Successful Regenerative Therapy of Periodontal Defects Associated With Tongue Piercing: A Clinical Report.

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework.

Bone-to-Implant Contact: Its Relationship to Factors That Affect Primary and Biologic Implant Stability.

The authors assessed the literature regarding bone-to-implant contact (BIC). A wide range of mean BIC percentages was observed with respect to different commercially inserted implants. Higher BIC related to mandibular implants was found compared to maxillary fixtures and with respect to anterior versus posterior implants. Higher bone density is associated with better implant stability and BIC, while rough implant surfaces provide increased BIC versus smooth surfaces. This article discusses how to determine the percentage of BIC and describes factors that affect its values.

Clinical, Radiographic, and Inflammatory Peri-Implant Parameters around Narrow Diameter Implant Crowns among Prediabetic and Non-Diabetic Subjects.

Background and Objectives: To compare the clinical, radiographic, and inflammatory peri-implant parameters around narrow diameter implants (NDI) supported single and splinted crowns in non-diabetics and prediabetes. Materials and Methods: The clinical and radiographic parameters and the levels of IL-6 and TNF-α in the peri-implant crevicular fluid (PICF) of narrow diameter single (NDISCs) and splinted (NDISPs) crown implants were assessed both in non-diabetics and participants with prediabetes. The glycemic state of the patient was assessed using glycated hemoglobin (HbA1c) levels. The peri-implant soft tissue indices (Plaque index (PI), bleeding on probing (BoP), probing depth (PD)) and marginal bone loss were recorded and compared between the groups. Success of the prosthesis was assessed by the frequency of technical complications and patient satisfaction. Inter-group comparison was performed using ANOVA (one-way analysis of variance) while the normal distribution of dependent variables was calculated using Shapiro-Wilk. A p-value of less than 0.05 was considered to be statistically significant. Results: Sixty participants (30 non-diabetics and 30 with prediabetes) with a total of 178 (118 NDISCs and 60 NDISPs) platform-switched NDIs were a part of the study. Of the 118 NDISCs, 56 were placed in the non-diabetic individuals and 62 were placed in the prediabetes group whereas 30 NDISPs each were placed in both the study groups. The clinical parameters of PI, BoP and PD in the single crown and splinted crown groups showed comparable results. However, a statistically significant difference (p-value of less than 0.05) in PI, BoP and PD and in the values of IL-6 and TNF-α was found when a comparison was made between the non-diabetes and prediabetes group. A total of 91% of the patients were satisfied with the esthetics of the implants while 79% of the patients showed satisfaction with function. Conclusions: All the clinical and radiographic parameters were statistically similar in both single and splinted types of narrow diameter implants. However, the bone loss, probing depth, plaque index, and levels of inflammatory markers were statistically higher in prediabetes as compared to non-diabetes implying that a slight hyperglycemic state impacts peri-implant health.

Efficacy of nonsurgical periodontal therapy for treatment of periodontitis: practical application of current knowledge.

This article summarizes the practical application of current knowledge with respect to nonsurgical treatment of periodontitis. The benefits of nonsurgical therapy with or without adjunctive therapies are discussed. The dental literature was searched for articles that addressed outcomes related to mechanical nonsurgical therapy with or without adjunctive aids to treat periodontitis. The classic periodontal literature was assessed for relevant information, and recent systematic reviews and meta-analyses of adjunctive therapies (published within the last 5 years) were evaluated. Mechanical nonsurgical periodontal therapy can provide a predictable result for the treatment of periodontitis in many situations. Unnecessary cementum removal should be avoided because it can cause root sensitivity and loss of clinical attachment in shallow probing depths. Manual and ultrasonic instruments are both effective for treating periodontitis. Depending on the clinician's preference, either manual or ultrasonic instrumentation can be used because both methods achieve equivalent results when treating most cases of periodontitis. Full- and partial-mouth scaling and root planing (SRP) are both effective therapies. At present, clinical trials have failed to show that lasers--whether used as a monotherapy or an adjunct to SRP--provide a significant clinical benefit compared with nonsurgical therapy. To date, studies have shown that the use of systemic and local drug delivery, photodynamic therapy, and probiotics as adjuncts to SRP yields modest improvements compared with SRP alone.

Repairing Maxillary Sinus Membrane Perforations, Iatrogenic or Intentional: Two Case Reports.

INTRODUCTION: Maxillary sinus augmentation is a common and predictable procedure utilized to gain vertical alveolar bone height to allow for successful placement of dental implants in the deficient posterior maxilla. The surgical techniques, however, may be associated with intraoperative complications, the most common of which is Schneiderian membrane perforation and, less commonly, bleeding and the loss of an implant into the sinus cavity. CASE PRESENTATION: In the current report, we present two cases with unique complications. A large perforation which was discovered after the graft material had been placed was successfully managed by carefully removing the graft material from both sides of the perforation and sealing the perforation with a resorbable membrane and a tack fixation. The second case involved a patient who presented with an implant that had migrated into the sinus during an unsuccessful transcrestal sinus lift. The case was successfully treated by locating and removing the implant through an intentional membrane perforation, repairing the perforation, and placing a new implant with simultaneous grafting. CONCLUSION: Management and repair of maxillary sinus membrane perforations that are either intentionally or iatrogenically created can be predictable procedures with favorable outcomes if thoughtful evaluation and treatment are provided. Managing such complications at the time of occurrence avoids unnecessary additional surgical procedures that might prove to be even more complicated.

Significance of Facial Bone Thickness After Dental Implantations in Healed Ridges: A Literature Review.

Literature has suggested that a minimum threshold of bone thickness facial to a dental implant is necessary to ensure successful implantations. The authors, therefore, decided to review the effect of buccal bone thickness on horizontal and vertical bone resorption, recession, and implant survival. Databases were searched, and seven human studies were found that evaluated the effect of facial bone thickness on hard- and soft-tissue outcomes and survival rates related to dental implants. Results revealed that a wide range of buccal bone thickness after implant placement (0.5 mm to ≥2 mm) resulted in a high implant survival rate (97% to 100%). Vertical and horizontal bone loss usually occurs following implant placement, 0.4 mm to 1 mm and 0.08 mm to 0.7 mm, respectively, after restorations are placed. Peri-implant mucosal recession of around 0.5 mm is frequently observed 1 year after implant placement. This literature review concluded that implants have a high survival rate despite a range of facial bone thickness adjacent to implants. It also found that no minimum initial facial bone thickness adjacent to an implant could be verified that would preclude horizontal and vertical bone loss after implant insertions.

Biomarkers as Independent Predictors of Bone Regeneration around Biomaterials: A Systematic Review of Literature.

BACKGROUND: Biomarkers are detected during bone formation and resorption associated with the dynamics of bone metabolism and are gaining importance as preferential indicators of bone healing in comparison with conventional methodologies. Current literature suggests that the usage of bone turnover markers for monitoring bone regeneration in association with biomaterials is limited. AIM: To systematically review literature and evaluate whether bone-biomarkers can independently predict bone regeneration following implantation of various bone biomaterials. MATERIALS AND METHODS: An electronic search was conducted in PubMed (MEDLINE) database from 1980 to January 2017. The articles for systematic review were selected based on formulated inclusion and exclusion criteria Results: Upon database searching, 443 articles were retrieved and thoroughly reviewed based on the inclusion and exclusion criteria. In all, 41 studies were finally included for evaluation out of which 4 were clinical studies and the remaining 37 studies utilized animal models. On further evaluation, 12 studies reported the presence of biomarkers in association with cellular response during bone regeneration around bio-materials. Moreover, biomarkers related to enzyme activity and matrix protein derivatives were enhanced during bone-matrix deposition as reported in 14 studies. Inorganic skeletal matrix biomarkers indicative of bone mineralization showed positive expression in eight studies. CONCLUSION: Several biomarkers appear to be useful for the assessment of bone regeneration around biomaterials. Although biomarkers are capable of independently predicting bone regeneration, lack of substantial evidence in the literature limits their true clinical utility. CLINICAL SIGNIFICANCE: Noninvasive and inexpensive methods of isolating and characterization of biomarkers from cellular and extracellular skeletal matrix during bone regeneration have proven value in evaluating success of bone biomaterials.

Assessment of fluoride concentrations in commercially available mouthrinses in central Saudi Arabia.

OBJECTIVES: To assess the fluoride concentration of different commercially available mouthrinses in central Saudi Arabia, and compare the obtained measurements with label values. METHODS: This cross-sectional study identified 25 brands of mouthrinses in the markets of Riyadh city  between August and September 2013. Nineteen brands of mouthrinses whose labels indicate the percentage of sodium fluoride (NaF) and 6 brands not indicating the fluoride percentage were included in the study. Three bottles of 2 manufacturing batches of each brand were acquired, coded, and analyzed after dilution using specific electrodes for fluoride and an ion analyzer at the College of Science, King Saud University, Riyadh, Saudi Arabia.   RESULTS: The average fluoride concentrations in the tested mouthrinses ranged from 8.4 ppm (Voza) to 448.7 ppm (Sensodyne `Pronamel`). Analysis of variance showed a statistically significant difference (p<0.05) in the fluoride concentration between the studied 25 brands. Almost 60% of the brands' fluoride concentrations were significantly different (mainly lower) from the label value. However, only 5 brands contain fluoride at a concentration not significantly different from the recommended fluoride concentration in daily mouthrinses 0.05% (225 ppm). CONCLUSION: Most of the studied commercially available mouthrinses contain topical fluoride at concentrations below the manufacturers' label value, but above the recommended 0.05%.