E-newsletter Vol - I I
Number- I June 2007
Laughter - The best
Achieve self reliance
in dental health care: President APJ Abdul Kalam
technology to hit the detection of Dental Caries
Usage of nanocrystalline
Hydroxylapatite in paste form to preserve post–extractive sites. A
one–case report.- Dr.Marco Iorio
Brush, Floss ... and Rinse?
Its 1 year and 1 month since we started Dental Follicle . We thank
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the mail boxes of morethan 30K dentists across the globe.We would
like to introduce more and more features which would be of immense
use to you .Please send in your suggestions so that we make "Dental
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Man: "Darling, your teeth remind me of the stars"
Woman: "Because they gleam and sparkle"
Man: "No, because they come out at night!"
self reliance in dental health care: President APJ Abdul Kalam
President A P J Abdul Kalam today ,the 29th of June ,called on
the medical practitioners and R and D centres to achieve 'self
reliance' in dental healthcare, as the country was lagging
behind many others in providing quality dental care.
Inagurating Implantology at Army College of Dental Sciences (ACDS)
herein Hyderabad, Kalam said ''there is a need to network the
Dental centres located in different parts of the country to
generate clinical database which will be useful for research.''
He also said ''Better use of tele-medicine for the dental care
in the remote villages will enable the doctors to examine the
patients using intra oral X-rays through digital sensors and
consult through 'Virtual Dental Clinics' which can provide
knowledge to the field centres,''
The President said a case study should be conducted about the
use of Neem tree material as a cost effective solution for
promoting dental care in the villages.
Dental implant company BIOMET 3i™ has just introduced a new dental
implant using nanotechnology.
The NanoTite Implant adds deposits of nanoscale calcium phosphate
crystals to approximately 50% of the surface. These nanoscale
deposits create a complex surface on the implant that, according to
pre-clinical studies, appears to play a key role in how the implant
bonds with the bone. Human bone recognizes calcium phosphate as
being biologically natural, allowing the bone and implant to bond
applications and benefits of the NanoTite Implant include use to
replace single or multiple missing teeth due to cavities, decay,
trauma or disease. The NanoTite Implant, like all dental implants,
is designed to help preserve bone structure and natural facial
nanocrystalline Hydroxylapatite in paste form to preserve
post–extractive sites. A one–case report.
DMD, DDS, private
Castelletto Ticino (NO) Italy
This article proposes a technique to preserve
post–extractive sites in order to simplify prosthetically-guided
insertion of osseointegrated dental implants.
Nanocrystalline hydroxylapatite, dental implants, extraction
sockets, bone regeneration.
process following tooth extraction often leads to a partial filling
of the empty socket1,2, together with 3–4mm ridge
resorption both in transversal and vertical direction1,3.
The result of these processes is a narrow and reduced ridge, with
inadequate bone volume to support soft tissue or to permit implant
placement in an ideal position.
principles to post–extractive sockets significantly reduces the
amount of bone resorption3.
To make GBR
effective, it is mandatory to obtain and maintain soft tissue
coverage over the augmented site4,5 by elevating and
advancing a wide mucoperiosteal flap. This inevitably leads to a
modification of normal mucoginigival anatomy of the augmented
site, with a subsequent esthetic alteration. Full thickness flap
elevation interrupts periosteal vascularization of buccal bony
plate, thus inducing a partial resorption.
technique to preserve post–extractive site was propose (Bio–Col
technique, Sclar 20036). The tooth has to be extracted
without causing trauma to the neighboring tissue, the empty socket
has to be filled with bovine bone mineral — a slow–resorbing
osteconductive material — and the site has to be sealed with
resorbable collagen sponge and cyanoacrylate.
combination, according to the Author, leads to a good re generation
of alveolar bone, without the problems caused by the need to obtain
primary wound closure.
problem with this technique is the long resorbtion time of bovine
Nanocrystalline hydroxylapatite in paste form (Ostim®, Heraeus–Kulzer
GmbH, Hanau, Germania) is a pure, unsintered hydroxylapatite
material, made of crystals of hydroxylapatite (average dimension 18
in 35% water suspension. The nanocrystalline structure of the
biomaterial allows a quick vascularization of the graft, with a wide
contact surface between the graft and the osteoblasts (106 m2/g,
vs 50–90 m2/g of bovine bone mineral). This
characteristic makes hydroxylapatite in paste form a very quick
resorbing biomaterial. A recent animal study reports a 53,9% average
percentage of mineralization of a defect filled with Ostim® at 12
weeks; this data is not statistically different from the percentage
of mineralization of a similar defect filled with autogenous bone7.
characteristic of nanocrystalline hydroxylapatite in paste
form is its complete radiolucency, which allows for a radiographical
evaluation of bone regeneration process.
A 37 years
old, Caucasian male man presented at my office requesting the
substitution of the ill–fitting gold–acrylic veneer crown on tooth
2.4. Radiological examination (Fig. 1) revealed very deep caries on
2.5 and external root resorption on 2.4.
The proposed treatment plan was, after full mouth
scaling and root planing, to perform endodontic therapy of 2.5, to
place a cast gold post and core restoration on 2.5; 2.4 had to be
extracted and a technique of socket preservation was applied before
placing an osseointegrated implant.
The tooth 2.4
was extracted by means of periotomes and thin elevators, an envelope
flap was raised, performing intrasulcular incisions on 2.3 and 2.5
and a limited exposition of buccal and palatal bony margins of the
socket were exposed (Fig. 2).
The empty socket was carefully debrided and rinsed
with sterile saline, then it was filled with Ostim® up to the level
of the surrounding bone (Fig. 3). The material, extruded from the
syringe, was adapted to the bone cavity, then stabilized with a PLA
mesh (Vicryl VM302, Ethicon inc., Cornelia GA, USA) (Fig. 4). The
mesh was covered with a resorbable collagen sponge (Hémocollagène,
The flap was
sutured with a 4–0 resorbable PLA thread (FS–3 Vicryl JV394, Ethicon inc.,
Cornelia GA, USA), applying two single sutures on the papillae and a
cross suture over the collagen sponge (Fig. 5–6).
To further protect the grafted site a fixed
provisional restoration (crown on 2.5 and mesial cantilever ovate
pontic on 2.4) was placed (Fig. 7); no occlusal contacts, neither in
centric occlusion, nor in lateral excursions, were present on the
Three months after the extraction good bone
regeneration is evident at the grafted site (Fig. 8); after flap
elevation it is not possible to notice any difference between native
and regenerated bone (Fig. 9). One single self–tapping, external
hex, rough surface, 4mm in diameter and 15mm in length implant was
placed (OSS415, 3i Implant Innovations, West Palm Beach FL, USA)
After 6 months of healing (Fig. 11), there’s still a
deficiency in tissue volume below th mucogingival junction (Fig.
12), a roll technique was performed, at the same time the healing
abutment was connected (Fig. 13–14). Overcorrection of the defect
was necessary to compensate for the subsequent graft contraction.
After 3 months of soft tissue healing, the final
impression was taken (Fig. 15) using a polyether material (Permadyne
H/Permadyne L, 3M Espe AG, Seefeld, Germania) (Fig. 16). Prosthetic
rehabilitation was carried out using a UCLA cast–on abutment on the
implant (SGUCA1C, 3i Implant Innovations, West Palm Beach FL, USA)
and two single ceramometal crowns (Fig. 17).
The position of 2.4 and 2.5 interproximal contact
points, in a apico–coronal direction, was placed — according to
Tarnow’s investigations8 — at less than 5mm from the
crest of the ridge to predictably obtain a papilla both in the
interproximal space in between the crowns and between each crown and
neighboring natural teeth (Fig. 18–19).
The usage of
the socket preservation technique allowed for an ideal implant
placement, avoiding the use of more complex techniques such as
sagittal osteotomies (“split crest”), guided bone regeneration or
onlay block graft.
subsequent soft tissue augmentation and the placement of
interproximal contact point following well–documented scientific
criteria permitted, after only three months from final prostheses
delivery, to obtain a natural looking esthetic result with a
complete filling of the interproximal spaces by papillary tissue
would like to thank his office team: Dr. Mario Iorio MD, DMD, DDS
(thank you dad!), Dr. Rossana Repossi RDH, Dr. Silvia Terazzi DMD,
Mr. Luca Varalli and Mr. Marco Brignoli MDT, Ms. Patrizia Losi, Ms.
Erica Bagaini, Ms. Alice Guerini dental assistants for the
invaluable help in treating this patient and many others.
Lekovic V, Kenney EB, Weinlaender M, et al. A bone regeneration
approach to alveolar ridge maintenance following tooth extraction:
Report od 10 cases. J Periodontol 1997; 68:563–570
N, Becker W, Karring T. Alveolar bone formation. In Lindhe J (ed). Textbook of
clinical periodontology and implant dentistry, ed 3. Copenhagen:
Lekovic V, Camargo PM, Klokkevold PR, et al. Preservation of
alveolar bone in extraction sockets using bioabsorbable membranes. J
Periodontol 1998; 69:1044–1049.
Warrer K, Gotfredsen K, Hjorting–Hansen E, Karring T. Guided tissue
regeneration ensures osseointegration of dental implants into
extraction sockets. An experimental study in monkeys. Clin Oral
Implants Res 1991;2:166–171.
Becker W, Becker B, Handelsman M, Ochsenbein C, Albrektsson T.
Guided tissue regeneration for implants placed into extraction
sockets: A study in dogs. J Periodontol 1991;62:703–709.
Sclar AG. The Bio–Col Method. In: Sclar AG (ed.). Soft Tissue and
Esthetic Considerations in Implant Therapy. Carol Stream: Quintessence
Publishing Co, Inc., 2003:75–112
Thornwarth WM, Schlegel KA, Srour S, Schultze–Mosgau S, Wiltfang J.
Untersuchung zur knöchernen Regeneration ossärer Defekte unter
Anwendung eines nanopartikulären Hydroxylapatitis (Ostim®).
Cliff Whall, director of the ADA Seal of
Acceptance program, agrees that adding "rinse" to the mantra of
"Brush twice" would probably be a good move for most everyone as
well, as antimicrobial mouthwashes have been shown in clinical
studies to prevent the gingivitis.Listerine , chlorhexidine
and Flouride containing mouthwashes have carried the ADA Seal of
Acceptance for two decades now for this very reason.
A December 2002
article in the American Journal of Dentistry suggested that in
combination with brushing, rinsing with an antimicrobial mouth rinse
is actually more effective than flossing when it comes to preventing
gingivitis. Follow-up studies published in the Journal of the
American Dental association in 2003 and 2004 further solidify the
effectiveness of adding antimicrobial mouth rinses to the medicine