Dental cementum: the dynamic tissue covering of the root.
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This study evaluated a biodegradable polylactic acid matrix as a wound stabilizing implant in reconstructive periodontal surgery. Supra-alveolar circumferential periodontal defects, 5 to 6 mm large, were surgically created around the mandibular premolars in 7 beagle dogs. The root surfaces in left and right jaw quadrants were treated with either heparin or saline. In this model, root surface treatment with heparin compromises periodontal repair and results in a long junctional epithelium and a reduced connective tissue repair to the root surface, whereas saline treatment results in almost complete connective tissue repair. Following heparin or saline treatment a polylactic acid implant was placed on 1 premolar in each quadrant. After 4 weeks of wound healing, the dogs were sacrificed and tissue blocks prepared for histometric analysis. Postoperatively, the implant became exposed and infected in 3 dogs and had to be removed. Therefore, the results reflect the 4 dogs in which healing progressed uneventfully. Connective tissue repair to the root surface in teeth treated with heparin averaged 82% of the defect height. Mean connective tissue repair in teeth treated with heparin and the implant was significantly greater and comprised approximately 99% of the defect height (P less than 0.05). Teeth treated with saline either with or without the implant also healed with almost complete connective tissue repair. The results support the importance of wound stabilization in periodontal wound healing. Development of biodegradable implant systems aimed at stabilizing and supporting the healing wound seems a desirable direction for future research in regenerative periodontal procedures.
Use of combination antiretroviral therapy regimens, including a protease inhibitor, has greatly improved the survival and systemic health of HIV-positive patients. Due to the esthetic requirements of the patient in this case report, placement of an endosseous implant into a fresh extraction site, restored with a single crown, was the treatment of choice. The implant and restoration are functioning well 18 months after placement of the fixture.
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The effect of orthodontic therapy is dependent of the biological possibilities and limitations of the dento-alveolar complex. Biomechanical effects determine the first phase of tooth movement. In the second phase hyalinisation occurs in almost all cases. Elimination of the hyalinised tissue is associated with undermining bone resorption. Next, 'real' tooth movement starts. At the pressure side the normal structure of the periodontal ligament is destroyed and so is the tooth attachment. At the tension side deposition of trabecular bone is found and the tooth attachment remains. The regulation of these processes is still not completely understood, but cytokines and growth factors play an important role. The biological system does not react according to a simple dose-response relation and large individual differences in susceptibility of the system exist.
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Two cases in which all of the zinc oxide canal filling did not resorb are described. The histories emphasize the importance of careful monitoring of treated primary teeth. The cases described were monitored for more than five years.
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