measures improved significantly from baseline to T4, with no statistically significant differences between the experimental and control groups for either measurement. With GTR therapy, the improvement in neither measure achieved statistical significance. With DBP sites, both parameters achieved statistically significant improvement. ALs improved 3.1 mm or more in both groups, and PDs improved 3.3 mm or greater. Inflammatory complications localized to treatment M3 sites occurred in 5 patients. Two in the DBP group required wound care and oral antibiotic therapy. Two patients in the GTR therapy group had membrane exposures develop, with 1 having a secondary infection and 1 patient with localized alveolitis. No postoperative inflammatory complications developed in the control extraction sites. Discussion.—The risk of developing a periodontal defect on the distal aspect of M2 was not altered by either DBP grafting or GTR therapy compared with the risk associated with performing no treatment. Regardless of which treatment was performed, all patients had nearly statistically significant or statistically significant improvements in at-
tachment levels and probing depths on the distal aspect of M2 after M3 extraction. Neither DBP nor the use of a bioresorbable membrane is recommended to prevent periodontal defects on M2 after M3 extraction.
Clinical Significance.—Routine use of demineralized bone powder and guided tissue regeneration proved ineffective in preventing bony defects distal to third molar extraction sites. More study is needed to determine why these defects form.
Dodson TB: Management of mandibular third molar extraction sites to prevent periodontal defects. J Oral Maxillofac Surg 62:1213-1224, 2004 Reprints available from TB Dodson, Massachusetts Gen Hosp, Dept of Oral and Maxillofacial Surgery, 55 Fruit St - Warren 1201, Boston, MA 02114; e-mail: [email protected]
Oral Biology New calcium phosphate-based root canal sealers Background.—The response of vital tissues to the endodontic filling materials that are placed directly on them can affect the outcome of endodontic treatment. Therefore, the ideal root canal sealer is nonirritating to the periapical tissues and compatible with living connective tissues. Most of the sealers currently available have problems in these areas. Calcium phosphate cement is highly biocompatible, making it useful in many applications. New calcium phosphate-based root canal sealers, specifically CAPSEAL I and II, were compared to other calcium phosphate sealers
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(Apatite Root Sealer types I and II) and a zinc oxide eugenol-based sealer (Pulp Canal Sealer EWT) when implanted in the subcutaneous tissue of rats. Methods.—Tubes of the root canal sealers were implanted into the rat subcutaneous tissues, then removed with surrounding tissues after 1, 2, 4, and 12 weeks. A histopathologic evaluation was performed in which tissue reactions were measured as mild (1), moderate (2), or severe (3). Biocompatibility was judged on the basis of crite-
ria developed by the Federation Dentaire Internationale (1980). Results.—The test groups did not differ significantly with respect to the histopathologic results obtained. Significant differences were found, however, among the experimental periods in the groups. The control group showed no inflammation, but the zinc oxide eugenol group and the Apatite Root Sealer type II group had severe inflammatory reactions after 1 week. Macrophages, lymphocytes, and foreign body giant cells accumulated at the sites of these implantations. The Apatite Root Sealer type I group and the CAPSEAL I and II groups also had an inflammatory reaction, with the severity being moderate to severe. The intensity of the inflammation decreased after 2 weeks, and the inflammation decreased further with increasing time. After 12 weeks, fibroblasts, collagen fibers with few inflammatory cells, and fibrous capsules were noted. The tissue responses of the CAPSEAL I and II groups were similar, with less inflammation than was noted with the other root sealers.
Discussion.—The newest root sealers provoked a lesssevere tissue response than the other sealers tested at all experimental sampling points. All the tested sealers were biocompatible according to current standards.
Clinical Significance.—Tissue irritating potential is one drawback to root canal sealers currently in use. Calcium-based materials, in the genre of MTA, are demonstrating greater biocompatibility with periapical tissues.
Kim J-S, Baek S-H, Bae K-S: In vivo study on the biocompatibility of newly developed calcium phosphate(based root canal sealers. J Endodont 30:708-711, 2004 Reprints available from K-S Bae, Dept of Conservative Dentistry, College of Dentistry, Seoul Natl Univ, 28 Yongon-Dong, ChongnoGu, Seoul, 110-749, Korea; e-mail: [email protected]
Oral Medicine Periodontal pathogens related to stroke risk Background.—Periodontitis produces pathologic periodontal pockets where bacterial infection persists and causes chronic inflammation, serving as a reservoir of mainly gram-negative bacteria. Periodontitis is also a potential risk factor for coronary heart disease (CHD), but has not been extensively evaluated in relation to cerebrovascular events or stroke. An investigation spanning 13 years looked at whether elevated serum antibody levels to major periodontal pathogens are linked to stroke.
Methods.—The participants were part of the Mobile Clinic Health Survey conducted from 1973 to 1976 in Finland and ranged in age from 45 to 64 years. One hundred seventy-three of the 6950 subjects had a stroke over the 13-year follow-up. One hundred nine subjects appeared healthy, and 64 had suffered a stroke or had signs of CHD at baseline. For each case, 2 controls were matched for gender, age, municipality, and disease status. Multiserotype enzyme-linked immunosorbent assay (ELISA) was used to determine the serum IgG and IgA class antibody
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