Comparative Evaluation of Accuracy of Adjacent Parallel Implant Placements Between Dynamic Navigation and Static Guide: A Prospective Study.

Aim The study aims to compare the accuracy of dynamic navigation (DN) and static guides (SGs) for simultaneous adjacent parallel placement of implants, the time taken for the surgery, and the ease of handling the instruments. Materials and methods This prospective trial was carried out at the Department of Implantology of Saveetha Dental College from October 2022 to February 2023. A total of 20 patients who needed simultaneous adjacent dental implants were allocated randomly into two groups: Group 1 SG surgery and Group 2 DN surgery. Forty implants were placed, 20 under DN and 20 under SG. Bucco-lingual displacement, apico-coronal displacement, mesiodistal displacement, and mesiodistal angulation were compared between the two groups. The patients' data in both groups were evaluated by operating surgeons along with the surgical time taken and the ease of handling of instruments. Results The 20 patients who underwent implant placement in the DN and SG groups all had adjacent missing teeth in posterior sites, including lower posteriors (70%) and upper posteriors (30%). There was improved precision in relation to the mesiodistal displacement and angulation of the anterior implant of the adjacent parallel implants. The mesiodistal displacement in Group 1 (SG) was 5.61 + 3.1 mm, which was higher than Group 2 (DN), which was 0.55 + 0.56 mm. The mesiodistal angulation was 3.1 + 2.9 degrees in Group 2 and 0.42 + 0.5 degrees in Group 1. The second implant had a significant difference (p < 0.005) in mesiodistal displacement, mesiodistal angulation, and bucco-lingual displacement. The difference between the intergroup surgical time (mean + SD) in Group 1 was 30 + 4.5 mins and in Group 2 was 60.7 + 10.1 mins, with p < 0.05 statistically significant. The comfort of the operator was better in the SG group. Conclusion Any digitally aided implant placement technique can improve placement accuracy but each has its downfalls. Achieving the highest levels of precision and long-lasting prosthetic results hinges on both the suitability of the chosen case and the expertise of the surgeon performing the implant placement.

Dynamic Navigation Protocol for Direct Sinus Lift and Simultaneous Implant Placement: A Case Report.

AIM: This study aims to evaluate the accuracy associated with the use of a dynamic navigation system for the lateral window opening for a direct sinus floor elevation (SFE) procedure with simultaneous implant placement. MATERIALS AND METHODS: A female patient, aged 27 years, reported to the Department of Implantology seeking treatment for her lost tooth. On radiographic examination, the residual alveolar ridge height was 6 mm in the 26 (left upper first molar) region. For the implant placement, the case was planned to be carried out under dynamic navigation (Navident, Claronav, Canada). To make the lateral window accessible to the sinus floor, an implant trajectory resembling the required window dimensions and prosthetic implant position was planned. Post-surgery cone beam computed tomography (CBCT) was taken to assess the accuracy of the lateral window and implant trajectories using Evalunav (Navident, Claronav, Canada) analysis with dynamic navigation software. RESULTS: There was improved accuracy of the lateral window opening, and the visualization of the lateral window was maintained in real-time throughout the procedure, which was advantageous to eliminate the tearing of the thin sinus membrane. The deviations found in the trajectory of the lateral window in comparison between the planning and post-procedure were: (a) entry was deviated by 2.83 mm; (b) the apex was deviated by 2.52 mm; (c) vertically, the apex was deviated by 0.29 mm; and (d) there was an 8.93° deviation in the angulation of the trajectory. The implant that was placed simultaneously with the SFE's accuracy was in comparison with the position that was planned: (a) entry was deviated by 0.03 mm, (b) the apex was deviated by 0.82 mm, (c) vertically, the apex was deviated by 0.82 mm, and (d) there was a 0° deviation in the angulation of the trajectory. CONCLUSION: Dynamic navigation technology can help overcome complications associated with direct sinus lift procedures by providing highly accurate and precise planning and execution of the surgical procedure. This can lead to improved implant stability and a reduced risk of complications.

Efficacy of copper oxide nanoparticles using Piper longum and Piper betle.

It is of interest to evaluate the antibacterial, anti-inflammatory, and antioxidant effects of copper nanoparticles synthesized using Piper longum and Piper betle. The copper nanoparticles were characterized using various techniques and found to have a diameter between 30 and 90 nm. The nanoparticles exhibited significant antibacterial activity against E. faecalis, S. aureus, C. albicans, and S. Mutans, comparable to gold standards. They also demonstrated anti-inflammatory effects similar to the gold standard values. Furthermore, the copper nanoparticles displayed antioxidant capabilities, with maximum inhibition of 85.16% at 50 g/ml and a minimum inhibition of 50.62% at 10 g/ml. Overall, the study suggests that Piper longum and Piper betle mediated copper nanoparticles possess promising antibacterial, anti-inflammatory, and antioxidant properties, indicating their potential use in various applications.

Hybrid Navigation Technique for Improved Precision in Implantology.

The hybrid navigation technique involves the merging of the Dynamic navigation (DN) system (Navident, Claronav, Canada) and static navigation technique (3Shape, Copenhagen, Denmark). Combining the advantages of both techniques, devising a protocol of hybrid navigation will be advantageous to eliminate the difficulties faced by operators in using either methods separately. Three patients requiring dental implants were included in this study. This requires the cone beam computed tomography (CBCT) (Digital Imaging and Communications in Medicine (DICOM) data) and intra-oral scan (Standard Tessellation Language (STL) format) data for the accurate planning of the implant positions in both the static and dynamic approaches. The steps carried out were repeated for each of the patients, the accuracy of the implant placement was verified postoperatively by merging the CBCT data pre and post through the Evalunav software (NaviDent, Claronav). The accuracy of the implants placed were assessed based on the mesio-distal, bucco-lingual, apical deviations in distance and in angulation. The semi-robotic DN and static guide combination as a hybrid technique is an interesting method to improve the accuracy of flapless implant surgeries and can be used in cases where the anatomical landmarks are determinant factors for the implant placement.

Effect of different drugs for controlling post-operative swelling after implant surgery among Indians.

Pain and swelling are common complications associated with dental implant surgery. Forty five patients were included in this study (Group 1: Paracetamol+ amoxicillin (n=15), Group 2: Paracetamol+ Cold packs (n=15), Group 3: Paracetamol (n=15)). Post op drugs were given based on the group, and Pre and post-operative photographs were evaluated with Adobe photoshop software. The photographs were evaluated with Adobe Photoshop for Statistical analysis was done by repeated measures ANOVA. The first day post-surgery, there was increased swelling in group 1 with mean surface area of swelling of 47.6±2.1 mm2 and considerable decrease in group 2, 42.1±3.5 mm2. The surface area of swelling in this group was maintained in the same range till Day 7.

Evaluation of neo-implant abutment junction sealing gel among Indian patients.

With the advent of various implant abutment junctions, the ultimate aim is to develop a precise implant abutment junction with negligible micro-leakage. However precise the mechanical connection is, there seems to be a negligible amount of micro-leakage that is present that can be addressed with the help of sealing gel. This study aims to assess the micro-leakage between the neo-sealing gel and the commercially available implant sealing gel. The study was conducted on implants (n=15) with internal hex connections, group 1 (No gel, n=5), group 2 (Neo gel, n=5) and group 3 (commercial gel, n=5). Mean dE*ab values of 0.28± 0.02, 0.04± 0.01 and 0.17±0.01 were noted for the 3 groups, and there was statistically significant difference between the 3 groups (p≤0.05). The study suggests that the neo sealing gel may be a promising material to prevent bacterial ingress and micro-leakage at the implant abutment junction.

STITCH enabled molecular interaction of glycrhizzin with peri-implant microbiota.

Glycyrrhizin is present in the root extract of the licorice plant used for various conditions, including gastric ulcers. Therefore, it is of interest to document the STITCH enabled molecular interaction of glycrhizzin with peri-implant microbiota. The peri implant pathogens includes Aggregatibacter actinomycetemcomitans (D7S-1), Centipeda periodontii, Campylobacter gracilisi, Fusobacterium nucleatumi, Slackia exigua, Prevotella intermedia, Tannerella forsythia, Staphylococcus aureus, Bacteroides fragilis, and Bacteroides fragilis. Hence, a user-defined query was used to conduct analysis on the provided bacterial strains whose molecular data available in the STITCH database. Thus, we used the STITCH tool to examine protein interactions and the VirulentPred tool to assess pathogenicity using the known molecular data on glycrhizzin and peri implant pathogens. Data shows that glycyrrhizin interacts with peri implant pathogens.

Mandibular molar teeth deviations for fabrication of implant-specific strip crowns among Indians.

An understanding of tooth morphology provides better insight and is an important foundation for providing successful endodontic and restorative treatment. It also provides a deeper evaluation and baseline for future prosthetic rehabilitation. The study aimed to measure and characterizes mandibular molars using a normal divider and measurement scale using mandibular casts. Over 300 mandibular first molars were measured in dimensions including the buccolingual width, mesiodistal width, mesiobuccal height, mid-buccal height, and distobuccal height; same were repeated with intra-oral scanners digitally. The mean and standard deviation of the measurements and the correlation to age and gender were calculated using SPSS software to fabricate implant-specific strip crowns.

Comparison of pre and post-operative stresses among Indian patients undergoing intra-oral grafting procedures.

With the advent of implantology as an important means to rehabilitate the edentulous patients, the neglect over the years post extraction leads to severe bone loss. This can be corrected by grafting procedures. Grafting procedures are complex as it takes into account various factors such as the type of graft material, surgical site, surgeon's skill and the patient's compliance. Totally 20 patients ( male n=10 ; female n=10) were included in the study, 14 patients underwent GBR, 4 patients underwent direct sinus lifts and 2 underwent block grafts. The stress levels of the patient also is an important factor to consider as varying cortisol levels will be detrimental to the healing of the surgical site. Premedication with painkillers and corticosteroids can help patients comply with the treatment and feel less anxious. The stress levels of the patient were assessed using State trait anxiety index, 50.6± 6.9 was the pre-operative stress and 36.95± 9.3 was the post-operative stress. Stress levels were significantly greater before the procedure than after it, according to statistical analysis. The females were significantly having increased stress both pre and post-operatively. Also, the patients in the age group of 41-50 years showed increased amounts of stress.

Post-operative pain management using two drugs following dental implant surgery among Indians.

It is of interest to assess two drug regimens for managing pain and swelling in 40 dental implant surgery patients. Visual analogue scale readings were taken at 24 hours, 72 hours and 1 week. Data shows that a combination of acetaminophen and aceclofenac with trypsin - chymotrypsin was found to be more effective than acetaminophen alone.

Inflammation in smokers and non-smokers during implant surgery among Indians.

One of the main drawbacks faced by the dental implant surgeons is to assess the healing of the tissues and implant success for patients who are smokers. It is of interest to evaluate inflammatory biomarkers to understand the soft and hard tissue healing between smokers and non-smokers based on levels of IL-6 and STAT-3. This study included totally 20 patients (Group 1 : smokers (n=10) and Group 2: non-smokers (n=10)) undergoing stage-1 implant surgery and collected a tissue sample for the patients to assess the levels of IL-6 and STAT-3. The results indicated that there is a pronounced increase in the biomarkers in patients who are smokers in comparison to non-smokers.

Feedback on dental implants with dynamic navigation versus freehand.

The Aim of the study is to understand and identify if Dynamic Navigation (DN) has an upper hand to provide ease and comfort to the patients during and after surgery. 60 patients requiring 120 Implants, were randomly allocated in 2 groups (Group 1- Freehand surgery, Group 2- Dynamic navigation surgery) requiring dental implant therapy. Patients in both the groups were given a Patient satisfaction questionnaire assessing the following domains: comfort, fear, prior experience with robotics, dental anxiety and pain perception. Patient related Experience measures (PREM's) were assessed using the following domains: experience with robotics, pain perception and comfort of using various instrumentations during the surgery. The pre and post CBCT were compared using EVALUNAV application of the Navident software. There was significant difference (p<0.05) between the two groups in the patient outcomes pertaining to the future of robotics in medicine (group 1: 2±1.259, group 2 :4.8±0.484) and Patients reliability to a specific procedure due to the less surgical time taken (group 1:3.3±0.651, group 2: 4.63±0.556). The post-operative pain between the groups was also assessed with VAS scale.

Comparison of clinical efficacy of diode laser and erbium, chromium: Yttrium, scandium, gallium, and garnet for implant stage 2 recovery procedure - A randomized control clinical study.

AIM: The aim is to compare the clinical efficacy of diode laser and erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er, Cr:YSGG) laser for implant stage 2 recovery procedure. MATERIALS AND METHODS: A total of 30 patients who had undergone dental implant placement were included in this study. The subjects were randomly allocated into three groups. Group 1 patients (n = 10) had implant recovery using diode laser, Group 2 (n = 10) implant recovery with Er, Cr:YSGG and conventional scalpel method (n = 10) was the third group. The pain assessment was recorded using visual analog scale (VAS scale), time taken for the procedure, intra-operative bleeding, time taken for healing were recorded for the three groups. RESULTS: Data were tabulated and the results were analyzed using SPSS software version 26. Mann-Whitney U-test was used to compare the postoperative analgesic used, postoperative VAS score, the time taken for recovery and time taken for healing between the three study groups. Results were considered to be statistically significant when P < 0.05. Operation duration under Er, Cr:YSGG were much faster than the diode laser, however the results were not statistically significant (P = 0.051). The operation time under Er, Ch: YSGG and laser were faster than the conventional scalpel group (P = 0.000). The time taken for healing was faster in the Er, Cr:YSGG laser group than the diode laser and the scalpel group (P = 0.000). VAS scale at day 0 was higher in the conventional group than the two laser groups (P = 0.000). CONCLUSION: Considering the advantages of both these laser systems such as less anesthesia, less surgical trauma and faster healing, and post-operative comfort, lasers are an effective tool for implant stage two recovery techniques. However, since diode lasers are more cost effective when compared to Er, Cr:YSGG, diode lasers may meet the clinical needs when compared to hard-tissue lasers.