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Abstract-2



1. Effects of Guided Bone Regeneration Around Commercially Pure Titanium and
Hydroxyapatite-Coated
   Dental Implants. I. Radiographic Analysis

2. A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction. Report of 10
    Cases

3. A new antibiotic therapy using tetracycline-impregnated fibers
4 The use of porcelain laminate veneers and a removable gingival prosthesis for a periodontally compromised patient: A clinical report
5 Do traditional techniques produce better conventional complete dentures than simplified techniques?
6 Effect of rotary or manual instrumentation, with or without a calcium hydroxide/1% chlorhexidine intracanal dressing, on the healing of experimentally induced chronic periapical lesions
7 Longevity of ceramic inlays and onlays luted with a solely light-curing composite resin
8 Influence of force location in orthodontic shear bond strength testing
Effects of Guided Bone Regeneration Around Commercially Pure Titanium and Hydroxyapatite-Coated Dental Implants. I. Radiographic Analysis

William C. Stentz, Brian L. Mealey, Pirkka V. Nummikoski, John C. Gunsolley, and Thomas C. Waldrop


The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study assessed radiographic density changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 x 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 x 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment (control). Standardized radiographs were taken at 1 week and 4 months post-implant placement. Computer-assisted densitometric image analysis (CADIA) was performed at 6 areas of interest (coronal, middle, and apical defect areas mesial and distal to each implant) for each of the implant sites. Significantly greater increase in bone density was obtained using DFDBA/ePTFE compared to ePTFE alone or the controls; likewise, ePTFE alone resulted in greater bone density change than the controls. There were no significant differences in radiographic bone density adjacent to Ti versus HA-coated implants. When 3 dogs having postoperative membrane complications were eliminated from the analysis, the results were similar with the exception that defects adjacent to Ti implants had significantly less density gain when compared to HA-coated implants. The results of this study indicate the use of DFDBA/ePTFE in large surgically-created defects promotes a denser healing of bone adjacent to implants when measured radiographically than either ePTFE alone or no treatment.
J Periodontol 1997;68:199-208.


A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction. Report of 10 Cases

V. Lekovic, E.B. Kenney, M. Weinlaender, T. Han, P. Klokkevold, M. Nedic, and M. Orsini


Ten patients who required two or more anterior teeth extractions were utilized in this study. Extraction procedures were carried out with a full-thickness surgical flap approach. After flap reflection, teeth were removed with a minimum of trauma to the surrounding bone. Following extraction, silicone-based impression techniques were used to produce a model of the alveolar process and small metal pins were placed in the alveolus to be used as fixed points to make measurements of ridge dimensions. One socket was covered with an expanded polytetrafluoroethylene (ePTFE) barrier membrane (experimental site); the other socket was a conventional control. The soft tissue flaps were then mobilized using periosteal releasing incisions, and the wound closed with ePTFE mattress sutures. Six months following extraction, patients were treated with flap surgery to expose both extraction sites to remove the ePTFE membranes and to measure ridge dimensions using the pins as fixed points. Clinical and model measurements have shown statistically significant better ridge dimensions at experimental sites than at control sites (P less than or equal to 0.05). Three patients with exposed membranes had similar dimensional changes as controls. Results from this study suggested that this improved technique offers a predictable alveolar ridge maintenance enhancing the bone quality for dental implant procedures and esthetic restorative dentistry.
J Periodontol 1997;68:563-570.

Actisite
A new antibiotic therapy using tetracycline-impregnated fibers(trade name Actisite) for treating localized periodontal infection has been cleared for marketing by the U.S. Food and Drug Administration. These fibers offer new options to help control subgingival microflora and bleeding in isolated sites of periodontal disease.

This first controlled local-antibiotic-delivery-system is supplied as a nine-inch monofilament of ethylene/vinyl acetate copolymer 0.5mm in a diameter containing 12.7mg of evenly-dispensed tetracycline. When placed in a periodontal pocket, it provides continuous release of tetracycline with a mean gingival fluid concentrations of 32 micrograms/ml. 250mg of oral tetracycline generally produces about 10 micrograms/ml in the gingival sulcus fluid.

Studies have demonstrated that scaling and root planing followed by tetracycline fiber placement was more effective than scaling alone and reduced mean pocket depth by an additional 0.6mm and bleeding on probing by an additional 13% after six months. Bacterial populations were also reduced. The benefits of the fibers seem to increase over a six-month period, possibly due to the fact that tetracycline is retained in the roots.

Proctor & Gamble, which is marketing Actisite, recommends tha fibers be used as an adjunct to therapy for recurrent periodontal disease in isolated individual problem sites. The fibers can also be used in acute periodontal abscesses, but should be loosely packed to allow for drainage. If the site fails to respond to fiber therapy, then periodontal surgery may be indicated.

A single fiber is placed into a completely fill pocket to its base using a cord packer. Cyanoacrylate adhesive is used to help secure the fiber in place and the patient is instructed not to brush or floss the area for ten days. Local analgesia is usually not required at placement and the fibers are removed after ten days as they become a foreign body after about 14 days. The fibers should be placed by the doctor only. If stripping of the epithelial attachment occurs and is kept open by the apical placement of the fiber, a permanent increase in pocket depth may occur. The development of tetracyline fibers is an important step in treating localized periodontal infections by sustained high-dosage of local antibiotic delivery. When multiple areas are infected, tetracycline fibers are not the treatment of choice. Many other medications are currently being tested, including metronidazole, doxycycline, minocycline and chlorhexidene in chips, fibers, strips and gels. The obvious next step would be a delivery system that is more time efficient at placement, biogrades in the pocket so removal is not necessary, and is known to be effective against the specific bacterial infection under treatment.

Clinical studies indicate that some sites don't respond favorably to the tetracycline fibers. This may be because tetracycline is a non-specific antibiotic and some specific infections are resistant to tetracycline or may be located too deep in the tissue to be affected. One tetracycline fiber study reported that some patients infected with Actinobacillus actinomycetemcomitnas, which is know to invade tissue, got worse or showed no improvement.

Tetracycline fibers are the first of an exciting new mode of therapy in our continuing fight against periodontal disease.

"Updates": In Wilson's recent study pretaining to a five year investigation of treating periodontal disease with scaling and root planing plus tetracycline fibers a regression was noted from the original gains in the previous parent study that lasted six months. It appears that the use of the tetracycline fibers provided no significant advantage with regards to probing depth reduction or clinical attachment gain in a five year period. This underscores the need for long-term evaluations for these types of therapy.

References:
1. Listgarten M: Effect of Tetracycline and /or scaling on human periodontal disease. J. Clin Perio 1978 5:246-71.
2. Newman MG, Kornman KS, Doherty FM: A 6-month multi-center evaluation of adjunctive tetracycline fiber therapy used in conjunction with scaling and root planing in mainternace patients: J Periodontl 1994 Jul;65(7):685-91.
3. Kerry G: Tetracycline-loaded fibers as adjunctive treatment in periodontal disease. JADA 1994 Sep;125(9):1199-1203.
4. Tonetti MS, Pini-Prato G, Cortellini P: Principles and clinical applications of periodontal controoled drug delivery with tetracycline fibers. Int. J. Periodontics Restorative Dent 1994 Oct;14(5):421-435.
5. Wilson T. Long-Term Results of Tetracycline Therapy. J Perio 1997;68:1029-1032.
4 The use of porcelain laminate veneers and a removable gingival prosthesis for a periodontally compromised patient: A clinical report The Journal of Prosthetic Dentistry, Volume 93, Issue 4, April 2005, Pages 315-317 Classic Article Waldimir Carvalho CDa, , , Eliane P. Barboza CD, MScD, DScDb and Cresus Vinicius Gouvea CDc aGraduate Student, Federal Fluminense University bVice-Chairwoman, Master of Science in Dentistry Program, School of Dentistry, Federal Fluminense University and Director, Brazilian Institute of Periodontology cChairman, Master of Science in Dentistry Program, School of Dentistry, Federal Fluminense University School of Dentistry, Federal Fluminense University, Rio de Janeiro, Brazil; Brazilian Institute of Periodontology, Rio de Janeiro, Brazil. Available online 28 March 2005. Periodontal disease may lead to tooth and tissue loss that can result in esthetic problems. Combined periodontal/prosthodontic treatment for patients with advanced periodontal disease is well documented. This clinical report illustrates a method of treatment for advanced tissue loss in an esthetic area using porcelain laminate veneers and a removable gingival prosthesis. 5 Do traditional techniques produce better conventional complete dentures than simplified techniques? Journal of Dentistry, In Press, Corrected Proof, Available online 9 March 2005, Yasuhiko Kawai, Hiroshi Murakami, Batoul Shariati, Esa Klemetti, John V Blomfield, Lucie Billette, James P Lund and Jocelyne S Feine a Nihon University School of Dentistry at Matsudo, Chiba, Japan b Faculty of Dentistry, McGill University, Montreal, Canada c Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran d Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, Kuwait e Division of Prosthodontics, McGill University, Faculty of Dentistry, Montréal, Canada f Private practice, Montréal, Canada g Centre de recherche en sciences neurologiques, Université de Montréal, Montréal, Quebec h Faculty of Dentistry, and Associate Member, Department of Epidemiology and Biostatistics and Occupational Health, and Department of Oncology, Faculty of Medicine, McGill University, Montréal, Canada Received 2 September 2004; revised 4 October 2004; accepted 7 January 2005. Available online 9 March 2005. Summary Objectives To compare the quality of conventional complete dentures fabricated with two different techniques. A randomized controlled clinical trial was conducted to compare traditional (T) and simplified (S) methods of making complete conventional dentures on patients' ratings of satisfaction, comfort and function at 3 and 6 months following delivery. The quality of the prostheses was rated by prosthodontists at 6 months. Materials and methods One hundred twenty-two male and female edentulous individuals, aged 45–75 years, were randomly allocated into groups that received dentures made with either T or S methods. Following delivery, patients' ratings of several denture-related factors were measured using 100 mm visual analogue scales, and denture quality was assessed by blinded prosthodontists using ratings on a validated quantitative scale. Results There were no significant differences between the two groups in patient ratings for overall satisfaction (3 months: mean T=83 mm, mean S=83 mm, P=0.97; 6 months: mean T=79 mm, mean S=79 mm, P=0.96 ) or in prosthodontists' ratings of denture quality (T=66, S=63; P=0.38). Conclusion These results show that the quality of complete dentures does not suffer when manufacturing techniques are simplified to save time and materials. Dental educators should consider these findings when re-designing prosthodontic training programs. Keywords: Randomized controlled trial; Complete dentures; Denture quality; Patient satisfaction; Education 6 Effect of rotary or manual instrumentation, with or without a calcium hydroxide/1% chlorhexidine intracanal dressing, on the healing of experimentally induced chronic periapical lesions Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Volume 99, Issue 5, May 2005, Pages 628-636 Endodontology Andiara De Rossi DDS, MSca, , , Léa A.B. Silva DDS, PhDb, Mario R. Leonardo DDS, PhDc, Lenaldo B. Rocha DDS, MScd and Marcos A. Rossi MD, PhDe aPostgraduate student of Experimental Pathology, Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo. Recipient of a Scholarship from FAPESP (01/04732-9) bProfessor, Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo cProfessor, Department of Endodontics, Araraquara School of Dentistry, State University of São Paulo dPostgraduate student of Experimental Pathology, Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo eProfessor, Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo Received 3 May 2004; revised 17 June 2004; accepted 18 July 2004. Ribeirão Preto and Araraquara, Brazil UNIVERSITY OF SÃO PAULO AND STATE UNIVERSITY OF SÃO PAULO. Available online 8 December 2004. Objective To evaluate the healing of experimentally induced chronic periapical lesions in dogs at 30, 75, and 120 days after root canal instrumentation with rotary NiTi files or manual K-files, with or without a calcium hydroxide/1% chlorhexidine paste intracanal dressing. Study design The second, third, and fourth mandibular premolars and the second and third maxillary premolars of 5 dogs (12 to 18 months of age, weighing 8 to 15 kg) were selected for treatment (a total of 82 root canals). After pulp removal, the root canals were left exposed to the oral cavity for 7 days to allow microbial contamination, after which the root canals were sealed with ZOE cement until periapical lesions were confirmed with radiography. Group I and II teeth were instrumented with manual K-files using the crown-down technique. In group III and IV teeth, NiTi rotary files were used. The apical delta was perforated by using #20 to #30 K-files at the length of the tooth, thus creating a standardized apical opening. The apical stop was enlarged to size 70, with 2.5% sodium hypochlorite irrigation at each file change. Teeth in groups II and IV were dressed with calcium hydroxide (Ca(OH)2)/1% chlorhexidine (CHX) paste for 15 days before root filling. Group I and III teeth did not receive an intracanal dressing. The access openings of the teeth were permanently restored with silver amalgam condensed on a glass ionomer cement base. Pairs of standardized periapical radiographs were taken at the beginning of the treatment (0 days) and at 30, 75, and 120 days after filling. Results There was no significant difference in the rate of radiographic healing of the periapical lesions between manual and rotary instrumentation. Radiographs taken at 120 days showed that the treatment with Ca(OH)2/1% CHX paste resulted in a significant reduction in mean size of the periapical lesions in comparison to single-session treatment. These findings were also true for histologic observations. Conclusion The findings support the hypothesis that, regardless of the instrumentation technique (manual or rotary), the use of an intracanal dressing is important in the endodontic treatment of dog's teeth with experimentally induced chronic periapical lesions. 7 Longevity of ceramic inlays and onlays luted with a solely light-curing composite resin Journal of Dentistry, Volume 33, Issue 5, May 2005, Pages 433-442 Andreas G. Schulte, Alexander Vöckler and Rüdiger Reinhardt Longevity of ceramic inlays and onlays luted with a solely light-curing composite resin Andreas G. Schulte, , Alexander Vöckler and Rüdiger Reinhardt Department of Conservative Dentistry, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany Received 30 July 2004; revised 23 October 2004; accepted 29 October 2004. Available online 2 February 2005. Summary Objectives. To determine the longevity of heat-pressed glass ceramic inlays and onlays luted with solely light-curing composite resin. Methods. The records of patients who had received a ceramic inlay or onlay at the Heidelberg University Department of Conservative Dentistry from 1993 to 2002 were evaluated. The mean observation time and the survival probability of the ceramic inlays and onlays was calculated with the aid of the Kaplan–Meier algorithm. This was done for the total number of all restorations as well as for various subgroups (number of surfaces, tooth type, endodontic condition at the time that the ceramic restoration was incorporated, experience of operator). The log-rank test was used to compare groups and look for significant differences, and p<0.05 was set to be statistically significant. In addition, 95% confidence intervals of the survival probability values were computed. Results. At the time of the last observation, 783 (96.7%) of these restorations were still in place. The mean observation period for all ceramic restorations was 17.3 months (SD 20.2), with an observation interval of between 0 and 116 months. The last loss of a ceramic restoration was observed 45 months after it had been placed, so that the survival probability of all ceramic restorations amounted to p=0.90 (95% confidence interval 0.86–0.94) from this time onward. Factors such as endodontic condition of tooth, type of tooth, position of tooth, extent of restoration, experience of operator or gender of patient had no significant influence on the survival probability of the ceramic restorations. Conclusions. Heat-pressed glass ceramic inlays and onlays can be used successfully in routine clinical therapy. In addition, this type of inlays and onlays can be placed successfully with solely light-curing composite resin. 8 Influence of force location in orthodontic shear bond strength testing Influence of force location in orthodontic shear bond strength testing Arndt Klocke , and Bärbel Kahl-Nieke Department of Orthodontics, University Hospital Hamburg-Eppendorf, Kieferorthopaedie, ZZMK, Pav. O 53, Martinistr. 52, D-20246 Hamburg, Germany Received 4 May 2004; accepted 15 July 2004. Available online 22 October 2004. Summary Objective The purpose of the present study was to analyze the influence of debonding force location in shear bond strength testing of orthodontic brackets in vitro. Methods Ninety extracted permanent bovine mandibular incisors were randomly divided into 3 groups of 30 specimens each. Teeth were bonded with stainless steel orthodontic brackets. Enamel surfaces were etched with 37% phosphoric acid for 30 s and bonded with a composite adhesive. Debonding force measurements were performed with a universal testing machine. Location of the debonding force was: bracket base (group A), ligature groove (group B), occlusal bracket wings (group C). Results Mean shear bond strength measurements were as follows: 22.70(4.23) MPa (group A), 11.52(2.74) MPa (group B), 9.44(2.96) MPa (group C). Analysis of variance indicated that there were significant differences in shear bond strength. Post-hoc Tukey tests showed that bond strength measurements of group A were significantly different from those of groups B and C. The adhesive remnant index also showed significant differences and ranged from a mean of 1.53 in group A to a mean of 2.10 in group C. Significance Debonding force location had a significant influence on shear bond strength measurements and bond failure pattern, indicating that this parameter needs to be taken into consideration for interstudy comparison of in vitro results. Keywords: Bond strength testing; Orthodontic ; Force location; Distance; In vitro; Adhesion

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