شریعه فقیهی

Statement of Problem: Intraoral radiographs are the most common diagnostic tool used to assess alveolar bone loss with periodontal origin. However, radiographic assessment tends to underestimate the amount of bone loss. Digital processing and manipulation of radiographic images may enhance diagnostic interpretation of radiographs.

The aim of the present study was to evaluate the validity of linear measurement of intraosseous periodontal lesions by conventional periapical (PA) and digitized radiographs in comparison with clinical measurements.

In this practical study, 35 standard conventional PA radiographs (Parallel technique) were obtained from 50 vertical periodontal osseous lesions. During mucoperiosteal full thickness flap surgery, the distances between the depth of periodontal osseous lesions and the crest of interproxiaml bones were measured and compared with liner measurements of the lesions by conventional PA radiographs and digitized radiographs manipulated by gamma adjustment Photoshop 7.0 software for statistical evaluation. The results of the two radiographic measurements were compared with intrasurgical measurement by Dunnett test.

Conventional PA radiographs underestimated the depth of lesion in comparison with clinical measurements. Linear measurements by the two observers did not show any significant difference between digitized radiographs and clinical dimensions, but measurements by the third observer underestimated the depth of the lesion in digitized radiographs in comparison with clinical measurements. However, the amount of underestimation was less than that of measured by conventional PA radiographs.

In this study, the validity of digitized radiographs was more than that of the conventional PA radiographs in comparison with clinical measurements (Gold standard).

Today, the relationship between the classification of F.I.*1 and some factors such as, the amount of horizontal and vertical bone loss, the pattern of the interradicular bone and root morphology is revealed. Recently, some attention has been paid to the importance of the length of R.T.*2 in identifying the diagnosis and prognosis of F.I. So, the length of R.T. may be included in some F.I. classifications in the future. In the present study, the R.T. length of the first and second maxillary and mandibular molarteeth was measured and the prevalence of short, long and medium sized root trunks aswell as type A, B, and C was estimated.

The sample consisted of 322 first and second extractedmaxillary and mandibular molar teeth because of various reasons in Shiraz. All of theteeth were intact from C.E.J. up to the apex of the root without any fracture, filling,restoration or caries. At first, a series of reference points including C.E.J. top of thefornix on the furcation area and apex of the root were marked. The distance betweenC.E.J., and the furcation area was measured in order to determine the root trunk length,while the distance between C.E.J and the apex was measured to determine the total root length. The study was single blind and all the measurements were made by the sameoperator. Different types of R.T. were identified based on the root trunk length to thetotal root length ratio on individual aspects.

The R.T. length of buccal and mesial aspects was markedly more than that of the distal aspect in maxillary molars. Although a major proportion of RTs of all of the teeth, was included in the medium sized group, the buccal aspect of the mandibular first molars had a shorter vertical length than the others.

The results revealed that the incidence of type B, R.T. in all aspects of both maxillary and mandibular molars were more than type A and C. More incidence of F.I. on the buccal side of the mandibular first molars is related to shorter R.T. of this area than the others. Further investigations are suggested about the relationship between the amount of periodontal attachment loss and the type of the R.T.

The relation between periodontitis and cardiovascular diseases has been of interest inrecent years. Cardiovascular diseases in the developed countries account for 50% of themortality rate and are the principal causes of death. Periodontitis, one of the mostcommon diseases of human, is an infectious condition that can result in inflammatorydestruction of the peridontal ligament and alveolar bone. Periodontitis and atherosclerosishave complex etiologies like genetics and gender, and they potentially share many riskfactors, the most significant of which may be smoking. A number of studies have shown asignificant relationship between periodontitis and cardiovascular diseases, but the needfor further studies of new definitions of relationship between them especially in womenseems to be demanded

Gingival recession or apical migration of gingival margin, is a commonperiodontal lesion. A number of methods have been used to treat Miller's Class I & IIgingival recessions with a notable success in root coverage. Howevers in the treatment ofMiller's Class III & IV gingival recessions, a predictable method has not been presented.It seems that the application of connective tissue grafts combined with various kinds ofpedicle flaps may bring about satisfying results. In this study, a combination of palatalfree connective tissue graft and a special kind of coronally positioned flap was used totreat Miller's Class III & IV gingival recessions. Eight patients including 6 females and 2 males with a total number of 28 anterior affected teeth with an average age of 35 years old were included in this study. The depths of recessions were between 0.8 and 5.6 mm (with an average depth of 3.2 mm). The following parameters were measured before and 1,3 and 6 months after the procedure: probing pocket depth, the depth of gingival recession from C.E.J and stent, width of attached gingiva, clinical attachment level (CAL) and root sensitivity. In the surgical procedure, a coronally positioned flap was done with the first incision MGJ and continued with an apically directed partial thickness incision up to 5 mm. Then, it was followed by a second incision, which dissected the periosteum from the bone at the bottom of the buccal vestibule. Consequently, an intracervicular incision ran around the affected teeth, and the flap complex was pushed coronally. Prepared free connective tissue graft was placed beneath the flap on interdental areas and denuded root surfaces, and then it was sutured to the superficial flap. The apical end of the flap was sutured to the depth of vestibule. The results showed an average of 1.21-mm root coverage on the distobuccal side of the teeth. The amount of root coverage on midbuccal, mesiobuccal, mesial papilla and distal papillaes were 1.74, 1.25, 1.17and 0.93 mm respectively. The increase of CAL on mesiobuccal and midbuccal sides was significant with p<0.001. The width of keratinized gingiva remained unchanged but the width of attached gingiva increased considerably, from 4.5 mm at the baseline to 8.27 mm after the procedure. The surgical procedure can be used successfully for papilla reconstructionand root coverage in Calss III and IV gingival recessions.

There are many researches evaluation different methods for covering the root surface. In the most of these studies, type I and II of Miller treatment had been searched. The purpose of this study was a comparison between connective tissue graft (CTG) and guided tissue regeneration (GTR) with a collagen membrane in the treatment of gingival recession defects (Miller class III). Six patients, each contributing a pair of Miller class III buccal gingival recessions, were treated. The clinical measurements were obtained at baseline and 1,2,4,6,12,18 months after surgery. Statistical analysis were performed using paired t-test between periods (baseline versus 6 months and baseline versus 18 months) within each treatment group and also between treatment groups before treatment and 6, 12 and 18 months after the treatment. The treatments were compared by a triple analysis of variance along the time (treatment, patient, time). Both CTG and GTR with a bioabsorbable membrane demonstrated significant clinical and esthetic improvement for gingival recession coverage. The CTG and GTR procedures had mean root coverage of 55% and 47.5% respectively, in the end of study. The CTG group was statistically better than GTR for recession depth, recession width and keratinized tissue width. Also, passing the time (18 months) as a distinct factor of treatment procedures was effective in increasing of clinical attachment level and keratinized tissue width.