Sinus floor elevation and simultaneous implant placement in fresh extraction sockets: a systematic review of clinical data

Combining different procedures to reduce the number of surgical sessions and patient discomfort in implant placement and sinus floor elevation has been recommended, and evidence supports good outcomes. The aim of this study was to review the results of clinical studies on sinus floor elevation through extraction sockets and simultaneous immediate posterior implant placement. An electronic search was carried out in PubMed, Scopus, andWeb of Science to find English articles published in or before August 2020. A manual search was also performed. Titles, abstracts, and the full-text of the retrieved articles were studied. Thirteen studies met our eligibility criteria: 6 retrospective case series, 3 case reports, 2 prospective cohort caseseries, 1 prospective case series, and 1 randomized controlled trial. Overall, 306 implants were placed; 2 studies reported implant survival rates of 91.7% and 98.57%. The others either did not report the survival rate or reported 100% survival. Sinus floor elevation through a fresh extraction socket and simultaneous immediate implant placement appears to be a predictable modality with a high success rate. However, proper case selection and the expertise of the clinician play fundamental roles in the success of such complex procedures.

Three-dimensional optimization and sensitivity analysis of dental implant thread parameters using finite element analysis

OBJECTIVES: This study aimed to optimize the thread depth and pitch of a recently designed dental implant to provide uniform stress distribution by means of a response surface optimization method available in finite element (FE) software. The sensitivity of simulation to different mechanical parameters was also evaluated. MATERIALS AND METHODS: A three-dimensional model of a tapered dental implant with micro-threads in the upper area and V-shaped threads in the rest of the body was modeled and analyzed using finite element analysis (FEA). An axial load of 100 N was applied to the top of the implants. The model was optimized for thread depth and pitch to determine the optimal stress distribution. In this analysis, micro-threads had 0.25 to 0.3 mm depth and 0.27 to 0.33 mm pitch, and V-shaped threads had 0.405 to 0.495 mm depth and 0.66 to 0.8 mm pitch. RESULTS: The optimized depth and pitch were 0.307 and 0.286 mm for micro-threads and 0.405 and 0.808 mm for V-shaped threads, respectively. In this design, the most effective parameters on stress distribution were the depth and pitch of the micro-threads based on sensitivity analysis results. CONCLUSION: Based on the results of this study, the optimal implant design has micro-threads with 0.307 and 0.286 mm depth and pitch, respectively, in the upper area and V-shaped threads with 0.405 and 0.808 mm depth and pitch in the rest of the body. These results indicate that micro-thread parameters have a greater effect on stress and strain values.

Effects of root debridement with hand curettes and Er:YAG laser on chemical properties and ultrastructure of periodontally-diseased root surfaces using spectroscopy and scanning electron microscopy

Introduction: The efficacy of erbium-doped yttrium aluminum garnet [Er:YAG] laser for root debridement in comparison with curettes has been the subject of many recent investigations. Considering the possibility of chemical and ultra-structural changes in root surfaces following laser irradiation, this study sought to assess the effects of scaling and root planing [SRP] with curettes and Er:YAG laser on chemical properties and ultrastructure of root surfaces using spectroscopy and scanning electron microscopy [SEM]

Methods: In this in vitro experimental study, extracted sound human single-rooted teeth [n = 50] were randomly scaled using manual curettes alone or in conjunction with Er:YAG laser at 100 and 150 mJ/pulse output energies. The weight percentages of carbon, oxygen, phosphorous and calcium remaining on the root surfaces were calculated using spectroscopy and the surface morphology of specimens was assessed under SEM. Data were analyzed using one-way analysis of variance [ANOVA]

Results: No significant differences [P > 0.05] were noted in the mean carbon, oxygen, phosphorous and calcium weight percentages on root surfaces following SRP using manual curettes with and without laser irradiation at both output energies. Laser irradiation after SRP with curettes yielded rougher surfaces compared to the use of curettes alone

Conclusion: Although laser irradiation yielded rougher surfaces, root surfaces were not significantly different in terms of chemical composition following SRP using manual curettes with and without Er:YAG laser irradiation. Er:YAG laser can be safely used as an adjunct to curettes for SRP

Clinical comparison of full and partial double pedicle flaps with connective tissue grafts for treatment of gingival recession

Statement of the Problem: Gingival recession has been considered as the most challenging issue in the field of periodontal plastic surgery

Purpose: The purpose of this study was to evaluate the clinical efficacy of root coverage procedures by using partial thickness double pedicle graft and compare it with full thickness double pedicle graft

Materials and Method: Eight patients, aged 15 to 58 years including 6 females and 2 males with 20 paired [mirror image] defects with class I and II gingival recession were randomly assigned into two groups. Clinical parameters such as recession depth, recession width, clinical attachment level, probing depth, and width of keratinized tissue were measured at the baseline and 6 months post-surgery. A mucosal double papillary flap was elevated and the respective root was thoroughly planed. The connective tissue graft was harvested from the palate, and then adapted over the root. The pedicle flap was secured over the connective tissue graft and sutured. The surgical technique was similar in the control group except for the prepared double pedicle graft which was full thickness

Results: The mean root coverage was 88.14% [2.83 mm] in the test group and 85.7% [2.75 mm] in the control group. No statistical differences were found in the mean reduction of vertical recession, width of recession, or probing depth between the test and control groups. In both procedures, the width of keratinized tissue increased after three months and the difference between the two groups was not statistically significant in this respect

Conclusion: Connective tissue with partial and full thickness double pedicle grafts can be successfully used for treatment of marginal gingival recession

Validity of panoramic indices to evaluate the association of bone mineral density with morphology of the mandible in osteoporotic patients

Objective: Osteoporosis is the most common metabolic disease of the bone decreasing bone mineral density [BMD] particularly in postmenopausal women. On the other hand, panoramic radiography has several applications in dentistry. It appears that by calculating some indices on panoramic radiographs, we may be able to predict the risk of osteoporosis in high-risk individuals. The present study was conducted to determine the correlation of skeletal pattern of bone and the morphology of the mandible in osteoporotic patients presenting to the Osteoporosis Clinic of Khatamolanbia Hospital and Imam Khomeini Dental Clinic in Yazd

Methods: This descriptive, analytical, cross-sectional study was conducted on 70 women aged over 45 years, whom were selected from the above-mentioned centers. The gonialangle [GA], gonial index [GI], antegonial angle [AA], mental index [MI], antegonial index [AI] and antegonial depth [AD] were calculated on panoramic radiographs of patients and their BMD was measured in the lumbar area and femoral areas using dual X-ray absorptiometry [DXA]. The correlation of panoramic indices with BMD was assessed using Spearman and Pearson's correlation tests. The difference in BMD values in different morphological patterns of the inferior cortex of the mandible was analyzed by Student t-test and in different thicknesses of the cortex using one-way ANOVA

Results: The morphology of the inferior cortex was C1 in 62.9% and C2 in 37.1%. The cortex was thin in 24.3%, moderately thick in 32.9% and thick in 42.9%. Lumbar BMD was 0.92 [0.14] and 0.75 [0.15] g/cm2, in C1 and C2, respectively [p<0.001]. Femoral BMD was 0.81 [0.13] and 0.66 [0.09] g/cm2 in C1 and C2, respectively [p<0.001]. No significant association was found between GI, AI, GA, AA and AD [based on the estimates made on panoramic radiographs] with the BMD [based on DXA estimates]

Conclusion: Use of mandibular cortex indices on panoramic radiographs may be efficient for assessment of osteoporosis. However, further multicenter studies on larger sample sizes are required

Effects of fresh mineralized dentin and cementum on socket healing: a preliminary study in dogs

OBJECTIVES: Dentin is composed of many minerals and growth factors. Based on this composition, we studied its effect as a possible regenerative material for alveolar healing. MATERIALS AND METHODS: This study was conducted using four 2.5-year-old mongrel dogs (male; weight, 25 to 30 kg). The third mandibular premolars were carefully mobilized with a dental elevator and then removed using forceps. The crown portions of the extracted teeth were removed with cutters, and the root portions of the remaining teeth were collectively trimmed as closely as possible to 350 to 500 microm. Dentin and cementum (DC) chips harvested from the extracted teeth were soaked in blood and packed into the fresh sockets (autograft). Biopsies were performed at the ends of day 14 and day 56 following implantation. Data were expressed as mean+/-standard deviation and compared with t-test results. RESULTS: The ratio of SA(bone) to total area of each probe was determined and was 170+/-16 microm2 for the control group and 71+/-14 microm2 for the DC group, a significant difference (P<0.05). CONCLUSION: DC particulate grafts offered no improvement in bone regeneration in alveolar extraction sockets.

Effect of low level laser therapy on proliferation and differentiation of the cells contributing in bone regeneration

Low level laser therapy [LLLT] also known as photobiomodulation, is a treatment that uses low-level lasers or light-emitting diodes [LEDs] to change cellular function and is a clinically well accepted tool in regenerative medicine and dentistry. Considering the variety of laser, exposure, cells and study types, the exact effects of low level laser therapy seems to be unclear. The aim of this study was to review the data published in the field of the effects of low level laser therapy on proliferation and differentiation of the cells contributing in bone regeneration. To access relevant articles, an electronic search in PubMed was conducted from 2001 to April 2014. English language published papers on low level laser therapy were found using the selected keywords .The full texts of potentially suitable articles were obtained for final assessment according to the exclusion and inclusion criteria. 240 articles were found from 2001 to April 2014. Following the initial screening of titles and abstracts as well as the final screening of full texts, 22 articles completely fulfilled the inclusion criteria of this study. Wavelength used in LLLT irradiation varied between 600 to 1000 nm with an energy density of 0.04-60J/cm[2]. Although almost all studies agreed on getting positive effects from LLLT, some had opposing results. Low level laser with low-energy density range appears to exert a biostimulatory effect on bone tissue, enhance osteoblastic proliferation and differentiation on cell lines used in in vitro studies. Despite the fact that many researches have been recently done on the effects of LLLT on different cell lines, without knowing the precise mechanism and effects, we are not able to offer a clinical treatment protocol. This paper is a beginning to help further progress and extend practical use of LLLT in future

Comparison of the reproducibility of results of a new peri-implantitis assessment system (implant success index) with the Misch classification

OBJECTIVES: The present study was conducted to determine the reproducibility of peri-implant tissue assessment using the new implant success index (ISI) in comparison with the Misch classification. MATERIALS AND METHODS: In this descriptive study, 22 cases of peri-implant soft tissue with different conditions were selected, and color slides were prepared from them. The slides were shown to periodontists, maxillofacial surgeons, prosthodontists and general dentists, and these professionals were asked to score the images according to the Misch classification and ISI. The intra- and inter-observer reproducibility scores of the viewers were assessed and reported using kappa and weighted kappa (WK) tests. RESULTS: Inter-observer reproducibility of the ISI technique between the prosthodontists-periodontists (WK=0.85), prosthodontists-maxillofacial surgeons (WK=0.86) and periodontists-maxillofacial surgeons (WK=0.9) was better than that between general dentists and other specialists. In the two groups of general dentists and maxillofacial surgeons, ISI was more reproducible than the Misch classification system (WK=0.99 versus WK non-calculable, WK=1 and WK=0.86). The intra-observer reproducibility of both methods was equally excellent among periodontists (WK=1). For prosthodontists, the WK was not calculable via any of the methods. CONCLUSION: The intra-observer reproducibility of both the ISI and Misch classification techniques depends on the specialty and expertise of the clinician. Although ISI has more classes, it also has higher reproducibility than simpler classifications due to its ability to provide more detail.

Receptor activator of nuclear factor kappa-B gene polymorphisms in Iranian periodontitis and peri-implantitis patients

PURPOSE: Peri-implantitis and periodontitis are inflammatory and infectious diseases of implant and tooth-supporting tissues. Recently, the role of gene polymorphisms of immune response components in the relevant pathogenesis has been investigated. The present study was the first to evaluate the relationship between two known single nucleotide polymorphisms (SNPs) of the receptor activator of nuclear factor kappa-beta (RANK) gene (rs3018362 and rs35211496) in chronic periodontitis and peri-implantitis patients in an Iranian population. METHODS: Eighty-one periodontally healthy patients, 38 patients with peri-implantitis, and 74 patients with chronic periodontitis were enrolled in this study. DNA was extracted from blood arm vein samples by using Miller's salting out technique according to the manufacturer's instructions given in the extraction kit. The concentration of DNA samples was measured using a spectrophotometer. The genetic polymorphisms of the RANK gene were evaluated using a competitive allele specific polymerase chain reaction (KBioscience allele specific PCR) technique. Differences in the frequencies of genotypes and alleles in the diseased and healthy groups were analyzed using chi-squared statistical tests (P<0.05). RESULTS: Analysis of rs35211496 revealed statistically significant differences in the expression of the TT, TC, and CC genotypes among the three groups (P=0.00). No statistically significant difference was detected in this respect between the control group and the chronic periodontitis group. The expression of the GG, GA, and AA genotypes and allele frequencies (rs3018362) showed no statistically significant difference among the three groups (P=0.21). CONCLUSIONS: The results of this study indicate that the CC genotype of the rs35211496 RANK gene polymorphism was significantly associated with peri-implantitis and may be considered a genetic determinant for peri-implantitis, but this needs to be confirmed by further studies in other populations.

Interleukin 17 receptor gene polymorphism in periimplantitis and chronic periodontitis

Gene polymorphism of cytokines influencing their function has been known as a contributing factor in the pathogenesis of inflammatory diseases of the tooth and implant supporting tissues. The aim of this study was to investigate the association of IL-17R gene polymorphism [rs879576] with chronic periodontitis and periimplantitis in an Iranian population. 73 patients with chronic periodontitis, 37 patients with periimplantitis and 83 periodontally healthy patients were enrolled in this study. 5cc blood was obtained from each subject's arm vein and transferred to tubes containing EDTA. Genomic DNA was extracted using Miller's Salting Out technique. The DNA was transferred into 96 division plates, transported to Kbioscience Institute in United Kingdom and analyzed using the Kbioscience Competitive Allele Specific PCR [KASP] technique. Chi-square and Kruskal Wallis tests were used to analyze differences in the expression of genotypes and frequency of alleles in disease and control groups [P-Value less than 0.05 was considered statistically significant]. There were no significant differences between periodontitis, periimplantitis with AA, GG, GA genotype of IL-17R gene [7M].8239]. Also comparison of frequency of alleles in SNP rs879576 of IL-17R gene between the chronic periodontitis group and periimplantitis group did not revealed statistically significant differences [P=0.8239]. The enigma of IL-17 and its polymorphism-role in periodontitis and periimplantitis is yet to be investigated more carefully throughout further research but this article demonstrates that polymorphism of IL-17R plays no significant role in incidence of chronic periodontitis and Periimplantitis

Comparison of the thermal and surface changes of dental implant using rotary instruments and piezoelectric device after implantoplasty: an in vitro study

Objective: Peri-implantitis is an irreversible inflammatory reaction in the soft and hard tissues around a functional implant. One of the treatment approaches of this disease include smoothing and polishing the rough surface and removing threads on the implants using rotary instruments, which is called implantoplasy. Clinicians should perform implantoplasty with caution because it may raise the temperature of the implant body as well as the surrounding bone. This study aimed to compare micromorphology and thermal changes obtained with different rotary instruments and piezoelectric device after implantoplasty

Methods: In this in vitro study 48 Intra Lock fixture surfaces were processed in 60 seconds with six polishing procedures using 6,12 bladed carbide burs, 90, 30 µm mean-particles-size diamond burs, and piezosurgery inserts OT1 [grain size= 91 microm] and OP5 [grain size= 30 microm]. These instruments were applied in single or sequences procedures. Variations in temperature were recorded every 5 seconds. The roughness of treated surfaces was evaluated with a profilometer for Ra1, Rz1 [single polish procedures], Ra2, and Rz2 [sequence polish procedures] parameters. Also, surfaces were observed using a field emission scanning electron after each step of implantoplasty

Results: The piezosurgery group showed statistically significant differences with the other two groups [maximum temperature 1.2°C]. No statistically significant differences were observed between the carbide and diamond burs regarding the temperature changes and the temperature decreased from the start point in both groups. The mean Ra value in piezoelectric group [1.53 [0.23]] was significantly lower than diamond (2.45 [0.40], p<0.05] and carbide [2.10 [0.28], p<0.05] groups

Besides, this measure in the carbide group was significantly lower than that of the diamond group [p<0.05]. Rz1 value was significantly greater in diamond and carbide groups compared to piezoelectric group. The results revealed significant differences among the three groups concerning Rz2. The minimum Rz2 value was seen in piezoelectic group, while the diamond group showed the highest Rz2 parameter

Conclusion: This in virto study showed that in suitable cooling conditions, implantoplasty with rotary and piezoelectric devices does not produce excessive heat increases which can damage the soft tissue or bone around the affected implant. The piezoelectric device produced smoother surfaces in single or sequence procedures compared to the burs and can be useful for implantoplasy?

Comparison of manual tools, ultrasonic and erbium-doped yttrium aluminum garnet [er:yag] laser on the debridement effect of the surface of the root of teeth suffering from periodontitis

Periodontal diseases are considered as some of the most common reasons of teeth loss, which occur due to the aggregation of microbial plaque and other precipitations on the dental surfaces. In this study, the scaling effect using manual tools, ultrasonic machine and Erbium-Doped Yttrium Aluminum Garnet [Er:YAG]laser on the connection of the human gums connective tissue cells on the root surface of the teeth suffering from severe periodontitis will be compared. After removal of the big precipitations with manual tools, Er:YAG laser light emission of Photona machine is used with respect to the following characteristics: wavelength: 2940 micro m, each pulse: 100mJ, frequency: 10 pulse/sec, optic fiber with cross section 0.5x1.65mm, fiber tip angle with root surface: 15-20 degrees with non-contact mode, 1.5mm farther than the root surface and pulse duration 230 very short. The gingival fibroblast cellular was incubated as a sample of the human gums connective tissue cells under 37C. These cells were departed from the culture medium after the cellular reproduction in the third passage. On the 3[rd] day after incubation, the gingival fibroblast cells morphology was studied by Scanning Electron Microscopy [SEM]. The results of SEM images in the present study indicated the spread fibroblast cells with philopodia were found in all of 5 groups; untreated healthy group [control], untreated group suffering from periodontitis, the scaling effect using manual tools [Scaled Gracey], ultrasonic machine and Er:YAG laser. There is a meaningful difference among the three treatment groups [P<0.001] in the numbers of the fibroblast cells, while all the four treated groups had a meaningful difference with the positive control group [P < 0.001]. The present study indicated that although various dental surfaces cleaning methods may be different in other aspects, but are similar concerning the fibroblasts morphology. Also in addition to power, laser emission time may also be effective in the cells morphology results.

Comparison of the effect of hand instruments, an ultrasonic scaler, and an erbium-doped yttrium aluminium garnet laser on root surface roughness of teeth with periodontitis: a profilometer study

PURPOSE: The present study aimed to measure root surface roughness in teeth with periodontitis by a profilometer following root planning with ultrasonic and hand instruments with and without erbium-doped yttrium aluminium garnet (Er:YAG) laser irradiation. METHODS: Sixty single-rooted maxillary and mandibular teeth, extracted because of periodontal disease, were collected. The crowns and apices of the roots were cut off using a diamond bur and water coolant. The specimens were mounted in an acrylic resin block such that a plain root surface was accessible. After primary evaluation and setting a baseline, the samples were divided into 4 groups. In group 1, the samples were root planned using a manual curette. The group 2 samples were prepared with an ultrasonic scaler. In group 3, after scaling with hand instrumentation, the roots were treated with a Smart 1240D plus Er:YAG laser and in group 4, the roots were prepared with ultrasonic scaler and subsequently treated with an Er:YAG laser. Root surface roughness was then measured by a profilometer (MahrSurf M300+RD18C system) under controlled laboratory conditions at a temperature of 25degrees C and 41% humidity. The data were analyzed statistically using analysis of variance and a t-test (P<0.05). RESULTS: Significant differences were detected in terms of surface roughness and surface distortion before and after treatment. The average reduction of the surface roughness after treatment in groups 1, 2, 3, and 4 was 1.89, 1.88, 1.40, and 1.52, respectively. These findings revealed no significant differences among the four groups. CONCLUSIONS: An Er:YAG laser as an adjunct to traditional scaling and root planning reduces root surface roughness. However, the surface ultrastructure is more irregular than when using conventional methods.

Effect of hand, ultrasonic scaler and erbium-doped yttrium aluminum garnet [er: yag] laser on the morphology of root surfaces with periodontitis: a comparative in vitro scanning electron microscopy study

The main purpose of the present study was to describe the ultra structural changes which happened after treatment of the root surfaces with ultrasonic and hand devices followed by Erbium-Doped Yttrium Aluminum Garnet [Er:YAG] laser irradiation. Sixty single-rooted maxillary and mandibular teeth which had been extracted due to periodontal problems were collected. Crown and apical parts of the root were cut off using a diamond bur. The specimens were mounted on an acrylic resin in order to make a plain surface of the root accessible. The samples were assigned as following: group1: samples were root planed using conventional hand curette, group2: were prepared by ultrasonic device, group3: roots after scaling by hand instrumentation were treated by Er:YAG laser with 50 mJ/pulse and frequency of 10 Hz, group4: roots were prepared by ultrasonic scaler and consequently were treated by laser. Furthermore, the teeth were dried, sputter-coated with gold, and monitored with scanning electron microscope [SEM]. Photomicrographs from ten samples of root surfaces which were taken at magnifications up to 500X revealed that there were not any severe morphologic changes, such as melting and charring, in any group. However, the samples treated by laser irradiation showed more irregularities and distortions. Er:YAG laser setting at 50mj/pulse, as an adjunctive to traditional scaling and root planning, did not induce severe damages to root surfaces, although root surface irregularities were more pronounced in laser treated groups compare to hand instruments.

Using diode laser for soft tissue incision of oral cavity

The purpose of this case report is to analyze the results of vestibuleplasty around an over-denture based on dental implants to determine the evidence on the effectiveness of laser-assisted surgery and soft tissue management in implant dentistry. The patient in this case report was a 57 year- old male who was completely edentulous, with a mandibular over denture based on 4 standard implants suffering from pain on chewing, and a general discomfort, especially in anterior segment. He received a standard gingival augmentation surgery which failed to create sufficient vestibular depth. A laser-assisted vestibuloplasty was done to make the environment suitable for making a new overdenture. There were clinically significant improvements in vestibular depth and peri implant soft tissue situation by laser. Also, bleeding during surgery was well controlled; the patient's discomfort and pain were less than the first operation done with gingival graft. Based on our clinical data and review of the literature, an evidence-based approach to the use of lasers for the management of soft tissue in oral surgery is necessary. Simply, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. However, improved hemostasis and patient's satisfaction can be considered as advantages of adjunctive laser therapy in some clinical situations like vestibuloplasty