Influence of Soft Tissue and Crestal Bone Resorption in Moderate Cigarette-Smokers and Nonsmokers: A 5-Year Study.

This study aimed to determine the impact of implant placement depth (bone-level [BL] and subcrestal [SC]) on soft-tissue inflammatory parameters bleeding on probing (BOP), probing depth (PD), and crestal bone resorption (CBR) in moderate cigarette-smokers and nonsmokers at 5 years postplacement. Patient details were recorded, including sex, age, smoking history, duration of implants in function, implant arch location, and daily toothbrushing and flossing habits. Peri-implant BOP, PD, and CBR were measured in all groups, and group comparisons were done; a probability score < .05 was selected as a value for statistical significance. Fifty-three patients (27 smokers, 26 nonsmokers) had BL implants, and 55 patients (28 smokers, 27 nonsmokers) had SC implants. Among all patients, PD was higher in smokers than nonsmokers (P < .05). The peri-implant sites that demonstrated BOP were higher (P < .05) in nonsmokers than smokers. Among smokers, the CBR was higher in those with BL implants than those with SC implants (P < .05). Among nonsmokers, there was a difference in BOP, PD, and CBR at the 5-year follow-up. At 5 years, SC implants demonstrated less CBR than BL implants. Peri-implant PD is higher in smokers than nonsmokers, irrespective of the implant placement depth.

Influence of Moderate Cigarette Smoking on the Peri-Implant Clinicoradiographic Inflammatory Parameters Around Cement- and Screw-Retained Dental Implants.

The aim of this study was to assess the influence of moderate cigarette smoking on the clinical (bleeding on probing [BoP] and probing depth [PD]) and radiographic (crestal bone resorption [CBR]) parameters around cement- and screw-retained dental implants at 5-year follow-up. A questionnaire was used to collect information about age, gender, smoking history, duration of implants in function, jaw location of the implant, and daily toothbrushing and flossing. Peri-implant BoP, PD, and CBR were measured in all groups. Group comparisons were performed using 1-way analysis of variance, and for multiple comparisons, the Bonferroni post hoc adjustment test was performed. The level of significance was set at P < .05. Forty-eight patients (25 smokers and 23 nonsmokers) had cement-retained dental implants, and 48 (24 smokers and 24 nonsmokers) had screw-retained dental implants. Among patients with cement- and screw-retained dental implants, PD (P < .05) and CBR (P < .05) were significantly higher among smokers than nonsmokers. The peri-implant sites that demonstrated BoP were statistically significantly higher among nonsmokers (P < .05) than smokers among patients with cement- and screw-retained dental implants. There was no statistically significant difference in peri-implant PD and CBR among smokers with cement- and screw-retained dental implants. Among nonsmokers with cement and screw-retained dental implants, there was no statistically significant difference in BoP, PD, or CBR. Cigarette smoking is associated with an increased PD and CBR around cement- and screw-retained dental implants. Cigarette-smoking increases peri-implant soft-tissue inflammation as well as loss of crestal bone, and this relationship is independent of the type of implant retention protocol used. The author recommends that cement- and screw-retained dental implants are suitable for prosthesis restoration in nonsmokers. Further studies on dual smokers (individuals smoking cigarettes and other forms of tobacco products) are needed related to the clinicoradiographic inflammatory parameters around cement- and screw-retained dental implants.

Knowledge, Attitude, and Management of General Dentist toward Medication-related Osteonecrosis of the Jaws.

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is an intense negative drug response causing increasing bone destruction in the maxillofacial area of patients. AIMS AND OBJECTIVES: To evaluate the knowledge and attitude of dental practitioner regarding risk factors of MRONJ in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional, questionnaire survey was carried out in King Khalid Hospital, Al-Kharj among dental practioners. RESULTS: Approximately 60% of the practioners had a poor knowledge and there was a weak positive correlation with work experience. CONCLUSION: Poor knowledge regarding the MRONJ invites a continuing dental education specially to focus on general practioners.

Mechanical properties enhancement of self-cured PMMA reinforced with zirconia and boron nitride nanopowders for high-performance dental materials.

We report on the mechanical properties regarding self-cured acrylic polymethyl methacrylate (PMMA) reinforced with hexagonal boron nitride (h-BN) and stabilized zirconia (8Y ZrO2) nanopowders. The nanocomposites were prepared by using both manual and ultrasonic mixing techniques. The fabricated specimens were subjected to micro indentation, bending strength, and modulus of elasticity measurements. A fully complete polymerization process under liquid monomer was provided by ultrasonic mixing as evidenced by Fourier transform infrared (FTIR) measurement. Independently of the nanopowder used, the hardness, bending strength, and modulus of elasticity of the formed nanocomposites highly increase in values with the increase of the filler concentrations. Higher bending strengths and modulus of elasticity of the nanocomposite were recorded when using h-BN nanopowder fillers whereas hardness increases when using 8Y ZrO2 nanopowder. Results showed that with respect to the unloaded specimens made by manual mixing, ultrasonic mixing of PMMA with a 5 wt% h-BN increased the flexural strength (FS) and the modulus of elasticity or Young's modulus (YM) values to about 550% and 240%, respectively. However, a similar concentration of 8Y ZrO2 increased the Vickers Hardness numbers (VH) to about 400%. This may suggest that PMMA loaded with a combination of h-BN and 8Y ZrO2 nanopowders may lead to nanocomposites with outstanding mechanical performance.

Effect of Hexagonal Boron nitride Nanopowder Reinforcement and Mixing Methods on Physical and Mechanical Properties of Self-Cured PMMA for Dental Applications.

We report for the first time on the effect of biocompatible hexagonal boron nitride (h-BN) nanopowder reinforcement with different concentrations on the structural and mechanical properties of fabricated self-cured polymethyl methacrylate (PMMA) based dental materials (GC UNIFAST III). A comparison among the structural and mechanical properties between hand and ultrasonic mixing is also presented. Fabricated specimens were studied by scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared spectrometry (FTIR), micro indentation, and flexural strength techniques. The ultrasonic mixing method provides better sample textures of the composite as compared to hand mixing. It is found that XRD and IR intensity of the peaks increases with the increase of h-BN concentration due to nanocomposite formation. The additions of h-BN nanoparticles to the acrylic resin enhanced the hardness and the flexibility values of the composites. Independently of the mixing method used, adding h-BN nanopowder relatively increases the Vickers Hardness numbers (VH) and Flexural Strength (FS) of the unmodified materials. However, using ultrasonic mixing method combined with h-BN nanopowder increases VH numbers to 300% and FS values to 550% with respect to the unmodified sample made by hand mixing. The results obtained are very encouraging and will support future research in vivo, to confirm whether PMMA loaded with h-BN nanoparticles is an improvement compared to current dental restorative materials.

Levels of advanced glycation end products in gingival crevicular fluid of chronic periodontitis patients with and without type-2 diabetes mellitus.

BACKGROUND: It is hypothesized that levels of advanced glycation end products (AGEs) are higher in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients with type-2 diabetes mellitus (type-2 DM) than controls (systemically healthy individuals without CP. The aim was to assess the levels of AGEs in the GCF of CP patients with and without type-2 DM. METHODS: Participants were divided into three groups as follows. Group-1: Patients with type-2 DM and CP; group-2: Non-diabetic individuals with CP; group-3: Non-diabetic individuals without periodontal diseases. Demographic data were collected using a questionnaire. Full-mouth plaque-index (PI), bleeding-on-probing (BOP), probing depth (PD), clinical attachment loss (AL), and marginal-bone-loss (MBL) were assessed. Hemoglobin A1c (HbA1c) levels were recorded. The GCF was collected and levels of AGEs were assessed using standard techniques. Group comparisons were performed and P <0.05 was considered statistically significant. RESULTS: Ninety-four individuals (32, 31, and 31 individuals in groups 1, 2, and 3, respectively) were included. Mean HbA1c levels were significantly higher in group-1 than groups 2 (P <0.05) and 3 (P <0.05). The mean age of individuals in groups 1, 2, and 3 were 55.2, 51.5, and 50.7 years, respectively. The mean duration of type-2 DM among individuals in group-1 was 8.2 years (7 to 10 years). Levels of AGEs were detected in all the patients. The mean GCF levels of AGEs were significantly higher among patients in group-1 (521.9 pg/mL [428.5 to 569.3 pg/mL]) (P <0.01) than groups 2 (234.84 pg/mL [216.8 to 318.9 pg/mL]) and 3 (87.2 pg/mL [75.2 to 97.8 pg/mL]). The mean GCF levels of AGEs were significantly higher among patients in group-2 (P <0.01) than group-3 (P <0.01). CONCLUSION: The GCF levels of AGEs are higher in CP patients with type-2 DM compared to systemically healthy individuals with and without periodontal diseases.

"Religious Belief": An Undervalued Ethical Inclusion Criterion for Clinical Trials on Bone Grafting Procedures.

The aim of the present review was to assess randomized controlled trials (RCTs) on bone grafting procedures that included religious belief as an eligibility criterion. Indexed databases were searched up to and including February 2019 using different search strategies. In strategy 1, the following terms were used: (a) belief; (b) bone graft; (c) faith; (d) inclusion; (e) exclusion; (f) eligibility; (g) criteria; (h) randomized clinical trial; (i) religion; and (j) xenograft. In strategy 2, the following terms were used in addition to those used in strategy 1: Xenografts AND oral surgery OR xenografts AND maxillofacial OR xenografts AND dental implants. These searches were filtered using the terms "Randomized clinical trial" and "human studies". The initial search yielded 3932 studies. Filtration of results using the terms "Randomized clinical trial" and "human studies" showed 0 studies. Evaluation of patients' religious beliefs seems to be undervalued in RCTs related to the placement of xenografts. This is an essential and ethical criterion that should be taken into consideration prior to inclusion of participants and signing the informed consent form for RCTs related to the placement of bone grafts.

Comparison of cotinine levels in the peri-implant sulcular fluid among cigarette and waterpipe smokers, electronic-cigarette users, and nonsmokers.

BACKGROUND: Assessment of cotinine levels in the peri-implant sulcular fluid (PISF) may serve as a valuable biomarker of peri-implant diseases in nicotine-product users. PURPOSE: The aim of the present study was to compare cotinine levels in the PISF among cigarette smokers, waterpipe users, electronic-cigarette users, and nonsmokers. MATERIALS AND METHODS: Cigarette smokers, waterpipe smokers, electronic-cigarette users, and nonsmokers were included. A questionnaire was used to collect information about age, gender, duration of smoking and vaping, family history of smoking, duration of smoking/vaping, and daily frequency of smoking/vaping. Implant-related data including implant dimensions and duration of implants in function were also recorded. In all groups, peri-implant probing depth (PD), bleeding on probing (BoP), and plaque index (PI) were assessed. Using standard techniques, PISF was collected and levels of cotinine in the PISF were measured. Sample-size estimation was performed, and statistical comparisons were done using one-way analysis of variance and Bonferroni post hoc adjustment tests. P values below .05 were categorized as statistically significant. RESULTS: One hundred two male individuals (35 cigarette smokers, 33 waterpipe smokers, 34 electronic-cigarette users, and 35 nonsmokers) were included. Scores of peri-implant PI (P < .05) and PD (P < .05) were significantly higher among cigarette smokers, waterpipe smokers, and electronic-cigarette users compared with nonsmokers. Peri-implant BoP was more often manifested in nonsmokers compared with cigarette smokers (P < .05), waterpipe smokers (P < .05), and electronic-cigarette users (P < .05). The volume of collected PISF was significantly higher among cigarette (P < .05) and waterpipe smokers (P < .05) and electronic-cigarette users (P < .05) than nonsmokers. Cotinine levels were significantly higher in the PISF of cigarette (P < .05) and waterpipe smokers (P < .05) and electronic-cigarette users (P < .05) than nonsmokers. CONCLUSIONS: Habitual use of nicotinic products enhances the expression of cotinine in the PISF. Cotinine levels in the PISF of cigarette and waterpipe smokers and electronic-cigarette users are comparable.

Efficacy of mechanical debridement with adjunctive probiotic therapy in the treatment of peri-implant mucositis in cigarette-smokers and never-smokers.

BACKGROUND: Efficacy of mechanical debridement (MD) with adjunctive probiotic therapy (PT) in the treatment of peri-implant mucositis (PiM) in cigarette-smoking and never-smoking subjects remains uninvestigated. PURPOSE: The aim was to assess the efficacy of MD with adjunctive PT in the treatment of PiM in cigarette-smoking and never-smoking individuals. MATERIALS AND METHODS: Patients with (group I) and without PiM (group II) were included. Demographic data was collected using a questionnaire. Treatment-wise, patients in groups I and II were subdivided into: (a) Patients that underwent MD with adjunct PT (using Lactobacillus reuteri); and (b) MD alone. In all groups, probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were measured at baseline and compared after 3- and 6-months. Baseline peri-implant crestal bone levels were also measured. Sample-size estimation was performed, and statistical comparisons were done using one-way analysis of variance and Bonferroni post-hoc adjustment tests. P values under .05 were deemed significant. RESULTS: Eighty individuals (group I: 40 cigarette-smokers and group II: 40 never-smokers) with PiM participated in this study. At all-time intervals, no significant difference in PD, PI, and BOP were observed in all patients in group I. At 3-months' follow-up, the differences in BOP (P < .05), and PI (P < .05) were significantly higher in group II that underwent MD + PT than MD alone. At 6-months' follow-up, there was no difference in the changes in BOP and PI among subjects that underwent MD with and without adjunct PT. CONCLUSION: On a short-term basis, MD with adjunct PT is more effectual in the treatment of PiM than MD alone in never-smokers. Cigarette-smoking compromises peri-implant soft tissue healing following MD with or without adjunct PT.

Evaluation of Interactions of Surface Fluorides on Nickel-chromium and Casted Titanium Alloys: An In Vitro Study.

AIM: The present study was conducted to assess the effects of topical fluoride on casted Titanium and nickel chromium using Scanning Electron Microscope. MATERIALS AND METHODS: This in vitro study comprised of 45 specimens of Titanium and 45 specimens of nickel-chromium of same dimensions. They were divided into three groups of 15 each. GroupI specimens were immersed in 2% neutral sodium fluoride (NaF) solution for 16 minutes. Group II specimens were placed in 1.23% acidulated phosphate fluoride (APF) gel for eight minutes. Group III specimens were placed in distilled water for 8 minutes. All specimens were evaluated for surface roughness using a scanning electron microscope. RESULTS: Data thus obtained were subjected to statistical analysis including post-hoc test and analysis variance (ANOVA). There was no significant increase in surface roughness of nickel- chromium specimens in group I, II and III (p > 0.05) whereas Titanium specimens in group II showed a substantial increase in surface roughness (p < 0.05). There was surface corrosion of Titanium specimens and slight pitting of nickel-chromium specimens in group II. CONCLUSION: The studied preparation (1.23%) of acidulated phosphate fluoride has shown to affect the surface roughness of Titanium and nickel-chromium specimens whereas 2% neutral sodium fluoride and distilled water has no noticeable effect, therefore, providing some logical clinical correlations. CLINICAL SIGNIFICANCE: Clinicians must be well known about the logical usages of topical fluorides in dentistry. Different fluoride concentrations and preparations are capable of producing prosthesis's surface roughness of various degrees. Surface roughness is acting as potent areas of bacterial adhesion, plaque retention, calculus retention and microcrack formation with poor esthetics and therefore it significantly affect long-term prosthesis success. Thus, the operator must be very critically monitoring and managing the harmful effects of acidic fluoridated on prosthesis made up of casted Titanium and nickel-chromium.