Background This retrospective study evaluated and assigned scores to six prognostic factors and derived a quantitative scoring system used to determine the periodontal prognosis on molar teeth. Methods Data were gathered on 816 molars in 102 patients with moderate to severe periodontitis. The six factors evaluated, age, probing depth, mobility, furcation involvement, smoking, and molar type, were assigned a numerical score based on statistical analysis. The sum of the scores for all factors was used to determine the prognosis score for each molar. Only patients with all first and second molars at the initial examination qualified for the study. All patients were a minimum of 15 years post treatment. Results The post treatment time ranged from 15 to 40 years and averaged 24 years. When the study was completed, 639 molars survived (78%), and of those surviving molars, 566 survived in health (89%). In molars with lower scores (1,2,and 3) the 15-year survival rates ranged from 99% to 96%. For scores 4, 5, 6 the 15 year survival rates ranged was 95% to 90% and for molars with scores of 7, 8, 9, and 10 the survival rates ranged from 86% to 67%. Conclusions Our results indicate that the periodontal prognosis on molars diagnosed with moderate to severe periodontitis can be calculated using an evidence-based scoring system.

The purpose of this study was to compare periodontal soft and hard tissue repair using expanded polytetrafluoroethylene (ePTFE) membranes with and without decalcified freeze-dried cortical bone allografts (DFDBA). Six patients with 17 mandibular Class II buccal molar furcal invasions received oral hygiene instructions followed by scaling and root planing. Baseline soft tissue measurements with periodontal probes were made to assess probing depths (PD), recession (REC), and probing attachment levels (PAL). After non-surgical therapy, 10 teeth were randomly selected as test sites (ePTFE + DFDBA) and 7 as controls (ePTFE alone). Full-thickness flaps were elevated, and open surgical measurements were made to determine alveolar crestal height (CEJ-AC) and vertical (CEJ-BDF) and horizontal (HPDF) defect depth. The ePTFE membranes were removed at 6 weeks. After 6 months, all sites were reentered and both soft tissue and open surgical measurements recorded. The following mean changes (mm) were found for ePTFE and ePTFE + DFDBA treated sites respectively: decreased PD = 1.5, 2.2; increased REC = 1.3, 1.3; loss(-)/gain PAL = -0.2, 0.8; decreased CEJ-BDF = 3.8, 5.0; increased CEJ-AC = 0.5, 0.4; and decreased HPDF = 2.3, 2.4. None of the changes were statistically significant. The addition of DFDBA to the GTR procedure did not significantly improve any of the mean soft tissue and open surgical measurements between control (ePTFE alone) and test (ePTFE+DFDBA) groups in mandibular Class II buccal furcations. Both treatment procedures resulted in significant decreases in PD, CEJ-BDF, and HPDF and a significant increase in REC. There were no differences for PAL and CEJ-AC within control and test groups seen with this sample. Larger randomized clinical trials are needed to more fully evaluate whether combined graft and GTR procedures offer an advantage over GTR alone.

A number of grafting materials have been used in vertical and horizontal ridge augmentation to enable implant placement in optimal positions. Autogenous block grafts from intraoral or extraoral sites have been used with positive results. Allograft blocks with cortical bone are also used for ridge augmentation. In this case series, cancellous allograft blocks were used for horizontal augmentation of the maxilla. The observed increase in ridge width allowed subsequent implant placement after a 5-month healing period. Four months after placement, the implants were uncovered and restored. The results suggest that cancellous block allografts may be a viable alternative to autogenous block grafts or cortical allograft blocks in treatment of deficient maxillary alveolar ridges to allow subsequent implant placement in optimal position in the maxilla.

This study evaluated clinically the effectiveness of hand versus sonic subgingival scaling and root planing in the removal of calculus by visually examining the root surface at the time of periodontal flap surgery. Consideration was given to the method of instrumentation, probing depth, number of roots, and type of tooth surface. Eleven patients with moderate to advanced periodontal disease were evaluated. Four subjects were scaled and root planed with the Titan-S only, four with curettes only, and three with the Titan-S + curettes. At reevaluation 3 to 6 weeks after scaling and root planing, the decision to perform periodontal flap surgery was made based upon probing depth, bleeding upon probing, previous access to the root surface, furcation involvement, and the patient's level of oral hygiene. A full thickness mucoperiosteal flap was elevated to gain access to the root surface and measure the distance from the cementoenamel junction to the residual calculus. A total of 690 surfaces were evaluated surgically. The percentage of surfaces with residual calculus for each method of instrumentation was: Titan-S only (31.9%), curettes only (26.8%), and Titan-S + curettes (16.9%). Overall, 15.7% of the surfaces probing 0 to 3 mm, 29.3% of the surfaces probing 4 to 5 mm, and 44.4% of the surfaces probing 6 to 12 mm had residual calculus.(ABSTRACT TRUNCATED AT 250 WORDS)

The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students' critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to reine study protocols. The study design was a natural experiment with crosssectional data collection using the HSRT for 15 classes (2013-17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was signiicantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary indings support future research to further evaluate a proposed model of critical thinking in clinical dentistry.Dr. Reed is Associate Professor,

The purpose of this study was to evaluate the effects of a magnetized water oral irrigator on plaque, calculus and gingival health. 29 patients completed this double-blind crossover study. Each patient was brought to baseline via an oral prophylaxis with a plaque index < or = 1 and a gingival index < or = 1. Subjects used the irrigator for a period of 3 months with the magnet and 3 months without the magnet. After each 3 month interval, data were collected using the plaque index, gingival index, and accretions index. The repeated measures analysis on plaque, gingival and calculus indices yielded a statistically-significant period effect for PlI (p=0.0343), GI (p=0.0091), and approached significance for calculus (p=0.0593). This meant that the effect of irrigation resulted in a decrease of all indices over time. Therefore, the treatment effect on each index was evaluated using only the measurements obtained at the end of the first period (i.e., assuming a parallel design). Irrigation with magnetized water resulted in 64% less calculus compared to the control group. The reduction was statistically significant (p< or =0.02). The reduction by 27% in gingival index was not statistically significant. The reduction in plaque was minimal (2.2%). A strong positive correlation between the plaque index and the Watt accretion index was observed. The magnetized water oral irrigator could be a useful adjunct in the prevention of calculus accumulation in periodontal patients, but appears to have minimal effect on plaque reduction. The results indicated a clinical improvement in the gingival index, but this was not a statistically significant finding.

The analysis of dental students' clinical production/participation has been used to assess whether a prospective graduate is capable of unsupervised and independent practice (that is, competent to perform that practice). This method and others have inherent biases that may not accurately reflect whether the student has mastered the associated concepts and techniques required for dentistry. The aim of this study was to assess an informatics system that assigned curriculum meta-tags with time-based relative educational value units (ReVUs) to each clinical procedure performed by Medical University of South Carolina (MUSC) students. The system has been used since 1998, but for this study the complete data sets for the MUSC graduating classes of 2007 through 2016 were mapped using microcompetency codes for the dental procedures. In total, 421,494 procedures were formatted and analyzed using software developed to aggregate disparate data sets from clinical activities into a common format for evaluation. The results showed that the ten classes (cohorts) were very consistent with cohort high ReVUs averaging 7,317.1 points, cohort mean ReVUs being 5,180.2 points, and cohort low ReVUs averaging 3,381 points. A detailed analysis of student effort by dental subspecialty found that preventive activities represented 13.4%, patient assessment 32.6%, periodontology 2.8%, restorative dentistry 16.3%, prosthodontics 21.9%, endodontics 6.7%, and oral surgery 5.7% of the total points in the clinical part of the curriculum. In this system, point thresholds can be easily generated to monitor students' progress towards competence for each defined competency and thus assess their progress towards acquiring the skills required for unsupervised, independent practice.

A number of grafting materials have been used in vertical and horizontal ridge augmentation to enable implant placement in optimal positions. Autogenous block grafts from intraoral or extraoral sites have been used with positive results. Allograft blocks with cortical bone are also used for ridge augmentation. In this case report, a cancellous allograft block was used for horizontal augmentation of the maxilla. The observed increase in ridge width allowed subsequent implant placement after a 5 month healing period. After 4 months the implant was uncovered and restored as a unit in a 4-unit fixed splinted implant reconstruction. The result suggests that cancellous block allografts may be a promising alternative to autogenous block grafts or cortical allograft blocks in treatment of deficient maxillary alveolar ridges to allow subsequent implant placement in optimal position.