1/33. Combined systemic and local antimicrobial therapy of periodontal disease in Papillon-Lefevre syndrome. A report of 4 cases.4 patients, 2 pairs of siblings, suffering from Papillon-Lefevre syndrome were treated for periodontal disease. Following extraction of hopeless teeth, the children received scaling and adjunctive systemic antibiotics (metronidazole and amoxicillin for 7 to 10 days). In addition, they performed supragingival pulsated jet irrigation with 0.06% chlorhexidine digluconate 1 x daily. In 2 siblings, A. actinomycetemcomitans was suppressed subgingivally below detectable levels, pocket probing depths were reduced to 4 mm or less, and plaque and bleeding indices were low. No further disease progression was seen over a 3-year-period. Another female patient also showed clinical improvement and suppression of subgingival A. actinomycetemcomitans and B. forsythus up to the 9-month-follow-up, while her sister showed further attachment loss over the course of 4 years. The present case reports indicated that in some patients suffering from Papillon-Lefevre syndrome periodontal disease may be arrested by means of (i) oral hygiene instruction, (ii) extraction of severely diseased teeth, (iii) scaling, (iv) systemic antibiotics and (v) long-term antimicrobial irrigation.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/33. Orthodontic, genetic, and periodontal considerations in the treatment of impacted maxillary central incisors: A study of twins.Treatment of twins each with one impacted maxillary central incisor and a mesiodens is described. Treatment included rapid expansion, extraction of the mesiodens, surgical exposure of the impacted central incisor, and its forced eruption. The impacted incisor was brought into functional position in one patient but was lost in the other because of insufficient root length and high mobility. Orthodontic, genetic, and periodontal considerations of these 2 cases are evaluated.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
3/33. The periodontal management of a patient with a profound immunodeficiency disorder.A case of severe, uncontrolled periodontal disease in a patient with a profound immunodeficiency disorder is reported. The periodontal disease was noted before the age of 10 years and is generalized, with marked associated alveolar bone loss, even threatening a mandibular fracture. Severely involved teeth were allowed to exfoliate, and extractions were avoided. At the age of 17 years, the patient now has only nine remaining teeth. The management adopted and alternative approaches are critically reviewed. The implications of the dental findings for current concepts of the pathogenesis of periodontal disease and dental caries are discussed.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
4/33. Enamel pearls and cervical enamel projections on 2 maxillary molars with localized periodontal disease: case report and histologic study.Presented here is an unusual case of teeth with aberrant enamel. One small and 3 large enamel pearls were identified in 2 maxillary third molars of a patient. One long enamel projection was connected to one of the large enamel pearls, along with 2 short cervical enamel projections. The ectopic enamel was associated with advanced localized periodontal destruction. After extraction, the molars were investigated radiographically and under the scanning electron microscope. The 3 large pearls contained distinct dentinal cones. The enamel of the pearls and the long cervical projection exhibited most of the structural attributes of crown enamel but were somewhat irregular, with variable shape and course of the prisms. Morphologic considerations suggest that these enamel pearls were aberrations and should not be regarded as attempts at new cusp or new tooth formation.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
5/33. The relationship between peripheral levels of leukocytes and neutrophils and periodontal disease status in a patient with congenital neutropenia.BACKGROUND: Congenital neutropenia is characterized by an almost total absence of neutrophils and increased susceptibility to infection. oral manifestations include ulcerations of mucous membranes, acute gingival inflammation with focal necrosis, and rapid loss of attachment. Treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) increases neutrophil numbers and ameliorates the periodontal status. methods: We report the treatment of a 22-year-old male with congenital neutropenia (Kostman syndrome), referred to us due to periodontal disease, and the effect of treatment on peripheral neutropenia. diagnosis of neutropenia was made at year 1; at age 15, the patient started to receive injections of rhG-CSF, reducing the occurrence of infection and improving neutrophil count, although levels remained below normal. The patient underwent extraction of a molar at age 8; scaling, root planing, and modified Widman flaps at age 9; and oral hygiene maintenance every 2 to 3 months from age 18 to 21. At age 23, he initiated treatment at our periodontal clinic. The patient's gingiva was severely inflamed, and the dentition was covered with plaque and calculus. Attachment loss was advanced, all teeth were mobile, and bone loss was approximately 75% in most sites. Neutrophil counts were below normal, but other hematologic parameters were normal. Scaling and root planing were performed and the patient received antibiotics and chlorhexidine rinses twice each day for 2 weeks. Extracoronal splinting was performed, fluoride varnish was used to desensitize cervical areas, and tooth FDI #46 was restored. root planing and deplaquing were repeated, and the patient received subgingival chlorhexidine irrigation 13 times over one year. Assessments were made on presentation, after the initial treatment, and at 1 and 2 years post-treatment. RESULTS: Mean probing depth was reduced posttreatment with a further reduction during the maintenance period. This was correlated with an increase in attachment levels. Total white blood cells increased, due in part to an increase in neutrophils, reaching normal levels. CONCLUSIONS: This report demonstrates for the first time that periodontal therapy, resulting in decreased bacterial load, may result in restoration of normal levels of circulating neutrophils in individuals with congenital neutropenia under treatment with rhG-CSF. The results also suggest that periodontal pathogens may be associated with depressed neutrophil levels, even when patients receive treatment for neutropenia.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
6/33. Multiple dental extractions using general anesthesia for a patient with Down and Eisenmenger syndromes and periodontal disease.A patient with down syndrome and severe retardation and Eisenmenger syndrome sought dental treatment at the oregon health Sciences University Hospital Dental Service. Eisenmenger syndrome is a form of cyanotic congenital cardiovascular pulmonary disease. The cardiac structural abnormalities associated with Eisenmenger syndrome preclude the use of conscious sedation and predispose a patient to the development of bacterial endocarditis. A prophylactic antibiotic regimen is recommended for patients with Eisenmenger syndrome who are undergoing procedures that produce a transient bacteremia. This article reviews the appropriate measures necessary for the safe anesthetic, operative, and perioperative care of a severely compromised patient. It is based on an understanding of the pathophysiology associated with Eisenmenger syndrome.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
7/33. Successful periodontal maintenance of a case with Papillon-Lefevre syndrome: 12-year follow-up and review of the literature.BACKGROUND: Various approaches to treating the periodontal condition associated with Papillon-Lefevre syndrome have been reported. These include oral hygiene instruction, use of mouthrinses, frequent debridement, multiple antibiotic regimens, periodontal surgery, extraction of hopeless teeth, and extraction of all deciduous teeth. Because Papillon-Lefevre syndrome is rare, most publications are case reports, and very few document long-term successful treatment of the periodontal condition. methods: In 1986, a 3.5-year-old Indo-Canadian male was diagnosed with Papillon-Lefevre syndrome and began periodontal treatment. Initial therapy consisted of debridement every 3 weeks, a 0.12% chlorhexidine mouthrinse, 2 regimens of metronidazole, and oral hygiene instruction for his parents. After 10 months it became apparent that the treatment was having little beneficial effect, since the periodontal destruction continued and teeth 51 and 61 exfoliated. At age 4, all remaining deciduous teeth were extracted and complete dentures inserted for the following 2-year edentulous period; then a 3-month maintenance schedule was maintained. RESULTS: The patient is now 17 years old and all his adult teeth are present with the exception of the third molars. His oral hygiene varies between moderate and good, with his most recent plaque score at 80% effectiveness. There are no probing depths greater than 4 mm, with the exception of the distal of the lower second molars where opercula are present. CONCLUSIONS: Extraction of all the deciduous teeth followed by a period of edentulousness may partially explain the fact that there has been no recurrent attachment loss in the permanent teeth up to age 17. Other explanations are discussed as part of the literature review of Papillon-Lefevre syndrome.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/33. Characteristics and dental treatment of partial trisomy 9.A description is made of the dental characteristics and treatment of a patient with partial trisomy 9. Due to the deep mental retardation and motor deficiency of the patient involved, treatment (extractions, caries restorations and periodontal treatment) is conducted in hospital and under general anesthesia. trisomy 9 has only rarely been described in literature, and the present study provides one of the first descriptions of both the dental characteristics of these patients and the treatment of their oral pathology.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
9/33. Papillon-Lefevre syndrome: a case report.We report the first diagnosed case of Papillon-Lefevre syndrome in thailand. The patient is the youngest child of consanguinous parents, and she has had symmetrical hyperkeratotic plaques on both plantar surfaces since birth with a history of chronic gingivitis, periodontitis, and premature loss of primary dentition. The histologic study revealed compact hyperkeratosis with epidermal acanthosis. Radiologic studies of the skull were normal. The radiographic panoramic view of the oral cavity revealed generalized severe vertical and horizontal alveolar bone loss. The immunologic analysis of polymorphonuclear leukocyte phagocytic function by nitrobluetetrazolium test (NBT test) showed decreasing response to latex stimulation. serum parathyroid hormone, calcium, phosphate, and alkaline phosphatase levels were within normal limits. The skin lesions were temporary relieved with topical keratolytic agents. The oral lesions were improved by the extraction of hopeless teeth and conventional periodontal treatments.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
10/33. Treatment of intrabony defects associated with interradicular root proximity/fusion in molar furcations.To treat furcation involvement is a crucial challenge to periodontists, not only because of the limitation in pocket reduction by osteoplasty and apically positioned flap, but also because of the unpredictability in regenerative approaches. Therefore, if the first molar is absent and the second molar has to be retained strategically for prosthetic reasons, very few alternatives besides nonsurgical/surgical debridement can be taken in treating the furcation of the second molar, where the interradicular root proximity and fusion frequently occur. On the other hand, root amputation/hemisection has long been considered a contraindication in treating furcations with two close roots; however, this impression is only empirical. A series of clinical cases involved in the treatment of intrabony defects associated with interradicular root proximity and fusion by root amputation/hemisection has been reported. Without any help of regenerative material, thorough root debridement and pocket reduction were attained. Based on these cases, we suggested that the cut surface created by odontoplasty during root amputation was compatible for periodontal healing and the extraction socket provided striking potential for defect repair. We re-examined the clinical feasibility and benefit of treating intrabony defects associated with interradicular root proximity and fusion in molar furcations by root amputation/hemisection, and suggested that its role should be favorably reconsidered on case basis. The short-term success in periodontal and prosthetic aspects needed to be further evaluated at long-term follow-up.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
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