Effect of Hyaluronic Acid on Socket Healing After Lower Impacted Third Molar Tooth Extraction in 40 Dental Patients.

BACKGROUND Surgical extraction of impacted mandibular third molars is the most commonly performed procedure in oral surgery; its associated complications include sensory nerve damage, swelling, and trismus. This study aimed to evaluate the effects of hyaluronic acid (HA) on healing of the socket following extraction of the lower impacted third molar tooth in 40 dental patients. MATERIAL AND METHODS This prospective, double-blind, randomized, controlled study was carried out on 40 adult healthy patients indicated for surgical removal of bilateral impacted mandibular third molars with equal surgical difficulty (moderate surgical difficulty according to the Koerner index. Patients with right mandibular third molars were included into the study (HA) group and those with left mandibular third molars were included into the control group. Surgical removal of impacted teeth was performed at different times for each patient for proper measurement of postoperative clinical variables, including pain, swelling, and mouth opening. RESULTS Postoperative pain evaluation results using the visual analog scale (VAS) showed reduced pain levels at all observation periods. Postoperative swelling peaked in intensity within 12-48 hours, resolving between the 5th and 7th days, and there was no significant difference in pre- and postoperative measurements of interincisal opening between both groups (P>0.05). CONCLUSIONS We found that intra-socket application of hyaluronic acid after surgical extraction of impacted mandibular third molars promoted normal wound healing, and there was a clinical benefit of reduced postoperative pain and swelling.

Denoised encoder-based residual U-net for precise teeth image segmentation and damage prediction on panoramic radiographs.

OBJECTIVES: This research focuses on performing teeth segmentation with panoramic radiograph images using a denoised encoder-based residual U-Net model, which enhances segmentation techniques and has the capacity to adapt to predictions with different and new data in the dataset, making the proposed model more robust and assisting in the accurate identification of damages in individual teeth. METHODS: The effective segmentation starts with pre-processing the Tufts dataset to resize images to avoid computational complexities. Subsequently, the prediction of the defect in teeth is performed with the denoised encoder block in the residual U-Net model, in which a modified identity block is provided in the encoder section for finer segmentation on specific regions in images, and features are identified optimally. The denoised block aids in handling noisy ground truth images effectively. RESULTS: Proposed module achieved greater values of mean dice and mean IoU with 98.90075 and 98.74147 CONCLUSIONS: Proposed AI enabled model permitted a precise approach to segment the teeth on Tuffs dental dataset in spite of the existence of densed dental filling and the kind of tooth. CLINICAL SIGNIFICANCE: The proposed model is pivotal for improved dental diagnostics, offering precise identification of dental anomalies. This could revolutionize clinical dental settings by facilitating more accurate treatments and safer examination processes with lower radiation exposure, thus enhancing overall patient care.

Incorporation of Zirconium Oxide Nanoparticles in Adhesive Resin for Bonding of Brackets to Enamel Conditioned with Er,Cr:YSGG, Photodynamic Therapy, and Phosphoric Acid.

Objective: To evaluate the effect of enamel conditioning methods, that is, total-etch and rinse (TER), Er,Cr:YSGG (ECYL), and photodynamic therapy (PDT) on the shear bond strength (SBS) of orthodontic metallic brackets bonded using Zirconium oxide experimental adhesive (ZOEA). Methods: Sixty human incisor buccal surfaces were cleaned and allocated into three groups based on the method of enamel surface treatment, that is, TER using 37% phosphoric acid gel, methylene blue photosensitizer activated by PDT and ECYL (n = 20 each). Each group was further divided into two subgroups (n = 10) based on the type of adhesive, that is, ZOEA and experimental adhesive (EA). Metallic brackets were seated using composite resin. Samples were placed in a universal testing machine for SBS and failure mode using the ARI index. One-way analysis of variance and post hoc Tukey were used for multiple comparisons. ARI was presented in percentages in different investigated groups. Results: TER+ZOEA (17.16 ± 0.41 MPa) displayed the highest bond integrity. However, group PDT+EA (11.34 ± 0.25 MPa) demonstrated the lowest bond scores. The intergroup comparison revealed that the TER system displayed significantly higher SBS values than the PDT and ECYL groups (p < 0.05). The intragroup comparison revealed that enamel conditioned with TER and brackets bonded with ZOEA and EA displayed comparable bond integrity (p > 0.05). Conclusions: Enamel conditioned with TER bonded to a metallic bracket displayed better bond strength than PDT and ECYL. Zirconium oxide nanoparticles incorporated in adhesive have proved to be promising in improving the bond integrity of adhesive.

Three-Dimensional FEA Analysis of the Stress Distribution on Titanium and Graphene Frameworks Supported by 3 or 6-Implant Models.

Titanium is the main component of dental implants. It is also routinely used as a framework material for implant-supported full-arch prostheses due to its low density, biocompatibility, and other mechanical properties. Remarkable mechanical properties such as lesser mass density and higher young's modulus of graphene have gained popularity among scientists, improving the properties of biomedical implants. Thus, our study aimed to compare the outcome through the von Mises stresses generated on All-on-6 and All-on-3 implant models, as well as on the framework, and evaluate the effect of stress patterns on the crestal bone around implants in the mandible. FEA (Finite Element Analysis) study was carried out using edentulous mandible models. Four 3D FEA models with 3 and 6 implants were used (Model 1: Titanium bar-supported 6 straight implants; Model 2: Graphene bar-supported 6 straight implants; Model 3: Titanium bar-supported 3 implants with 30 degrees-tilted; Model 4: Graphene bar-supported 3 implants with 30 degrees-tilted) in order to simulate endosseous implant designs. The implant measuring 4.2 mm in diameter and 11.5 mm in length were used. The most distal implants in the 3-implant models were placed with angulation of 30 degrees; in 6 implants, they were vertically placed. All the models were analyzed for vertical and oblique axis with a single force magnitude of 100 N. In all four implant models and under loading conditions, the peak stress points were always on the neck of the most distal implant. von Mises stresses were within the normal stress range. In a conventional six-straight implant model supported by a titanium framework, the cortical stress in the region of implants was 25.27 MPa, whereas, in the graphene framework, it was 12.18 MPa. Under vertical load, there was a significant difference in the cortical stress around the tilted implants (30 degrees) in the 3-implant system of titanium and graphene frameworks, respectively, 70.31 MPa and 21.27 MPa. The graphene framework demonstrated better results than the titanium framework for the conventional six-implant system under vertical load, achieving stress of 30.09 MPa and 76.60 MPa, respectively. In the case of the 3-implant system, a significant difference in the bar stress was observed between graphene and titanium, respectively, 256.32 MPa and 180.1 MPa of bar stress. Within the limitation of this study, the peri-implant stresses were decreased using graphene framework models. Hence, it was possible to conclude that the best load-bearing capacity results were found in the graphene framework group compared to the titanium framework for All-on-6 and All-on-3 implant models, even though both materials are reliable options used as framework materials in implant-supported full-arch prostheses.

Temporomandibular Joint Space Dimensions among Saudi Patients with Temporomandibular Disorders: MRI-Based Retrospective Study.

Introduction: The temporomandibular joint is a complex synovial joint in the body. It is the area in which the mandible articulates with the cranium. The temporomandibular joint space is located between the articular eminence and the glenoid fossa of the temporal bone at the base of the skull and the condylar process of the mandible. This interarticular space is divided into superior joint space (1.2 ml) and inferior joint space (0.9 ml) by the articular disc. The purpose of this study is to detect and evaluate the variations in the temporomandibular joint space among patients having temporomandibular joint disorders. Materials and Methods: In this retrospective study, 60 magnetic resonance imaging scans were evaluated at King Faisal Specialist Hospital in Riyadh, Saudi Arabia, between the years 2006 and 2016. Measurements were done in sagittal view in three areas: anterior, central, and posterior areas. However, coronal view readings were recorded in two different areas: medial and lateral joint spaces. All measurements were recorded at the highest point of the condyle that is perpendicular to the opposing bone. The SPSS program was used for statistical analysis. Results: The central joint space values were higher than the anterior and posterior joint spaces in both coronal and sagittal views. We also found that joint spaces among male patients were higher than female patients (right side P=0.015 and left side P=0.006). It is worth mentioning that the number of temporomandibular joint disorder female patients was more than the number of male temporomandibular joint disorder patients (52 females versus 24 males). Additionally, patients who were older than 55 years old had wider joint spaces than patients who were younger than 25 years old. Conclusion: The central joint space value was the highest among the other joint spaces on both views of magnetic resonance imaging, and the values of joint spaces among males were larger than those of females on sagittal magnetic resonance imaging. Patients with elderly temporomandibular joint disorders showed larger joint spaces than young patients. This study spotlights the importance of magnetic resonance imaging evaluation in temporomandibular joint disorder patients for a better understanding of the clinical evolution of temporomandibular disorders.

The need for socket preservation: a systematic review.

The aim of this study was to evaluate the clinical need and impact of socket preservation to protect the bone for future dental implant placement. Moreover, we aimed to list down various methods of socket preservation by going through randomized clinical trials. We searched PubMed, Google Scholar, and Cochrane databases for all relevant publications, where researchers compared various methods and tools for socket preservation. All eight randomized controlled trials mentioned several methods that are helpful in preserving bone levels both horizontally and vertically. The studies included in this systematic review demonstrate that each material has certain efficacy in preserving the socket after tooth extraction for future implant placement. Socket preservation methods and materials are effective in preparing patients for future prostheses.

Distraction Osteogenesis of Severely Resorbed Mandible.

Edentulous patients require an adequate rehabilitation so that the alveolar ridge in the interforaminal region be restored for subsequent implant-supported overdentures. The ultimate goal of distraction is to reconstruct the alveolar ridge to a suitable height and width compatible with Atwood class 2 in an appropriate direction allowing the sagittal interalveolar relation to be normally restored. Methods. A 65-year-old man presented with a grade 4 Mandibular atrophy as per Atwood classification which resulted in unsatisfactory treatment with full dentures. Endo-Distractor Krenkel® device was used for anterior mandibular vertical distraction osteogenesis. Four mandibular implants (ITI Straumann, Basel, Switzerland) measuring diameter Ø = 4.1 mm and length L = 16 mm were inserted after the required retention period. Standardized prosthetic treatment was completed with titanium bar retained over dentures. Results. A distraction of 11 mm was achieved within 18 days followed by a retention period of 4 months. No signs of infection nor distractor anchorage loosening were detected, and minimal lingual tilting has occurred. Conclusion. Distraction is possible on severely atrophic mandibles. The quality of bone reconstruction is satisfactory for both functional and esthetic results.

Efficacy of Antibiotic Versus Probiotics As Adjuncts to Mechanical Debridement for the Treatment of Peri-Implant Mucositis.

The objective was to compare the efficiency of probiotic therapy (PT) vs antibiotic therapy (AT) as adjuvants to nonsurgical-mechanical debridement (NSMD) for the treatment of peri-implant mucositis (Pi-M). Volunteers with Pi-M were encompassed. Therapeutically, patients were randomly divided into 3 groups: (a) Group 1: NSMD + PT; (b) Group 2: NSMD + AT; and (c) Group 3: NSMD alone. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were recorded at baseline and at 3 and 6 months follow-up. P < .05 was selected as the indicator of statistical significance. Forty-two male individuals (14, 14, and 14 in Groups 1, 2, and 3, respectively) were included. At 3 and 6 months of follow-up, PI (P < .01), BOP (P < .01), and PD (P < .01) were higher in Group 2 than Group 1. At 3 months of follow-up, PI (P < .01), BOP (P < .01), and PD (P < .01) were higher in Group 3 than Group 2. At 6 months of follow-up, PI, BOP, and PD were comparable in Groups 2 and 3. In Group 3, PI, BOP, and PD were comparable with the respective baseline values at 6 months of follow-up. The CBL in all groups remained unchanged up to 6 months of follow-up. The NSMD with adjuvant PT is more effective than adjunct AT for the treatment of Pi-M for up to 3 months.

Role of Probiotics for the Treatment of Peri-Implant Mucositis in Patients With and Without Type 2 Diabetes Mellitus.

This study hypothesized that probiotic therapy (PT) does not offer additional benefits to mechanical debridement (MD) for the treatment of diabetic subjects with peri-implant mucositis (PM). This study compared the influence of PT as an adjunct to MD for the treatment of PM in type 2 diabetic and nondiabetic patients over a 12-month follow-up period. Patients with and without type 2 diabetes were included. PM patients were categorized into 2 groups based on the treatment procedure: (1) nonsurgical + PT and (2) nonsurgical MD alone. Demographics and education statuses were recorded. Gingival index (GI) and plaque index (PI), crestal bone loss (CBL), and probing depth (PD) were measured at baseline and after 6 and 12 months. Significant differences were detected with P < .01. The hemoglobin A1c level was significantly higher in patients with diabetes at all time durations than in patients without type 2 diabetes (P < .001). Baseline GI, PI, PD, and CBL were comparable in all groups. In patients with type 2 diabetes, there was no difference in PI, GI, PD, and CBL at 6- and 12-month follow-up. In patients without type 2 diabetes, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01) at 6-month and 1-year follow-up as compared with baseline. In patients without type 2 diabetes, MD with or without adjunct PT reduced soft-tissue inflammatory parameters in patients with PM.

Knowledge and Awareness of Postextraction Complications among Dental Seniors and Interns in Riyadh Province.

BACKGROUND: Postextraction complications are multifactorial. Taking proper medical and dental history, thorough planning, and a skillful dentist can help the prediction and reduction of these complications. OBJECTIVE: This study aims to assess and compare the knowledge of senior students and interns regarding postextraction complications in government and private colleges in Riyadh Province. MATERIALS AND METHODS: A random sampling technique was used to select a minimum of 250 participants for this study. A self-designed, close-ended questionnaire was disseminated through an online platform in a manner. Sixth-year (senior) dental students and interns were included in the study. Data were coded and entered into spreadsheet software and analyzed using Chi-square tests. RESULTS: More than half were dental interns (54.04%), and the rest were senior students (45.96%). Male participants comprised 52.57% of the total participants, whereas females were 47.43%. Most participants were from government colleges (53.31%), whereas 46.69% belonged to private colleges. Male interns from government colleges demonstrated the best knowledge among all the participants. In private colleges, females demonstrated better knowledge than males in both the senior and intern groups, and the difference was statistically significant. The difference in knowledge between participants from government and private colleges was found to be statistically significant (P = 0.001). Government colleges were found to demonstrate more complications than private colleges, and the difference was statistically significant (P = 0.003). CONCLUSION: Male interns from government colleges had the best knowledge about the postextraction complications among the candidates.

Relationship between buccal alveolar bone thickness and crown-to-root dimensions around mandibular first and second molars: A cone-beam-computed tomography-based study.

BACKGROUND: Assessment of buccal alveolar bone thickness (ABT) and crown-to-root dimensions are essential in implant density; therefore, three-dimensional evaluation of these parameters provides a superior visualization than conventional radiographs. OBJECTIVE: The present cross-sectional cohort study aims to investigate the relationship between buccal ABT and crown-to-root dimensions around the mandibular first and second molars using cone-beam-computed tomography (CBCT). METHODS: Initially, CBCT-based scans from 271 individuals were assessed. Based on the inclusion and exclusion criteria, 171 CBCT-based scans were excluded. In total, 100 CBCT-scans were included in the present investigation and processed for data extraction. On the mandibular first and second molars, the mesial and distal root lengths and mesiodistal diameter of the crowns were measured. The pulpal floor served as a reference point for assessment of root length. The buccal ABT was measured at the coronal, middle and apical one-third of the root. Statistical analysis was performed and the level of significance was set at P< 0.01. One-hundred CBCT-scans from 294 mandibular teeth (137 first molars and 157 second molars) were included. One hundred and eighty-nine and 105 teeth were from males and females, respectively. RESULTS: The normality plot showed a normal data distribution. The mesiodistal crown width showed a weak yet significant correlation with mesial root length (r= 0.137), bone thickness at mesial apical third (r= 0.180), distal apical (r= 0.157) and distal coronal third (r= 0.161). Bone thickness at mesial, middle and apical third correlated significantly with one other (r= 0.786). CONCLUSION: There is a direct correlation between the buccal ABT and tooth dimensions around the mandibular first and second molars.

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.