Giuliabonarini_dds_rdh

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Giuliabonarini_dds_rdh Dentist | Dental Hygenist
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🄸🄳🅁🄰-Implant Disease Risk Assessment⁣⁣IDRA is a risk assessment tool proposed by Heitz-Mayfield in 2019. The functional ...
16/05/2022

🄸🄳🅁🄰-Implant Disease Risk Assessment⁣
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IDRA is a risk assessment tool proposed by Heitz-Mayfield in 2019. The functional risk assessment diagram was constructed incorporating eight parameters, each with documented evidence for an association with peri-implantitis:⁣
1-assessment of a history of periodontitis⁣
2-percentage of sites with bleeding on probing (BOP)⁣
3-number of teeth/implants with probing depths (PD) ≥5 mm⁣
4-the ratio of periodontal bone loss (evaluated from a radiograph) divided by the patient's age⁣
5-periodontitis susceptibility as described by the staging and grading categories from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases⁣
6-the frequency/compliance with supportive periodontal therapy ⁣
7-the distance in mm from the restorative margin of the implant-supported prosthesis to the marginal bone crest ⁣
8-prosthesis-related factors including cleanability and fit of the implant-supported prosthesis. ⁣
⁣
This IDRA risk assessment tool will require validation through retrospective or prospective studies in multiple private practice and University settings, but is a useful tool for assessing risk for an individual patient after implant therapy.

🄿🅁🄴🅂🄴🄽🄲🄴 / 🄰🄱🅂🄴🄽🄲🄴 🄾🄵 🄸🄽🅃🄴🅁🄿🅁🄾🅇🄸🄼🄰🄻 🄿🄰🄿🄸🄻🄻🄰⁣⁣🇬🇧 The vertical distance between the contact point and the crest of the bon...
03/04/2022

🄿🅁🄴🅂🄴🄽🄲🄴 / 🄰🄱🅂🄴🄽🄲🄴 🄾🄵 🄸🄽🅃🄴🅁🄿🅁🄾🅇🄸🄼🄰🄻 🄿🄰🄿🄸🄻🄻🄰⁣
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🇬🇧 The vertical distance between the contact point and the crest of the bone is significant in determining the presence of the interpoximal papilla. When the distance is 5 mm or less the papilla was almost always present and when the distance was 7 mm or more the papilla was usually missing. These were the conclusions, still suitable, of an important article by Tarnow in 1992. Other variables, such as the degree of inflammation, pocket depth of adjacent teeth, anterior or posterior teeth, history of NSPT and SPT and the presence of proximal restoration, may all contribute to the presence/absence of the papilla; however the vertical distance is a determining factor.

Implant success is as difficult to describe as the success criteria required for a tooth. On 5th October 2007, the Italy...
08/01/2022

Implant success is as difficult to describe as the success criteria required for a tooth. On 5th October 2007, the Italy Consensus Conference established
three primary categories:
⏺ success,
⏺ survival,
⏺ failure.

There are 4 implant groups to describe the clinical conditions of success, survival, or failure.

▪️Group I:represents success and is considered optimum health conditions. No pain is observed with palpation, percussion, or function. No clinical implant mobility is noted in any direction. Less than 2.0 mm of radiographically crestal bone loss is observed compared with the implant insertion surgery. The implant has no history of exudate.

▪️Group II implants are categorized as “survival” and have satisfactory health. They are stable, but show a history of, or potential for, clinical problems. No pain or tenderness is observed on palpation, percussion, or function. No observable mobility exists. Radiographic crestal bone loss is between 2.0 and 4.0 mm from the implant insertion.

▪️Group III implants are also in the “survival” category, but exhibit a slight to moderate peri-implantitis and compromised health status. Group III implants are characterized by no pain in function. No vertical or initial horizontal mobility is evident. Greater than 4 mm radiographic crestal bone loss has occurred since implant placement, but bone loss is less than 50% from around the implant. Probing depths have increased from baseline up to one-half the length of the implant, often accompanied with bleeding on probing. Exudate episodes (if present) may have lasted more than 2 weeks.

▪️The Group IV of the Pisa Implant Health Scale is clinical or absolute failure. The implant should be removed under any of these conditions

🅆🄷🄰🅃 🄸🅂 🅃🄷🄴 🄴🄵🄵🄸🄲🄰🄲🅈 🄾🄵 🄿🄼🄿🅁 🄰🄽🄳 🄲🄾🄽🅃🅁🄾🄻 🄾🄵 🅁🄴🅃🄴🄽🅃🄸🅅🄴 🄵🄰🄲🅃🄾🅁🅂 🄸🄽 🄿🄴🅁🄸🄾🄳🄽🅃🄰🄻 🅃🄷🄴🅁🄰🄿🅈?⁣⁣“professional mechanical plaque re...
01/08/2021

🅆🄷🄰🅃 🄸🅂 🅃🄷🄴 🄴🄵🄵🄸🄲🄰🄲🅈 🄾🄵 🄿🄼🄿🅁 🄰🄽🄳 🄲🄾🄽🅃🅁🄾🄻 🄾🄵 🅁🄴🅃🄴🄽🅃🄸🅅🄴 🄵🄰🄲🅃🄾🅁🅂 🄸🄽 🄿🄴🅁🄸🄾🄳🄽🅃🄰🄻 🅃🄷🄴🅁🄰🄿🅈?⁣
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“professional mechanical plaque removal”, (PMPR) is considered an essential component in the primary and secondary prevention of periodontitis as well as within the basic treatment of plaque-induced periodontal diseases . Since the presence of retentive factors, either related to tooth anatomy or more frequently, due to inadequate restorative margins, are often associated with gingival inflammation and/or periodontal attachment loss, they should be prevented/eliminated to reduce their impact on periodontal health. It has been established that retentive factors may increase the risk of worsening the periodontal condition .⁣
The removal of the supragingival dental biofilm and calcified deposits (calculus) and the reduction/elimination of plaque retentive factors is mandatory during the first phase of periodontal therapy.⁣

🄿🄴🅁🄸🄾🄳🄾🄽🅃🄻 🅂🅄🅁🄶🄴🅁🅈Residual PPD≥6 mm represents an incomplete periodontal treatment outcome and require further therapy. ...
20/07/2021

🄿🄴🅁🄸🄾🄳🄾🄽🅃🄻 🅂🅄🅁🄶🄴🅁🅈
Residual PPD≥6 mm represents an incomplete periodontal treatment outcome and require further therapy.
Indeed, compared with PPD=3 mm, PPD= 6 mm represent a risk factor for tooth loss with odds ratios of 9,3 and 11, respectively, at site and tooth levels. The corresponding odds ratios for PPD=5 mm is 5,8 and 7,7 (Matulienne, 2008). ⁣
In cases of deep (PPD≥6 mm) residual pockets and intrabony defects in patient with periodontitis stage III after adequate first and second step of periodontal therapy, access periodontal surgery can be carried out using different flap design. On the contrary in moderately deep residual pockets (4-5mm), the repeating of subgingival instrumentation is recommended. ⁣
The surgical procedures have been classified depending on the amounts of marginal gingiva and interdental papillary tissue removal into: ⁣
- open flap instrumentation with intra-sulcular incisions (OFD).�- flaps with para-marginal incisions, such as modified Widman flap (MWF) and�- papilla preservation flaps. ⁣
There is insufficient evidence for a recommendation of the choice of flap procedure.⁣

⁣🄸🅂 🅃🄷🄴🅁🄴 🄰 🄽🄴🄴🄳 🄵🄾🅁 🄾🄲🄲🄻🅄🅂🄰🄻 🄴🅀🅄🄸🄻🄸🄱🅁🄰🅃🄸🄾🄽 🄸🄽 🅃🄷🄴 🄿🄴🅁🄸🄾🄳🄾🄽🅃🄰🄻🄻🅈 🄲🄾🄽🄿🅁🄾🄼🄸🅂🄴🄳 🄳🄴🄽🅃🄸🅃🄸🄾🄽?⁣⁣When to equilibrate: ⁣⁣•Whethe...
27/06/2021

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🄸🅂 🅃🄷🄴🅁🄴 🄰 🄽🄴🄴🄳 🄵🄾🅁 🄾🄲🄲🄻🅄🅂🄰🄻 🄴🅀🅄🄸🄻🄸🄱🅁🄰🅃🄸🄾🄽 🄸🄽 🅃🄷🄴 🄿🄴🅁🄸🄾🄳🄾🄽🅃🄰🄻🄻🅈 🄲🄾🄽🄿🅁🄾🄼🄸🅂🄴🄳 🄳🄴🄽🅃🄸🅃🄸🄾🄽?⁣
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When to equilibrate: ⁣
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•Whether the inflammatory periodontitis has been treated successfully. After the stabilization of periodontal disease an occlusal therapy may be necessary for some patients and could involve either occlusal equilibration or splinting. ⁣
•Occlusal equilibration is considered an effective form of therapy for teeth with increased mobility which has developed together with an increase in the width of the periodontal ligament. Eliminating any occlusal interferences for a tooth which has a reduced bone height as a result of periodontal disease will result in bone formation and remodelling of the alveolus only to the pre-trauma level. ⁣
•In contrast, if the hypermobile tooth has reduced bone height but normal periodontal ligament width, then elimination of occlusal trauma will not alter the mobility of the tooth. In this situation occlusal equilibration is only indicated if the patient is complaining of loss of function or discomfort. ⁣
�In this case, the hypermobility is both the result of the reduced height of the supporting tissues that can no longer withstand the masticatory forces and the result of a widened periodontal ligament. In such situations, the reduction of mobility can only be obtained by an occlusal adjustment and joining teeth together in a splint. Since increased tooth mobility due to reduced height of the periodontal support should be considered as physiological mobility, LR3- LR2-LR1- LL1- LL2- LL3 were splinted after an occlusal adjustment because the hypermobility disturbs the patient’s masticatory function and chewing comfort. The objective of splinting is to create a situation in which the mobility of the teeth splinted is either “normal” or at least non-progressive ⁣
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Unlucky, at the time I visited the patient the splint was present without a periodontal therapy. Bear in mind that, trauma from occlusion only doesn’t causes gingivitis or periodontitis and⁣
occlusal therapy is not a substitute for conventional methods of resolving plaque-induced inflammation.⁣
⁣

🄵🄾🄲🄰🄻 🄸🄽🄵🄻🄰🄼🄼🅃🄸🄾🄽 🄷🅈🄿🄾🅃🄴🅂🄸🅂⁣⁣🇬🇧 Pro-inflammatory molecules are significantly elevated within the gingival tissue during ...
13/06/2021

🄵🄾🄲🄰🄻 🄸🄽🄵🄻🄰🄼🄼🅃🄸🄾🄽 🄷🅈🄿🄾🅃🄴🅂🄸🅂⁣
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🇬🇧 Pro-inflammatory molecules are significantly elevated within the gingival tissue during periodontitis. In particular elevated concentrations of Interleukin(IL)-6, C-Reactive Protein (CRP) have been detected in the gingival fluid. ⁣
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Patients with periodontitis also present consistently elevated systemic levels of CRP and IL-6 when compared with matched healthy populations. These findings corroborate the hypothesis that periodontitis triggers systemic inflammation. ⁣
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This chronic systemic inflammatory state could be due to: ⁣
1) the excess spill of locally produced inflammatory molecules at the gingival level, ⁣
2) due to the triggering of a distant hepatic host response (acute phase response) either by circulating bacteria or inflammatory molecules. ⁣
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On average cases with periodontitis present with 1.56 mg/l more CRP than controls2. In the same systematic review, data originated from 6 clinical randomized studies demonstrated that effective periodontal treatment produced a significant reduction (on average of 0.50 mg/L) in CRP serum levels. ⁣
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🇮🇹 Le molecole pro-infiammatorie sono significativamente elevate all'interno del tessuto gengivale durante la parodontite. In particolare, nel fluido gengivale sono state rilevate concentrazioni elevate di Interleuchina (IL) -6, Proteina C-Reattiva (CRP).⁣
⁣
I pazienti con parodontite presentano anche livelli sistemici costantemente elevati di PCR e IL-6 rispetto alle popolazioni sane. Questi risultati confermano l'ipotesi che la parodontite inneschi l'infiammazione sistemica.⁣
Questo stato infiammatorio sistemico cronico potrebbe essere dovuto a:⁣
1) l'eccessiva fuoriuscita di molecole infiammatorie prodotte localmente a livello gengivale,⁣
2) a causa dell'attivazione di una risposta epatica dell'ospite (risposta di fase acuta) da parte di batteri circolanti o molecole infiammatorie.⁣
⁣
In media i casi di parodontite presentano 1,56 mg / l di PCR in più rispetto ai controlli. Nella stessa revisione sistematica, i dati provenienti da 6 studi clinici randomizzati hanno dimostrato che un trattamento parodontale efficace ha prodotto una riduzione significativa (in media di 0,50 mg / L) dei livelli sierici di PCR.⁣

🅄🄻🄲🄴🅁🄰🅃🄸🄾🄽 🄾🄵 🄶🄸🄽🄶🄸🅅🄰🄻 🄴🄿🄸🅃🄷🄴🄻🄸🅄🄼⁣⁣⁣⁣🇬🇧 In health, the gingival sulcular epithelium along with innate immune molecules a...
06/06/2021

🅄🄻🄲🄴🅁🄰🅃🄸🄾🄽 🄾🄵 🄶🄸🄽🄶🄸🅅🄰🄻 🄴🄿🄸🅃🄷🄴🄻🄸🅄🄼⁣⁣
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🇬🇧 In health, the gingival sulcular epithelium along with innate immune molecules acts as a natural barrier system that inhibits and eliminates penetrating bacteria. ⁣⁣
⁣⁣
The inflamed and ulcerated epithelium found in periodontitis is vulnerable to bacteria and forms an easy port of entry. The estimated inflamed/ulcerated area found in a patient with generalized periodontitis amounts to 40cm2 (equivalent to the palm of the hand). ⁣⁣
⁣⁣
An increased number of bacteria can then invade the gingival tissues and systemic circulation. ⁣⁣
Bacteremia occur after irritation of inflamed gingiva upon tooth brushing, chewing, oral examination, and professional tooth cleaning. ⁣⁣
⁣⁣
The microorganisms making through the blood circulation are efficiently neutralized by the immune systems within minutes (transient bacteremia) with no consequences. ⁣⁣

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🇮🇹 Nello stato di salute, l'epitelio solculare gengivale insieme alle molecole immunitarie innate agisce come un sistema di barriera naturale che inibisce ed elimina i batteri che penetrano.⁣⁣
⁣⁣
L'epitelio infiammato e ulcerato riscontrato nella parodontite è vulnerabile ai batteri e costituisce un facile accesso. L'area stimata infiammata / ulcerata riscontrata in un paziente con parodontite generalizzata è pari a 40 cm2 (equivalente al palmo della mano). Un numero maggiore di batteri può quindi invadere i tessuti gengivali e la circolazione sistemica.⁣⁣
La batteriemia puó avvenure durante lo spazzolamento dei denti, la masticazione, l'esame orale e le sedute di igiene professionale.⁣⁣
⁣⁣
I microrganismi che attraversano la circolazione sanguigna vengono efficacemente neutralizzati dal sistema immunitario in pochi minuti (batteriemia transitoria) senza conseguenze.⁣⁣
Tuttavia, i batteri e i loro fattori di virulenza possono stimolare siti distanti (invadere i tessuti vascolari) e innescare una moderata risposta infiammatoria sistemica.

🄳🄾🄴🅂 🅃🄷🄴 🄰🄳🄹🅄🄽🄲🅃🄸🅅🄴 🅄🅂🄴 🄾🄵 🄿🅁🄾🄱🄸🄾🅃🄸🄲🅂 🄸🄼🄿🅁🄾🅅🄴 🅃🄷🄴 🄲🄻🄸🄽🄸🄲🄰🄻 🄾🅄🅃🄲🄾🄼🄴 🄾🄵 🅂🅄🄱🄶🄸🄽🄶🄸🅅🄰🄻 🄸🄽🅂🅃🅁🅄🄼🄴🄽🅃🄰🅃🄸🄾🄽?⁣⁣🇬🇧 Probiotics are ...
30/05/2021

🄳🄾🄴🅂 🅃🄷🄴 🄰🄳🄹🅄🄽🄲🅃🄸🅅🄴 🅄🅂🄴 🄾🄵 🄿🅁🄾🄱🄸🄾🅃🄸🄲🅂 🄸🄼🄿🅁🄾🅅🄴 🅃🄷🄴 🄲🄻🄸🄽🄸🄲🄰🄻 🄾🅄🅃🄲🄾🄼🄴 🄾🄵 🅂🅄🄱🄶🄸🄽🄶🄸🅅🄰🄻 🄸🄽🅂🅃🅁🅄🄼🄴🄽🅃🄰🅃🄸🄾🄽?⁣
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🇬🇧 Probiotics are defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” (FAO/WHO). It has been suggested that probiotics may alter the ecology of micro-environmental niches such as periodontal pockets, and as such they may disrupt an established dysbiosis. This may re-establish a symbiotic flora and a beneficial interaction with the host via several mechanisms including modulation of the immune-inflammatory response, regulation of antibacterial substances and exclusion of potential pathogens via nutritional and spatial competition. From a theoretical point of view, restoring these reduced numbers of beneficial bacteria via probiotics might be of considerable interest in the treatment of plaque-related periodontal diseases. ⁣
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The meta-analysis of 5 RCTs (Donos et al., 2019) testing preparation containing L. rhamnousus SP1, L. reuteri, or the combination of S. oralis KJ3, S. uberis KJ2 and S. rattus JH145 demonstrated that, compared with placebo, treatment with probiotics resulted in a mean difference in PPD reduction of 0.38 mm at 6 months. ⁣
⁣
The mean estimated difference in probing pocket depts (PPD) reduction between probiotics and placebo was not statistically significant and of limited clinical relevance (difference

🄳🄸🅂🅃🄰🄽🄲🄴 🄵🅁🄾🄼 🄿🄻🄰🅀🅄🄴 🄵🅁🄾🄽🅃 🅃🄾 🄿🄴🅁🄸🄾🄳🄾🄽🅃🄰🄻 🄰🅃🅃🄰🄲🄷🄼🄴🄽🅃⁣⁣🇬🇧 Loss of periodontal fiber attachment could invariably be relate...
16/05/2021

🄳🄸🅂🅃🄰🄽🄲🄴 🄵🅁🄾🄼 🄿🄻🄰🅀🅄🄴 🄵🅁🄾🄽🅃 🅃🄾 🄿🄴🅁🄸🄾🄳🄾🄽🅃🄰🄻 🄰🅃🅃🄰🄲🄷🄼🄴🄽🅃⁣
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🇬🇧 Loss of periodontal fiber attachment could invariably be related to the apical growth of subgingival plaque, and downgrowth of plaque was always associated with an inflammatory process which involved lysis of the attachment fibers within a distance varying between 0.2 and 1.8 mm from the apical border of the plaque (average distance 0,96). ⁣
⁣
Reduction in height of the alveolar crest could also be related to the downgrowth of plaque. The distance from plaque to bone was never found to be less than 0.5 mm and never more than 2.7 mm (average distance 1,63). ⁣
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🇮🇹 La perdita dell'attacco delle fibre parodontali puó invariabilmente essere correlata alla crescita apicale della placca sottogengivale e quest’ultima è sempre associata a un processo infiammatorio che coinvolge la lisi delle fibre di attacco a una distanza variabile tra 0,2 e 1,8 mm dal bordo apicale di questa (distanza media 0,96mm).⁣
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Anche la riduzione in altezza della cresta alveolare potrebbe essere correlata alla crescita della placca. La distanza dalla placca all'osso non è mai inferiore a 0,5 mm e mai superiore a 2,7 mm (distanza media 1,63mm).⁣
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