Dental Hypotheses
Volume:4 Issue: 2, Apr-Jun 2013

Bisphosphonates (BP), included under host modulation therapy are drugs that inhibit bone resorption and commonly prescribed to prevent skeletal related changes in malignant diseases of bone and bone diseases such as osteoporosis. The sudden rise of this group of drugs is unfortunately because of the serious complication of osteonecrosis of jaws called Bisphosphonate related osteonecrosis of jaws which leads to many dental related complications. This literature review is undertaken to review the general recommendations to the dentist and clinical implications of BP''s. The implications of BP''s use in dentistry are still being determined.

It is generally agreed that juvenile periodontitis is more likely caused by genetic factors than environmental/bacterial factors. Until now, all research reports focus on alveolar bone destruction as a characteristic symptom. This is questioned in the present study. The Hypothesis: It is hypothesized that initial so-called bone loss in juvenile periodontitis can be explained as arrest in alveolar bone apposition during alveolar growth. Therefore, the purposes of this study are to analyze the morphology of cortical bone at the alveolar process located between the second premolar and first molar and to analyze whether the time of occurrence of juvenile periodontitis coincides with the time of the body growth spurt maximum of the individual. Orthopantomograms and dental films from 29 patients diagnosed with juvenile periodontitis were analyzed. Visual assessment of cortical bone on the alveolar process anterior to the first molar was performed. In addition, skeletal hand maturation was scored on hand radiographs from five patients and the maturity was related to body height. The results showed that in 18 patients the alveolar bone had a distinct compact with a normal level compared to the enamel cementum border of the second premolar and a pathological deep level compared to the enamel cementum border of the first molar. This abnormal alveolar bone level was first diagnosed shortly after pubertal maximum. Furthermore, 11 patients had uneven, indistinct alveolar cortical bone with the same abnormal level compared to the column of the second premolar and first molar. Evaluation of the Hypothesis: As a conclusion, it is evaluated that patients in the early stage of juvenile periodontitis have a bone loss due to arrest in alveolar bone growth anterior to the first molars during the early stage of the disease. Thereafter, the destruction of the cortical bone occurs.

Mechanical force is not the only means to cause tooth movement, but just one kind of stimuli for it. Biological stimuli, with potential of accelerating alveolar bone remodeling, other than mechanical force, have been attracted by orthodontists who are combating prolonged treatment duration. It has been approved that some traditional Chinese medicines, such as Gu-Sui-Bu (Rhizoma Drynaria), affect the process of bone remodeling. The Hypothesis: We make the hypothesis that local use of iontophoresis with Gu-Sui-Bu (Rhizoma Drynaria) as a non-invasive and safe drug delivery system with no trauma, risk of infection or damage to patients is a new potential approach for accelerating orthodontic tooth movement, and shorten the orthodontic treatment time. Evaluation of the Hypothesis: Gu-Sui-Bu is effective at inducing bone remodeling, and iontophoresis as a non-invasive technique for drug delivery, is suitable for the transmission of some traditional Chinese herbal medicines into periodontal tissues.

Study on the effect of topically applied mutanase on plaque formation and caries in rats showed strong inhibition of dental caries. Furthermore, it has been shown that the presence of mutanase in dental plaque may affect the synthesis and structure of sticky, extracellular glucans. The Hypothesis: Mutanase can be easily added to gum base. After chewing of mutanase-containing chewing gum, the enzyme will be released into the oral cavity. Mutanase will hydrolyze sticky, extracellular glucans, e.g., mutan inhibiting cariogenic bacteria to cohere/adhere and form plaque. Evaluation of the Hypothesis: The main challenge with this hypothesis is the source of mutanase. It can be obtained from Paenibacillus sp. MP-1 or Trichoderma harzianum F-340. Directly compressible medicated chewing gum bases can be used to avoid inactivation of mutanase during the manufacturing process.

The aim of this study was to elucidate the diagnosis, etiology, and therapeutic options for the treatment of gummy smile. The smile level is an imaginary line after the lower superior lip and used seems to be convex. The presence of 3 mm or grater continuous gingival band exposures to natural smile or speech performs the gummy smile. Original articles studying the diagnosis, etiology, and therapeutic alternatives for the treatment of gummy smile were searched in the Medline, Scopus, Science direct, and EBSCO host databases. Together with some example and diagnosis method was purposed. The authors conclude that the etiology is multifactorial and can be showed excessive vertical maxillary grow up, excessive labial contraction, shorter upper lip, gingival excess, and extrusion of the anterior teeth. The therapeutics alternative are often multidisciplinary, besides can be used orthognathic, plastic and periodontal surgery, and orthodontic.

Periapical surgery is an important treatment alternative in the presence of a large periapical cyst. To achieve optimal healing and regeneration of the bone different bone substitutes can be used. Case Report: A 35 year old male patient reported with the soft diffuse swelling in anterior palatal region and drainings in us with 21 labially. He had a history of trauma 5 years back. The clinical and radiographic diagnosis of infected periapical cyst with 11,21; invasive cervical root resorption with 21 and internal root resorption with 11 was made. Endodontic treatment was performed with11,2 followed by periapical curettage. A picectomy and retrograde filling with white mineral trioxide aggregate (MTA) was carried out with 11,21. The cervical resorption defect with 21 was restored with white MTA. Platelet rich fibrin (PRF) was mixed with demineralised bone matrix (Osseograft) and used as a regenerative biomaterial in the periapiacl defect. 14 months follow up shows satisfactory healing and regeneration of periapical region. There is considerable clinical interest in using PRF alone or in combination with graft materials as it is a reservoir of many growth factors and have potential for accelerated soft-and hard tissue healing. PRF is a new generation of platelet concentrate, derived from patients own blood.

Talon cusp is an uncommon odontogenic anomaly which most frequently affects maxillary permanent incisors. Its presence causes the problem in esthetics, prevention of caries, and occlusal accommodation for the patient and problems in the diagnosis and clinical management for the dentist. Case Report: This article reports a case of talon cusp on the palatal surface of the permanent maxillary central incisor. Since, the presence of talon cusp usually demands that definitive treatment be instituted; it represents a problem of clinical significance. The dentist should be able to diagnose it as the maxillary incisor is also the principal site for supernumerary tooth.