Cases reported "Periodontal Diseases"

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1/7. Decision analysis for periodontal therapy.

    Current decision-making approaches in clinical medicine and dentistry are based on principles developed when diagnostic and therapeutic options were few. The rapid pace of new technology development and the role of third-party payment systems are increasingly requiring that health-care providers and patients confront very complex decisions. These decisions typically involve significant uncertainty (e.g., How will a specific patient respond to each possible treatment?) and difficult tradeoffs (e.g., How much are patients willing to pay in money, time, and treatment effectiveness to avoid pain and discomfort?). This paper discusses high-quality decision-making. High-quality diagnostic and therapeutic decisions result from a well-developed decision basis that represents the alternatives, information, and preferences pertaining to the decision at hand. An effective decision basis is framed to address patients' and clinicians' key concerns. The resulting recommendation for action is based on an understanding of what factors are most sensitive in determining the best course of action. Moreover, the value of additional information-gathering efforts (e.g., further diagnosis) can be measured before the information is obtained to determine whether it is worth more than it costs. The paper illustrates the need for better decision-making methods with a sample patient case, discusses key decision analysis principles and methods, identifies specific areas where periodontal decision-making can be improved by decision analysis, and presents a periodontal decision analysis case. It then discusses how intelligent decision system technology can make decision analysis widely available in a clinical setting and concludes by exploring how a future dental office might use this technology on a routine basis.
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ranking = 1
keywords = dentistry
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2/7. Interdisciplinary treatment for the advanced periodontal and restorative case.

    While recent advances in implant therapy have expanded options for providing care, preserving the natural dentition in an optimal state of health, function, comfort, and esthetics remains a primary goal of dentistry. For patients with moderate to advanced periodontal disease, retention of the teeth through regenerative therapy has become a predictable form of treatment for many osseous defects. Periodontal therapy, including regenerative treatment, often can enhance restorative options by retaining key abutment teeth for fixed or removable partial dentures. A case involving regenerative and resective periodontal therapy as well as fixed prostheses is described.
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ranking = 1
keywords = dentistry
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3/7. Periodontal problem solving. Interrelationship of periodontal therapy and esthetic dentistry.

    Periodontal disease, dental caries, facial trauma, posterior bite collapse, and occlusal trauma are discussed as complicating factors in achieving functional and esthetic restorative results. Various solutions to these challenging problems are offered, using a multimodal approach to therapy.
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ranking = 4
keywords = dentistry
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4/7. Periodontal surgery as an adjunct to endodontics, orthodontics, and restorative dentistry.

    Periodontal surgery and biologic principles can be used to treat a variety of restorative and endodontic complications. Four cases illustrated the application of orthodontic therapy and periodontal surgery in the treatment of these difficulties.
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ranking = 4
keywords = dentistry
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5/7. Rapid loss of alveolar bone associated with nonprecious alloy crowns in two patients with nickel hypersensitivity.

    In recent years there has been a dramatic increase in the use of nonprecious alloy and porcelain crowns in clinical dentistry. The alloy in these restorations frequently contains a high percentage (greater than 70%) of nickel. Most cases of metal hypersensitivity are related to nickel, and clinical manifestations of the hypersensitivity are the result of a cellular (T lymphocyte) immune response. In this report, we review the cases of two women who demonstrated significant loss of alveolar bone about nickel-rich nonprecious alloy and porcelain crowns. The loss of alveolar bone occurred within 18 months after placement of the restorations. Both individuals displayed a positive patch test to a nickel preparation. These findings suggest that a Type IV hypersensitivity reaction may have accounted for the rapid loss of alveolar bone. Though the majority of individuals treated with nonprecious alloy and porcelain crowns apparently tolerate these restorations quite well, greater care is urged in case selection.
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ranking = 1
keywords = dentistry
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6/7. orthodontic extrusion: a multidisciplinary treatment approach.

    A multidisciplinary approach, using orthodontic and periodontic treatment and restorative dentistry, is described for restoration of an apparently nonrestorable tooth.
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ranking = 1
keywords = dentistry
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7/7. The role of orthodontics in periodontics and restorative dentistry.

    Uprighting and extrusion are two movements that are used to aid in the treatment of difficult periodontal and restorative problems. Simple appliances can be used to alter tooth position, enhancing either the periodontal therapy, restorative dentistry, or both. Treatment time can be limited to 3 to 6 months.
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ranking = 5
keywords = dentistry
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