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1/85. The eleventh hour or where are our orthodontic limits? Case report.

    It is illustrated in a patient with periodontal attachment loss up to the apical root third that a combined periodontal/orthodontic approach may be beneficial even in seemingly hopeless cases. The problems of orthodontic limits and the positive effects of guided tissue regeneration are discussed. ( info)

2/85. 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. ( info)

3/85. 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. ( info)

4/85. Combined treatment of a large periodontal defect using GTR and DFDBA.

    The regeneration of periodontal structures lost to inflammatory disease is an elusive yet attainable goal of periodontal therapy. This article reports the successful treatment of a large periodontal defect using a combination of demineralized freeze-dried bone allograft (DFDBA) and guided tissue regeneration (GTR). The case presents endodontic and mucogingival complications in the combined GTR osseous graft technique. The combined techniques used in this 27-year-old patient achieved a reduction in probing depth, radiographic evidence of bone fill, and a reduction in clinical mobility. ( info)

5/85. Surgical technique for treatment of infrabony defects with enamel matrix derivative (Emdogain): 3 case reports.

    A surgical protocol is described for the placement of Emdogain enamel matrix derivative during new attachment procedures. Three cases with infrabony defects were treated and a significant probing attachment level (PAL) gain, probing depth reduction, and bone fill were evident on clinical probing and during reentry procedures. The first patient presented a combined one-walled and circumferential defect at a maxillary central incisor. After 1 year the PAL gain was 7 mm. The second case showed a 3-walled defect distal to a maxillary canine. After 1 year the PAL gain was 8 mm, and a reentry procedure showed an almost total fill of the defect. The third patient presented a combined one- and 3-walled defect in the most apical part of the mesial aspect of a maxillary central incisor. One year after the surgical procedure, an orthodontic treatment was performed in this patient. After 6 more months the soft tissue showed a very good esthetic appearance, the papilla height was fully maintained, and there was a PAL gain of 5 mm; 18 months after surgery, reentry showed a significant regeneration of hard tissue that was impossible to probe. Because of these encouraging clinical results, further studies should be initiated to investigate the efficacy of the enamel matrix derivative in new attachment procedures. ( info)

6/85. 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. ( info)

7/85. Aplastic anemia: current concepts and dental management.

    Aplastic anemia (AA) is a rare blood dyscrasia in which the peripheral blood cells are decreased because of bone marrow failure. The clinical course reflects the severity of pancytopenia and is unpredictable for the individual. hemorrhage and infection remain the major threats to these patients. Recent advances in transfusion medicine, infection management, bone marrow transplantation, and immunosuppressive therapy have improved survival of patients with AA. oral manifestations of AA are common and may have serious sequelae. Two cases of acute periodontal infection associated with AA are presented. Dental management guidelines are presented in the context of interdisciplinary care. ( info)

8/85. Treatment of periodontal destruction associated with a cemental tear using minimally invasive surgery.

    BACKGROUND: A patient presented with moderate probing depth, pain on occlusal contact, and a fistula on a mandibular bicuspid. The probing depth increased 2 mm over a 3-month period despite relief of the occlusal trauma and resolution of the fistula. A radiograph showed an apparent separation of the cementum in the area of the pocket. methods: The lesion was treated using a minimally invasive surgical approach to place a bone graft. RESULTS: The probing depth was reduced to 2 mm with less than 1 mm of increased recession. A histologic examination of the damaged calcified tissue confirmed that it was cementum. CONCLUSIONS: The increasing probing depth associated with a cemental tear seems to indicate that this phenomenon contributed to loss of attachment and bone. Removal of the detached cementum in combination with bone grafting using a minimally invasive surgical approach appears to have successfully corrected the periodontal destruction. ( info)

9/85. Attachment loss associated with the presence of a tongue bar: a case report.

    Recent reports demonstrate that tongue bars can cause damage to the dentition. The first known report of attachment loss associated with the presence of a tongue bar is described. ( info)

10/85. Subgingival restorations with resin ionomer: a periodontal alternative.

    The successful use and placement of subgingival resin-ionomer restorations in both anterior root and molar furcation defects are demonstrated in this article. Sustained tissue health and minimal probing depths at the surgical site demonstrate clinical success. These case reports illustrate the continued success of alternative treatment procedures for restoring subgingival mechanical root or periodontal lesions. ( info)
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