Activation of cellular regenerative events in periodontal wound healing/regeneration is rapid; the general framework for tissue formation is broadly outlined within 14 days. Most bone formation apparently originates from endosteally derived pre-osteoblasts; the PDL possibly acting as a supplementary source, with a primary function likely being regulatory/homeostatic. Blood accumulation at the surgical site warrants exploration; supplementation may be beneficial.
In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.
Type of Case: A 32‐year‐old female presents missing tooth #5 and requesting replacement with a dental implant. She has an unremarkable medical history. The tooth #5 site is a healed ridge with adequate bone to support an implant without additional augmentation. Clinical Approach #1 (CMR and TMJ): This approach involves routine implant surgery with placement of a healing abutment. Preoperative management includes 2 g amoxicillin 1 hour prior to the procedure and postoperative pain medication. The rationale for use of an antibiotic is to decrease the risk of infection and implant failure and to reduce peri‐implant inflammation during early healing. The desired effect of the antibiotic is to minimize or eliminate the negative effects of bacteria in the wound site and on the implant surface during healing. This clinical approach is recommended to protect the investment of resources and time by the patient and dental team for optimal treatment outcomes. Clinical Approach #2 (AWB, BGC, and KJE): This approach involves routine implant surgery with placement of a healing abutment. Postoperative management includes pain medications without antibiotic use. The rationale for avoidance of antibiotics is to eliminate risk of an adverse drug reaction such as urticaria, anaphylaxis, or gastrointestinal disturbances. Because the evidence justifying antibiotic coverage is considered to be weak, clinicians are advised to consider withholding antibiotic prescriptions for routine implant placement as a means of risk mitigation for the patient and public health in general.
Introduction Patient‐, site‐, and procedure‐related factors important for successful periodontal regeneration have been defined in the periodontics literature by insightful clinician‐researchers. Prevention of bacterial contamination of the surgical site through careful wound closure and meticulous postoperative care is a critical procedure‐related factor necessary for periodontal regeneration. Dense polytetrafluoroethylene (dPTFE) is a nonresorbable barrier material that may protect bone replacement grafts (BRG) against bacterial contamination for a short period during early wound healing if membrane exposure occurs. Case Presentation A 35‐year‐old African American female with a deep/narrow infrabony periodontal defect and Hamp degree I furcation involvement at tooth #14 (mesial) underwent combination BRG/guided tissue regeneration (GTR) using a mineralized/demineralized freeze‐dried bone allograft and a dPTFE barrier membrane. Favorable clinical and radiographic outcomes were noted nine months following the procedure. Conclusions Two reports evaluating clinical parameters following use of dPTFE membranes for GTR appear in the literature. The present case provides clinical and radiographic outcome assessments following combination BRG/GTR using a dPTFE membrane. This material may be of interest for periodontal regeneration due to an ability to temporarily limit bacterial influence if membrane exposure occurs.
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