Assessment of Periodontal Health Among Removable and Fixed Partial Denture Wearers in Aseer Region of Saudi Arabia

BACKGROUND Prosthetic rehabilitation will have harmful effects on periodontal structure if the patient fails to maintain an oral hygiene protocol. This study aimed to evaluate oral hygiene in fixed and removable partial denture wearers in the Aseer Province of Saudi Arabia. MATERIAL AND METHODS This was a cross-sectional study done on 286 prosthesis wearers aged between 25 and 55 years; 142 were men and 144 women. Clinical examination was done using 3 periodontal parameters: plaque index, gingival index, and calculus surface index. RESULTS It was found that 72% and 25% of patients used fixed and removable partial prostheses, respectively. Most patients were in the 45-55 year age group (38.1%), were medically fit (78%), and used toothbrush and paste (70.6%). Most patients were instructed regarding the use of oral hygiene measures for their prostheses (71.3%). However, around half of the study group (52.8%) had odor from their prostheses. Most fixed prostheses were in the posterior teeth (73.2%) and had 3 units or more (58.7%). Removable partial dentures were mostly tooth-tissue supported (74%). A statistically significant difference was found for plaque index and gingival index between natural teeth and abutments in terms of various prosthetic parameters (P£0.001). The higher prevalence of gingival inflammation, plaque, and calculus accumulation in this study may be correlated to improper oral hygiene methods used by patients. CONCLUSIONS It can be concluded that there is a need to reinforce meticulous oral hygiene practices among patients using prosthodontic appliances.

Interleukin-17 levels in gingival crevicular fluid of aggressive periodontitis and chronic periodontitis patients

Context

Interleukin-17 (IL-17) plays an important function in initiation, progression of any inflammatory condition. It is a pro-inflammatory cytokine and considered to be founding member. Periodontitis being an inflammatory condition of periodontium, IL-17 does have a potential role in periodontitis. The current research has shown positive correlation between the IL-17 and severity of periodontitis. Therefore, this research study aimed to evaluate the levels of IL-17 in aggressive periodontitis (AgP), chronic periodontitis (CP), and "healthy gingival sites."

Materials and Methods

A total of 45 selected subjects (90 samples) were equally divided into three different groups. Group 1 (Healthy gingiva on clinical examination): Subjects with healthy gingiva and no evidence of periodontal attachment level (PAL), probing pocket depth (PPD) <3 mm papillary bleeding index (PBI) <1. Group 2 (AgP): Subjects having age <35 years with at least six permanent teeth apart from the incisors and first molars with PPD and PAL ≥5 mm. Group 3 (CP): It consist of subjects with clinical features of inflammation of gingiva with minimum six teeth in each jaw, with PPD ≥4 mm, PAL ≥4 mm. IL-17 levels were analyzed by using Gingival crevicular fluid (GCF). It was collected from the sulcus of first maxillary molar sites for quantitative analysis.

Results

GCF IL-17 levels in AgP were found to be 1.12 ± 0.29, 1.96 ± 1.71 in CP and 0.64 ± 0.23 in healthy gingival sites. Clinical parameters such as (1) plaque index (Turesky et al., modification of Quigley-Hein), (2) PPD, (3) PBI were higher (significantly) in periodontitis group as compared to healthy gingiva. Positive correlation was found to be significant between levels of IL-17 with PAL and PPD in AgP however in cases of CP, positive correlation of IL-17 levels was found only with PAL but not PPD.

Conclusion

Our study shows that the IL-17 levels were comparatively higher in GCF of AgP, CP in comparison to healthy gingiva, but the GCF IL-17 levels were higher in CP as compared to AgP.

Extraction socket grafting using recombinant human bone morphogenetic protein-2-clinical implications and histological observations

Objectives

Rehabilitation of edentulous ridges to promote the insertion of dental implants has been the key indicator for retaining osseous structures since tooth extraction. Recombinant Bone Morphogenetic Protein-2(rhBMP-2) is exploited for bone augmentation due to its osteoinductive capacity. The objective of the study to determine the effectiveness of bone induction for implant placement by rhBMP-2 delivered on beta-tricalcium phosphate graft (β-TCP) and PRF following tooth extraction.

Results

Minimal changes in the width of the crestal bone relative to baseline values were found three months after socket grafting. A bone loss in the mesiodistal and buccolingual aspects of 0.6 ± 0.13 mm and 0.5 ± 0.13 mm was found, respectively. While drilling before the implant placement, the bone's clinical hardness evaluated through tactile was analogous to drilling into spruce or white pine wood. Total radiographic bone filling was seen in 3 months and no additional augmentation was needed during implant placement. Besides, histology shows no residual graft of bone particles. Therefore, the data from this study demonstrated that the novel combination of rhBMP-2 + β-TCP mixed with PRF has an effect on de novo bone formation and can be recommended for socket grafting before implant placement.

Evaluation of survival of 8 mm-length implants in posterior resorbed ridges: A pilot study

Context

Rehabilitation of jaws with reduced bone height is technically demanding and expensive. Short implants are emerging as an alternate in such cases.

Aim

This study aimed to evaluate the survival of implants of 8 mm in length (short implants), clinically and radiographically, in posterior resorbed ridges.

Materials and Methods

A total of 11 patients with single missing posterior tooth, having 9-10 mm of residual bone height determined using radiographs, were selected for the study. Twelve implants of 8 mm length were inserted in the resorbed alveolar ridges following standard operating procedure. A second-stage surgery was performed 4-6 months after implant placement for placement of gingival former. This was followed by placement of prosthesis. Twelve months after prosthesis placement, all the patients were examined clinically and radiographically.

Results

According to Albrektsson et al.'s criteria, all implants were successful with mean bone loss of 1.1 ± 0.32 mm mesially and 0.83 ± 0.35 mm distally with healthy gingival condition at 12-month follow-up.

Conclusion

Short implants (8 mm in length) can be a viable alternative in cases of atrophic alveolar ridges.

Piezosurgery®-assisted periodontally accelerated osteogenic orthodontics

Periodontally accelerated osteogenic orthodontic procedure has become useful adjunct to reduce orthodontic treatment time as compared with conventional orthodontics. This case demonstrates the use of Piezosurgery^® to facilitate rapid tooth movement with relatively shorter treatment time. A 23-year-old male with Angles Class I malocclusion having spaced anterior teeth and protrusion requested orthodontic treatment with reduced time period. Before surgery, presurgical orthodontic treatment was done to do initial alignment of the teeth. This was followed by piezosurgical corticotomy and final space closure was achieved by active orthodontic tooth movement. The total treatment time required to complete the orthodontic treatment was 5 months. 1-year follow-up revealed no evidence of any adverse periodontal effects or relapse. Thus, Piezosurgery^®-assisted corticotomy may prove to be a noble and effective treatment approach to decrease the orthodontic treatment time.

Soft tissue expansion before vertical ridge augmentation: Inflatable silicone balloons or self-filling osmotic tissue expanders?

Recent advances in periodontal plastic surgical procedures allow the clinician to reconstruct deficient alveolar ridges in more predictable ways than previously possible. Placement of implant/s in resorbed ridges poses numerous challenges to the clinician for successful esthetic and functional rehabilitation. The reconstruction frequently utilizes one or combination of periodontal plastic surgical procedures in conjunction with autogenous bone grafting, allogenic bone block grafting, ridge split techniques, distraction osteogenesis, or guided bone regeneration (GBR) for most predictable outcomes. Current surgical modalities used in reconstruction of alveolar ridge (horizontal and/or vertical component) often involve the need of flap transfer. Moreover, there is compromise in tissue integrity and color match owing to different surgical site and the tissue utilized is insufficient in quantity leading to post surgical graft exposition and/or loss of grafted bone. Soft tissue expansion (STE) by implantation of inflatable silicone balloon or self filling osmotic tissue expanders before reconstructive surgery can overcome these disadvantages and certainly holds a promise for effective method for generation of soft tissue thereby achieving predictable augmentation of deficient alveolar ridges for the implant success. This article focuses and compares these distinct tissue expanders for their clinical efficacy of achieving excess tissue that predominantly seems to be prerequisite for ridge augmentation which can be reasonably followed by successful placement of endosseous fixtures.

Hereditary gingival fibromatosis

Hereditary gingival fibromatosis is a rare benign oral condition characterised by slow and progressive enlargement of both maxillary and mandibular attached gingiva. It may develop as an isolated disorder but can feature along with a syndrome. A case of 12 year old female child who presented with generalised severe gingival overgrowth, involving both the arches and covering almost the entire dentition, and had all the teeth remaining invisible within the confinement of gingival tissues. The excess gingival tissue, in this non-syndromic case was removed by conventional gingivectomy using local as well as general anaesthesia. The post-operative result was uneventful and the patient appearance improved considerably. Good aesthetic result was achieved to allow patient to practice oral hygiene measures. After treatment regular recall visits are necessary in order to evaluate oral hygiene and stability of periodontal treatment.