Le Receuil

No 9/2013
Sommaire
Rdactrice en chef
Dr Maya GHARIB
Comit de rdaction
Dr Maya Gharib
Dr Hala Abboud
Dr Ghassan Makhlouf
Dr Joseph Hanna
Recommandations aux auteurs

Editorial
Membres du conseil de lordre
Mot de la Prsidente

Le recueil est une publication annuelle officielle de

lOrdre du Corps Dentaire
du Liban - Tripoli

Articles
Les articles publis dans

cette revue engagent exclusivement la responsabilit de leurs auteurs.
magasine 2013.indd 1
3
4
5
6
7
8
9 - 14
15 - 22
23 - 28
29 - 36
37 - 42
43 - 46
47 - 49
Ortho: Non-Surgical Treatment of an Adult

Patient with Severe Anterior Open Bite
51 - 56
Pharmaco: Antibacterials In The Treatment

Of Common Dental Infections
57 - 62
Restorative Dentistry: EQUIA

KAREH printing press - 06/665786
63
64
1
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No 9/2013
Recommandations aux auteurs

Le Recueil est une publication du Corps Dentaire du Liban - Tripoli.
Vous souhaitez faire publier un travail original dans cette Revue?
Voici comment procder:
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Ex. MELLONIG J.T. Et TRIPLETTR.G.: Rgnration Tissulaire Guide et implants endosseux.
Int. J. Priodont. Rest. Dent. 13: 109-120 1993.
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2
5/21/2013 3:33:23 PM
Editorial
Road To Success
Cest le titre du 7me Congres International de
lOrdre Des Dentistes au Liban Nord.
Jespre que ce thme soit toujours le but de vous
tous mes chers collgues, comme il a t le but du
conseil depuis le premier jour ou nous sommes devenus les responsables envers vous et envers nous
mme de la protection et la prservation de notre
Ordre.
Ce recueil prsente ci-joint, en plus des articles rdigs par des professionnels, les diffrentes activits
de la prsidente ainsi que du conseil, les vnements
scientifiques qui ont pour but de vous assurer la formation continue ncessaire pour rester toujours sur
le chemin du succs, ainsi quun bouquet de divers
activits sociales.
Je vous laisse chers collgues en vous souhaitant un
temps agrable avec ce numro du Recueil.
Rdactrice en Chef
Dr. Maya Gharib
3
5/21/2013 3:33:30 PM
No 9/2013
Conseil de lordre du Corps

Dentaire du liban - Tripoli
2012 - 2013
Prsidente
Dr Rahil DOUAIHY
Vice - Prsident
Dr. Jalal KASSAB
Secrtaire Gnrale
Dr. Ghassan MAKHLOUF
Trsorier
Dr. Joseph HANNA
Membres
Dr. Maya GHARIB
Dr. Bilal BARAKEH

Dr. Miled DIB
Dr. Gendarc ESPER
Dr. Houssein KHODER
4
5/21/2013 3:33:31 PM
5
5/21/2013 3:33:36 PM

,
,
,
,

,
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6
5/21/2013 3:33:43 PM

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7
5/21/2013 3:33:48 PM
No 9/2013
Chers collgues,
Avec ce numro de notre revue, je tiens vous signaler la grande importance qui est de plus en plus
accorde dans le monde la formation continue.
Nous ne pouvons plus nous arrter dapprendre et
damliorer nos connaissances pour le bien de nos
patients. Ceci amliorerait nos prestations et ouvre,
pour nos patients, de nouvels horizons jadis inesprs.
Les articles dans les revues, les congrs universitaires
et associatives, les formations de courtes dures et
les diplmes universitaires assurent la communaut des stomatologues la persistance en phase avec
les progrs dont bnficie leur domaine de part le
monde. La recherche scientifique travers les socits savantes et les universits permet douvrir davantage les voies du progrs.
Nous allons uvrer dans le comit scientifique
apporter nos collgues le maximum dactualit et
les outils ncessaires leur dveloppement dans le
cadre professionnel que nous assure notre conseil au
Liban Nord.
Nous souhaitons tre ensemble avec vous, en collaboration troite, et nous restons lcoute de toutes
les suggestions qui visent amener la collectivit sur
les chemins du progrs en amliorant les connaissances des uns et des autres, et en permettant, la
majorit dentre nous, de parfaire sa pratique et dy
ajouter de nouvelles performances.
Je vous souhaite une bonne lecture.
Dr Bilal Farouk BARAKE
Reprsentant du Comit Scientifique
8
5/21/2013 3:33:54 PM

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Articles
Anthony Macari DDS MS

Assistant professor at the division of Orthodontics and Dentofacial
Orthopedics Department of Otolaryngology and Head and Neck
Surgery at the American University of Beirut Lebanon.
Non-Surgical Treatment of an Adult

Patient with Severe Anterior Open Bite
Abstract
In this report we describe a treatment of Class II division 1 malocclusion with
severe anterior open bite and unilateral crossbite in an adult patient. Treatment
modality included the usage of tongue crib to prevent tongue positioning between the anterior teeth during the active orthodontic treatment extraction of
maxillary 2nd premolars and vertical control of the maxillary and mandibular posterior teeth. Retention was achieved with bonded multi-stranded wires and a
modified Hawley retainer with anterior crib.
Introduction
Orthodontists skills have been mostly
challenged by treatment of malocclusions that includes vertical discrepancies.1 Anterior open bite (AOB) one of
the manifestations of vertical discrepancy is a condition in which the anterior
teeth (incisors) do not overlap when the
jaws are closed. (2 3)
Depending on the ethnic background
the prevalence of AOB can reach up to
11% of the population and 17% of orthodontic patients. (45) Functional and
genetic problems have been shown to
be the inducing factors of open bite. (67)
For example various digits lip and other
oral habits have been reported to cause
open bite. A large tongue or a tongue
that is habitually postured between the
incisors is another commonly cited etiologic factor. In addition mouth breathing can induce anterior open bite.
Treatment of AOB have been shown to
be challenging and requires high diagnostic skills. (8) Discontinuing these habits
if might be the first step in trying to address the open bite. In contemporary orthodontics many treatment modalities
can be used for the treatment of open
bite: High-pull headgear bite blocks
functional appliances extractions miniimplants and orthognathic surgery. (914) Regardless of the treatment modality
long term stability has been the ultimate
goal to achieve even when combined
orthodontic and orthognathic surgery
was performed. (15) One of the factors
that has been shown to increase long
51
5/21/2013 3:35:36 PM
No 9/2013
term stability of AOB was extraction of

permanent teeth. (16 17) Moreover long
term stability have been directly linked
to the long term tongue position/posture
for that the use of anterior tongue crib
is recommended to modify tongue behavior thus maintain the open bite correction. (18 19)
The aim of this article is to describe the
orthodontic correction of anterior open
bite in an adult patient with an increased
lower anterior facial height treated with
extraction of maxillary second premolars.
Treatment report
The patient 16 years old male presented with a severe anterior open bite. His
chief complaint was that he did not like
his bite or his smile and that he had a
lisp. He was in good health. The patient
had a trauma at 10 years of age which
caused the incisal edge of the maxillary
incisors to break.
The subject had an oval symmetrical
face with normal vertical proportions
and lip competency at rest. Upon smiling; less than the full crowns of the maxillary incisors are visible. The smile arc
was not consonant with maxillary anterior teeth curvature neither with occlusal
plane inclination.
He also presented with a slightly convex
profile with a prognathic maxilla (Fig.1).

He had a Class II (full cusp) molars and
canines on both sides with an overjet of
3 mm. the maxillary and mandibular incisors were proclined. An open bite from
right 1st premolars to left canines was
present. The mandibular midline is deviated 1 mm to the right and a crossbite
existed on the right 2nd premolar and 1st
molar (Fig.1).
Examination of the dental casts showed
that the maxillary arch is square-shaped
and asymmetrical with a 6.5mm lack of
space. The mandibular arch was parabolic and symmetrical with an extra 2mm
of space. Anterior Bolton discrepancy of
80.7% existed.
The panoramic radiograph revealed
normal anatomical structures with the
absence of pathology. All permanent
teeth are present including maxillary
and mandibular 3rd molars. The maxillary
and mandibular widths are within normal
Fig 2: Pre-treatment A- panoramic; B- postero-anterior

cephalograph; C- lateral cephlaograph
range (Fig.2).
The analysis of the lateral cephalograph showed a skeletal Class II tendency (ANB=3.6) with increased lower facial
height (LFH=57%) a normodivergent pattern (PP/MP=25 MP/SN=31.6) and proclined maxillary and mandibular incisors.
(Fig.2; Table 1)
Fig 1: Pre-treatment facial and intraoral photographs
showing the anterior open bite and the Class II molars and
canines relationship.
52
5/21/2013 3:35:38 PM
Articles
Diagnosis and treatment plan
In summary this patient had a Class II division 1 with an anterior open bite along
with tongue positioning between maxillary and mandibular incisors. The goals of
the orthodontic treatment were to:
1. Reduce the proclination of the anterior teeth
2. Correct the crossbite on the right side
3. Correct the anterior open bite by enhancing spontaneous extrusion of maxillary incisors.
4. Avoid extruding posterior teeth
5. Achieve Class I canines on right and
left
6. Achieve long term stability
Since the anterior open bite severe the
ideal treatment for this malocclusion was
a Le Fort 1 osteotomy by maxillary autorotation with possibly bilateral sagittal
split to advance the mandible and genioplasty. However the patient declined
this approach.
An anterior tongue crib was used initially to prevent the tongue to interpose
between the anterior teeth thus allowing correction of the anterior open bite
by spontaneous eruption of the anterior
teeth. The mandibular arch was bonded using pre-adjusted fixed appliance
(0.022x0.028 slot; Roth prescription) and
leveling was initiated using a series of
round Ni-Ti arch wires. Closure of mandibular spaces was done by retraction
of incisors using 0.016 SS AW with power
chains to anterior helices. (Fig.3A). Eight
months after treatment initiation the
maxillary teeth were bonded and patient was referred for the extraction of
the maxillary 2nd premolars at the same
time bilateral vertical elastics were delivered to start correcting the AOB (Fig.3B).
After achieving Class I canines the anterior tongue crib was removed and elas-
tics were continued for full correction of

AOB (Fig.3C).Treatment was extended
beyond what was initially planned since
patient broke the anterior tongue crib
at initial stages and was not compliant
wearing the elastics at the finishing stages of treatment. Please note that patient
had asked his dentist to grind the tip of
Fig 3: Progress pictures showing: A- Tongue crib appliance inserted in the maxilla to inhibit tongue positioning
in between the anterior teeth and allow spontaneous
eruption of the maxillary incisors. B- The usage of posterior box elastics the same day the maxillary teeth were
bonded; note the closure of AOB- right central incisor is
almost in occlusion. C- Closure of the anterior open bite
with correction of the crossbite and achievement of Class
I canines.
the canines without our approval.

Treatment results
A comparison of pre and post treatment intra and extra oral photographs
show that the orthodontic treatment
helped reducing the protrusion of the lips
and achieving a more harmonious gingival display upon smiling (Fig.4). In addition optimal overjet and overbite were
achieved along with a Class I canines on
both sides (Fig.4).
To minimize relapse fixed maxillary
and mandibular retainers were bonded
along with a removable Hawley appliance with anterior tongue crib to prevent tongue thrust (Fig. 4).
Slight shallow overbite and anterior
spaces among maxillary incisors were
kept in order to have prosthetic restorations on the maxillary incisors to correct
broken incise edge of the central incisors
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5/21/2013 3:35:38 PM
No 9/2013
Fig 4: Post treatment extraoral and intraoral pictures

showing the correction of AOB and crossibte; note the
need for insical edges restorations with possibly composite build up. In addition to the fixed retainer the patient is
asked to wear a removable retainer upon sleeping with a
tongue crib built in to avoid AOB relapse.
and build up the proportionally small lateral incisors.

Optimal relationship between the maxillary and mandibular incisors and parallelism between the roots are achieved.
(Fig. 5A-C).
Fig 5: Post-treatment A- panoramic; B- postero-anterior

cephalograph; C- lateral cephlaograph
The superimposition of pre and post

treatment cephalometric radiographs
reveals the correction of the open bite
with maxillary and mandibular incisors retraction and extrusion. (Fig. 6A-C)
Discussion
Logan20 demonstrated that second
premolar extraction enables the closure of anterior open bite by inducing a
counterclockwise mandibular rotation
54
Fig 6: Lateral cephalometric tracings superimposition:

A- on anterior cranial base at Nasion showing the correction of the anterior open bite with the repositioning of the
lips. B- on the palatal plane indicating the retraction and
extrusion of the maxillary incisors. C- On the mandibular
base at the symphysis revealing the retraction into optimal
position of the mandibular incisors.
without molar intrusion. The mesialization

of the molars facilitates the correction of
the anterior open bite. Thus the vertical
control of the maxillary and mandibular
posterior teeth namely the molars plays
an important role in the correction of the
anterior open bite.
The superimposition of the pre and post
lateral cephalometric radiographs of this
patient showed no extrusion of the maxillary and mandibular molars (Fig. 6). In
case the molars extruded the opening
of the bite would have increased and
its orthodontic correction would have
been more difficult. In this case the combined orthodontic and orthognathic
surgery could have been the only option to consider. In addition this vertical
control along with the extraction of the
maxillary 2nd premolars helped in avoiding a clockwise rotation of the mandibular plane and a consequent increase in
the open bite. The orthodontic control of
the posterior teeth and the mandibular
plane allowed us to close the bite and
correct the Class II orthodontically.
Our patient had an anterior open bite
with Class II division 1 malocclusion.
5/21/2013 3:35:40 PM
Articles
Spaces in the mandibular arch allowed
the retroclination of the mandibular incisors to ideal position without the need
to extract mandibular teeth. In this case
the extraction of mandibular premolars
to help correcting the anterior open bite
as indicated by Logan was not initiated
given the spontaneous maxillary extrusion facilitated by the tongue crib.
Accordingly the extraction of the maxillary 2nd premolars was done to achieve
the Class I canine and correct to ideal
overjet. This modality of treatment (i.e.
extraction of maxillary 2nd premolars only
without the mandibular ones) showed
that it is successful when a tongue crib
is inserted to facilitate extrusion and other orthodontic movement. As it is mostly
used in growing patients who suffers from
bad habits such as thumb sucking the insertion of the tongue crib in adults is not
a routine practice and its usage on our
patient was crucial in the correction and
long term stability of the occlusion.
Not only the treatment of the AOB is
difficult its retention can be even more
challenging. In this context orthodontists have used many different strategies
including positioners spurs or holes in retainers elastics posterior bite blocks and
Essix style retainers. (21) The willingness
of the patient to comply with the usage
of these appliances is very important for
long term stability.
We bonded a multi-stranded stainless
steel wire (0.0215) from 1st premolar on
one side to the other 1st premolar in the
maxilla and mandible. In addition we
delivered a modified Hawley retainer
with anterior crib inserted in it to prevent
the tongue from repositioning between
the anterior teeth and thus causing the
anterior open bite to relapse (Fig 4).
Conclusion
Correction of anterior open bite in
adult is still one of the most challenging
treatments. In this report we showed on
option of treatment that included a vertical control of the posterior teeth a habit
breaker appliance (tongue crib) and
maxillary 2nd premolar extractions.
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1984; 85:28-36.
2. Glossary of dentofacial orthopedic
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3. Proffit WR Fields HW Jr Ackerman JL
Bailey LJ Tulloch JSC. Contemporary orthodontics. 3rd ed. St Louis: Mosby; 2000. p. 10
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4. Ng CS Wong WK Hagg U. Orthodontic
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5. Gile RA. A longitudinal cephalometric
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10. Poulton DR. The influence of extraoral
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the maxillo-facial morphology. Eur J Orthod
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15. Solano-Hernndez B Antonarakis GS
Scolozzi P Kiliaridis S. Combined orthodontic
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stability. J Oral Maxillofac Surg. 2013;71:98109.
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Henriques JF Canado RH. Long-term stability of anterior open bite extraction treatment
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Dentofacial Orthop. 2004;125:78-87.
17. Janson G Valarelli FP Beltro RT de
Freitas MR Henriques JF. Stability of anterior open-bite extraction and nonextraction
treatment in the permanent dentition. Am J

Orthod Dentofacial Orthop. 2006;129:768-74.
18. Torres F Almeida RR de Almeida MR
Almeida-Pedrin RR Pedrin F Henriques JF.
Anterior open bite treated with a palatal
crib and high-pull chin cup therapy. A prospective randomized study. Eur J Orthod.
2006;28:610-7.
19. Huang GJ Justus R Kennedy DB Kokich
VG. Stability of anterior openbite treated
with crib therapy. Angle Orthod. 1990;60:1724.
20. Gottlieb EL Cozzani M de Harfin JF
Helmholdt RD Logan LR Warren DW. Stability
of orthodontic treatment. Part 1. J Clin Orthod. 2006 Jan;40(1):27-38.
21. Huang GJ Greenlee GM. Stability of
Anterior Open Bite Correction- An Assessment of the Evidence. In: Evidence-Based
Orthodontics. Editors: Greg J. Huang Stephen Richmond & Katherine W.L. Vig. Iowa;
2011 Wiley-Blackwell.
Table 1. Pre-treatment (T1) and post-treatment (T2) cephalometric measurements
56
*Norms from Steiner CC. Proffit WR. Burstone CJ. Downs WB. McNamara JA. Jr and Wits cephalometric analyses.
**Measurements corrected for the anterior cranial base (SN) cant.
5/21/2013 3:35:40 PM
Articles
Ayman Alameddine Rph Pharm.D

Clinical Pharmacist AlDiya Pharmacy
Antibacterials In The Treatment

Of Common Dental Infections
ORAL MICROBIOTA AND DENTAL PATHOGENIC FLORA
Oral bacteria (dental or commensal pathogens) and their products (toxins) may
move from this primary location to other neighbouring or distant locations. Invasive
dental procedures and oral surgery favour bacterial dissemination, especially into the
bloodstream, causing transient bacteraemia.
Transient bacteraemia is unavoidable, but its severity (bacterial load), duration
(time in which bacteria remain in the bloodstream), type of bacteria in the blood
(aerobic, anaerobic or mixed) and the patients predisposition (underlying diseases,
susceptible site of infection, etc.), all play a significant role in the onset of possible
complications.
Predominant organisms are Streptococcus from the viridans group (), Staphylococcus spp and, in 4-7% of cases, gram-negative HACEK bacilli (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella), several of which are considered as dental
pathogens. We should not neglect the existence of mixed (aerobic/anaerobic) bacteraemia, or anaerobic bacteraemia alone (Eubacterium, Peptostreptococcus, Propionibacterium, Lactobacillus), which are detected in a significantly high percentage
of cases when an appropriate microbiological method is used (oxygen-free blood
cultures for anaerobic recovery)
ANTIMICROBIAL SPECTRUM
The choice of the antimicrobial spectrum used for prophylaxis should take the following into consideration: bacteria that are normally present in the mouth (potential
pathogens such as Streptococcus Viridans), aerobic and anaerobic bacteria detected in bacteraemia of mouth-dental origin, bacteria involved in odontogenous
infection, and all bacteria involved in local and systemic complications. Three types of
bacteria should be considered, in view of their clinical significance:
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1. Periodontal pathogens that cannot be cultured or are difficult to isolate, e.g.

Treponemas such as T. denticola (and other spirochaeta), which are sensitive to penicillin and present aetiopathogenic specificity for severe periodontitis.
2. Anaerobic gram-negative bacteria such as Prevotella spp and Fusobacterium spp
(these are the most prevalent anaerobic bacteria in dental infections such as periodontitis, pericoronaritis, periodontal and periapical abscesses). Approximately 50%
of these bacteria produce inactivant enzymes (-lactamases). Some of them are also
detected in mixed bacteraemia.
3. Aerobic gram-positive bacteria such as Streptococcus viridans, responsible for
post-operative bacteraemia in oral procedures and distant complications such as
endocarditis.
EFFECTIVE/INEFFECTIVE COVER OF THE TARGET
RAL MICROBIOTA. CONSEQUENCES
Pharmacodynamic cover is understood as the value of the relation between serum
pharmacokinetic parameters and in vitro susceptibility, thus predicting efficacy in
terms of a) the dose percentage interval at which levels that exceed the MIC (minimum inhibitory concentration for in vitro bacterial growth), must be over 40-50% for
-lactamics, macrolides and lincosamides, and b) the relation of the area under the
curve of serum levels /CMI that must be over 25 for azalides (azythromycin). According to studies conducted on amoxicillin + clavulanic acid , spiramycin and metronidazole , antibiotic concentrations in gingival fluid are similar to or higher than serum
levels. According to studies that have applied the concepts of pharmacokinetics
and pharmacodynamics in dentistry, and analysed different antibiotics used for the
five most prevalent bacteria isolated (but not all bacteria involved) in dental infections (Viridans group streptococci, Peptostreptococcus sp., Prevotella intermedia,
Porphyromonas gingivalis and Fusobacterium nucleatum) , the only antibiotics that
meet pharmacodynamic requirements are amoxicillin + clavulanic acid, at a dose of
875/125 mg / 8hrs, its new formulation of 2000/125 mg / 12 hrs, and clindamycin 300
mg / 6-8hrs. However, clindamycin does not cover the following genera appropriately:
Staphylococcus, Streptococcus and Peptostreptococcus, because they present a
notable level of resistance. metronidazole, macrolides and spiramycin do not cover all
gram positives (Streptococcus and Peptostreptococcus) and the latter two antibiotics
do not cover Fusobacterium either.
Microbiology of failing dental implants:
Infection represents one of many factors contributing to the failure of dental implants.
Presently, no single micro-organism has been closely associated with colonisation or
infection of any implant system
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Articles
Staphylococci and Candida spp. are commonly isolated from peri-implant lesions
(not usually associated with periodontitis or dental abscesses)
Staphylococcus aureus and coagulase-negative staphylococci are frequently responsible for infections associated with metallic biomaterials and indwelling medical
infections in general.
Staphylococcus aureus has been demonstrated to have the ability to adhere to titanium surfaces. This may be significant in the colonization of dental implants and subsequent infections.
Prophylactic antibiotic regimens in oral implantology
There are many studies showing that the use of antimicrobials can lead to a significant reduction in postoperative wound infections.
The most commonly used antimicrobials in implant dentistry are antibiotics and antimicrobial rinses, such as 0.12% Chlorhexidine Gluconate (CG).
Antimicrobial rinses CG has bactericidal characteristics which cause lysis after binding to bacterial cell membranes. It has been shown to be slowly released from oral
tissues and is widely accepted as the rinse of choice during the healing phase.
Prophylactic Antibiotics
Penicillin V: Well absorbed within 30 minutes but detectable levels only last for 4
hours. The main disadvantage is the frequent dosing needed to maintain blood levels
and development of resistant bacteria.
Amoxicillin: Better absorption and bioavailability (diffusion into infected tissues) than
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No 9/2013
Penicillin V, with very low toxicity. Used in preference for the non-allergic patient.
Amoxicillin/Clavulanic acid. Recommended for sinus augmentation as it inactivates
resistant bacteria in cases where penicillinases are thought to be present.
Cephalexin: First generation cephalosporins are used in penicillin allergic patients as
their spectrum is similar but are less prone to beta-lactamase destruction.
Cefuroxime axetil: 2nd and 3rd generation cephalosporins have lower crossreactivity, broader spectrum and an improved resistance to beta-lactamase destruction.
Erythromycin (a macrolide): It has great absorption, is not affected by food, has a
low toxicity but has a high incidence of nausea. Since it is bacteriostatic it is not recommended as a first choice antibiotic and is usually used in penicillin allergic patients.
Clindamycin: More effective against anaerobic bacteria but also targets aerobic
pathogens especially bacteroides. Disadvantages include high toxicity, a high prevalence of diarrhea (20-30%), and
pseudomembranous colitis (if taken over a long period). The drug is only bacteriostatic (unless given in high concentrations). It can be mixed with a chosen graft material in its aqueous form of 300mg/2ml.
Ciprofloxacin (1st generation quinolone): A broad spectrum bactericidal antibiotic
used orally or parenterally.
Levofloxacin (3rd or 4th generation quinolone): Useful against resistant and anaerobic bacteria and mainly used in sinus augmentation procedures.
Selection of Antibiotics
Relatively few studies have been performed regarding
which antibiotics should be selected for aggressive
periodontitis patients in whom the subgingival micobiota
have been characterized through microbiological
testing. In addition, the optimal dose of antibiotics
remains unclear since most current antibiotic regimens
are empirically developed rather than through
systematic research.
Metronidazole may arrest disease progression in
recalcitrant periodontitis patients with Porphyromonas
gingivalis and/or Prevotella intermedia infections with
few or no other potential pathogens.
60
Metronidazole can readily attain effective antibacterial concentrations

in gingival tissue and crevicular fluid.
Metronidazole therapy in conjunction with scaling and root planing

may result in slight but statistically significant improvement in clinical attachment
levels.

Metronidazole is cleared by hepatic metabolism with a half life of about 6 to
14 hours in most patients. The half-life is unchanged with renal dysfunction but is prolonged
5/21/2013 3:35:41 PM
Articles
in patients with hepatic function impairment.
Although adverse effects are relatively minor, there is an important
interaction of metronidazole with warfarin, alcohol(disulfiram like reaction)..ect

Clindamycin has demonstrated efficacy in recurrent periodontitis and may be
considered with periodontal infections of Peptostreptococcus, -hemolytic streptococci, and various oral Gram-negative anaerobic rods.
Eikenella corrodens is resistant to clindamycin.

Clindamycin should be prescribed with caution because of the potential for
pseudomembranous colitis as a result of intestinal overgrowth with Clostridium difficile.

Tetracyclines (tetracycline-HCl, doxycycline, minocycline) may be indicated in

periodontal infections in which Actinobacillus actinomycetemcomitans is the
prominent pathogen; however, in mixed infections tetracycline antibiotics may not
provide sufficient suppression of subgingival pathogens to arrest disease progression.
Contrary to earlier concepts, the average
gingival crevicular fluid concentration of tetracycline
after systemic administration seems to be less than
the that of plasma concentration and varies widely
among individuals (between 0 and 8 g/ml) with
approximately 50% of samples not achieving levels of
1g/ml, possibly explaining much of the variability in
clinical response to systemic tetracyclines observed
in practice. The tetracyclines also have the possible
benefit of inhibiting gingival collagenases. Doxycycline
has the highest protein binding capacity and the
longest half-life, and minocycline has the best absorption
and tissue penetration of tetracyclines. All tetracyclines
have important adverse reactions with respect
to teeth and bones, and they are contraindicated during
pregnancy and for children below 8 years of age.
Fluoroquinolones (ciprofloxacin) are effective against
enteric rods, pseudomonads, staphylococci, Actinobacillus
actinomycetemcomitans, and other periodontal
microorganisms.
Fluoroquinolones penetrate
readily into diseased periodontal tissue and gingival
crevice fluid and may even reach higher concentrations
than that of serum. Fluoroquinolones may induce
tendinopathy and strenuous exercise should be avoided
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No 9/2013
during therapy.(not recommended in pregnancy)(drug drug interactions to be

noted)
Azithromycin exhibits an excellent ability to penetrate
into both normal and pathological periodontal
tissues.

is also highly active against many periodontal pathogens, although some Enterococcus, Staphylococcus, Eikenella corrodens, Fusobacterium
nucleatum, and Peptostreptococcus strains may exhibit resistance.
Metronidazole plus amoxicillin provides a relatively predictable eradication of Actinobacillus actinomycetemcomitans and marked suppression of Porphyromonas
gingivalis in aggressive forms of adolescent periodontitis and in recalcitrant adult
periodontitis.
Metronidazole plus ciprofloxacin may substitute for metronidazole plus amoxicillin in
individuals who areallergic to -lactam drugs and are at least 18 years of age.
Metronidazole plus ciprofloxacin is also a valuable drug combination in periodontitis
patients having mixed anaerobic-enteric rod infections. Nonperiodontopathic viridans streptococcal species that have the potential to inhibit several pathogenic
62
species (beneficial organisms) are resistant to the metronidazole-ciprofloxacin drug

combination and may recolonize in treated subgingival sites.
In addition to reducing levels of periodontopathic
bacteria, systemic antibiotic therapy may lead to
increased levels of antibiotic-resistant, innocent or beneficial
bacteria like streptococci or actinomyces.
However,
overgrowth of mutans streptococci on exposed
root surfaces may increase the risk of dental caries and
argue for prophylactic application of topical fluoride
concomitant with antibiotic periodontal therapy.
Antibiotic therapy is indicated for periodontal
abscesses with systemic manifestations (fever, malaise,
lymphadenopathy). Antibiotics for the treatment of
abscesses should be prescribed in conjunction with
surgical incision and drainage.
Food does not influence the bioavailability of most
oral antibiotics, with the exception of tetracyclines,
fluoroquinolones, and azithromycin. These three groups
of antibiotics should be taken 1 hour before or 2 hours
after food intake. Cost can be a determinant in selecting antimicrobial
periodontal therapy. Antibiotics in the lower cost
group include tetracyclines, amoxicillin, and metronidazole.
More expensive antibiotics include azithromycin,
clarithromycin, ciprofloxacin, amoxicillin/clavulanic
acid, and clindamycin.
5/21/2013 3:35:41 PM
Articles
Dr. Brigitte Douaihy
Work quickly and cost-effectively while

creating great aesthetics the straightforward
and intelligent solution from GC
EQUIA establishes itself as a modern
posterior filling concept.
The success of EQUIA is based on its
two-step concept. The cavity is first filled
with EQUIA Fil, a glass ionomer technology based filling material. Protective
EQUIA Coat adds a layer of highly-filled,
light-curing resin. The synergetic effect of
the two components enhances all the
physical and aesthetic properties of the
definitive filling (GC Research and Development Data, 2007).
Over the past years EQUIA has been
tried and tested in numerous studies and
has proven its capabilities: It can be used
as a long-term filling material for all class I
cavities as well as for less extensive class II
cavities, assuming the isthmus occupies
less than half the intercuspal space. A
clinical study involving 245 patients over

a period of two years documented that
EQUIA is a reliable choice for long-term
restorations even when exposed to occlusal loading.
EQUIA is fast and easy to use. This allows
the dentist to place an entire posterior
restoration in a few minutes from mixing
right up to curing.
EQUIA is an evenly-weighted solution
for posterior fillings, an ideal balance
between economical, aesthetic and
straightforward application.
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No 9/2013

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Recommandations aux auteurs

Le recueil est une publication annuelle officielle de

Les articles publis dans

Ortho: Non-Surgical Treatment of an Adult

Pharmaco: Antibacterials In The Treatment

Restorative Dentistry: EQUIA

Recommandations aux auteurs

Envoi des articles:

Conseil de lordre du Corps

Dr. Jalal KASSAB

Dr. Ghassan MAKHLOUF

Dr. Joseph HANNA

Dr. Maya GHARIB

Dr. Bilal BARAKEH

Anthony Macari DDS MS

Non-Surgical Treatment of an Adult

term stability of AOB was extraction of

profile with a prognathic maxilla (Fig.1).

Fig 2: Pre-treatment A- panoramic; B- postero-anterior

tics were continued for full correction of

the canines without our approval.

Fig 4: Post treatment extraoral and intraoral pictures

and build up the proportionally small lateral incisors.

Fig 5: Post-treatment A- panoramic; B- postero-anterior

The superimposition of pre and post

Fig 6: Lateral cephalometric tracings superimposition:

without molar intrusion. The mesialization

treatment in the permanent dentition. Am J

Table 1. Pre-treatment (T1) and post-treatment (T2) cephalometric measurements

Ayman Alameddine Rph Pharm.D

Antibacterials In The Treatment

1. Periodontal pathogens that cannot be cultured or are difficult to isolate, e.g.

Metronidazole can readily attain effective antibacterial concentrations

Metronidazole therapy in conjunction with scaling and root planing

Tetracyclines (tetracycline-HCl, doxycycline, minocycline) may be indicated in

during therapy.(not recommended in pregnancy)(drug drug interactions to be

species (beneficial organisms) are resistant to the metronidazole-ciprofloxacin drug

Work quickly and cost-effectively while

clinical study involving 245 patients over

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