trauma in the group with approximately 70% ABL. Thus, the results suggest that the degree of healing would be different in the group with > or =70% ABL and in the group with 40-65% ABL.

Adult↗

Occlusal considerations in periodontics.

Periodontal disease does not directly affect the occluding surfaces of teeth, consequently some may find a section on periodontics a surprising inclusion. Trauma from the occlusion, however, has been linked with periodontal disease for many years. Karolyi published his pioneering paper, in 1901 'Beobachtungen uber Pyorrhoea alveolaris' (occlusal stress and 'alveolar pyorrhoea'). (1) However, despite extensive research over many decades, the role of occlusion in the aetiology and pathogenesis of inflammatory periodontitis is still not completely understood.

Animals↗