Faculty Bibliography

BACKGROUND: Subtle changes in marginal alveolar bone level can be demonstrated using digital subtraction of sequential radiographs. OBJECTIVE: We aimed to evaluate the practical application of geometrically corrected digital subtraction in a clinical study of alveolar bone response to a drug previously shown to inhibit alveolar bone loss. STUDY DESIGN: Selected periapical radiographs were acquired with projective standardization of patients with clinical marginal alveolar bone loss. Subsequently, patients received a 6-month regimen of subantimicrobial doxycycline or placebo. Standardized radiographs of the same alveolar regions were acquired after 3 and 6 months, and baseline radiographs were subtracted from these images. RESULTS: Blinded digital subtraction analysis indicated various levels of marginal bone gain in 3 of the 6 patients in the experimental group, whereas in 3 of the 5 placebo patients the method showed bone loss. CONCLUSION: These results suggest that geometrically corrected digital subtraction possibly agrees with clinical predictors of bone loss severity

Over the past 140 years, dentistry has matured from the original tenets of GV Black by moving from 'extension for prevention' to a minimal intervention approach. This is part of an evolution that stresses a medical, rather than a surgical model for caries management. This transition has been facilitated by the introduction and advancement of adhesive dentistry, which encourages preservation of tooth structure. Even with these changes, some of the original writings of Black are still relevant today: 'The day is surely coming...when we will be engaged in practicing preventive, rather than reparative, dentistry.'