1/12. guided tissue regeneration in the management of severe periodontal-endodontic lesions.diagnosis of combined periodontal-endodontic lesions can prove difficult and frustrating. They are often characterised by extensive loss of periodontal attachment and alveolar bone, and their successful management depends on careful clinical evaluation, accurate diagnosis, and a structured approach to treatment planning for both the periodontic and endodontic components. Recent advances in regenerative periodontics have led to improved management of periodontal-endodontic lesions. This paper reviews the management of such lesions in light of these recent advances and illustrates this through reports of two patients who had severe periodontal involvement.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/12. Treatment of molar furcation involvement using root separation and a crown and sleeve-coping telescopic denture. A longitudinal study.Because of the inconsistent results of periodontal and prosthetic therapy, periodontists may choose to treat maxillary molar furcation involvements (FI) with poor root morphology utilizing a root resection technique (RRT). In addition, poor root morphology of the remaining root following RRT is usually considered a high risk factor for long-term periodontal and prosthetic success. The purpose of this retrospective study was to investigate the differences in the clinical periodontal parameters between molar abutments with and without molar root separation and/or resection (RSR) before and after periodontal and prosthetic therapy, using a crown and sleeve-coping telescopic denture (CSCTD). A total of 85 molars (47 maxillary and 38 mandibular) were treated in 25 subjects. There were 33 abutments without root separation/resection and 52 abutments with RSR. Forty-three CSCTD were placed, 23 in the maxillary arch and 20 in the mandibular arch. The mean observation period was 6.7 /-1.9 years (range, 5 to 13 years). The plaque index, gingival index, probing depth, clinical attachment level, and alveolar bone change were recorded. The differences in these parameters before and after periodontal and prosthetic therapy between the advanced furcation-involved molars with and without RSR were evaluated. The results revealed a remarkable improvement in the periodontal parameters in advanced Class II and Class III FI in molars with RSR as compared to those without RSR. It was, therefore, concluded that molar abutments with RSR in conjunction with a specifically designed telescopic device provide a modified approach for treating molars with advanced Class II and III FI.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
3/12. Treatment of furcation defects with DFDBA combined with GTR: human histologic evaluation of a case.The purpose of this study was to evaluate whether regeneration is possible in human furcation defects. Three molars with Class II furcation involvement were included in this study. A notch was placed in calculus in the furcation to serve as a reference point for histologic evaluation. The defects were treated with a demineralized freeze-dried bone allograft combined with a bioabsorbable membrane. At 6 months postoperative, the teeth were extracted with a small piece of tissue from the furcation area. The samples were then processed for histologic evaluation. Regeneration was found in 2 of the 3 samples. This study demonstrated that regeneration is possible in human furcation defects.- - - - - - - - - - ranking = 0.0025608222868751keywords = process (Clic here for more details about this article) |
4/12. Periodontal regeneration of a class II furcation defect utilizing a bioabsorbable barrier in a human. A case study with histology.This case report describes human histologic data of periodontal regeneration following guided tissue regeneration therapy (GTR) with a bioabsorbable barrier composed of polylactic acid. The tooth that was examined was part of a previously published study of the clinical effects of GTR therapy without the use of bone or bone substitutes on Class II furcation defects. Twenty-five months following the surgical procedure, the tooth was extracted for non-periodontal reasons. During this extraction, the bone within the furcation that was treated in the study was luxated with the tooth. At the completion of the study (month 12), the furcation's vertical probing depth had decreased by 2 mm with a 2 mm gain in clinical attachment. The horizontal furcation measurement decreased by 3 mm. Following extraction, the tooth was prepared for light microscopy and sectioned in the mesial-distal plane. Reference notches were not placed in the tooth at the time of surgery as there were no plans to perform histologic analysis in the study. However, using the buccal root prominences and what we interpreted to be root planing marks on the cementum, we were able to demonstrate that complete periodontal regeneration occurred on the root surface that was exposed to the pocket environment prior to surgery. New alveolar bone, cementum, and periodontal ligament were consistently observed throughout the furcation in the areas that demonstrated clinical attachment gain and a decrease in horizontal probing depth. This case report adds to the accumulating evidence of histologic periodontal regeneration following guided tissue regeneration with bioabsorbable polylactic acid barriers.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
5/12. Failure of resin ionomers in the retention of multi-rooted teeth with Class III furcation involvement: a rebuttal case report.BACKGROUND: Severe periodontal furcation invasion has long been a treatment dilemma for the clinician. Many techniques have been advocated in the treatment of multi-rooted posterior teeth ranging from conventional scaling and root planing (SRP), apically positioned flaps, root amputations, root resections, tunnel procedures, guided tissue regeneration, and restorations. The keys to success depend on the clinician's ability to access the furcation to remove local factors and create an environment that enhances the patient's own hygiene efforts. Long-term success in treating teeth with furcation invasion depends upon tooth retention and arresting the destructive processes within the furcation area. methods: A Class III furcation invasion in a mandibular molar was treated by surgical access for SRP along with obliterating the furcation utilizing a resin ionomer restoration. RESULTS: Initially, the patient was asymptomatic. Within 3 months of treatment, the patient presented with suppuration that was refractory to local efforts. Radiographs taken only 5 months postsurgery demonstrated advanced bone loss apical to the restoration. The tooth ultimately was extracted because mobility increased and the tooth became symptomatic. CONCLUSIONS: The clinician must consider the multi-factorial etiology of periodontal breakdown within a furcation. For this patient, the technique of sealing off the exposed furcation with restorative material appeared to have resulted in progressive bone loss and accelerate tooth loss. This single case report is presented as a rebuttal to recently published articles, which have demonstrated excellent results when treating furcations with ionomer restorations.- - - - - - - - - - ranking = 0.0025608222868751keywords = process (Clic here for more details about this article) |
6/12. The mandibular molar class III furcation invasion: a review of treatment options and a case report of tunneling.BACKGROUND: The predictable management of a mandibular molar that has lost all of its interradicular periodontal support-in other words, that has experienced a Class III furcation invasion, or FI-often is a frustrating and disappointing process for both clinician and patient. The strategic value of retaining such a periodontally involved tooth must be determined by both the patient and dentist before a treatment option is selected. In this article, the authors present and describe various therapeutic plans available for Class III FIs in mandibular molars, discussing the advantages and disadvantages of each approach. They focus particularly on a surgical technique called "tunneling," which is performed to debride the remaining soft and hard tissues in the furcal area; this, in turn, allows access for effective oral hygiene and maintenance. CASE DESCRIPTION: The authors report on the 23-year result of a case involving tunneling. The procedure facilitated the retention of a mandibular molar with a Class III FI in a manner acceptable to both the patient and the clinician. CLINICAL IMPLICATIONS: Tunneling, in a properly selected patient who is motivated to perform careful oral hygiene, can result in comfortable, functional, healthy retention of the affected tooth, with a minimal commitment of time and financial outlay.- - - - - - - - - - ranking = 0.0025608222868751keywords = process (Clic here for more details about this article) |
7/12. Treatment of furcation defects with an allograft-alloplast-tetracycline composite bone graft combined with GTR: human histologic evaluation of a case report.The purpose of this study was to histologically evaluate furcation defects in humans treated with an allograft-alloplast-tetracycline composite graft combined with an absorbable membrane for guided tissue regeneration (GTR). Three teeth with Class II furcation involvement on the buccal aspects were included in this study. A notch was placed in calculus during the procedure to serve as a reference point for histologic evaluation. The defects were then treated with an allograft-alloplast-tetracycline composite graft combined with an absorbable membrane for GTR. At 6 months postoperative, the teeth were extracted with conservative block sections and processed for histologic evaluation. Regeneration (new bone, cementum, and connective tissue attachment) coronal to a notch could be seen in one of the three defects treated. In the other two defects, a new connective tissue attachment was demonstrated (new connective tissue attachment into new cementum) in the notch placed in calculus. In this study, regeneration of a furcation defect in a human was documented with histology.- - - - - - - - - - ranking = 0.0025608222868751keywords = process (Clic here for more details about this article) |
8/12. Oral Kaposi sarcoma associated with severe alveolar bone loss: case report and review of the literature.BACKGROUND: In AIDS patients who present with an oral neoplasm, Kaposi sarcoma is the tumor most frequently encountered, comprising 50% to 80% of all tumor occurrences. However, oral Kaposi sarcoma associated with erosion of underlying bone is a relatively rare finding. This report and review of the literature documents a case of AIDS-related oral Kaposi sarcoma exhibiting severe bilateral erosion of the maxillary alveolar ridges. methods: An hiv-seropositive male with extensive maxillary Kaposi sarcoma and associated bilateral alveolar bone erosion presented for dental evaluation subsequent to radiation therapy. Clinical and radiographic examinations were performed. Medical and dental histories were procured and supplemented with consultations from the patient's primary physician and radiation oncologist. Maxillary edentulation with surgical revision for primary closure was the treatment of choice for management of the dentoalveolar pathology. A maxillary immediate treatment denture was designed to obturate anticipated antral communications with the maxillary sinus. RESULTS: Surgical and prosthetic treatments were completed, but complicated by an oral-antral perforation that subsequently healed without complication. Soft tissue biopsies obtained during surgery revealed no evidence of residual Kaposi sarcoma. CONCLUSIONS: Although AIDS-related oral Kaposi sarcoma is a relatively common finding, erosion of subjacent alveolar bone is uncommon. Treatment of the tumor with subsequent dental reconstruction can be complicated by the severe lack of bone, surgical perforation of the maxillary sinus, and lack of stable teeth to serve as abutments. Significant advances in understanding the pathogenesis of AIDS-related Kaposi sarcoma have occurred in the last decade. HHV-8 and various inflammatory cytokines have been implicated in the pathogenesis and are likely to become the primary targets for therapeutic intervention.- - - - - - - - - - ranking = 8keywords = alveolar (Clic here for more details about this article) |
9/12. The healing potential of periodontal-endodontic lesions.Osseous lesions involving the periodontium, and which are sometimes associated with discomfort and pathologic changes such as swelling or the development of a sinus tract, are not always due to periodontal disease. Thus, it is not uncommon to find a dentition with generally good periodontal health but with one tooth having a severe isolated bony periodontal defect. In other cases, periodontal treatment may result in a general improvement, except in relation to one tooth which does not respond to the therapy. Very often these cases are instances of combined periodontal-endodontic lesions, but which are solely of pulpal origin. This paper serves to help the dental practitioner recognise the disease process underlying the condition and appreciate its effective management with non-surgical root canal treatment.- - - - - - - - - - ranking = 0.0025608222868751keywords = process (Clic here for more details about this article) |
10/12. Progressive, generalized, apical idiopathic root resorption and hypercementosis.BACKGROUND: root resorption is a multifactorial process that results in loss of tooth structure. The causes of root resorption may vary, leading to several types of resorptions. Some factors have been identified and may be categorized into physiological resorption, local factors, systemic conditions, and idiopathic resorptions. The objective of this report was to present a case of a 17-year-old white female with progressive, generalized, apical idiopathic root resorption followed up for 34 months. methods: Two panoramic radiographs, 14 and 34 months after initial clinical and radiological examinations, showed the rapid progression of apical root resorption. Two molars, teeth #15 and #16, which had to be extracted, and a bone sample from the distal aspect of tooth #15 were processed for histologic analysis. RESULTS: Two millimeters apical to the cemento-enamel junction, an abrupt increase in the cementum thickness was noted, amounting to 300 and 800 microm in teeth #15 and #16, respectively. The thickening of the cementum layer was due to an accelerated deposition of cellular intrinsic fiber cementum. An unusually high number of mineralization foci were observed in association with acellular extrinsic fiber cementum, and both free and fused cementicles were seen. In contrast to tooth #16, tooth #15 revealed extensive dentin replacement by a bone-like and a cementum-like tissue. Furthermore, ankylosis was demonstrated in tooth #15 and confirmed in the bone sample. CONCLUSIONS: At present, there is no preventive or therapeutic regimen for the type of root resorption seen in this case report. Treatment usually consists of the extraction of teeth with advanced lesions.- - - - - - - - - - ranking = 0.0051216445737501keywords = process (Clic here for more details about this article) |
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