Bøger af Charu Agrawal

Um das Feld weiter voranzubringen, sind große Validierungsstudien erforderlich, um diese Daten zu bestätigen und zu untersuchen, ob Speichel-Biomarker durch Alter, Geschlecht, Rasse, Rauchen, das Vorhandensein von oralen Entzündungen oder Komorbiditäten beeinträchtigt werden . Wir glauben, dass Validierungsstudien zu ihrer Verwendung in Point-of-Care-Geräten führen könnten, die einen großen Einfluss auf die Parodontalbehandlung haben könnten . Man kann sich vorstellen, dass diese Geräte zur Beurteilung der parodontalen Gesundheit eingesetzt werden könnten, ähnlich wie ein Glukometer zur Beurteilung des Blutzuckerspiegels bei Diabetikern. Spezifische Biomarker (d.h., MMP-8, OPG, MIP-1a, IL-1b), deren Werte über bestimmten Schwellenwerten liegen, könnten auf eine sofortige Therapie hinweisen, ähnlich wie Insulin verabreicht wird, wenn der Blutzuckerspiegel bei Diabetikern erhöht ist. Im Gegenzug könnte in naher Zukunft eineindividualisierte Parodontalbehandlung auf der Grundlage der Speichel-Biomarkerwerte angeboten werden, und diese Analysen könnten zu einem integralen Bestandteil der Bewertung der parodontalen Gesundheit in zahnärztlichen und nicht zahnärztlichen Einrichtungenwerden .

Un¿adeguata selezione dei pazienti e una pianificazione del trattamento sono essenziali per garantire un¿elevata prevedibilità e il mantenimento a lungo termine dell¿osso marginale perimplantare.Pertanto, ci si aspetta che i risultati di questa tesi contribuiscano a una migliore comprensione degli aspetti gerarchici che incidono in modo significativo sul tasso e sulla qualità dell¿osteointegrazione, sulla sopravvivenza dell¿impianto e sul successo delle diverse modalità di trattamento, ispirando la ricerca futura e i progressi nelle tecnologie implantari orali, e una migliore processo decisionale clinico basato su un database sistematico.

Une sélection adéquate des patients et une planification du traitement sont essentielles pour garantir une prévisibilité élevée et un maintien à long terme de l¿os marginal péri-implantaire.Ainsi, les résultats de cette thèse devraient contribuer à une meilleure compréhension des aspects hiérarchiques qui ont un impact significatif sur le taux et la qualité de l'ostéointégration, la survie des implants et le succès des différentes modalités de traitement, inspirant les recherches futures et les avancées dans les technologies d'implants oraux, et une meilleure prise de décision clinique basée sur une base de données systématique.

Um eine hohe Vorhersagbarkeit und den langfristigen Erhalt des periimplantären Randknochens zu gewährleisten, sind eine adäquate Patientenauswahl und Behandlungsplanung unerlässlich.Daher wird erwartet, dass die Ergebnisse dieser Arbeit zu einem besseren Verständnis hierarchischer Aspekte beitragen, die sich erheblich auf die Geschwindigkeit und Qualität der Osseointegration, das Implantatüberleben und den Erfolg verschiedener Behandlungsmodalitäten auswirken, und so zukünftige Forschung und Fortschritte in der oralen Implantattechnologie inspirieren und verbessern klinische Entscheidungsfindung auf Basis einer systematischen Datenbank.

Adekwatnyj otbor pacientow i planirowanie lecheniq neobhodimy dlq obespecheniq wysokoj predskazuemosti i dolgosrochnogo sohraneniq marginal'noj kosti wokrug implantata.Takim obrazom, ozhidaetsq, chto rezul'taty ätoj dissertacii budut sposobstwowat' luchshemu ponimaniü ierarhicheskih aspektow, kotorye suschestwenno wliqüt na skorost' i kachestwo osteointegracii, wyzhiwaemost' implantatow i uspeh razlichnyh metodow lecheniq, wdohnowlqq na buduschie issledowaniq i dostizheniq w oblasti tehnologij oral'nyh implantatow, a takzhe na luchshee prinqtie klinicheskih reshenij na osnowe sistematicheskoj bazy dannyh.

A seleção adequada dos pacientes e o planejamento do tratamento são essenciais para garantir alta previsibilidade e manutenção a longo prazo do osso marginal peri-implantar.Assim, espera-se que os resultados desta tese contribuam para uma melhor compreensão dos aspectos hierárquicos que impactam significativamente a taxa e a qualidade da osseointegração, a sobrevivência dos implantes e o sucesso das diferentes modalidades de tratamento, inspirando futuras pesquisas e avanços nas tecnologias de implantes orais, e uma melhor tomada de decisão clínica com base em um banco de dados sistemático.

Para fazer avançar ainda mais este campo, são necessários grandes estudos de validação para confirmar estes dados e investigar se os biomarcadores salivares são confundidos pela idade, sexo, raça, tabagismo, presença de condições inflamatórias orais ou condições co-mórbidas. Acreditamos que os estudos de validação poderiam levar à sua utilização em dispositivos de ponto de atendimento que poderiam ter um grande impacto nos cuidados periodontais . Podemosimaginar que estes dispositivos poderiam ser utilizados para avaliar a saúde periodontal de forma semelhante à forma como um glucómetro avalia a glicemia em indivíduos diabéticos. Biomarcadores específicos (i.e, Os níveis de biomarcadores específicos (ou seja,MMP-8, OPG, MIP-1a, IL-1b) acima dos limiares definidos podem sugerir que uma terapia imediata seria benéfica, à semelhança da forma como a insulina é administrada quando a glucose está elevada num diabético. Por suavez, os cuidados periodontais individualizados com base nos níveis de biomarcadores salivares podem ser fornecidos numfuturo próximo e estas análises podem tornar-se parte integrante da avaliação da saúde periodontal em contextos dentários e não dentários.

Per far progredire ulteriormente il campo, sono necessari ampi studi di validazione per confermare questi dati e indagare se i biomarcatori salivari sono confusi da età, sesso, razza, fumo, presenza di condizioni infiammatorie orali o condizioni di co-morbilità. Riteniamo che gli studi di convalida potrebbero portare all'utilizzo di questi biomarcatori in dispositivi point-of-care che potrebbero avere un impatto importante sulla cura parodontale . Si può immaginare che questi dispositivi possano essere utilizzati per valutare la salute parodontale in modo simile acome un glucometro valuta la glicemia nei soggetti diabetici. Biomarcatori specifici (ad es, Ilivelli di MMP-8, OPG, MIP-1a, IL-1b) al di sopra di determinate soglie potrebbero suggerire l'opportunità di una terapia immediata , analogamente a quanto avviene con l'insulina quando il glucosio è elevato in un diabetico. A sua volta ,nel prossimo futuro si potrebbe fornire una cura parodontale personalizzata basata sui livelli dei biomarcatori salivari e queste analisi potrebbero diventare parte integrante della valutazione della salute parodontale in ambito odontoiatrico e non.

Pour faire progresser ce domaine, de vastes études de validation sont nécessaires pour confirmer ces données et déterminer si les biomarqueurs salivaires sont influencés par l'âge, le sexe, la race, le tabagisme, la présence d'affections inflammatoires buccales ou d'affections comorbides. Nous pensons que les études de validation pourraient conduire à l'utilisation de ces biomarqueurs dans des dispositifs de soins qui pourraient avoir un impact majeur sur les soins parodontaux .On peut imaginer que ces dispositifs pourraient être utilisés pour évaluer la santé parodontale de la même manièrequ'un glucomètre évalue la glycémie chez les diabétiques. Des biomarqueurs spécifiques (par ex, MMP-8, OPG, MIP-1a, IL-1b) dépassant les seuils fixés pourraient suggérer qu'un traitement immédiat seraitbénéfique, de la même manière que l'insuline est administrée lorsque le taux de glucose est élevé chez un diabétique. En retour,des soins parodontaux individualisés basés sur les niveaux de biomarqueurs salivaires pourraient être fournis dans unavenir proche et ces analyses pourraient devenir une partie intégrante de l'évaluation de la santé parodontale dans les environnements dentaires et non dentaires.

Dlq dal'nejshego razwitiq ätoj oblasti neobhodimy krupnye walidacionnye issledowaniq, chtoby podtwerdit' äti dannye i wyqsnit', ne wliqüt li na slünnye biomarkery wozrast, pol, rasa, kurenie, nalichie wospalitel'nyh zabolewanij polosti rta ili soputstwuüschih zabolewanij. My schitaem, chto walidacionnye issledowaniq mogut priwesti k ispol'zowaniü ätih biomarkerow w ustrojstwah dlq tochechnogo nablüdeniq, kotorye mogut okazat' znachitel'noe wliqnie na lechenie parodontita . Mozhno predstawit', chto äti ustrojstwa budut ispol'zowat'sq dlq ocenki sostoqniq parodonta podobno tomu, kak glükometr oceniwaet urowen' glükozy w krowi u bol'nyh saharnym diabetom. Specificheskie biomarkery (naprimer, Urowen' MMP-8, OPG, MIP-1a, IL-1b), prewyshaüschij ustanowlennyj porog, mozhet swidetel'stwowat' o neobhodimosti nemedlennoj terapii , podobno tomu, kak pri powyshenii urownq glükozy u diabetika wwoditsq insulin. V swoü ochered' , wblizhajshem buduschem mozhno budet obespechit' indiwidual'nyj uhod za parodontom na osnowe urownq slünnyh biomarkerow , a äti analizy mogut stat' neot#emlemoj chast'ü ocenki zdorow'q parodonta w stomatologicheskih i nestomatologicheskih uchrezhdeniqh.

Adequate patient selection and treatment planning are essential to guarantee high predictability and long-term maintenance of the peri-implant marginal bone.Thus, the results of this thesis are expected to contribute to a better understanding of hierarchical aspects that significantly impact the rate and quality of osseointegration, implant survival and success of different treatment modalities, inspiring future research and advances in oral implant technologies, and a better clinical decision making based on a systematic database.

To further advance the field, large validation studies are needed to confirm these data and investigate if salivary biomarkers are confounded by age, gender, race, smoking, presence of oral inflammatory conditions, or co-morbid conditions. We believe that validation studies could lead to their use in point-of-care devices that could have a major impact on periodontal care. One can envision that these devices could be used to assess periodontal health similar to the way a glucometer assesses blood glucose in diabetic subjects. Specific biomarkers (i.e., MMP-8, OPG, MIP-1a, IL-1b) levels above set thresholds might suggest immediate therapy would be beneficial, similar to how insulin is provided when glucose is elevated in a diabetic. In turn, individualized periodontal care based on salivary biomarker levels could be provided in the near future and these analyses could become an integral part of the assessment of periodontal health in dental and non-dental settings.

Minimally invasive treatment is a major advancement in dental therapy and is rapidly becoming part of the daily practice. The extent of this radical advancement can be illustrated by changes in periodontal therapy. These procedures often resulted in esthetic deformities, food impaction, and increased thermal sensitivity. The innovations described in this text detail approaches that stand in marked contrast to traditional methods. Minimally invasive methods for periodontal treatment routinely yield long-term reductions of probing depths and increased clinical attachment levels that exceed those reported for traditional approaches. In addition, minimal thermal hypersensitivity and no gingival recession have been reported. One of the greatest advantages to the clinician is the increased patient acceptance and satisfaction with minimal encroachment versus traditional approaches. This given details will allow the reader to understand minimally invasive periodontal procedures and how they can benefit the reader¿s practice. It will give the reader significant information on the advantages of the application of minimally invasive procedure to their daily practice.

Peri-implantitis is a destructive inflammatory disease affecting the soft and hard tissues around dental implants.It causes bone loss around an osseointegrated implant in function. The etiology of the implant infection is determined by the status of tissue surrounding the implant, implant design, degree of roughness, external morphology, and excessive mechanical load.Dental plaque has been universally accepted as the primary etiologic factor.The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. The management of implant infection should be focused on the control of infection, the detoxification of the implant surface, and regeneration of the alveolar bone. Prognosis of the affected implant will mainly depend upon early detection and treatment of peri-implant mucositis and peri-implantitis. Even though the studies dealing with different treatment modalities of peri-implantitis are not comparable, an overall picture of some clinical improvement emerges with the use of anti-infective therapies, in terms of resolution of inflammation and bone healing.

Periodontitis is an inflammatory disease induced by microbes leading to destruction of tooth supporting structures.Host inflammatory response contributes to the main damage and clinical signs of the disease.This modality of treatment of host part of the disease is called as Host Modulating Therapy (HMT). It is a valuable innovation in the management of Periodontal disease that aims to reduce tissue destruction and help to even regenerate the periodontium by modifying the host response.The use of host Modulation Agents as an adjunct to periodontal therapy not only aims to reduce the severity of disease but also susceptibility of host towards the disease.HMT is targeted to regulate immune and inflammatory response by maintaining the balance between pro-inflammatory and anti-inflammatory mediators.Till date Subantimicrobial dose doxycycline (SDD) has been approved by FDA for use in patients and other numerous agents are under research.