Category: Newsletter

Increasing the density of bone at the time of implant placement.

Implant dentistry is a successful, predictable therapy for replacing missing teeth or supporting over dentures. Implants can be placed in healed edentulous ridges or in immediate extraction sites with similar success percentages.

The initial stability of implants depends on the density of bone present at the site. As expected, early stability of an implant placed in the mandibular anterior area is better than the maxillary molar positions.

When creating a site to place an implant, the drills used remove bone from the osteotomy site. No change in bone density occurs.

Osseodensification is a technique that increases the density of bone at the implant site. This procedure does not remove bone from the osteotomy site, but condenses the bone back into the hole, creating denser bony walls to place the implant. As a result, the insertion torque to place the implant is increased, creating a more stable implant at the time of placement. This is important when placing implants into low density bone, extraction sites or when placing immediate temporaries on implants.  Early implant stability means that implants can be restored sooner.

Also, this technique can be used to conservatively raise the floor of the sinus at the time of implant placement. Since no bone is removed, the bone is condensed apically which can raise the sinus floor.

I am excited to add Osseodensification to our practice! I believe this technique is the next evolution in implant dentistry.

As always, thank you for your support and confidence in our practice. I am always striving to be on the cutting edge of periodontics and implant dentistry.

Should you have any questions regarding periodontal or implant issues, please do not hesitate to call or email me.

Correcting Gum Recession Quickly With Less Pain.

I am excited to inform you that I am the first and only periodontist in North Central Florida certified in the Pinhole® Surgical Technique (PST).

Pinhole® Surgical Technique (PST), is a scalpel-free, suture-free, graft-free procedure for correcting gum recession.

Through a small hole made by a needle, specially designed instruments are used to gently loosen the gum tissue and glide it over the receded part of the tooth. Collagen is then placed in the areas of recession and the gingival tissues are moved coronally to cover the areas of gingival recession. Since there is no cutting or stitching, patients can expect minimal post-operative symptoms (pain, swelling and bleeding). Most patients are also surprised by the instant cosmetic improvement.

The Pinhole® Surgical Technique (PST) is an alternative treatment to traditional soft tissue grafting. I believe no one procedure is appropriate for all cases. Case selection for different grafting techniques is vital to the success of these surgical procedures.

As always, thank you for your support and confidence in our practice. I am always striving to be on the cutting edge of periodontics and implant dentistry.

Should you have any questions regarding periodontal or implant issues, please do not hesitate to call or email me.

There Are New Guidelines For Total Joint Prophylaxis During Dental Procedures

In December 2012, the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) in a joint effort developed new guidelines for treating patients with total joint replacements. These new guidelines are called “Prevention of Orthopaedic Implant Infections in Patients Undergoing Dental Procedures”.

The recommendations back in 2003 concluded that “The risk/benefit and cost/effectiveness ratios fail to justify the administration of routine antibiotic prophylaxis” for patients with total joint replacements.

In 2009, the AAOS promoted a new protocol for antibiotic prophylaxis of total joint replacements.  This guideline recommended that patients receive antibiotic prophylaxis for at least 2 years after joint replacement who are receiving invasive dental procedures.  Since 2009, the orthopedic groups have suggested that patients may need to have prophylaxis of joint placements forever.

Well, here we are in 2013 and we have come full circle.  The new guidelines are evidence based and showed that invasive dental procedures, with or without antibiotics, did not increase the odds of developing a prosthetic joint infection.  Dr. Jevsevar, chair of the AAOS Evidence Based Practice Committee stated, “There is no conclusive evidence that demonstrates a need to routinely administer antibiotics to patients with an orthopaedic implant who undergo dental procedures.”  Antibiotic prophylaxis may still be considered for immunocompromised patients.

Here is the ADA link to the guideline for you to review:
http://www.ada.org/files/dentaleditorial.pdf

Also, there is a toolkit to help discuss antibiotics with patients with orthopaedic implants.  This can be found at:
http://www.ada.org/news/8107.aspx

Should you have any questions regarding periodontal or implant issues, please do not hesitate to call or email me.

Reviewing these gum recession classifications can aid in evaluating the type of defect your patients may have.

GUM RECESSION

Mucogingival defects are very common defects seen in patients with or without periodontal disease. Gingival recession can occur on any tooth and can be found on buccal or lingual surfaces. The causes of gingival recession are well documented. Causes include frenums, gingival infection which may weaken the attachment of the tissue to the tooth and trauma which can cause tissue damage. Trauma can range from aggressive tooth brushing habits to lip or tongue piercing. There is also a correlation between gingival recession and past orthodontic therapy.

Dr. P.D. Miller, a periodontist and fellow alumni from the University of Alabama, classified gingival recession. By reviewing these classifications, I hope it will aid you to diagnose the type of recession defects your patients may have. Having this classification system will also help in your knowledge of expected surgical root coverage results.

CLASSIFICATION OF MARGINAL TISSUE RECESSION

Miller’s Class I

Marginal tissue recession that does not extend to the mucogingival junction.

Miller’s Class II

Marginal tissue recession that extends to or beyond the mucogingival junction, with no periodontal attachment loss (bone or tissue) in the interdental area.

Miller’s Class III

Marginal tissue recession that extends to or beyond the mucogingival junction, with periodontal attachment loss in the interdental area or malpositioning of teeth.

Miller’s Class IV

Marginal tissue recession that extends to or beyond the mucogingival junction, with periodontal attachment loss in the interdental area or malpositioning of teeth.

ROOT COVERAGE EXPECTATIONS

Class I and II defects can expect about 80-100% root coverage with soft tissue grafting

• Class III defects can expect less than 80% root coverage.
• Class IV defects can expect little to no root coverage.

In future Newsletters, I will review soft tissue treatment options for root coverage and increasing attached gingiva.

Should you have any questions regarding any periodontal or implant issues, please don’t hesitate to call or email me.

There’s a new study that questions some previous findings about Pregnancy and Periodontics.

One of the benefits of our newsletter is that new information can be shared with many people as soon as it is learned. In the December 2010 Journal of the American Dental Association, there was an article, “The effectiveness of periodontal disease treatment during pregnancy in reducing the risk of experiencing preterm birth and low birth weight.” There are several risk factors for preterm birth such as age, smoking, ethnicity and multiple pregnancies. There is also evidence that systemic infection stimulates the inflammation pathway that can start early labor.

Periodontal disease is known to be related to many other diseases, such as diabetes, osteoporosis, heart disease, stroke, respiratory disease, Alzheimer’s disease and pancreatic cancer.

In 2003, a landmark study was written by Dr. Marjorie Jeffcoat, one of my mentors and past chairman of Periodontics at the University of Alabama, discussing the relationship between periodontal disease and preterm birth. Since that time it has been believed that treating periodontal disease during pregnancy reduces the risk of experiencing preterm births and low birth weight babies.

A new review of the literature now shows that the earlier studies may not have taken into account the number of patients who smoked or who were treated with antibiotics for their periodontal condition.

The conclusion of this new meta-analysis review of the literature is that periodontal therapy during pregnancy does not reduce the risk of preterm birth or low birth weight. This is the complete reverse of what we have thought for the past eight years. It is important for us to be able to embrace new findings and implement this information into our clinical practice. The author of this new study stated that although periodontal therapy during pregnancy may not change experiencing preterm birth or low birth weight, it may be important for periodontal health to be achieved prior to becoming pregnant.

I think the bottom line is that achieving periodontal health should always be our goal, regardless if it affects pregnancy or not. I hope I have brought you new information for your practice. I look forward to sharing clinical cases with you in the future.