Retrieval of Fractured Implant Abutment Screws: A Narrative Review.

Objective: Implant abutment screws can fracture due to various biomechanical factors. Improper fit of the prosthesis, inadequate seating of the abutment, occlusal interference, and manufacturing errors are some of the causes that can result in an abutment screw fracture. Retrieval of the retained fractured abutment screw is quite challenging to the clinician. The objective of this review is to provide information on various fractured abutment screw retrieval techniques reported in literature and to formulate a structured treatment protocol for the management of fractured abutment screws. Materials and Methods: An electronic search of Scopus and PubMed databases was performed for articles between January 1989 and December 2021 using the keywords "Implant screw fracture" and "screw retrieval." Results: Most of the articles were of the opinion that abutment screw fractures occurred due to screw loosening. Both conservative approaches and the use of commercial retrieval kits have been advocated to retrieve the fractured abutment screws. Based on various review articles, an innovative novel technique to retrieve an abutment screw fractured due to excessive torque was devised in our unit. Conclusion: Although clinicians can use various techniques to remove fractured abutment screws, every effort should be made to eliminate the cause of screw fracture. Retrieval of the broken screw fragment should be done judiciously to prevent any internal damage to the implant structure.

Goji berry (Lycium barbarum) inhibits the proliferation, adhesion, and migration of oral cancer cells by inhibiting the ERK, AKT, and CyclinD cell signaling pathways: an in-vitro study.

Background: Lycium barbarum (L. barbarum), popularly referred to as Goji berry, is a promising herb known for its powerful anti-antioxidant, antibacterial, and anti-inflammatory properties. It is used in traditional Chinese medicine for treating inflammatory and infectious diseases. It has also shown good anti-cancer properties and has been tested against liver, colon, prostate, breast, and cervical cancers. However, no study has yet evaluated the role of goji berries against oral cancer. Hence, the present paper aims to evaluate the anticancer properties of L. barbarum against oral squamous cell carcinoma. Method: Ethanolic extract of L. barbarum (EELB) was tested for its anticancer properties by performing the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay, colony formation, cell proliferation, and scratch wound test. The impact of EELB on the signaling transduction pathways of Extracellular signal-regulated kinase (ERK1/2), protein kinase (AKT1), cyclin D1 and epithelial-mesenchymal transition (EMT) was also assessed by western blot. Results: The results showed that EELB can impede CAL-27 cell growth, proliferation and migration in-vitro. It even reduced the phosphorylation of ERK1/2 and AKT1 with concomitant downregulation of cyclin D1 (CCND1), cadherin 2 (CDH2), and vimentin (VIM) and upregulation of cadherin 1 (CDH1) expression suggesting its anti-proliferative and anti-EMT effects in oral cancer. Conclusion: Goji berry has good antiproliferative and anti-invasive properties. It affects potential EMT markers and signaling transduction pathways involved in oral cancers. Hence goji berry can be tried as a potential anticancer agent to manage oral squamous cell carcinoma.

Can povidone iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence-based update.

The Coronavirus disease in 2019 (COVID-19), also referred to as the novel 'CoV19 (nCov19)' is caused by a new coronavirus strain similar to Severe Acute Respiratory Syndrome (SARS-CoV-2). SARS-CoV-2 spreads via respiratory droplets, saliva, or direct contact. Therefore it is important to control the viral load in the saliva and respiratory secretions. One of the most simple and cost-effective measures that can be adopted by the public and healthcare professionals to prevent cross-contamination and community transmission, is the implementation of effective oral and throat hygiene. Recent evidence has confirmed that 0.5% povidone iodine (PVP-I) mouthrinse/gargle for 30 s can reduce SARS-CoV-2 virus infectivity to below detectable levels. PVP-I can even interrupt SARS-CoV-2 attachment to oral and nasopharyngeal tissues and lower the viral particles in the saliva and respiratory droplets. Thus, the use of PVP-I mouthrinse as a prophylactic measure has been advocated across the globe to reduce disease transmission. Although the efficacy of PVP-I against SARS-CoV-2 is proven, no review articles have yet discussed the evidence and mechanisms of PVP-I against the SARS-CoV-2. Thus, this paper highlights the rationale, safety, recommendations, and dosage of PVP-I gargle/mouthrinse as an effective method to decrease the viral loads during the pressing times of COVID-19.

A five-step risk management process for geriatric dental practice during SARS-CoV-2 pandemic.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that causes coronavirus infection (COVID-19). COVID-19 is a highly contagious disease transmitted through respiratory droplets, saliva and other contact routes. Within 10 months of its outbreak, SARS-CoV-2 has infected more than 23 million people around the world. Evidence suggests that older adults are the most vulnerable to infection and have an increased risk of mortality. Reduced immunity and underlying medical conditions make them risk-prone and vulnerable to critical care. Older adults affected with the SARS-CoV-2 virus present with distinct clinical manifestations necessitating specific treatment needs and management protocols. While it is crucial to prevent the spread of novel coronavirus (2019-nCoV), the role of oral healthcare workers in addressing the specific needs of ageing adult patients by adopting specific guidelines and appropriate infection control protocols is timely. This paper aims to develop specific guidelines and protocols for the dental management of geriatric patients during the COVID-19 pandemic.

Porphyromonas gingivalis adopts intricate and unique molecular mechanisms to survive and persist within the host: a critical update.

is an obligate, asaccharolytic, gram-negative bacteria commonly associated with increased periodontal and systemic inflammation. P. gingivalis is known to survive and persist within the host tissues as it modulates the entire ecosystem by either engineering its environment or modifying the host's immune response. It interacts with various host receptors and alters signaling pathways of inflammation, complement system, cell cycle, and apoptosis. P. gingivalis is even known to induce suicidal cell death of the host and other microbes in its vicinity with the emergence of pathobiont species. Recently, new molecular and immunological mechanisms and virulence factors of P. gingivalis that increase its chance of survival and immune evasion within the host have been discovered. Thus, the present paper aims to provide a consolidated update on the new intricate and unique molecular mechanisms and virulence factors of P. gingivalis associated with its survival, persistence, and immune evasion within the host.

Ibuprofen-induced localized frontal and temporal forehead swellings: A rare case report.

Ibuprofen, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), is one of the most commonly prescribed analgesics for managing musculoskeletal, orofacial, and postoperative pain after periodontal therapy. Although considered as one of the safest analgesic agents, the onset of adverse drug reactions after ibuprofen intake has been recently observed. The present report aims to highlight the development of localized swellings in the temporal and frontal forehead following intake of 200 mg of ibuprofen after routine oral prophylaxis. This is the first case report to document the development of an adverse drug reaction with ibuprofen in a patient following a routine dental procedure. The article also aim to comprehensively describe the most appropriate and effective method to diagnose, manage, and prevent NSAIDs-induced adverse drug reactions in routine dental practice.

An update on possible pathogenic mechanisms of periodontal pathogens on renal dysfunction.

Periodontitis is a potential source of permanent systemic inflammation that initiates renal dysfunction and contributes to the development of chronic kidney diseases (CKDs). Although numerous studies have confirmed the bidirectional role of periodontal infection and renal inflammation, no literature has yet highlighted the sophisticated pathogenic mechanisms by which periodontal pathogens, particularly Porphynomonas Gingivalis, induce renal dysfunction and contributed in the development of CKDs. The present review aims to critically analyze and highlight the novel pathogenesis of periodontitis induced CKDs.

Etiology and classification of food impaction around implants and implant-retained prosthesis.

BACKGROUND: Food impaction is a common risk factor for the initiation of peri-implant inflammation and failure of the osseointegrated implant. Although clinicians do acknowledge the presence of food impaction around implants and implant-retained prosthesis, no classification system has yet classified the food impaction around the implant and implant-retained prosthesis. PURPOSE: The present paper aims to identify and classify the plausible etiology of food impaction around implants and implant-related prosthesis. MATERIALS AND METHODS: The following search terms were utilized for data search: "Food Impaction" AND "Implants" AND "Food Impaction" AND "Perimplantitis" AND "Food Impaction" AND "Classification." Articles that were written in the English language in PubMed and Cochrane Library database from 1930 till September 2018 were scrutinized. A total of 24 articles were scrutinized, out of which only 15 articles were selected. RESULTS: Food impaction around implants is broadly classified into five categories based on the number of implants, nature of implants prosthesis involved for replacement and relation of the implant prosthesis to the adjacent tooth, restoration, or prosthesis. CONCLUSION: This is the first classification designed to classify food impaction around dental implants and implant-retained prosthesis. The classification can be used by clinicians for optimal diagnosis, interpretation, and treatment plan for patients.

Is zirconia a viable alternative to titanium for oral implant? A critical review.

PURPOSE: Titanium based implant systems, though considered as the gold standard for rehabilitation of edentulous spaces, have been criticized for many inherent flaws. The onset of hypersensitivity reactions, biocompatibility issues, and an unaesthetic gray hue have raised demands for more aesthetic and tissue compatible material for implant fabrication. Zirconia is emerging as a promising alternative to conventional Titanium based implant systems for oral rehabilitation with superior biological, aesthetics, mechanical and optical properties. This review aims to critically analyze and review the credibility of Zirconia implants as an alternative to Titanium for prosthetic rehabilitation. STUDY SELECTION: The literature search for articles written in the English language in PubMed and Cochrane Library database from 1990 till December 2016. The following search terms were utilized for data search: "zirconia implants" NOT "abutment", "zirconia implants" AND "titanium implants" AND "osseointegration", "zirconia implants" AND compatibility. RESULTS: The number of potential relevant articles selected were 47. All the human in vivo clinical, in vitro, animals' studies were included and discussed under the following subheadings: Chemical composition, structure and phases; Physical and mechanical properties; Aesthetic and optical properties; Osseointegration and biocompatibility; Surface modifications; Peri-implant tissue compatibility, inflammation and soft tissue healing, and long-term prognosis. CONCLUSIONS: Zirconia implants are a promising alternative to titanium with a superior soft-tissue response, biocompatibility, and aesthetics with comparable osseointegration. However, further long-term longitudinal and comparative clinical trials are required to validate zirconia as a viable alternative to the titanium implant.

Management of Furcal Perforation with Advanced Furcation Defect by a Minimally Invasive Tunnel Technique.

A perforation in the furcation area is a potential risk factor for extension of pulpal inflammation into the periodontium and formation of advanced furcation defect with severe loss of clinical attachment and interradicular bone. Furthermore, the management of such furcal perforation is difficult due to poor accessibility, visibility, and regenerative potential. The development of such advanced furcation defects further compromises the prognosis of the treatment as they preclude effective plaque control and maintenance by the patient. Therefore, the management of advanced furcation defects remains an enigmatic and challenging task for the clinician. This case report describes a minimally invasive approach for the treatment of a furcal perforation by a conservative tunnel preparation. The present case report aims to highlight the importance of surgical tunnel preparation as an alternative to conventional flap procedure to repair furcal perforation with advanced furcation defects.

Herpes zoster of gingiva in an older woman: a rare case report.

OBJECTIVE: The aim of the article is to highlight the distinguishing features of secondary varicella gingival infection in an older women. BACKGROUND: Herpes zoster is an acute sporadic, painful viral infection in older people caused by the reactivation of the latent varicella zoster virus. Herpes zoster affecting the gingiva without any dermal lesions is a rare pathological condition that mimics many intraoral vesiculobullous lesions. The ambiguous nature of this condition creates a diagnostic dilemma. MATERIALS AND METHODS: A 58-year-old woman presented with an acute, unilateral and persistent burning sensation and pain in the gingiva with desqaumating vesicullobulous lesion. RESULTS: The women was diagnosed with secondary varicella zoster infection. CONCLUSION: Herpes zoster of the gingiva could manifest as painful desquamative vesicular lesions, pulpal or other painful neuralgic condition in older individuals which need careful diagnosis before formulating appropiate treatment plan.

Auditory and Nonauditory Effects of Ultrasonic Scaler Use and Its Role in the Development of Permanent Hearing Loss.

PURPOSE: To evaluate the negative auditory and non-auditory effects developed immediately after using ultrasonic scalers and their potential role in the development of permanent hearing loss. MATERIALS AND METHODS: The auditory functions of 60 dental clinicians were evaluated with the pure tone audiometry test (PTA), tympanogram and the otoacoustic emission test (OAE) before and immediately after using ultrasonic scalers. The paired t-test was used to evaluate the difference in the pre- and post-exposure recordings for all three tests. RESULTS: There was a significant increase in the PTA and tympanogram test results, along with reduced OAE values immediately after using ultrasonic scalers. Hearing ability dropped by 63% to 66% immediately after using ultrasonic scalers. The maximum hearing disability was noted for low-frequency thresholds. The reduction was greater in the left than in the right ear. CONCLUSIONS: Noise-emitting devices such as ultrasonic scalers produce significant immediate auditory and non-auditory changes. It is important that dentists recognise the initial signs of hearing damage and adopt appropriate measures while working to prevent the development of permanent hearing impairment in future.

"United Pedicle Flap" for management of multiple gingival recessions.

Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions.

Green Tea Intake as an Adjunct to Mechanical Periodontal Therapy for the Management of Mild to Moderate Chronic Periodontitis: A Randomized Controlled Clinical Trial.

PURPOSE: To evaluate and compare the beneficial effects of green tea intake on the total antioxidant capacity of gingival crevicular fluid (GCF) and plasma, and to examine its role as an adjunct to nonsurgical periodontal therapy for the management of chronic periodontitis. MATERIALS AND METHODS: 120 subjects with mild to moderate chronic periodontitis were divided equally into two groups. After scaling and root planing in all subjects, green tea supplements were given to the case group and a placebo to the control group. The clinical parameters gingival index, plaque index, clinical probing depth, clinical attachment loss, percentage of sites with bleeding on probing, along with total antioxidant capacity of GCF and plasma were recorded at baseline, one and three months. RESULTS: There was a significant improvement in all clinical parameters along with an 8-fold greater antioxidant capacity in GCF in the case group than in the control group. CONCLUSION: Green tea intake as a component of nonsurgical periodontal therapy is promising for superior and rapid resolution of the disease process. Green tea increases the total antioxidant capacity of GCF and plasma along with potent anti-inflammatory, astringent and anti-plaque effects.

Calcium phosphate barrier for augmentation of bone in noncontained periodontal osseous defects: a novel approach.

AIM: The aim of this technique is to augment bone in non-contained osseous deformities using a unique self-sustaining calcium phosphate barrier. INTRODUCTION: Bone has the inherent ability to regenerate completely if it is provided with a fracture space or an undisturbed enclosed scaffold. A secluded environment is essential as it provides a secured, sterile and stable wound system that regenerates lost bone by a process of osteopromotion. Reconstructive techniques using bone grafts and barrier membranes utilize this principle for augmentation of deficient bony sites by providing a closed environment that promotes clot stability, graft retention, and facilitates correct cell repopulation. However, in noncontained bone defects like one walled infrabony periodontal defect or sites with horizontal bone loss, regeneration of bone still remains an unrealistic situation since osseous topography at such sites does not favor membrane stability or bone grafts retention. This case report presents a promising technique to augment bone in areas with horizontal loss. TECHNIQUE: Augmentation of bone in the interdental area with horizontal bone loss was accomplished by building a contained defect using a unique self sustaining calcium phosphate cement formulation. The calcium phosphate barrier stimulates the lost cortical plates and promotes graft retention and clot stability. At 6 months, there was a significant bone fill and trabecular formation in the interdental area and reduction in tooth mobility. CONCLUSION: This promising technique could prove to be a good alternative to the conventional approaches for treating osseous deformities. CLINICAL SIGNIFICANCE: Calcium phosphate is a promising barrier graft for repair of noncontained periodontal osseous defect. This technique cues both the clinicians and manufacturers to develop moldable tissue engineered constructs for osseous repair.