Dr. Rick Newhart Updates

Eosinophilic granuloma or aggressive periodontitis?

Silvestros et al. (JPerio2006 ;77:917-921) reported on a patient who was misdiagnosed as having aggressive periodontitis, when instead, they had a condition known as eosinophilic granuloma, or Langerhans’ cell histiocytosis.  Their 30 year-old female patient was examined in December of 2003 and treated for periodontal disease.   When the lesions worsened in May of 2004 with significant loosening of the teeth and gingival and sinus fenestrations, the patient was referred to a periodontal specialist.  At the time, new radiographs and biopsies were taken and the patient was histologically diagnosed as having Langerhands’ cell histiocytosis. The calverium is the most common site of attack, but bone destruction is noted in other sites as well. Inter-orally, this condition may simulate periodontal disease with advanced bone loss, tooth mobility, and poor healing after periodontal extractions.  Their patient responded to surgical excision, radiation, and chemotherapy. The authors conclude that in conditions of severely aggressive periodontitis, Langerhands’ cell histiocytosis should be considered in the differential diagnosis until the areas have resolved.

1,925 Implants in Extraction Sites

Wagenberg and Froum (IJOMI2006; 21:71-80) report on a retrospective chart review of 1,925 consecutive implants placed at the time of tooth extraction.  The extractions with immediate implant placement occurred from 1988 to 2004 in a total of 891 patients.  A total of 77 implants were lost in 68 patients over 16 years, with an overall implant survival rate of 96%.  Significant differences were found in that men were almost 1.5 times more likely to experience failure.  Patients who were unable to take an antibiotic for pre-medication were also more likely to experience failure.   Smooth surface implants were much more likely to fail than rough-surface implants. Implants placed in sites extracted due to periodontal disease also experienced a higher rate of failure. Suprisingly, there was no failure rate between smokers and non-smoker, or related to any type of medical condition, such as diabetes.  Dr. Newhart frequently places implants into extraction sites and feel this is a very good technique for the patient. 

Periodontal Disease Again Linked to Hypertension and Myocardial Infarction

Holmlund et al. (JPerio2006;77: 1173-1178) performed a cross-sectional study of 4,254 subjects to see if a relationship existed between periodontal disease and hypertension.  They found that the severity of periodontal disease was related to both myocardial infarction and hypertension, especially for middle-aged subjects.   They also found that tooth loss was associated with the presence of myocardial infarction.  The authors are not sure of the cause and effect relationship, but feel that this may be due to an increase in inflammatory mediators, such as tumor necrosis factor and interleukins-6 and 1.  These cell mediators may enter the circulation and cause vascular damage, resulting in systemic problems. Dr. Newhart feels that periodontal health is important for everyone, but especially for those who have cardiovascular disease or hypertension.  He recommends regular checkups and maintenance for these patients.  

SINUS PROBLEMS!

Barone et al. (IJOMI2006;21:81-85) report on the results and complications with maxillary sinus augmentation in 70 patients with 124 sinus elevation procedures.  The authors used autogenous bone alone in 93 sinuses, and in 31sinuses they used a mixture of cancellous pig bone and autogenous bone.  The authors report that surgical perforation of the sinus membrane during the elevation was incurred in 25 percent of the cases.  While approximately one in twenty of the cases exhibited post-surgical infection requiring removal of the bone and drainage.  Five of the seven patients with infection were smokers.  Block augmentation was also performed for some patients and the authors found that this also significantly increase the rate of complications. Two of the seven cases of infection required sinus surgery to open the osteum to facilitate drainage after surgery.  Suprisingly, the authors note that sinus tearing was not associated with post-surgical complications. Dr. Newhart desires all of his sinus elevation patients to stop smoking 2-3 weeks prior to surgery and 2-3 post-surgery, if they won’t stop completely.  He does not do block grafting in combination with sinus augmentation, due the elevated risk of failure.     

Dr. Newhart attends map seminar

In October, Dr. Newhart attended the Michael Allen Pikos Institute on Bone Augmentation and Sinus Elevation Surgery in Florida.  Dr. Pikos restoratively still suggests splinting all posterior implants, eliminating non-working interferences, and using rough, hydroxy-appetite coated implants in the posterior maxilla.

“Praise ye the Lord. 

O give thanks unto the Lord;

 for he is good:

 for his mercy endures for ever.”

Psalms 106:1

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 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 significant post-doctoral implant and periodontal education & training.