Comparing Single Tooth Implant Placement With and Without Allogenic Soft Tissue Augmentation. A Randomized Clinical Trial.

OBJECTIVE: To explore the effect of adding an allogenic soft tissue graft at time of single implant placement using a fully digital workflow for single implant placement and restoration without making either analog or digital impressions. MATERIALS AND METHODS: A prospective randomized clinical study was performed enrolling thirtynine participants requiring single tooth implant randomized into (+ graft) group which received an allogenic dermal graft at the time of implant placement (n=19), or (- graft) group (n=20). A fully digital surgical and restorative protocol was implemented. Intraoral scans were taken before implant placement (T0), at time of final crown delivery (T1) and at one-year post placement (T2). Intraoral scans were aligned using Geomagic Control X 2020 software), linear and volumetric changes in buccal tissues were measured at T0, T1 and T2. Implant survival, probing depths, and complications were recorded. Participants were asked to complete an OHIP-14 survey at T0 and T2. Marginal bone levels were measured at T0 and T2 on peri-apical x-rays. RESULTS: 39 participants completed surgery and restoration in incisor, canine, premolar and molar positions. Two early failures were recorded in central incisor positions (95% survival). Crown delivery without complication from the digital workflow (impressionless) was achieved for 36/39 of cases (92%) with implant depth control being implicated as the chief challenge. Thirtyseven participants attended the one-year follow-up visit. Both groups showed gain in buccal tissues thickness without significant differences between the two groups for both linear and volumetric measurements (P>0.05). Soft tissue grafting was associated with minimal added morbidity. The interproximal marginal bone changes recorded were -0.16mm mesial and - 0.12mm distal for the graft group and -0.01mm mesial and -0.11mm distal for the non-graft group (p=0.07 for mesial and 0.83 for distal). OHIP score was significantly reduced at T2 compared to T0 (P=0.003) for the entire cohort. CONCLUSIONS: The augmentation of alveolar mucosa on the buccal aspect of single tooth implants is associated with clinically favorable outcomes. A fully digital workflow has been validated to permit crown delivery on CAD/CAM abutments without implant impressions.

Retrospective Cohort Evaluation of Full-Arch Zirconia Implant-Supported Fixed Prostheses.

Objective: To determine the median event-free survival and relative complication rates of monolithic and minimally layered full-arch zirconia prostheses, as well as to identify risk factors for prosthesis complications. Materials and Methods: In this retrospective cohort study, a total of 129 subjects (173 prostheses) were included in the chart review and 56 subjects (75 prostheses) participated in a clinical follow-up visit. All subjects had either single- or dual-arch monolithic or minimally layered zirconia implant-supported prostheses. Data related to patient, implant, and prosthesis factors were extracted from charts. The subgroup that presented for a clinical visit were asked to complete a satisfaction questionnaire. For this subgroup, the following clinical measures were assessed: routine intraoral examination, number of occluding units, cantilever length on each side of the prosthesis (right and left), prosthesis height, occlusal scheme, and oral hygiene methods. Periapical radiographs were obtained when the last radiographs of the patient were taken more than 12 months prior. Results: The follow-up period ranged from 12 months to 7.1 years (mean: 1.9 years). Observed complications included implant loss, peri-implantitis, mucositis, purulence, sinus tract formation, oroantral communication, implant fracture, titanium base debonding, ceramic chipping, prosthetic screw fracture or loosening, damage to opposing teeth, and clicking sounds. There was an insufficient number of complications to evaluate the effect of covariates on the risk of specific complications, such as titanium base debonding (eight events), ceramic chipping (nine events), and peri-implantitis (eight events). The unadjusted event-free median survival time was 5.8 years. The proportion of all prostheses with at least one complication was 30%. There were no observed prosthesis losses during the follow-up period. Conclusion: Monolithic and minimally layered zirconia full-arch implant-supported prostheses demonstrate an acceptable median event-free survival time. Event-free survival times were increased and the number of complications was reduced in prostheses with five to eight implants and conventional (as opposed to zygomatic) implants. There was a reduced hazard of complications with a regular recall regimen. Patient satisfaction with these prostheses was high.

Macrogeometric Differentiation of Dental Implant Primary Stability: An In Vitro Study.

PURPOSE: To evaluate an alternative cutting, progressive thread design to increase primary stability in low-density bone. MATERIALS AND METHODS: Four different implants with different macrogeometries (Nobel Biocare Active [NA] Internal RP implants [4.3 × 11.5 mm], Straumann BLX Roxolid RB implants [4.5 × 10 mm], Astra Tech Implant EV implants [4.2 × 11 mm], and PrimeTaper [PT 4.2 × 11 mm]) were placed in simulated osteotomies and extraction sockets in synthetic bone (Sawbones) according to the manufacturers' protocol. Insertion torque and ISQ values were measured using Implantmed Plus motor and Ostell IDX, respectively. Insertion time was recorded. Average values were calculated and compared using ANOVA and Tukey test. RESULTS: Insertion torque (range: 5 to 44 Ncm) increased with increasing synthetic bone density for all implants. Different ISQ values in synthetic low-density bone were not observed in higher-density synthetic bone. Insertion torque of all implants was reduced when implants were placed in simulated sockets compared to simulated osteotomies. In both low-density and higher-density synthetic bone, the primary stability of PrimeTaper implants with cutting and progressive thread design was equivalent to that of the Nobel Biocare NobelActive implant with compressive thread design and greater than the BLX implant with compressive thread design. CONCLUSION: Different implant macrogeometries obtain relatively high primary stability in low-density bone when measured by ISQ. Doublethread implant designs reduce insertion times in higher-density bone. A cutting and progressive compressing thread design provides density-sensing performance compared to aggressive condensing thread designs. This macrogeometry can achieve high primary stability associated with modest insertion torque compared to aggressive threaded implant designs known to attain the highest insertion torque. The presence of multiple cutting threads may offer advantages in obtaining primary stability in low-density bone.

Informed Consent from a Historical, Societal, Ethical, Legal, and Practical Perspective.

Informed consent is often perceived as a regulatory obligation without recognizing its educational potential in the dynamic provider/patient relationship. This article discusses the complex interaction of ethics, society, and law through a historical and practical perspective. The purpose is to provide general dentists and specialists with a comprehensive understanding of the complexity and practical dimensions of informed consent.

Comparison of oral health indicators between two places of endemic dental fluorosis in Jordan.

INTRODUCTION: Excessive fluoride intake during tooth development causes dental fluorosis. AIM: This study aimed to (1) determine the prevalence of dental fluorosis in association with fluoride concentrations in drinking water, (2) explore the effects of altitude on the severity of fluorosis in two towns with high fluoride levels in the drinking water, and (3) assess decayed, missing, and filled teeth (DMFT) and oral hygiene practices among participants. MATERIAL AND METHODS: The sample consisted of 100 and 141 schoolchildren, aged 15.3 ± 1.4 and 16.1 ± 1.3 years, living in Ruwaished and Kuraymah, respectively. Oral examinations were carried out, and dental fluorosis was assessed using the Dean's index. The DMFT index was also used for assessment. Samples of drinking water were analyzed using a fluoride-ion selective electrode. SPSS was used to analyze the data. RESULTS: Two-thirds (68.8%) of adults from Kuraymah had moderate to severe fluorosis, with only 7% being unaffected. In Ruwaished, 50% of the sample had severe fluorosis, 22% showed moderate fluorosis, and none were unaffected. The average DMFT scores were 3.18 ± 1.81 and 3.81 ± 1.41 for Kuraymah and Ruwaished, respectively. In both towns, males had significantly higher caries scores than females. Oral hygiene was poor, as 64% and 57% of the participants from Kuraymah and Ruwaished, respectively, did not brush their teeth. A significant correlation was found between poor oral hygiene and increased DMFT scores. CONCLUSIONS: This study concluded that higher fluorosis incidence and severity were present in the higher-altitude location (Ruwaished). Moreover, this study also indicated that fluorosed teeth are not immune to caries, and the preventive management of dental fluorosis should be directed to de-fluoridation of drinking water in endemic areas.

Effect of freshly placed core buildup composites on setting of silicon impression materials.

Aim: The aim is to study the effect of freshly placed composite build-ups on setting of additional silicone impression materials. Settings and Design: In vitro - experimental study. Materials and Methods: Three composite materials; Build-It™ F. R™, Filtek™ Bulk Fill flow and Filtek™ Z350 and three light-bodied additional silicone impression materials; Elite HD+, Aquasil LV Ultra and Express™ were used. Cylindrical-shaped specimens were made of each material (diameter 15 mm and height 10 mm). The silicone specimens were brought into contact with the composite specimens, which were either freshly cured (9 groups, n = 90) or cured and then stored in normal saline for 1 week (9 groups, n = 90). Shore A hardness (SAH) scores of silicone surfaces were recorded following the ASTM D2240-5 standards for shore A Durometer testing. Six measurements were made per each silicone surface and medians were calculated. Kruskal-Wallis and Mann-Whitney tests (SPSS v20) were used to check statistical significant differences between all groups and paired comparisons, respectively (P < 0.05). Statistical Analysis Used: Kruskal-Wallis and Mann-Whitney tests. Results: The SAH scores of additional silicones in direct contact with freshly placed composites were significantly less than SAH scores of additional silicones in direct contact with composites specimens aged for 1 week in 7 out of 9 combinations (P < 0.05). Only when Express™ and Elite HD+ were applied over freshly placed Filtek™ Bulk Fill flow, the SAH scores difference was not statistically significant to SAH scores of matching combinations applied after 1 week of composite storage. Conclusions: Freshly placed composite might affect setting of additional silicone impression materials. Dentists should carefully assess final impression on areas of prepared teeth that have received composite fillings recently.

Are Nongrafting Solutions Viable for Dental Implant Treatment in Limited Bone Volume?

Dental implant therapies must be planned and executed to meet both the immediate and longer-term expectations of patients. The early developmental success of dental implants was dependent on the quality and quantity of a patient's bone. Implants were commonly placed into the parasymphyseal mandibular and anterior maxillary bone. Building on this success, bone grafting allowed patients lacking sufficient bone to obtain implant-supported prosthetic solutions for treatment of partial or complete edentulism. More recently, several nongrafting solutions for implant therapy, including pterygoid implants, zygomatic implants, tilted implants, and short implants, have reported success. This article will consider the rationale for graftless solutions in implant therapy as well as the data supporting the use of various graftless protocols as alternatives to grafting and conventional dental implant therapy. It will discuss factors concerning graftless versus grafted approaches to treatment of patients with limited bone volume and will describe the use of short dental implants as a graftless solution in the edentulous maxilla.

Defining salivary biomarkers using mass spectrometry-based proteomics: a systematic review.

Recent advancements in mass spectrometric proteomics provide a promising result in utilizing saliva to explore biomarkers for diagnostic purposes. However, the issues of specificity or redundancy of disease-associated salivary biomarkers have not been described. This systematic review was therefore aimed to define and summarize disease-related salivary biomarkers identified by mass spectrometry proteomics. Peer-reviewed articles published through July 2009 within three databases were reviewed. Out of 243 articles, 21 studies were selected in this systematic review with conditions including Sjögren's syndrome, squamous cell carcinoma, dental caries, diabetes, breast cancer, periodontitis, gastric cancer, systemic sclerosis, oral lichen planus, bleeding oral cavity, and graft-versus-host disease. The sample size ranged from 3-41 in both diseased and control subjects, with no consensus on sample collection protocol. One hundred eighty biomarkers were identified in total; 87 upregulated, 63 downregulated, and 30 varying based on disease. Except for Sjögren's syndrome, the majority of studies with the same disease produce inconsistent biomarkers. Larger sample size and standardization of sample collection/treatment protocol may improve future studies.

A new form of intraoral delivery of antifungal drugs for the treatment of denture-induced oral candidosis.

OBJECTIVES: To monitor the release of the antifungal drugs Fluconazole, Chlorhexidine and a combination of the two from an auto-polymerized poly (methyl methacrylate) (PMMA) denture base resin; and to investigate the effect of the released drugs upon the growth of Candida albicans. METHODS: A high performance liquid chromatography-Ultra violet (HPLC-UV) method was used in the analysis of the released drugs into distilled water from PMMA discs doped with the antifungal drugs Fluconazole (10%), Chlorhexidine (10%) and a combination of the two drugs (5% each). The antifungal efficacy of the released drugs was monitored, microbiologically, employing "well" technique on a Saborauds culture medium inoculated with a resistant strain of Candida albicans. RESULTS: It was shown that Fluconazole, Chlorhexidine and the combination of the two drugs can be successfully incorporated with PMMA. It was found that the drugs leach steadily out of the PMMA resin into distilled water at mouth temperature and that sustained drug release continued throughout the 28 days test period. It was also shown that the released drugs demonstrated an antifungal activity against the resistant Candida albicans and this was most remarkable in the combined drugs samples. CONCLUSIONS: The findings of this investigation have a clinical value in terms of their significant contribution to the treatment of fungal infections of the oral cavity. The sustained release of anti-fungal drugs from the PMMA resin clearly constitutes a new dosage form of these drugs via the poly (methyl methacrylate) delivery system.

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Recent advancement in mass spectrometry leads us to a new era of proteomic analysis. Human saliva can be easily collected; however, the complexity of the salivary proteome in the past prevented the use of saliva for proteomic analysis. Here we review the development of proteomic analyses for human saliva and focus on the use of a new mass spectrometric technology known as surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF). SELDI-TOF, a modification of matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF), combines the precision of mass spectrometry and the high-through-put nature of protein arrays known as Protein Chips. This technology shows a promising future for salivary proteomic analysis in monitoring treatments and diseases, as well as novel biomarker discovery.

The effects of disinfectants on dimensional accuracy and surface quality of impression materials and gypsum casts.

BACKGROUND: The study aimed to evaluating the effect of disinfecting impression materials on the dimensional accuracy and surface quality of the resulting casts. METHODS: Impressions of a steel die constructed according to ANSI/ADA specification No.18 were made with each of alginate, addition cured silicone, condensation cured silicone and zinc oxide eugenol paste, and disinfected consequently by each of 0.2% chlorhexidine gluconate, 1% sodium hypochlorite, 2% gluteraldehyde for 5 minutes, and 0.5% sodium hypochlorite for 10 minutes. Dimensions of the disinfected impressions and their resultant casts were measured using a computerized digital caliper, and the dimensional changes were calculated. Reproduction of detail and surface quality of the resultant casts were assessed by grading casts surfaces according to a specific scoring system. RESULTS: The 0.5% sodium hypochlorite was found to produce the least dimensional changes in all the impression materials. Corsodyl produced the maximum changes in both alginate and zinc-oxide eugenol while addition-cured silicon was most affected by Gluteraldehyde and condensation-cured silicon was most affected by Hexana. The dimensional changes, however, were minimal and clinically insignificant. Addition-cured silicon showed the best surface quality and dimensional stability followed by condensation-cured silicon. Alginate and zinc-oxide eugenol had poorer surface quality and were affected to a higher extent by the disinfection procedures. CONCLUSIONS: The results were comparable with the standard specifications for dimensional stability. Recommendations were made for the use of 10 minutes immersion in 0.5% sodium hypochlorite as the most appropriate disinfection protocol to the investigated impression materials. KEYWORDS: Disinfectants; Gypsum casts; Impressions; Alginate; Addition-cured silicone; Sodium hypochlorite.

The relationships of the maxillary central incisors and canines to the incisive papilla in Jordanians.

AIM: The validity of the relationship between the maxillary anterior teeth and the incisive papilla and the pertinence of this relationship to Jordanians was examined. METHODS AND MATERIALS: A computerized digital caliper (CDC) tool was developed and used in the measurements which were made on scanned images of dental casts of 298 Jordanians. The distances from a tangent to the labial surface of the central incisors to the midpoint and the posterior border of the incisive papilla were measured. The tool was also used in marking the exact point on the incisive papilla of the intersection with the line that connected the tips of the maxillary canines. The data sets were analyzed statistically and comparisons among various sets were drawn at a 95% confidence level. RESULTS: Gender had no significant effect on the relationship of the incisive papilla to the maxillary anterior teeth, whereas this relationship was significantly influenced by the incisal classifications of the examined subjects. CONCLUSION: Differences between the Jordanian scores and the Caucasian norms were insignificant. CLINICAL SIGNIFICANCE: Therefore, the guidelines recommended for Caucasians could be used as starting points in the preliminary location of maxillary incisors and canine teeth during construction of dentures for Jordanians.