Use of cone beam computed tomography in periodontology

Diagnosis of periodontal disease mainly depends on clinical signs and symptoms. However, in the case of bone destruction, radiographs are valuable diagnostic tools as an adjunct to the clinical examination. Two dimensional periapical and panoramic radiographs are routinely used for diagnosing periodontal bone levels. In two dimensional imaging, evaluation of bone craters, lamina dura and periodontal bone level is limited by projection geometry and superpositions of adjacent anatomical structures. Those limitations of 2D radiographs can be eliminated by three-dimensional imaging techniques such as computed tomography. Cone beam computed tomography(CBCT) generates 3D volumetric images and is also commonly used in dentistry. All CBCT units provide axial, coronal and sagittal multi-planar reconstructed images without magnification. Also, panoramic images without distortion and magnification can be generated with curved planar reformation. CBCT displays 3D images that are necessary for the diagnosis of intra bony defects, furcation involvements and buccal/lingual bone destructions. CBCT applications provide obvious benefits in periodontics, however; it should be used only in correctindications considering the necessity and the potential hazards of the examination.

Halitosis:the multidisciplinary approach

Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover, halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause （85%） for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated （10%） or gastrointestinal/ endocrinological （5%） disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach： dentists, periodontologists, specialists in family medicine, ear- nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo. Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

Management of the palato-radicular groove with a periodontal regenerative procedure and prosthodontic treatment:A case report

BACKGROUND Palato-radicular groove(PRG)is defined as an anomalous formation of teeth.The etiology of PRG remains unclear.The prognosis of a tooth with a PRG is unfavorable.The treatment of combined periodontal-endodontic lesions requires multidisciplinary management to control the progression of bone defects.Some researchers reported cases that had short-term observations.The management of teeth with PRGs is of great clinical significance.However,to date,no case reports have been documented on the use of bone regeneration and prosthodontic treatment for PRGs.CASE SUMMARY This case reported the management of a 40-year-old male patient with the chief complaint of slight mobility and abscess in the upper right anterior tooth for 15 d and was diagnosed with type II PRG of tooth 12 with combined endodonticperiodontal lesions.The accumulation of plaque and calculus caused primary periodontitis and a secondary endodontic infection.A multidisciplinary management approach was designed that included root canal therapy,groove sealing,a periodontal regenerative procedure,and prosthodontic treatment.During a 2-year follow-up period,a good prognosis was observed.CONCLUSION This report indicates that bone regeneration and prosthodontic treatment may contribute to the long-term favorable prognosis of teeth with PRGs.

Erbium-doped yttrium aluminum garnet laser and advanced plateletrich fibrin+in periodontal diseases:Two case reports and review of the literature

BACKGROUND The goal of periodontal disease treatment is to completely remove bacteria and promote wound healing.The erbium-doped yttrium aluminum garnet(Er:YAG)laser is commonly used to treat periodontal disease.Advanced platelet-rich fibrin+(A-PRF+)secrets growth factors that accelerates soft-and hard-tissue regeneration and wound healing.Herein I present 2 cases of patients with oral diseases treated with a combination of Er:YAG laser and A-PRF+.CASE SUMMARY Case 1 was a female with pocket depth bone loss over 8 mm and infection of tooth 31 and 41,and severe advanced periodontitis with grade III mobility.Case 2 was a male with tooth 22 root end apical swelling and infection and alveolar bony defects.Clinical outcomes were recorded at 6 and 36 mo.In case 1,the Er:YAG laser was used to perform open flap debridement(100 mJ/pulse,15 Hz)and remove calculus and granulation tissue(50 mJ/pulse,30 Hz).In case 2 the laser was used to create a semilunar full thickness flap incision(80 mJ/pulse,20 Hz)and eliminate the pathogen(100 mJ/pulse,15 Hz).In both patients,A-PRF+mixed with bone was used to fill bone defects,and A-PRF+autologous membranes were used to cover tension-free primary flaps.There was no recurrent infection at 36 mo,and tissue regeneration and would healing occurred.CONCLUSION Debridement with an Er:YAG laser followed by treatment with A-PRF+is effective for the treatment periodontal diseases with bone defects.