Association between metabolic syndrome and salivary MMP-8, myeloperoxidase in periodontitis.

OBJECTIVE: This study investigated the effect of metabolic syndrome (MetS) on periodontal clinical parameters and salivary biomarkers' matrix metalloproteinase-8 (MMP-8) and myeloperoxidase (MPO) in patients with periodontitis. METHODS: A total of 120 participants aged 25-55 were categorized into three groups: MetS with periodontitis (n = 40); systemically healthy with periodontitis (n = 40); and systemically and periodontally healthy controls (n = 40). Data collected included systemic parameters like waist circumference (WC), blood pressure (BP), high- and low-density lipoproteins, triglycerides (TG), fasting blood sugar (FBS), and glycated hemoglobin (HbA1c). Periodontal parameters estimated included bleeding on probing score (BoP), full-mouth plaque score (FMPS), periodontal probing depth (PPD), clinical attachment loss (CAL), and the number of missing teeth. Unstimulated whole saliva was analyzed via ELISA for active MMP-8 (aMMP-8), total MMP-8 (tMMP-8), and MPO. RESULTS: Participants with MetS and periodontitis exhibited significantly higher periodontal parameters, salivary aMMP-8, and MPO (26.26 vs. 24.1 ng/mL and 13.53 vs. 11.55 ng/mL compared to systemically healthy periodontitis patients) (all p < 0.01). Positive correlations occurred between aMMP-8 and WC, TG, and FBS (p < 0.01), and between MPO and WC, BP, and TG (p < 0.01). CONCLUSIONS: The positive associations between these biomarkers and metabolic parameters indicate their potential utility for monitoring cardiovascular and glycemic risk in patients with periodontal disease.

Knowledge of the monkeypox 2022 outbreak among dental hygienists and students in Saudi Arabia: A cross-sectional study.

OBJECTIVE: This study aimed to assess the knowledge of monkeypox infection among dental hygiene professionals and students in Saudi Arabia. METHODS: A cross-sectional study was conducted among a convenience sample of dental hygiene professionals (n = 259). The questionnaire was developed based on previous literature, and descriptive analysis and a Chi-square test were performed. RESULTS: A total of 159 dental hygienists responded to the questionnaire. Results indicated that only 1.7% had good knowledge, 7.7% had moderate knowledge and 90.6% had low knowledge of the monkeypox outbreak. The mean knowledge scores varied among dental hygiene students, practitioners and faculty members. Significant group differences were observed for some questions (p < 0.05). CONCLUSION: Our study concludes that dental hygienists had moderate to low level of knowledge of the monkeypox infection and its implications for oral health and patient care, indicating a need for more education on the subject.

Expression of advanced glycation end products and their receptors in diabetic periodontitis patients.

AIM: The systematic review aimed to compare the levels of advanced glycation end products (AGEs) and RAGE (AGE receptors) expression in diabetic periodontitis patients with non-diabetic periodontitis patients and to identify the relationship of AGE and RAGE levels with periodontal disease severity. MATERIALS AND METHODS: The literature search was carried out according to PRISMA guidelines by two independent researchers using four online databases: PubMed, Scopus, Web of Science Core Collection, and Pro-Quest. Relevant studies published between 2000 and March 2023 were included in this review. The association of diabetes and AGE/RAGE levels on periodontal health, periodontal pocket depth (PPD), and clinical attachment loss (CAL) was studied. RESULTS: Sixteen cross-sectional studies, including 2794 patients (age range 15-75 years), were identified in the final stage. An elevated AGE level was observed among patients with diabetes and chronic periodontal disease compared to the non-diabetic group. Furthermore, the levels of AGE and RAGE are associated with CAL and PPD. Potential confounding factors like genetic and methodological differences were also responsible for AGE and RAGE variation. CONCLUSION: Levels of AGEs and RAGE expressions in diabetic periodontitis patients differ from non-diabetic periodontitis patients. The differences may impact the course and severity of periodontal disease.

Width and thickness of the gingiva in periodontally healthy individuals in a central Indian population: a cross-sectional study.

OBJECTIVES: The present study was performed to determine the gingival dimensions (width and thickness) among young individuals in a central Indian population. MATERIALS AND METHODS: Periodontal probing depth, width of the keratinized and attached gingiva, and gingival thickness were recorded on maxillary and mandibular teeth from central incisor to first molar unilaterally in 75 systemically healthy individuals (32 males and 43 females; 19-30 years of age). Comparisons were made gender-wise, arch-wise, tooth-wise, and site-wise using either the Student's t test or the ANOVA. RESULTS: Keratinized and attached gingiva were wider in the maxilla than in the mandible both at proximal and at mid-buccal aspects (p < 0.001). At the tooth level also, gingiva was wider at the maxillary teeth than the corresponding mandibular teeth and at proximal aspects than at the mid-buccal aspect (p < 0.001). Regarding the thickness, gingiva was thicker among males, in the mandible, and at inter-proximal sites (p < 0.001). In either arch, maximum thickness was observed at the incisor region and least at the canine region. CONCLUSIONS: Dimensions of the gingival tissues vary between different populations and between different areas of the dentition within the same subject. These variations need to be better understood because these aspects may have an important bearing on periodontal treatment planning as width and thickness of gingiva are important in terms of maintenance of periodontal health. CLINICAL RELEVANCE: The dimensions of the clinically healthy gingiva are important in clinical practice as they can influence the progression of periodontal disease as well as impact the outcome of periodontal and restorative and orthodontic therapy.

Preparation, Characterization and Biological Applications of Biosynthesized Silver Nanoparticles with Chitosan-Fucoidan Coating.

Silver nanoparticles (AgNPs) are gaining a great deal of attention in biomedical applications due to their unique physicochemical properties. In this study, green synthesis of AgNPs was developed using seaweed polysaccharide fucoidan. The AgNPs were further coated with chitosan to form an electrolyte complex on the surface. The developed chitosan⁻fucoidan complex-coated AgNPs were characterized using UV-visible spectroscopy, Fourier transform infrared spectroscopy (FT-IR), and transmission electron microscopy (TEM). FT-IR results suggested strong polyelectrolyte complexation between fucoidan and chitosan. The developed chitosan⁻fucoidan complex-coated AgNPs significantly inhibited microbial growth. Moreover, the AgNPs showed efficient anticancer activity in human cervical cancer cells (HeLa). This study demonstrated that chitosan⁻fucoidan complex-coated AgNPs hold high potential for food and cosmeceutical applications.

Analyzing Relationship between Patient and Doctor in Public Dental Health using Particle Memetic Multivariable Logistic Regression Analysis Approach (MLRA2).

In the developing technology managing patient and doctor relationship and communication process is one of the critical factors because the patient may take high risk surgery, treatment and diagnosis. Due to the importance of the patient-doctor relationship, in this paper investigate the various aspects of relation between the doctor and dental problem related patients. During the analyzing process, data has been collected from adults who are facing dental problems and other dental injuries in which data has been gathered from 423 individuals by conducting interviews. The gathered data is investigated with the help of particle-memetic multivariable logistic regression analysis method which examines the patient income, dental surgical details, injuries and other factors relationship has been investigated. From the analyzed data, how the patients are treated by doctors examined for improving the relationship between patient and doctor in public dental health aspects.

The influence of frequently consumed beverages and snacks on dental erosion among preschool children in Saudi Arabia.

BACKGROUND: To determine the prevalence of dental erosion and its association to commonly used beverages and snacks among 3 to 5 year old preschool children in Riyadh, Saudi Arabia. METHODS: Three hundred eighty-eight preschool children between 3 and 5 years old were selected from 10 different schools using a cluster random sample selection; there were 184 (47%) boys and 204 (53%) girls. The surfaces of each tooth were examined for erosion, and the level of tooth wear was recorded. Data on the frequently used beverages and snacks were obtained by questionnaires completed by the parents of the preschool children. RESULTS: Among the 388 children examined, 47% exhibited low erosion, 10% exhibited moderate erosion and 4% exhibited severe erosion. There was no statistically significant difference between boys and girls in terms of the prevalence of erosion. Sixty percent of the children regularly consumed juice drinks. Among daily consumers, 84% of children showed erosion prevalence with strongly significant association (p < 0.005). Holding the drink in the mouth also showed a significant association with erosion (p < 0.02). CONCLUSION: It was concluded that an association was found between the prevalence of dental erosion and the frequency of citrus and carbonated juice consumed by the preschool children in Saudi Arabia.

Prevalence and Heritability of Early Childhood Caries Among Monozygotic and Dizygotic Twins.

Deciphering the relative importance of genetic and environmental factors, which play a major role in the prevalence of early childhood caries (ECC), can help clinicians with planning a long-term preventive treatment. The objective of the study was to determine the prevalence and heritability of ECC among monozygotic (MZ) and dizygotic (DZ) twins in Chennai, India, in the year 2013. A cross-sectional study was designed to estimate the prevalence of ECC among twins. Zygosity classification for the survey framework was adapted from a highly accurate parental report questionnaire pertaining to the physical similarity between twins. The associated heritability index was estimated. The Decayed, Missing, Filled Surface (DMFS) Index was used as the diagnostic criterion for dental caries. The prevalence of ECC was estimated at 18.7%. The correlation coefficient between the twin pair showed significant correlation. The heritability index for ECC was estimated at 15% higher prevalence of ECC found among children in the age group 25-36 months. The heritability estimate indicated a relatively low genetic influence for early childhood caries among twins. There was no significant difference detected in the concordance rate for the MZ and DZ twins. Further research could be directed toward the prevalence of ECC among higher age group children to explore the role of genetic and environmental factors.

Marine Fish Proteins and Peptides for Cosmeceuticals: A Review.

Marine fish provide a rich source of bioactive compounds such as proteins and peptides. The bioactive proteins and peptides derived from marine fish have gained enormous interest in nutraceutical, pharmaceutical, and cosmeceutical industries due to their broad spectrum of bioactivities, including antioxidant, antimicrobial, and anti-aging activities. Recently, the development of cosmeceuticals using marine fish-derived proteins and peptides obtained from chemical or enzymatical hydrolysis of fish processing by-products has increased rapidly owing to their activities in antioxidation and tissue regeneration. Marine fish-derived collagen has been utilized for the development of cosmeceutical products due to its abilities in skin repair and tissue regeneration. Marine fish-derived peptides have also been utilized for various cosmeceutical applications due to their antioxidant, antimicrobial, and matrix metalloproteinase inhibitory activities. In addition, marine fish-derived proteins and hydrolysates demonstrated efficient anti-photoaging activity. The present review highlights and presents an overview of the current status of the isolation and applications of marine fish-derived proteins and peptides. This review also demonstrates that marine fish-derived proteins and peptides have high potential for biocompatible and effective cosmeceuticals.

Evolution of Nickel-titanium Alloys in Endodontics.

To improve clinical use of nickel-titanium (NiTi) endodontic rotary instruments by better understanding the alloys that compose them. A large number of engine-driven NiTi shaping instruments already exists on the market and newer generations are being introduced regularly. While emphasis is being put on design and technique, manufacturers are more discreet about alloy characteristics that dictate instrument behavior. Along with design and technique, alloy characteristics of endodontic instruments is one of the main variables affecting clinical performance. Modification in NiTi alloys is numerous and may yield improvements, but also drawbacks. Martensitic instruments seem to display better cyclic fatigue properties at the expense of surface hardness, prompting the need for surface treatments. On the contrary, such surface treatments may improve cutting efficiency but are detrimental to the gain in cyclic fatigue resistance. Although the design of the instrument is vital, it should in no way cloud the importance of the properties of the alloy and how they influence the clinical behavior of NiTi instruments. CLINICAL SIGNIFICANCE: Dentists are mostly clinicians rather than engineers. With the advances in instrumentation design and alloys, they have an obligation to deal more intimately with engineering consideration to not only take advantage of their possibilities but also acknowledge their limitations.

Orthopedic Effect of Chin Cup during Mixed Dentition Stage.

INTRODUCTION: Chin cup (CC) therapy has been used as the traditional appliance for treating class III malocclusion during mixed dentition period. The aim of this study was to investigate the effect of CC on the improvement of skeletal and dentoalveo-lar skeletal changes in class III patients during mixed dentition stage. MATERIALS AND METHODS: A total of 30 patients (7-9 years old) with skeletal class III malocclusion were selected based on clinical and cephalometric examination. Out of 30 patients, 20 underwent CC therapy. All orthodontic records and measurements were taken before and after treatment. Similar records were collected from the control group. The lateral cephalometric films were traced before and after treatment and analyzed. RESULTS: There was a significant improvement in maxillary and the mandibular skeletal measurements after CC therapy. Improvement of ANB angle and an increase in Wits appraisal have been detected in the treated group according to intermaxillary skeletal variables. CONCLUSION: The study concluded that the CC therapy is effective for correcting skeletal class III malocclusion along with positive changes in the dentoskeletal variables during the mixed dentition stage.

Study on Personality Types of Dentists in different Disciplines of Dentistry.

AIM: The purpose of this study was to determine the most common personality type among dentists in seven selected clinical dentistry specialties using the Myers-Briggs Type Indicator (MBTI) and to compare between these different types of personalities. MATERIALS AND METHODS: A survey containing the MBTI and demographic and practice questions was used to assess the personality styles of 243 dental specialists in Riyadh, Saudi Arabia. The survey results were analyzed using descriptive statistics. RESULTS: The results of the MBTI for 243 specialist dentists revealed, generally, a higher percentage of scoring for introversion (I) with an average of 65% than extroversion (E). The study identified 10 common personality types among these specialists: ISTJ, ISFJ, INFJ, ISTP, INFP, INTP, ENFP, ENTP, ENFJ, and ENTJ (extraversion-introversion (E-I), sensing-intuition (S-N), thinking-feeling (T-F), and judging-perception (J-P)). The dominant personality type in all seven clinical specialties in dentistry was ISTJ, with an average of 54%. CONCLUSION: The personality types showed variation among the seven clinical dentistry specialties. However, among these seven clinician's specialties in dentistry, more than 50% of the individuals shared one common type of personality (ISTJ). CLINICAL SIGNIFICANCE: The identification of the personality type might help in their association with coworkers, students, and patients as well as knowing the individual preferences toward different specialties in dentistry.

Biomimetic approaches with smart interfaces for bone regeneration.

A 'smart tissue interface' is a host tissue-biomaterial interface capable of triggering favourable biochemical events inspired by stimuli responsive mechanisms. In other words, biomaterial surface is instrumental in dictating the interface functionality. This review aims to investigate the fundamental and favourable requirements of a 'smart tissue interface' that can positively influence the degree of healing and promote bone tissue regeneration. A biomaterial surface when interacts synergistically with the dynamic extracellular matrix, the healing process become accelerated through development of a smart interface. The interface functionality relies equally on bound functional groups and conjugated molecules belonging to the biomaterial and the biological milieu it interacts with. The essential conditions for such a special biomimetic environment are discussed. We highlight the impending prospects of smart interfaces and trying to relate the design approaches as well as critical factors that determine species-specific functionality with special reference to bone tissue regeneration.

Total and Differential Leukocyte Counts in the Peripheral Blood of Patients with Generalised Aggressive Periodontitis.

PURPOSE: To compare the total and differential leukocyte counts in the peripheral blood of generalised aggressive periodontitis patients with that of periodontally healthy subjects in a central Indian population. MATERIALS AND METHODS: Seventy-five patients with generalised aggressive periodontitis and 63 periodontally healthy subjects were enrolled for the purpose of the study. All participants received a full-mouth periodontal examination in which probing depth and clinical attachment level were recorded. The haematological variables analysed included total leukocyte count, neutrophil count, lymphocyte count, monocyte count, neutrophil percentage, lymphocyte percentage, monocyte percentage and platelet count. RESULTS: The patient group showed a significantly higher total leukocyte count (7.62 ± 1.70 x 109 cells/l, p = 0.008), neutrophil count (5.06 ± 1.47x109 cells/l, p < 0.001) and neutrophil percentage (70.61 ± 8.73, p < 0.001), as well as a significantly lower lymphocyte count (1.82 ± 0.65 x 109 cells/l, p = 0.002) and lymphocyte percentage (26.55 ± 8.05, p < 0.001) compared to the control group. Logistic regression analyses showed significant associations between aggressive periodontitis and elevated total leukocyte (p = 0.012) and neutrophil counts (p = 0.001). CONCLUSION: The findings of the present study suggest that patients with generalised aggressive periodontitis might also demonstrate a systemic inflammatory response, as evidenced by increased leukocyte counts. This systemic inflammatory response observed in patients with generalised aggressive periodontitis may be associated with an increased risk for cardiovascular diseases.

Study of the Mechanical Properties of the Novel Zirconia-reinforced Glass lonomer Cement.

OBJECTIVES: The purpose of this in vitro study is to compare the compressive strength (CS) and diametral tensile strength (DTS) of the zirconia-reinforced restorative material (Zirconomer®) with conventional glass ionomers (Fuji 1X) and amalgam. MATERIALS AND METHODS: Specimens (n = 120) were fabricated from silver amalgam, reinforced glass ionomer cement (GIC) (glass ionomer, Fuji 1X GC Corp.), and zirconia-reinforced glass ionomer (Zirconomer, Shofu Inc.) for testing the CS and DTS. The results were analyzed using analysis of variance, followed by a Tukey post hoc test. RESULTS: Both CS and DTS were found to be significantly higher for the zirconia-reinforced GIC and silver amalgam compared with GIC (p < 0.001). CONCLUSION: A newer class of restorative material like Zirconomer helps to overcome the potential hazard of mercury, but retains the strength and durability of amalgam as well as the sustained high-fluoride release of GICs. Furthermore, long-term studies are required to confirm its use as an alternative to the currently available posterior restorative material.

Chemical Plaque Control Strategies in the Prevention of Biofilm-associated Oral Diseases.

Dental plaque is a biofilm that forms naturally on the surfaces of exposed teeth and other areas of the oral cavity. It is the primary etiological factor for the most frequently occurring oral diseases, such as dental caries and periodontal diseases. Specific, nonspecific, and ecologic plaque hypothesis explains the causation of dental and associated diseases. Adequate control of biofilm accumulation on teeth has been the cornerstone of prevention of periodontitis and dental caries. Mechanical plaque control is the mainstay for prevention of oral diseases, but it requires patient cooperation and motivation; therefore, chemical plaque control agents act as useful adjuvants for achieving the desired results. Hence, it is imperative for the clinicians to update their knowledge in chemical antiplaque agents and other developments for the effective management of plaque biofilm-associated diseases. This article explores the critical analysis of various chemical plaque control strategies and the current trends in the control and prevention of dental plaque biofilm.

A Cross-sectional Study of the Prevalence of Dental Caries among 12- to 15-year-old Overweight Schoolchildren.

INTRODUCTION: Overweight and obesity are growing health-related problems worldwide, and it is currently the most prevalent nutritional disorder among children and adolescents. The objective of this study was to assess the association between overweight and dental caries among 12- to 15-year-old schoolchildren in Mangaluru district, Karnataka, India. MATERIALS AND METHODS: Data were obtained from 2000 school-going children aged 12 to 15 years. The children were categorized as overweight and normal-weight group by assessing the body mass index (BMI). Body mass index was categorized using the classification system given by the International Obesity Task Force (IOTF) and obtained in units of kg/m2. The dental caries was assessed by detection and was performed according to decayed, missing, and filled teeth (DMFT) index. RESULTS: Of the 2000 children examined, the mean BMI recorded was 26.87 ± 2.26 for the overweight children and 20.82 ± 1.48 for the normal-weight children. Even though the DMFT (3.90 ± 2.95) in the overweight children was slightly higher than the control group (3.36 ± 2.73), it was not statistically significant. CONCLUSION: Within the confines of the present study, it can be concluded that there is no significant association between overweight and dental caries among the schoolchildren of Mangaluru district in Karnataka. Longitudinal studies are necessary to substantiate the possible relationships between dental caries and overweight in children. Knowledge of these relationships could lead to preventive health measures designed to reduce the prevalence of both obesity and dental caries.

An aqueous method for the controlled manganese (Mn(2+)) substitution in superparamagnetic iron oxide nanoparticles for contrast enhancement in MRI.

Despite the success in the use of superparamagnetic iron oxide nanoparticles (SPION) for various scientific applications, its potential in biomedical fields has not been exploited to its full potential. In this context, an in situ substitution of Mn(2+) was performed in SPION and a series of ferrite particles, MnxFe1-xFe2O4 with a varying molar ratio of Mn(2+) : Fe(2+) where 'x' varies from 0-0.75. The ferrite particles obtained were further studied in MRI contrast applications and showed appreciable enhancement in their MRI contrast properties. Manganese substituted ferrite nanocrystals (MnIOs) were synthesized using a novel, one-step aqueous co-precipitation method based on the use of a combination of sodium hydroxide and trisodium citrate (TSC). This approach yielded the formation of highly crystalline, superparamagnetic MnIOs with good control over their size and bivalent Mn ion crystal substitution. The presence of a TSC hydrophilic layer on the surface facilitated easy dispersion of the materials in an aqueous media. Primary characterizations such as structural, chemical and magnetic properties demonstrated the successful formation of manganese substituted ferrite. More significantly, the MRI relaxivity of the MnIOs improved fourfold when compared to SPION crystals imparting high potential for use as an MRI contrast agent. Further, the cytocompatibility and blood compatibility evaluations demonstrated excellent cell morphological integrity even at high concentrations of nanoparticles supporting the non-toxic nature of nanoparticles. These results open new horizons for the design of biocompatible water dispersible ferrite nanoparticles with good relaxivity properties via a versatile and easily scalable co-precipitation route.

Bone morphology changes around two types of bone-level implants installed in fresh extraction sockets--a histomorphometric study in Beagle dogs.

BACKGROUND: Minimizing crestal bone loss following immediate implant placement is considered the most challenging aspect in implant therapy. Implant surface topography and chemical modifications have been shown to influence the success of Osseointegration. The Straumann Bone Level implant, featuring SLActive surface, has been introduced with the aim of enhancing bone apposition. Similarly, the OsseoSpeed implants from Astra Tech claim to have an enhanced osseointegration. Because of the specific features in the implant design, both companies claim that crestal resorption is minimal with these implants. OBJECTIVE: To evaluate the osseointegration and crestal bone level following immediate placement of Straumann Bone Level implant and OsseoSpeed implants in fresh extraction sockets in Beagle dogs. METHOD: The distal roots of the second, third and fourth premolars were extracted in both sides of the mandible. The distal roots were removed using a dental elevator. A total of 60 fixtures were installed in 10 Beagle dogs. Two types of implants were used: Straumann Bone-Level implants, which were 8 × 3.3 mm in size, and Astra Tech OsseoSpeed 3.5 S MicroThread implants, which were 8 × 3.5 mm in size. The histomorphometrical evaluation was performed at the end of 4- and 12-week healing. The implant-bone contact and bone volume percentage were assessed. RESULTS: The bone-to-implant contact (BIC) and the bone volume did not show any significant changes for both types of implants. The OsseoSpeed™ implants showed 67.4% and 65.3% BIC, respectively, at 4 and 12 weeks compared with 71.7 and 73.1 for the Straumann Bone-Level implants. The bone volume around both types of implants did not differ significantly at both time periods. The crestal bone resorption was observed for both types of implants. The first BIC at buccal side and lingual side of the implants also did not differ significantly for both implant systems. CONCLUSIONS: This study showed that Straumann Bone Level and OsseoSpeed implants induced similar bone response after immediate implantation at 4 and 12 weeks. The immediate implant placement resulted in peri-implant crestal bone-level changes for both types of implants.

Comparative evaluation of the combined application of titanium implants and calcium phosphate bone substitutes in a rabbit model.

OBJECTIVES: To study the healing of defects around titanium implants filled with biphasic calcium phosphates (BCP). MATERIAL AND METHODS: Forty custom-made, titanium implants (Ti) with a diameter of 5 mm, and length of 8 mm, with two-sided gaps, were fabricated and installed in the femoral condyle of 20 rabbits. Following a randomization protocol, implants were alternately installed in one condyle without BCP bone substitute material (Ti) in the gaps and in the contralateral condyle gaps were filled with BCP bone substitute material (Ti+BCP). The implants were retrieved after 4 and 12 weeks of healing, after which histological and histomorphometrical analyses were done to assess the percentage of bone implant contact (BIC), the percentage of bone area (BA) and the percentage of particle area (PA) within the region of interest (ROI); the rectangular area joining the two arms of the L-shaped implant was considered as the ROI. RESULTS: After 4 and 12 weeks of healing, Ti+BCP showed significantly higher BIC and BA values compared to Ti. Further, the BCP particles showed a significant decrease from 4 to 12 weeks of healing. The BCP particles (PA) showed a significant reduction from 31.6 ± 11.0% at 4 weeks to 21.0 ± 7.2% at 12 weeks. CONCLUSION: The addition of BCP bone substitute to fill peri-implant gaps significantly enhanced both bone formation (~2.5-fold) and bone to implant contact (>2-fold) for the custom-made titanium implants with two-sided gaps.