Cone Beam Computed Tomography Analysis of Posterior-Superior Alveolar Canal from a Fixed Reference Point: Implications for Sinus Floor Elevation Procedure through Lateral Approach.

Objective: Sinus floor elevation is commonly done in the maxillary posterior region prior to dental implant placement. This study primarily aimed at assessing the location of the posterior superior alveolar artery (PSAA) canal on cone beam computed tomography (CBCT) scans and its relation to the alveolar ridge and maxillary sinus from a fixed reference point. Material and Methods: A total of 226 edentulous maxillary molar sites were included in this retrospective analysis. The distance from the PSAA to the sinus floor (SF), alveolar crest (AC) and a fixed reference point, that is, the roof of sinus (RS) were measured. The alveolar bone height (ABH), thickness of the crestal keratinized mucosa (CKM) and thickness of Schneiderian membrane (SM) were also evaluated. Results: 54 sites (23.89%) were excluded from the study. The SF, AC, RS and ABH values averaged at 11.91 mm ± 3.63 mm, 16.05 mm ± 3.96 mm, 25.32 mm ± 7.13 mm and 4.93 mm ± 4.27 mm respectively. SF and AC was higher in second molar than first molar region (p < 0.001), but RS did not show significant difference (p = 0.85). CKM and SM averaged at 2.02 mm ± 0.68 mm and 1.31 mm ± 0.81 mm respectively. Conclusion: The PSAA can be visualized in CBCT scans with a prevalence of 76.11% and may not be detected when adherent to the sinus membrane. This study stresses on the need for a CBCT, prior to sinus surgeries through lateral approach, to assess the PSAA.

Survival and success of zirconia compared with titanium implants: a systematic review and meta-analysis.

OBJECTIVE: This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic and clinical parameters, as well as biological and mechanical complications, were considered. MATERIALS AND METHODS: A systematic search was performed up to March 2022 to identify CCTs/RCTs comparing zirconia and titanium implants with a minimum of 12 months of follow-up. Meta-analysis was performed when ≥ 2 articles with similar characteristics were retrieved. RESULTS: Four published articles with two RCTs (2 different patient populations) with 100 zirconia and 99 titanium implants that were followed up over 12-80 months were selected out of the 6040 articles. A non-statistically significant difference between zirconia and titanium implant survival at 12 months was suggested (P = 0.0938). The success rates were 57.5-93.3% and 57.1-100% for zirconia and titanium implants, respectively. The pink aesthetic score (PES) was higher for zirconia (10.33 ± 2.06 to 11.38 ± 0.92) compared to titanium implants (8.14 ± 3.58 to 11.56 ± 1.0). CONCLUSION: Based on the 2 RCTs retrieved in the literature, similar survival rates were reported for zirconia and titanium implants in the short term (12 months of follow-up). Future RCTs are warranted to evaluate the long-term outcomes of zirconia implants. CLINICAL RELEVANCE: Zirconia implants may be the procedure of choice, particularly in the aesthetic zone, since they show a similar survival and success rate as titanium implants on a short-term follow-up. TRIAL REGISTRATION: Systematic review registration number-CRD42021288704 (PROSPERO).

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments.

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

Three-dimensional assessment of the mandibular lingual foramina with implications for surgical and implant therapy: A multicentre cross-sectional study.

Treatment planning for dental implants in the anterior mandible is often complicated by the presence of vascular structures. The aim of our study was to investigate the prevalence, location and morphology of the mandibular lingual foramen (LF) through cone beam computed tomography (CBCT) scans and contribute to its anatomical knowledge in an Indian population. A total of 400 mandibular anterior CBCT scans from 4 centers were included in this retrospective analysis. The vertical distance from alveolar crest (Hcre) and inferior border of mandible (Hinf) to the LF, horizontal distance from lingual canal to labial cortical plate (LC-CP), length of the lingual canal (LLC) and diameter of the LF were measured. Data was analysed using Wilcoxon signed rank test and compared between median and lateral LF. 14 (3.5%) scans were excluded due to non-visualization of LF. A lateral LF was detected in 149 scans (38.6%), predominantly in the canine region (61.7%). Hcre was significantly higher for median LF (16.35 ± 4.59 mm) than lateral LF (12.94 ± 3.92 mm) (p < 0.001), while Hinf did not show significant difference between median (11.38 ± 3.62 mm) and lateral (12.94 ± 3.92 mm) LF (p = 0.0032). The LC-CP, LLC and diameter of LF averaged at 5.05 ± 1.76 mm, 6.26 ± 1.82 mm and 0.88 ± 0.72 mm respectively. The LF can be visualized in CBCT scans with a prevalence of 96.5%. This study stresses on the need for a CBCT, prior to surgeries in anterior mandible to avoid excessive bleeding episodes.

Effect of crown-to-implant ratio on the marginal bone level changes and implant survival - A systematic review and meta-analysis.

The purpose of the systematic review and meta-analysis was to analyze the existing evidence regarding the effect of crown-to-implant ratio (CIR) on the peri-implant crestal bone level change and implant survival. Randomized controlled clinical trials, prospective as well as retrospective studies with a minimum follow-up period of 12 months and 10 patients per group were included for this systematic review. Statistical analysis was performed to determine CIR effects on the peri-implant marginal bone level changes and implant survival. A total of 28 articles (14 prospective studies and 14 retrospective studies) from a database of 201 articles, with 2097 patients and 4350 implants, were included. A mean CIR ranging from 0.6 to 2.44 was presented by the study groups. A weighted mean implant loss of 0.19% per year and peri-implant marginal bone level change of 0.63 mm ± 0.55 over 46.8 ± 5.2 months was calculated from the included studies. The peri-implant marginal bone level change (p = 0.155) and the rate of implant loss (p = 0.245) showed a statistically insignificant difference between implant restorations of a high (>1.5:1) and low (<1.5:1) CIR. Within its limitations, this review concludes that a high (>1.5:1) or a low (<1.5:1) CIR does not significantly affect the peri-implant marginal bone level change and implant survival rate. However, until further evidence becomes available, extrapolation to long term clinical success cannot be ascertained.

Buccally displaced flap versus sub-epithelial connective tissue graft for peri-implant soft tissue augmentation: a pilot double-blind randomized controlled trial.

BACKGROUND: This article describes a novel surgical technique, the buccally displaced flap, for keratinized mucosa (KM) augmentation during implant uncovering. Furthermore, it clinically compares this technique with sub-epithelial connective tissue graft (SCTG) for peri-implant KM augmentation. Twelve weeks following implant placement, subjects were randomly divided for KM augmentation into group A (buccally displaced flap) and group B (SCTG). The width (WKM) and thickness (TKM) of the KM were assessed prior to the implant uncovering, 4 weeks and 1 year after implant loading. Post-operative pain assessment was performed using the Numeric Rating Scale. RESULTS: The study comprised of 20 implants that were uncovered in 20 subjects. For group A, the mean WKM increased from 0.98 (± 0.23 mm) to 3.01 mm (± 0.18 mm), and the mean TKM increased from 1.45 (± 0.13 mm) to 2.21 mm (± 0.16 mm) at 1 year. For group B, the mean WKM increased from 0.93 (± 0.18 mm) to 3.28 mm (± 0.13 mm), and the mean TKM increased from 1.41 (± 0.15 mm) to 2.25 mm (± 0.11 mm) at 1 year. Post-operative pain was significantly higher for group B 4.15 (± 1.35) as compared to group A 2.6 (± 1.22) (p < 0.001). CONCLUSION: The buccally displaced flap increased the WKM and TKM during implant uncovering, with results comparable to SCTG. The main advantages of the technique were lack of sutures, maintenance of blood supply, reducing number of surgical sites, and it was relatively atraumatic with lesser post-operative pain. TRIAL REGISTRATION: Clinical trials registry-India CTRI/2019/09/021059 . Date of registration-September 4, 2019, retrospectively registered.

Three-Dimensional Alveolar Bone Assessment of Mandibular First Molars with Implications for Immediate Implant Placement.

The aim of this retrospective study was to evaluate the alveolar dimensions of the mandibular molar using cone beam computed tomography (CBCT) for immediate implant placement. The width of buccal (WB) and lingual (WL) bone; width of interradicular bone 2 and 4 mm apical to the furcation and at the apex (IRB2, IRB4, and IRBA, respectively); and distance to the inferior alveolar nerve from the furcation (IAN-F) and mesial (IAN-M) and distal (IAN-D) roots were evaluated from CBCT records of 126 subjects (200 mandibular first molars). Mean WB (0.84 ± 0.39 mm) and WL (2.71 ± 1.17 mm) measurements showed significant differences (P = .003). Differences between IAN-F, IAN-M, and IAN-D measurements averaged at 14.14 ± 2.57 mm, 4.31 ± 1.06 mm, and 4.61 ± 1.02 mm, respectively. IRB2, IRB4, and IRBA dimensions were 1.93 ± 0.65 mm, 2.54 ± 0.9 mm, and 4.46 ± 1.91 mm, respectively. The findings of the study demonstrate the alveolar bone morphology of the mandibular first molar and the need for CBCT scans for proper treatment planning for immediate implant placement.

Quantitative Assessment of the Edentulous Posterior Maxilla for Implant Therapy: A Retrospective Cone Beam Computed Tomographic Study.

AIM: Dimensional changes of the alveolar bone are often noted in horizontal and vertical planes as a sequel to tooth extraction, particularly in the maxillary posterior region due to alveolar bone resorption combined with pneumatization of the sinus. The aim of this retrospective study was to quantitatively assess the maxillary residual alveolar ridge using cone beam computed tomography (CBCT) scans. MATERIALS AND METHODS: A total of 349 edentulous sites from 250 CBCTs were evaluated. The apico-coronal bone height and bucco-palatal crest width were measured in sagittal and coronal slices, respectively. Additionally, the obliqueness of the sinus floor at the edentulous sites was also evaluated. RESULTS: One hundred and twelve (55.45%) of the molar and 74 (54.42%) of the premolar sites had a horizontal ridge dimension < 6 mm, whereas 137 (67.83%) of the molar and 61 (44.86%) of the premolar sites showed an apico-coronal height < 8 mm. Furthermore, 183 (54.14%) of the evaluated sites had an oblique sinus floor morphology. CONCLUSION: Additional augmentative procedures are thus required in a high percentage of the population at the edentulous maxillary posterior site for rehabilitation using a standard dimension implant. This study stresses on the need for a three-dimensional CBCT prior to implant surgery for proper treatment planning.

Osseodensification -- A systematic review and qualitative analysis of published literature.

The recently introduced technique of osseodensification for dental implant involves the use of special drills (Densah) run in a counter-clockwise direction at the osteotomy site. It is claimed that this causes expansion of the osteotomy site, and increases density of the bone in immediate vicinity of the osteotomy. We reviewed published papers on the primary stability attained using this drilling technique. As a secondary finding, the bone to implant contact (BIC) and the bone area fraction occupancy (BAF) was also compared between the conventional drilling protocol and the osseodensification protocol, among these articles. A Systematic search was performed in PubMed-Medline, Embase and Google Scholar for clinical/animal studies up to November 2018. A total of 12 articles, from a database of 132 articles, consisting of 8 animal histologic studies, 2 human based clinical studies, 1 case series and 1 case report were assessed. 10/12 articles measured the insertion torque values, 7/12 articles measured the BIC and 6/12 articles estimated the BAF between the two techniques. Quality assessment of 8 studies performed using ARRIVE guidelines showed that 6/8 studies had a high score. An average increase in the insertion torque, BIC and BAF was noted in the osseodensification group as compared to the conventional drilling group. Since most of these studies are non-clinical, it can be inferred that osseodensification is an efficient way to enhance primary stability of implants in low density bone in an animal model. However, extrapolation to long term clinical success cannot be ascertained until further evidence becomes available.

Quantification and Comparison of the Impact of the Smoking Status on Oral Polymorphonuclear Leukocyte and Malondialdehyde Levels in Individuals with Chronic Periodontitis: A Double-Blinded Longitudinal Interventional Study.

BACKGROUND: The formation of reactive oxygen species by oral polymorphonuclear leukocytes (oPMNs) is amplified in smokers with chronic periodontitis (CP) causing tissue damage which can be measured by quantifying levels of malondialdehyde (MDA). OBJECTIVE: To quantify and compare the impact of smoking status on oPMN and MDA in individuals with CP before and after scaling and root planing (SRP). MATERIALS AND METHODS: Sixty individuals were divided into four groups, namely, periodontally healthy (Group A), current smokers with CP (Group B), former smokers with CP (Group C), and nonsmokers with CP (Group D). Parameters assessed were bleeding on probing (BOP), gingival index (GI), probing pocket depth (PPD), clinical attachment level, gingival recession, periodontal inflamed surface area, salivary MDA, and oPMN at baseline and 6 and 12 weeks after SRP. RESULTS: Increased PPD (P = 0.01) and decreased GI (P = 0.021) was noted in Group B as compared to C and D at baseline. Periodontal intervention caused a greater resolution of inflammation in Groups C and D as compared to B as noted from the GI and BOP. A reduction in MDA (P = 0.074) was noted in Groups C and D as compared to B, and oPMN levels were higher (P = 0.009) in Group C and D as compared to B. CONCLUSION: Greater periodontal destruction is seen in current smokers than former and nonsmokers with CP. MDA can be considered as a reliable biomarker for oxidative stress as it directly correlates with the oPMN levels.

Effect of Pre-Procedural Chair-Side Finger Stretches on Pinch Strength amongst Dental Cohort- A Biomechanical Study.

INTRODUCTION: Ergonomics is the essential principle behind the health and successful practice for a dentist and dental hygienist. During the procedure of dental Scaling and Root Planing (SRP), a high level of pinch force is exerted by the finger muscles resulting in early muscle fatigue. AIM: This pilot study comparatively evaluated the Pinch Strength (PS) of the finger muscles, prior to and after SRP, amongst dental cohort performing chair-side hand and finger stretches to those not performing the same. MATERIALS AND METHODS: Forty dental professionals were recruited by purposive sampling for the study and allocated into a test and control group. PS was recorded for both groups following which the test group performed finger stretches comprising of rubber band stretch, tendon glide, finger flexion and extension, thumb flexion and finger webbing. The subjects of both the groups carried out SRP for 30 minutes after which PS was again recorded. Inter-group difference was analysed for variability at baseline and 30 minutes after SRP using independent samples/unpaired t-test. Within group comparison of PS measurement was done using paired t-test. RESULTS: The PS for the test group declined from 14.425±2.577 pounds (lbs) to 13.725±2.557 lbs, while for the control group, a decline in PS from 13.65±2.636 lbs to 10.675±2.478 lbs after SRP was noted. On comparing the difference of means of both groups, a statistically significant result was obtained. CONCLUSION: Work-related musculoskeletal disorders can be reduced by performing a few simple chair-side stretches. These stretches can help prevent the finger muscle fatigue during SRP and thus, increase its efficacy.