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1/11. Implant site development using orthodontic extrusion: a case report.

    One of the most important factors in the successful placement of endosseous implants is the presence of adequate alveolar bone at the recipient site. alveolar bone loss associated with destructive periodontal disease frequently results in osseous defects that may complicate subsequent implant placement. Typically, such defects are treated prior to or at the time of implant surgery using the principles of guided bone regeneration. Under certain circumstances, however, such defects may be managed non-surgically by orthodontic extrusion. orthodontic extrusion can be used to increase the vertical bone height and volume and to establish a more favourable soft-tissue profile prior to implant placement. The addition, the increase in the vertical osseous dimension at interproximal sites may assist in the preservation of the interdental papillae and can further enhance gingival aesthetics. This report illustrates the treatment sequence for site development with orthodontic extrusion prior to immediate implant placement.
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ranking = 1
keywords = periodontal disease
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2/11. Human histologic evaluation of a bovine-derived bone xenograft in the treatment of periodontal osseous defects.

    This study evaluated a bovine-derived bone xenograft (Bio-Oss) in the treatment of human periodontal osseous defects. Four patients with at least one tooth that had been recommended for extraction because of interproximal advanced periodontal disease volunteered to participate. The surgical procedure consisted of flap reflection, soft tissue debridement, placing a notch in calculus as a histologic reference point, root planing, placement of the bovine-derived xenograft and a bioresorbable physical barrier, and flap closure. patients were seen every 2 weeks for plaque control and any necessary adjunctive treatment. At 4 to 6 months postsurgery, 6 teeth, along with the adjacent graft site, were removed en bloc. Histologic observations demonstrated new bone, new cementum, and new periodontal ligament coronal to the reference notch in 3 of the 4 specimens. This study indicates that periodontal regeneration is possible following grafting with a bovine-derived xenograft.
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ranking = 1
keywords = periodontal disease
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3/11. Combined mechanical and antibiotic periodontal therapy in a case of Papillon-Lefevre syndrome.

    BACKGROUND: Papillon Lefevre syndrome (PLS) is a rare entity and, as such, it is almost impossible to evaluate an effective therapy in a randomized controlled study. The amount of success reported after therapy for prepubertal periodontitis (PP) in PLS is highly variable from case to case. The goal of this case report is to evaluate the effects of a combined mechanical and antibiotic periodontal therapy regimen in the management of PLS. methods: A male patient was diagnosed as suffering from PP associated with PLS at the age of 7 years. He showed hyperkeratosis of the palms and soles, as well as advanced periodontal disease already affecting permanent teeth with maximal probing depth and vertical attachment loss of 12 mm and 11 mm, respectively. Subgingival debridement was performed with simultaneous administration of oral 250 mg amoxicillin 3 times daily and 250 mg metronidazole twice daily for one week. Clinical parameters were assessed and subgingival plaque was collected from all teeth prior to therapy and 7 and 26 months after treatment. Selective cultures for A. actinomycetemcomitans were incubated for each individual tooth and DNA probe analysis was performed for various periodontal pathogens. RESULTS: Prior to combined mechanical and antibiotic treatment, all teeth but one harbored actinobacillus actinomycetemcomitans subgingivally. However, at 7 and 26 months after therapy A. actinomycetemcomitans could be detected neither by culture nor by dna probes. Clinical parameters improved markedly and teeth erupting after therapy did not exhibit attachment loss of more than 1.5 mm during the observation period. CONCLUSIONS: Eradication (suppression beneath detection levels) of A. actinomycetemcomitans seems to play a significant role in the successful treatment of localized prepubertal periodontitis in PLS.
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ranking = 1
keywords = periodontal disease
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4/11. Treatment of periodontal disease in a patient with ehlers-danlos syndrome. A case report and literature review.

    BACKGROUND: ehlers-danlos syndrome (EDS) designates a heterogeneous group of connective tissue disorders characterized by skin elasticity, tissue fragility, and chronic joint pain. Dental findings have been reported with some types of EDS. This case report describes the periodontal findings in a patient with a previously undiagnosed EDS type VIII. methods: Diagnostic aids utilized included microbial testing, histological examination, gingival crevicular fluid (GCF) analysis for the levels of C-telopeptide pyridinoline cross-links (ICTP), and genetic counseling. Periodontal treatment consisted of mechanical debridement and adjunctive antibiotic therapy. RESULTS: genetic counseling and clinical presentation confirmed the diagnosis of EDS type VIII. Periodontal treatment led to marked clinical improvements and GCF levels of the bone resorptive marker ICTP were significantly reduced. The patient and her siblings are currently pursuing appropriate medical care and genetic counseling. CONCLUSION: Periodontal involvement may lead to the diagnosis of an underlying systemic condition. Identification of suspected etiological factors of periodontal disease may prove critical for the general well-being of some patients.
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ranking = 5
keywords = periodontal disease
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5/11. Comprehensive treatment concept in a young adult patient with severe periodontal disease: a case report.

    This case report describes the comprehensive treatment of generalized, advanced periodontal disease in a young patient. In view of the necessary reconstruction, the extensive destruction of the periodontal tissues required a systematic approach to determine the possibilities and the expectations of the patient. The subsequent oral rehabilitation was accomplished with fixed prosthodontics. In the mandible, strategically important anchor teeth were replaced with implants, allowing smaller units to be inserted. The long-term treatment result, however, can only be ensured with the full cooperation of the patient and consistent periodontal maintenance care.
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ranking = 1
keywords = periodontal disease
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6/11. Complications associated with diabetes mellitus after guided tissue regeneration--a case report revisited.

    Twelve to fourteen million individuals suffer from diabetes mellitus (DM), though the disease is undiagnosed in a large number of these people. dentists must be aware of the signs and symptoms of DM so they can better manage the treatment of whatever dental therapy their patients with diabetes require. DM has been reclassified into type 1 and type 2, based on the individual's insulin requirements. The diabetic patient may present with, or develop, advanced periodontal disease, which may be more difficult to control because of metabolic status and commitment to dental care. This article includes a description of a type 2 diabetic who reportedly was well controlled, yet experienced complications after guided tissue regeneration. The postsurgical results were acceptable and the patient remained stable during supportive periodontal therapy. However, she became noncompliant with her dental care and converted from a type 2 to a type 1 diabetic with poor control. The case illustrates the rapid progression of periodontal disease in a side that had been successfully treated. It also discusses the interrelationships between diabetes and periodontal disease.
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ranking = 3
keywords = periodontal disease
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7/11. Use of orthodontic treatment as an aid to third molar extraction: a method for prevention of mandibular nerve injury and improved periodontal status.

    BACKGROUND: Impaction of mandibular third molars predisposes to pathological conditions including periodontal disease. Extraction of these teeth also may lead to damage to the nerve and to periodontal involvement of the second molars. This report describes a series of cases in which the third molars were orthodontically induced to erupt to prevent the sequelae associated with extraction. methods: Impacted mandibular third molars in 18 patients were surgically exposed following placement of an orthodontic appliance. Depending on the individual case, 1 of 3 approaches was used: attachment of a bracket, placement of a post in the root canal, or placement of an orthodontic wire through a bucco-lingual canal. After suturing the mucoperiosteal flap, the orthodontic appliance was activated. After the tooth erupted, it was removed and periodontal parameters were measured on the second molar. RESULTS: No damage to the inferior alveolar nerve was found. Probing depths on the second molar were reduced from 7.9 /- 1.6 mm on the buccal and 7.4 /- 1.0 mm on the lingual to 1.8 /- 0.7 mm and 1.9 /- 0. 7 mm, respectively. There was an average gain of 5.0 mm in attachment. Keratinized tissue increased from 2.9 /- 0.7 to 3.8 /- 0.6 mm. CONCLUSIONS: The interdisiplinary use of periodontics and orthodontics results in non-surgical removal of impacted mandibular third molars without damage to the inferior alveolar nerve and iatrogenic periodontal sequelae to the second molars.
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ranking = 1
keywords = periodontal disease
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8/11. Characterization of patients presenting for treatment to a university refractory periodontal diseases unit: three case reports.

    BACKGROUND: Of the many forms of periodontal disease, refractory periodontal diseases are the least characterized. They are defined as the continued degeneration of the periodontium despite adequate management. This has led to the suggestion that there may be a systemic component that is a contributing factor to the development of this condition. The objectives of this report were to follow the progression of clinical changes associated with periodontal disease over a number of years in this unique population and review various hematologic and microbiologic factors that may be contributing to the disease progression. methods: Three subjects were profiled. They were referred to the Refractory Periodontal Disease Unit at the University of Toronto by periodontists or general practitioners in the Southern ontario region. Complete medical and dental histories were obtained along with baseline clinical measurements. Periodontal examinations were facilitated with the use of a computer-assisted periodontal probe. A microbiologic analysis using immunofluorescence techniques was able to detect prevotella intermedia, porphyromonas gingivalis, Tannerella forsythia, and actinobacillus actinomycetemcomitans and spirochetes. A hematologic analysis, including a complete blood count (CBC), immune profile, and glycosylated hemoglobin assay, was also performed. RESULTS: The clinical presentation revealed that patients receiving adequate maintenance therapy and with good to excellent oral hygiene demonstrated sites with continual loss of attachment. Few periodontal pathogens were detected. However, the most significant finding appeared to be the report elevated levels of CD8 cells within this group of patients compared to normal laboratory ranges. CONCLUSIONS: This report is an attempt at characterizing a unique population within the periodontal realm. The long-term monitoring of these patients allowed for an assessment of factors that may be involved in the continued decline of the periodontal health of these patients. Based on the immune profile, it is possible that a hyperresponsive state may be the primary feature of this population. Future assessments, including full-mouth interleukin (IL)-1 and matrix metalloproteinase (MMP)-8 levels, may assist in characterizing this population further, with the goal of producing markers that will assist clinicians in predicting treatment outcome.
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ranking = 7
keywords = periodontal disease
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9/11. Periodontal disease in a rubinstein-taybi syndrome patient: case report.

    INTRODUCTION: rubinstein-taybi syndrome (RTS) is a rare disorder affecting 1 of 300,000 people, characterized by growth, mental and motor retardation, small stature, broad thumbs and toes, characteristic face, high-arched palate, and recurrent respiratory infections. CASE REPORT: The present report describes the periodontal and immunological status of a 14-year-old female patient with RTS. Probing depth, clinical attachment level, bleeding on probing, and radiographic evaluation were performed. Periodontal examination revealed severe attachment loss in incisors and molars and generalized bleeding on probing. Periodontal treatment consisted of scaling and root planing and oral hygiene instructions. Periodontal treatment resulted in resolution of gingival inflammation and pocket depth reductions. The association of periodontal disease and RTS is previously undescribed. CONCLUSION: This case report underscores the importance of periodontal clinical diagnosis and the possibility of successful periodontal treatment in RTS patients.
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ranking = 1
keywords = periodontal disease
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10/11. The regenerative potential of ePTFE membranes and freeze-dried bone allografts--two case reports.

    The purpose of this article is to reexamine the indications of surgical techniques and materials used in the regenerative treatment of periodontal disease. Two cases are presented to illustrate the potential for regenerative therapy in instances where limited success might have been anticipated.
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ranking = 1
keywords = periodontal disease
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