Periodontal Diseases

Periodontal diseases are among the most common diseases affecting humans. Dental biofilm is a contributor to the etiology of most periodontal diseases. It is also widely accepted that immunological and inflammatory responses to biofilm components are manifested by signs and symptoms of periodontal disease. The outcome of such interaction is modulated by risk factors (modifiers), either inherent (genetic) or acquired (environmental), significantly affecting the initiation and progression of different periodontal disease phenotypes. While definitive genetic determinants responsible for either susceptibility or resistance to periodontal disease have yet to be identified, many factors affecting the pathogenesis have been described, including smoking, diabetes, obesity, medications, and nutrition. Currently, periodontal diseases are classified based upon clinical disease traits using radiographs and clinical examination. Advances in genomics, molecular biology, and personalized medicine ...

Recent research indicated that periopathogens colonize, besides the pockets, also other niches within the oral cavity including: the soft tissues, the saliva, the tongue, and even the tonsils. Since the supragingival plaque and the bacteria in these niches have a major impact on the ...

Studies on the oral health status of institutionalized older adults are less prevalent than those of community-dwelling older adults, as institutionalized older adults tend to be frailer. Poor oral health in older adults has a negative impact on the quality of life and self-confidence of older people and potentially poses a financial burden on both the older adult and society in general. The objective of this study was to assess and compare the oral health status of state institutionalized older adults in Malta with that of their European counterparts. A total of 278 older adults with an average age of 83.6 ± 6.5 years from nine state institutions in Malta were randomly selected. Participants were clinically examined for caries, periodontal disease, oral mucosal lesions, and prosthetic status. The oral health status of state institutionalized older adults was poor, with a very low routine dental attendance (29.3%) and, consequently, a high level of treatment need (44.4% of dentate i...

While the conventional periodontal therapies achieve management of periodontal diseases by repair, they are insufficient in reconstructing the lost structures. One major goal of periodontal surgical therapy includes regeneration of lost periodontal tissues including periodontal ligament, cementum and alveolar bone. The prerequisites for bone regeneration are cells, molecules, scaffold, and blood supply. Bone grafts provide the cells or may act as a scaffold for new bone formation. The search for an ideal bone graft perpetually continues. The following article presents an overview of the commonly used bone grafts in the management of periodontal affliction touching upon the topics of objectives and indications of bone grafts and their classification.

To assess the 10 year complication/failure rates for dental implants in general practice. Materials and Methods: Thestudy is a retrospective analysis of radiographs and clinical records for implant patients, who gave written consent. The datarecorded included implant type, position, prosthetic structure, abutment fit, fixation, complications, loss, periodontal chartingand medical histories. Results: 68 patients (165 implants): Total survival rates (91.5% 5yr; 72.1% 10yr). Periodontitis survivalrates (90.6% 5yr; 61.8% 10yr), Non-periodontitis rates (92.8% 5yr, 82.4% 10yr; 10yr Odds Ratio (OR) 2.8, p<.02). Periodontitispatients had greater bone loss compared with non-periodontitis subjects (OR: 2.7, p<.02 5yr; 11.1, p<.0001 10yr).Late loss was associated with peri-implantitis (p<.001) and oral hygiene difficulties with prostheses (POHI) (p<.003). Earlyloss was higher with: Periodontitis; surgical alignment issues; and Bicon™ implant use. Complications were implant misalignment,abutment loosening and POHI. POHI was associated with peri-implantitis (OR 4.5, p<.001) and bone loss (OR 2.0, p<.03).The crown: implant length ratio associated with bone loss in external hex implants (p<.007) but not conical connect implants(p=.56). Conclusions: Implant complications and failure rates were higher than in comparable specialist and university clinicstudies. Plaque accumulating prosthetic design issues were an important factor in increased bone loss and implant failure.

Background:  The aim of this study was to determine the range of histologically diagnosed lesions in 44 000 oral and maxillofacial pathology specimens, from adults 17 years and older, submitted for diagnosis to our laboratory over a 30-year period (1973–2002).Materials:  All entries for specimens from the patients were retrieved and compiled into 12 diagnostic categories.Results:  During the period, 44 007 specimens comprised a male-to-female ratio of 0.9:1. The diagnostic category with the largest number of specimens was mucosal pathology (36.0%) followed by odontogenic cysts (13.8%). Malignant tumours accounted for 5.4% of all specimens and benign tumours 4.6%.Conclusion:  This survey showed that while the majority of diagnoses are benign, approximately one in 19 cases required major head and neck surgery for malignant disease.

Abstract. Many well designed clinical studies have established the effectiveness of periodontal therapy. Surgical procedures have been shown to be effective in treating periodontitis when followed by appropriate maintenance care. Scaling and root planing alone have recently been compared to scaling and root planing plus soft tissue surgery in several longitudinal trials. A review of the literature indicates several important findings including a loss of clinical attachment following flap procedures for shallow (1–3 mm) pockets and no clinically significant loss after scaling and root planing. These studies also generally report either a gain or maintenance of attachment level for both procedures in deeper pockets (≥4 mm). For these pockets, neither procedure has been shown to be uniformly superior with respect to attachment gain. All reports indicate that both treatment methods result in pocket reduction. However, the literature also indicates that scaling and root planing combined with a flap procedure results in greater initial pocket reduction than does scaling and root planing alone. This difference in degree of pocket reduction between procedures tends to decrease beyond 1–2 years. It has been shown that both treatment methods result in sustained decreases in gingivitis, plaque and calculus and neither procedure appears to be superior with respect to these parameters.Additional data from the study at the University of Minnesota indicate that similar results are maintained up to 6 1/2 years following active therapy. Pocket depth did not change for shallow (1–3 mm) pockets treated by either scaling and root planing alone or scaling and root planing followed by a modified Widman flap. For pockets 4–6 mm, both treatment procedures resulted in equally effective sustained pocket reduction. Deep pockets (≥ 7 mm) were initially reduced more by the flap procedure. After 2 years, no consistent difference between treatment methods was found in degree of pocket reduction. However, as compared to baseline, pocket reduction was sustained to 6 1/2 years with the flap and only 3 years with scaling and root planing alone. After 6 1/2 years, sustained attachment loss in shallow (1–3 mm) pockets was found after the modified Widman flap. Scaling and root planing alone in these shallow pockets did not result in sustained attachment loss. For pockets initially 4–6 mm in depth, attachment level was maintained by both procedures but scaling and root planing resulted in greater gain in attachment as compared to the flap’at all time intervals. Treatment of pockets ≥ 7 mm in depth by either procedure resulted in a sustained gain in attachment with no difference between procedures.The results of these studies indicate that both scaling and root planing as well as scaling and root planing combined with a flap procedure are effective in treating periodontitis over time up to 6 1/2 years. Individual variations among patients were noted. Decisions for or against soft tissue surgery must be made on the basis of individual patient considerations.