Dr. Rick Newhart Updates

HEART DISEASE AND DEATH ASSOCIATED WITH ANTIBODIES TO PERIODONTAL PATHOGENS

Pussinen et al. (Arteriosclerosis, Thrombosis, and Vascular Biology 2005; 25: 833-838) studied a population of 1, 023 men between 1984 and 1989.  They found that serum antibody titers for porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were associated with carotid artery thickening and that high levels of antibodies to these bacteria were associate with increased risk of myocardial infarction or death from heart disease.  Pussinen concluded that high antibody levels to major periodontal pathogens are associated with subclinical, prevalent, and future incidences of coronary heart disease.

THE VANISHING BONE PROBLEM

Nevins et al. (IJPRD2006;26:18-29) studied the loss of the facial plate of bone in the anterior teeth after extraction, in comparison with teeth which were extracted with bone grafting present.  Nevins studied a total of 9 patients with 36 maxillary anterior teeth which were extracted and followed via computerized tomographic radiographs at 30 and 90 days after extraction.   Nineteen teeth received bone grafting, while 17 sockets received no bone grafting material.  All sites received primary closure.  The authors found that most of the sites treated with bone grafting lost less than 20% of the facial plate.  In contrast, over 70% of sites that had no grafting lost bone in excess of 20%.  The authors conclude that extraction of a anterior maxillary tooth with a thin buccal plate can lead to significant alveolar plate resorption, unless bone grafts are placed at the time of extraction.  Dr. Newhart prefers, if possible, to place a dental implant at the time of extraction of an anterior tooth.  However, if this is not possible he suggests bone grafting the area if the patient is interested in dental implant therapy. 

FAILED ROOT CANAL THERAPY!

Wolcott and Meyers (Compendium 2006; 27:104-110) discuss the advantages and disadvantages of endodontic retreatment for a failed root canal tooth or replacement of the tooth with a dental implant.  The authors mention Bender and Seltzer’s criteria for endodontic success as absence of pain and swelling, disappearance of fistula, no loss of function, no evidence of tissue destruction, and radiographic evidence of an eliminated or arrested area of rarefaction after an interval of 6 months to 2 years.  Occasionally root canals will fail and need to be retreated, but it should be noted that most endodontic treatment is highly successful.  The authors quote an endodontic success rate of 99.5% presented by Lazarski. The authors believe that the natural tooth is the best implant and they show a number of cases of successful retreatment.  Dr. Newhart strongly believes in saving natural teeth, if at all possible.  Our area is blessed with two very good endodontists.  Dr. Newhart feels that our local endodontists can be of great value in helping make the decision to extract or to save the tooth. 

PLATFORM SWITCHING TECHNIQUE

Lazzara and Porter (IJPRD2006;26:8-17) present the relatively new concept of platform switching for the restoration of dental implants.  Platform switching refers to the practice of restoring a wide-body dental implant with a standard, or narrower abutment.  The concept was inadvertently developed with Implant Innovations producing wide-body implants, but not wide-body prosthetic components.  Narrower prosthetic parts were used and long-term radiographic follow-up of these “platform switched” restorations revealed less bone loss than would be expected as compared with standard restorations.  Dr. Newhart feels it is important to point out that most of the cases presented were splinted together for prosthetic stability.  One must be careful to not narrow the abutment too much, especially with a single implant, as it could be possible to have a case failure due to fracture of one of the components. 

Thank you for your continued referral of dental implant and periodontal patients!

Please visit our website at: thegumdr.com

Dr. Richard Newhart, Periodontist

Dental Implant Placement

1308 Market Street    

Parkersburg, WV 26101

(304) 422-4867

Dr. Newhart’s periodontal update is a scientific, referenced literature and research review and newsletter. Dr. Newhart is not claiming to perform, endorse, or achieve the results of every surgical technique or procedure published in this newsletter. Dr. Newhart is a licensed periodontal specialist, who has achieved significant post-doctoral implant and periodontal education & training.