International Journal of Periodontics & Restorative Dentistry, 03/1993

This investigation evaluated the efficacy of obtaining baseline culture and sensitivity data on a routine basis from the patient with adult periodontitis. Patients diagnosed with chronic adult periodontitis, rapidly progressive periodontitis, or refractory periodontitis were followed for up to 6 years. More than 95% of patients with chronic adult periodontitis were successfully treated with mechanical therapy alone. Approximately one half of the patients with rapidly progressive periodontitis were treated successfully without antibiotics. All of the patients with refractory periodontitis required systemic antibiotics as part of treatment. Most patients with chronic adult periodontitis exhibited one or two species of organisms at baseline, and these organisms were eliminated or reduced to low levels by mechanical therapy. In contrast, patients with rapidly progressive or refractory periodontitis consistently demonstrated multiple species and required systemic antibiotics in conjunction with mechanical therapy to alter the subgingival microbial milieu. Routine culturing and antibiotic therapy is contraindicated in patients with chronic adult periodontitis, but may be beneficial for successful treatment of patients with rapidly progressive or refractory periodontitis.

This case illustrates the use of the principles of guided tissue regeneration to achieve osseointegration of an endosseous dental implant. One implant was placed immediately, with hydroxyapatite and a barrier membrane, in an extraction site, while another was placed in a healed site. Eighteen months postinsertion, the implant placed in the extraction socket exhibited better maintenance of crestal height than did the implant inserted in the healed site.

Success, as it is usually defined for osseointegrated implants, may leave much to be desired in terms of esthetics, phonetics, and function. Optimal occlusal function demands that the implant-supported restoration be placed in a position that will permit the desired cusp-fossae relations with axial loading. In the partially edentulous patient, the implant-supported restoration also should blend into the arch form of the adjacent and opposing teeth. From a phonetic viewpoint, the natural contour and position of the anterior teeth must be maintained. To achieve these goals, it may be necessary to restore the hard and soft tissue anatomy vertically and horizontally and to augment or reconstruct the sinus. Depending on the circumstances, these measures may be carried out before, during, or after implant placement. In this paper, the considerations involved in diagnosis and selection of reconstructive technique are outlined.

Limitations in position, quality, or dimension of bone often require that implants be placed in a nonideal axial inclination. Use of preangulated abutments may be the method of choice when anatomic limitations preclude the axial placement of an implant. This paper discusses the indications for and advantages of the use of preangulated abutments to fulfill esthetic and functional objectives.

This study addressed three factors that may affect the penetration of medicaments into periodontal pockets: calculus, ejection site pressure, and irrigator tip design. Ejection site pressure for the Max-I-Probe, the Viadent and Water-Pik tips were determined with a variant of Bernoullis' equation. Depth of irrigant penetration was determined by delivering disclosing solution supragingivally and subgingivally. Following irrigation, assessed teeth were extracted and the percentage of pocket penetration by the dye was calculated. The Max-I-Probe and Viadent tips had significantly greater penetration than did the Water-Pik tip. Furthermore, calculus deposits reduced irrigation penetration in deep pockets (7 to 10 mm). Ejection site pressures of the three tips ranged from 0.10 to 4.80 psi. The ejection site pressure of the Max-I-Probe side-port delivery system was lower than that of the other two systems. Results indicated that subgingival calculus, irrigator tip design, and placement of the tip affect the depth to which drugs can be delivered subgingivally.