Utilization of Low-Magnitude High-Frequency Vibration (LMHFV) as an Aid in Treating Peri-Implantitis: Case Presentations.

Peri-implantitis is an inflammatory process initiating in the soft tissue and then progressing to the hard tissue surrounding dental implants leading to loss of osseous support and potential loss of the implant if not identified early in the process. This process initiates in the soft tissue, which become inflamed spreading to the underlying bone leading to decreases in bone density with subsequent crestal resorption and thread exposure. In the absence of treatment of the peri-implantitis, the bone loss at the osseous implant interface progresses with inflammatory mediated decrease in the bone density that moves apically, eventually leading to mobility of the implant and its failure. Low-magnitude high-frequency vibration (LMHFV) has been shown to improve bone density, stimulate osteoblastic activity, and arrest progression of peri-implantitis with improvement of the bone or graft around the affected implant with or without surgery as part of the treatment. Two cases are presented using LMHFV to augment treatment.

The systemic oral health connection: Biofilms.

Frequently, periodontal health and it's associated oral biofilm has not been addressed in those patients who have systemic health issues, especially those who are not responding to medical treatment via their physician. Oral biofilm may be present in the periodontal sulcus in the absence of clinical disease of periodontal disease (bleeding on probing, gingival inflammation) and periodontal reaction is dependent on the patient's immune response to the associated bacterial and their byproducts. Increasing evidence has been emerging the past decade connecting oral biofilm with systemic conditions, either initiating them or complicating those medical conditions. The patient's health needs to be thought of as a whole-body system with connections that may originate in the oral cavity and have distant affects throughout the body. To maximize total health, a coordination in healthcare needs to be a symbiosis between the physician and dentist to eliminate the oral biofilm and aid in prevention of systemic disease or minimize those effects to improve the patient's overall health and quality of life. Various areas of systemic health have been associated with the bacteria and their byproducts in the oral biofilm. Those include cardiovascular disease, chronic kidney disease, diabetes, pulmonary disease, prostate cancer, colon cancer, pancreatic cancer, pre-term pregnancy, erectile dysfunction Alzheimer's disease and Rheumatoid arthritis. This article will discuss oral biofilm, its affects systemically and review the medical conditions associated with the oral systemic connection with an extensive review of the literature.

Increasing Lateral Ridge Width for Implant Placement Using Calcium Sulphate Bone Cement Technique.

Dental implant practitioners are often faced with a presentation of a narrow crest, making it difficult or impossible for implant placement and requiring modification of the ridge to allow implants to be utilized. Many different factors need to be considered when choosing the technique to expand the ridge laterally. Ideally, the technique should facilitate the goal of ridge width increase while reducing inflammation and postoperative pain for the patient. In this study, patients were treated for lateral ridge augmentation to improve ridge width using a calcium sulphate-based bone cement with a protocol that does not require membrane placement at the time of grafting. This minimally invasive, relatively economical surgical technique is aimed at improving postoperative comfort for patients while permitting widening of the lateral ridge.

Current State of Bone Replacement Grafting Materials for Dental Implants.

Contemporary dental implant therapy has flourished in recent years thanks in large part to advances made in bone augmentation capabilities. Bone grafts, which are often crucial to the success of implant restorations, are used mainly in three instances: at the time of extraction for delayed implant placement, when an immediate-socket implant is placed, and for ridge augmentation either laterally or vertically. Many bone grafting options are available to the surgeon depending on the site to be treated and the requirements in the area. Bone grafts and barriers come from different sources and are seen by the body's cell types in different manners. This yields a variety of biological outcomes, some of which have been published while others are in the process of being studied.

Socket Preparation for Delayed Implant Placement Using a Mineralized Cancellous Allograft.

Various materials have been used for extraction socket preservation in anticipation of implant placement or to limit resorption of socket walls. Materials have ranged from autogenous bone, allografts, and xenografts to synthetics. Ideally, the graft material being placed into the socket at the time of extraction should fully convert to host bone to yield vital bone that will permit implant osseointegration with as much contact between bone and the implant surface as possible. This article reviews different materials and presents two cases in which extraction of a molar was required and future implant placement planned.

Bone regeneration and graft material resorption in extraction sockets grafted with bioactive silica-calcium phosphate composite (SCPC) versus non-grafted sockets: clinical, radiographic, and histological findings.

PURPOSE: The purpose of the present study was to evaluate the effect of silica-calcium phosphate composite (SCPC) granules on bone regeneration in extraction sockets. METHODS: Ten patients were selected for a split-model study. In each patient, bone healing in SCPC-grafted and control ungrafted sockets was analyzed through clinical, radiographic, histomorphometric, and immunohistochemical assessments 6 months postoperatively. RESULTS: A radiographic assessment using cone-beam computed tomography showed minimal ridge dimension changes in SCPC-grafted sockets, with 0.39 mm and 1.79 mm decreases in height and width, respectively. Core bone biopsy samples were obtained 6 months post-extraction during implant placement and analyzed. The average percent areas occupied by mature bone, woven bone, and remnant particles in the SCPC-grafted sockets were 41.3%±12%, 20.1%±9.5%, and 5.3%±4.4%, respectively. The percent areas of mature bone and woven bone formed in the control ungrafted sockets at the same time point were 31%±14% and 24.1%±9.4%, respectively. Histochemical and immunohistochemical analyses showed dense mineralized bundles of type I collagen with high osteopontin expression intensity in the grafted sockets. The newly formed bone was well vascularized, with numerous active osteoblasts, Haversian systems, and osteocytes indicating maturation. In contrast, the new bone in the control ungrafted sockets was immature, rich in type III collagen, and had a low osteocyte density. CONCLUSIONS: The resorption of SCPC granules in 6 months was coordinated with better new bone formation than was observed in untreated sockets. SCPC is a resorbable bone graft material that enhances bone formation and maturation through its stimulatory effect on bone cell function. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03897010.

An Algorithmic Approach to Evaluation of an Ailing Implant.

With the incidence of failed and ailing dental implants increasing, the authors conducted research to evaluate and characterize all known criteria used in the assessment of implant health in the clinical setting. A review of articles found in electronic databases was performed. Once all parameters for implant assessment as supported by current literature were selected, implant assessment documents were created: a data acquisition form and a quantitative comprehensive evaluation. These documents provide the clinician an algorithm that yields a prognosis of survival for each implant. Diagnostic criteria were organized to offer a comprehensive assessment of risk factors related to implant health. Data acquisition prior to establishing the prognosis is necessary in accordance with the staging system developed. Parameters for diagnosis and staging include a thorough medical/social history of the patient, implant history, and clinical evaluation. The authors concluded that the establishment of parameters for comprehensive implant evaluation in the clinical setting is feasible. This assessment process enables an effective clinical approach to evaluate and treat ailing implants while facilitating a clinical diagnostic algorithm.

Sulcular Modified Internal Labial Enhancement (SMILE) Technique for Gingival Augmentation.

The concept of periodontal root coverage has evolved over many years. To achieve high predictability a minimally invasive approach that reduces morbidity and can provide root coverage for multiple teeth in the same surgery is needed. This article describes a novel approach that represents a progression of the latest tunneling techniques in root coverage. The somewhat unique method utilizes fewer instruments than other similar techniques and incorporates the use of platelet-rich fibrin.

Autogenous Dentin Grafting of Osseous Defects Distal to Mandibular Second Molars After Extraction of Impacted Third Molars.

Bone loss at the distal aspect of mandibular second molars frequently is reported after extraction of impacted third molars. Typically, osseous grafting of the extraction site is not routinely performed. This study examined osseous healing following guided bone regeneration treatment of osseous defects distal to mandibular second molars after surgical removal of impacted mesioangularly or horizontally inclined third molars using the processed third molar as the graft material. For the study, 13 patients who required impacted third molar extractions were selected based on angulation of impaction. Patients requiring bilateral extractions were designated for a split-mouth study, while others were selected based on impaction angulation as a random study group. After surgical extraction of the third molars, the extracted teeth were stripped of any soft tissue, including the periodontal ligament, then ground and disinfected using a dentin grinding protocol to produce an autogenous dentin graft (ADG). This graft was then placed into the extraction socket and covered with a hemostatic sponge prior to site closure. Patients in the control group underwent the same procedure as those in the study group except that no ADG was placed in the socket and only a hemostatic sponge was placed prior to wound closure. Clinical and radiological examinations were performed, including panoramic radiographs and probing depths at 3 months and 12 months postoperatively. The alveolar bone level distal to the second molar was established by both probing depths and radiographic evaluation, which were compared between the two groups. At 12 months postoperative the study group showed probing distal to the second molar with a mean depth of 1.15 mm, whereas the control group showed probing with a mean depth of 4.45 mm. The authors conclude that autogenous dentin grafting is a viable option for use in the treatment of osseous defects distal to mandibular second molars following extraction of impacted third molars.

Healing Dynamics Following Alveolar Ridge Preservation with Autologous Tooth Structure.

The objective of this clinical study was to assess the outcomes of autologous tooth structure in alveolar ridge preservation procedures. Extraction sites were grafted with autologous tooth structure prepared from the extracted teeth, and histologic samples were obtained at varying intervals to allow observation of bone-healing dynamics over time. Grafted areas were occupied by dentin particles that had begun to connect via bridges of woven bone at 3 months posthealing, and vital bone was in direct contact with residual particles with no inflammatory infiltrate. Further clinical investigation is warranted on the comparative effectiveness of autologous tooth structure against established bone-substitute biomaterials.

Comparative Evaluation of Fluoridated Mouthwash and Sodium Bicarbonate in Management of Dentin Hypersensitivity: An In Vitro SEM Study.

Sodium bicarbonate (ie, baking soda) can be used as an adjunct to surgical periodontal therapy to reduce dentin hypersensitivity (DH). Sodium bicarbonate mouthwash has numerous appealing attributes, including high availability, low cost, low abrasivity, water solubility, buffering capability, and, in high concentrations, antimicrobial properties. It is also safe to use. The primary underlying cause of DH is open dentinal tubules from loss of either cementum or enamel. The aim of this in vitro study was to evaluate, through scanning electron microscopic examination, the effect of sodium bicarbonate on dentinal tubule occlusion and compare it with that of fluoridated mouthwash.

Minimally Invasive Alveolar Ridge Preservation Utilizing an In Situ Hardening ß-Tricalcium Phosphate Bone Substitute: A Multicenter Case Series.

Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (ß-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone) in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material) while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that ß-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques.

Bone grafting: history, rationale, and selection of materials and techniques.

In the 100-year history of bone replacement in the human body for different purposes, a wide variety of surgical approaches and materials have been used. The techniques and materials selected significantly affect the outcome of bone replacement procedures in terms of bone formation volume and the quality and amount of vital bone. The choices facing the dental surgeon at the time of extraction, ridge augmentation, or sinus graft are wide-ranging. When choosing a bone graft material the surgeon should consider its ultimate effect on healing patterns in and around the alveolar bone at the endpoint of the procedure. As this article concludes, a better understanding of the materials and the results that can be predictably achieved with them can be valuable to the appropriately trained surgeon when preparing for these procedures.

Extraction site preservation using an in-situ hardening alloplastic bone graft substitute.

This case report highlights the use of an in-situ hardening alloplastic bone grafting material composed of beta-tricalcium phosphate (ß-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) to preserve the dimensions and architecture of the alveolar ridge after atraumatic extraction. This material provided a stable scaffold that, although left uncovered, deterred the ingrowth of unwanted soft tissue, allowing newly formed keratinized soft tissue to proliferate over the healing grafted socket and gradually cover the site. At re-entry after 4 months adequate newly formed bone was observed, allowing for the correct positional placement of an implant. The results of this case suggest that an in-situ hardening alloplastic grafting material can be successfully utilized with minimally invasive procedures to preserve the bone and the soft-tissue profile of the alveolar ridge for future implant rehabilitation.

An evaluation and comparison of the efficacy of nanocrystalline calcium sulfate bone grafts (NanoGen) and medical-grade calcium sulfate bone grafts (DentoGen) in human extraction sockets.

BACKGROUND: Grafting a fresh extraction socket is essential for successful regeneration of bone and maximizing volume preservation. Various synthetic grafts have been used to simulate bone formation. The purpose of the present study was to evaluate clinical, histomorphometric, and radiographic healing at 1-month, 3-month, and 4-month time points after tooth extraction with placement of calcium sulfate hemihydrate putty bone grafts NanoGen and DentoGen to determine their efficacy in ridge preservation following tooth extraction. METHOD: Sixty subjects who were in need of extraction were recruited. The subjects were randomly assigned their group based on computer software for both the test groups (NanoGen and DentoGen). DentoGen is a medical-grade calcium sulfate hemihydrate with particle of 30 µm, and NanoGen is a nanocrystalline version of DentoGen with particle size 400 µm to 800 µm. Data were recorded at 1, 3, and 4 months after extraction socket grafting. Bone biopsies were taken at 4 months for histomorphometric analysis. RESULTS: The mean percentage of bone formed by NanoGen was 51.19 ± 9.53% and by DentoGen 50.67 ± 16.16% after 4 months. No statistically significant difference was noted in the mean bone formation by NanoGen and DentoGen at various time intervals; no bone graft remnants of DentoGen were found at 4 months. The mean percentage of bone graft remnants left after 4 months for NanoGen was 6.83 ± 16% in the maxilla and 7.38 ± 21% in the mandible. The mean percentage of soft tissue formed was significantly higher with DentoGen in mandibular socket sites. On radiographic evaluation the mean percentage of socket fill with DenoGen was found to be 23.1 ± 11.65%, 50 ± 9.6%, and 76.7 ± 11% and with NanoGen was 29.2 ± 12.8%, 52.8 ± 15.6%, and 76.47 ± 12.43% at 1 month, 3 months, and 4 months postoperative intervals, respectively. CONCLUSION: Both the materials investigated in the study showed excellent bone forming capacity, but the nanocrystalline version (NanoGen) of calcium sulfate was found to have clinical and biologic advantages over DentoGen.

Periodontal management and restoration of an amelogenesis imperfecta patient: a case report.

This report describes the treatment of a young male patient diagnosed with amelogenesis imperfecta (AI), a hereditary disorder that affects the enamel of both primary and permanent dentition. For management and rehabilitation, it is crucial to determine the type of AI-hypoplastic, hypomaturation, or hypocalcified. As with this patient, who presented with tricho-dento osseous syndrome, patients may present with associated expression of a syndrome (partial or full) and secondary changes in the periodontium. AI is a serious problem; therefore extensive treatment using a multidisciplinary approach must be instituted, especially if the patient is syndrome-associated.

Enhancing extraction socket therapy with a biphasic calcium sulfate.

Studies have shown that tooth extraction results in loss of bone volume, which compromises dental implant placement. Prevention of site collapse at the time of extraction is recommended. In this 4-month case series, 40 patients were treated with an innovative biphasic calcium sulfate graft, demonstrating its ability to preserve or augment socket volume and resorb in the time period desired between extraction and implant placement. Some representative samples were retrieved at the time of implant placement and evaluated histologically and morphometrically for vital bone formation.

Flapless approach to maxillary sinus augmentation using minimally invasive antral membrane balloon elevation.

In the atrophic posterior maxilla, successful implant placement is often complicated by the lack of quality and volume of available bone. In these cases, sinus floor augmentation is recommended to gain sufficient bone around the implants. Sinus elevation can be performed by either an open lateral window approach or by a closed osteotome approach depending on available bone height. This case series demonstrates the feasibility and safety of minimally invasive antral membrane balloon elevation, followed by bone augmentation and implant fixation in 20 patients with a residual bone height of 2 to 6 mm below the sinus floor. The surgical procedure was performed using a flapless approach. At 18 months follow-up, the implant survival rate was 100%. Absence of patient morbidity and satisfactory bone augmentation with this minimally invasive procedure suggests that minimally invasive antral membrane balloon elevation should be considered as an alternative to some of the currently used methods of maxillary bone augmentation.