Histological Evaluation of Alveolar Ridge Preservation Using Different Bone Grafts: Clinical Study Analysis Part II.

To compare histologically the percentage of bone formation 12-20 weeks after ridge augmentation using 2 different techniques. Tooth loss is associated with 3-dimensional bone remodeling and ridge atrophy. Ridge preservation procedures can prevent alveolar bone volume loss. Different techniques and materials are used to preserve the alveolar ridge. Computer-generated randomization software was used to assign 2 ridge preservation techniques for 11 extraction sites. In group I, type I bovine Achilles tendon collagen plugs with bioactive resorbable calcium apatite crystals (CPCAC) were placed, and in group II, cortico-cancellous bone chips (CCBC) mix and an expanded polytetrafluoroethylene (ePTFE) barrier membrane were placed. The histomorphometric studies were performed using a computer-based image analysis system (ImageJ 1.4, National Institute of Health, Bethesda, Md) to calculate the pixel area of bone tissue and the remaining bone graft material. The histomorphometric data were analyzed using a Student t test to compare the measurements between the 2 experimental groups. This parametric statistical test was employed to determine if there were any statistically significant differences in the quantitative histological parameters between the groups. The sockets that received CPCAC showed a lower (31.89%) percentage of native bone surface area compared with the CCBC group (43.87%). However, the difference was not statistically significant (P < .05). In addition, the CPCAC group showed evidence of foreign-body reaction. The CCBC graft covered with an ePTFE barrier may induce more bone formation with minimal inflammation in an extraction socket compared with a collagen plug with calcium apatite crystals. In addition, histological analysis of the CPCAC graft showed evidence of foreign-body reaction, which indicates a negative clinical impact.

A Fully Digital Workflow to Achieve Predictable Esthetic and Functional Outcomes: A Case Series.

Various types of digital dental technologies have been successfully implemented as a part of dental treatment to improve predictability and efficiency of dental procedures. Virtual smile design can be used to enhance predictability from an esthetic perspective, and the virtual articulator can be a useful tool to create a desired occlusal scheme. This case series describes a fully digital workflow that can predictably achieve desired esthetic and functional outcomes. The proposed protocol also includes other currently available digital technologies, such as intraoral scanning, computer-aided design, milling, and 3D printing. Three clinical cases are presented to describe the workflow in detail.

Assessing readiness to manage medical emergencies among dental students at four dental schools.

BACKGROUND AND PURPOSE: Dentists treat a wide range of patients, including patients with compromised health conditions. While rendering treatment, various medical emergencies can and do occur. To help increase the knowledge required to manage such emergencies, dental students must be trained while in dental school. This study aims to assess the level of medical emergency preparedness and knowledge among dental students at four dental schools. MATERIAL AND METHODS: The participating dental schools were IUSD, Case Western Reserve University School of Dentistry, Marquette University School of Dentistry, and the University of Alabama School of Dentistry. Groups were designed to include 20 dental students from Years 1 to 4. Students were asked to fill out a survey and were then tested on 10 clinical medical emergency scenarios. RESULTS: A total of 331 dental students participated in the study. The scores based on 10 case scenarios presented with a range of 4.35-8.02. There was no statistically significant difference in the level of preparedness when dental schools were compared. However, Year 1 and Year 2 dental students had significantly lower total scores than those of Years 3 and 4. The students in Years 1 and 2 demonstrated less confidence in their current knowledge to manage medical emergencies. Satisfaction with the training received ranged from 38% to 84%. CONCLUSION: The results from this study indicate that students' preparedness to manage medical emergencies at these four dental schools is statistically similar. Additional yearly training could enhance students' preparedness in the management of medical emergencies in the dental setting.

Precision and trueness of implant placement with and without static surgical guides: An in vitro study.

STATEMENT OF PROBLEM: Malpositioning of implants is one of the main factors leading to hard- and soft-tissue deficiencies. Whether static computer-guided implant placement increases accuracy and prevents malpositioning is unclear. PURPOSE: The purpose of this in vitro study was to determine accuracy defined by trueness and precision (according to International Organization for Standardization 5725) of computer-assisted implant surgery (fully guided and partially guided) in comparison with freehand single implant placement. MATERIAL AND METHODS: Implants (n=20) were placed fully guided (sleeve-bone distance of 2, 4, or 6 mm), partially guided (guide used for pilot drill), or free hand in identical replicas produced from a cone beam computed tomography (CBCT) scan of a partially edentulous patient. The achieved implant position was digitized by using a laboratory scanner and compared with the planned position. Trueness (planned versus actual position) and precision (difference among implants) were determined. The 3D-offset at the crest of the implant (root mean square between virtual preoperative planning and postoperative standard tessellation language file) was defined as the primary outcome parameter. The means, standard deviation, and 95% confidence intervals were analyzed statistically with 1-way ANOVA and the Scheffé procedure. RESULTS: Fully guided implant surgery achieved significantly lower 3D deviations between the planned and actual implant position with 0.22 ±0.07 mm (2-mm sleeve-bone distance) than partially guided 0.69 ±0.15 mm and freehand placement 0.80 ±0.35 mm at the crest (P<.001). The distance among the implants in each group was again lowest in the fully guided group and highest in the freehand group. CONCLUSIONS: The static computer-assisted implant surgery showed high trueness and precision. The closer the sleeve to the bone, the more accurate and precise the method. Freehand implant placement was less accurate and precise than computer-assisted implant surgery (partially or fully).

The effect of partially exposed connective tissue graft on root-coverage outcomes: a systematic review and meta-analysis.

The aim of this systematic review was to compare the root-coverage outcomes of using a partially exposed connective tissue graft (CTG) technique with a fully covered CTG technique for root coverage. An electronic search up to February 28th , 2017, was performed to identify human clinical studies with data comparing outcomes of root coverage using CTG, with and without a partially exposed graft. Five clinical studies were selected for inclusion in this review. For each study, the gain of keratinized gingiva, reduction of recession depth, number of surgical sites achieving complete root coverage, percentage of root coverage, gain of tissue thickness, and changes of probing depth and clinical attachment level were recorded. Meta-analysis for the comparison of complete root coverage between the two techniques presented no statistically significant differences. A statistically significant gain of keratinized tissue in favor of the sites with an exposed CTG and a tendency of greater reduction in recession depth were seen at the sites with a fully covered CTG. Based on the results, the use of a partially exposed CTG in root-coverage procedures could achieve greater gain in keratinized gingiva, while a fully covered CTG might be indicated for procedures aiming to reduce recession depth.

Effect of membrane exposure on guided bone regeneration: A systematic review and meta-analysis.

AIMS: This review aimed at investigating the effect of membrane exposure on guided bone regeneration (GBR) outcomes at peri-implant sites and edentulous ridges. MATERIAL AND METHODS: Electronic and manual literature searches were conducted by two independent reviewers using four databases, including MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials, for articles up to February 2017. Articles were included if they were human clinical trials or case series reporting outcomes of GBR procedures with and without membrane exposure. A random-effects meta-analysis was conducted, and the weighted mean difference (WMD) between the two groups and 95% confidence interval (CI) were reported. RESULTS: Overall, eight articles were included in the quantitative analysis. The WMD of the horizontal bone gain at edentulous ridges was -76.24% (95% CI = -137.52% to -14.97%, p = .01) between sites with membrane exposure and without exposure. In addition, the WMD of the dehiscence reduction at peri-implant sites was -27.27% (95% CI of -45.87% to -8.68%, p = .004). Both analyses showed significantly favorable outcomes at the sites without membrane exposure. CONCLUSION: Based on the findings of this study, membrane exposure after GBR procedures has a significant detrimental influence on the outcome of bone augmentation. For the edentulous ridges, the sites without membrane exposure achieved 74% more horizontal bone gain than the sites with exposure. For peri-implant dehiscence defects, the sites without membrane exposure had 27% more defect reduction than the sites with exposure.

Evaluation of a post-treatment follow-up program in patients with oral squamous cell carcinoma.

OBJECTIVES: The duration and the frequency of follow-up after treatment of oral squamous cell carcinoma are not standardized in the current literature. The purpose of this study was to evaluate our local standard post-treatment and follow-up protocol. MATERIALS AND METHODS: Overall, 228 patients treated curatively from 01/2006 to 07/2013 were reviewed. To evaluate the follow-up program, data on the secondary event were used. To determine risk groups, all patients with tumor recurrence were specifically analyzed. Relapse-free rate were estimated by the Kaplan-Meier product limit method. The chi-square test was used to identify independent risk factors for tumor relapse. RESULTS: In total, 29.8 % patients had a secondary event. The majority of the relapse cases (88.2 %) were detected within 2 years postoperatively, 61.8 % of them within the first year. Most events were local recurrences (34.7 %). UICC-stage IV was significantly associated with tumor recurrence (p = 0.001). Gender (p = 0.188), age (p = 0.195), localization (p = 0.739), T-stage (p = 0.35), N-stage (p = 0.55), histologic grade (p = 0.162), and tobacco and alcohol use (p = 0.248) were not significantly associated with tumor recurrence. Patients with positive neck nodes relapsed earlier (p = 0.011). The majority of relapses (86.3 %) were found in asymptomatic patients at routine follow-up. CONCLUSIONS: The results of this study suggest an intensified follow-up within the first 2 years after surgery. CLINICAL RELEVANCE: Given the higher relapse rate of patients exhibiting an UICC-stage IV and/or positive neck nodes, it seems to be from special interest to perform in this group a risk-adapted follow-up with monthly examinations also in the second year.

Treatment of a Periodontic-Endodontic Lesion in a Patient with Aggressive Periodontitis.

Case Description. This case report describes the successful management of a left mandibular first molar with a combined periodontic-endodontic lesion in a 35-year-old Caucasian woman with aggressive periodontitis using a concerted approach including endodontic treatment, periodontal therapy, and a periodontal regenerative procedure using an enamel matrix derivate. In spite of anticipated poor prognosis, the tooth lesion healed. This case report also discusses the rationale behind different treatment interventions. Practical Implication. Periodontic-endodontic lesions can be successfully treated if dental professionals follow a concerted treatment protocol that integrates endodontic and periodontic specialties. General dentists can be the gatekeepers in managing these cases.

Assessment of the calibration of periodontal diagnosis and treatment planning among dental students at three dental schools.

Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.