Periodontal phenotype modification in orthodontic patients.

OBJECTIVE: The purpose of this study was to assess the feasibility of phenotype modification in orthodontic patients using combined bone and soft tissue grafting substitutes. CLINICAL CONSIDERATION: The surgical procedure was conducted on 18 patients (3 males, 15 females). Periodontal phenotype modification was conducted using demineralized freeze-dried bone allograft and a xenogeneic collagen matrix. The following parameters were recorded for each tooth at baseline and 12-month follow-up: O'Leary plaque index (PI), probing depth (PD), bleeding on probing (BOP), gingival thickness (GT), keratinized tissue width (KTW), gingival recession (GR), and vestibular depth (VD). The results showed a statistically significant increase in GT (2.02 ± 0.39 mm), KTW (1.11 ± 0.82 mm), and VD (0.18 ± 1.16 mm) (p < 0.05). GR was also significantly decreased (1.02 ± 0.99 mm) (p < 0.05). CONCLUSION: Within the limitation of this study, the proposed approach enhanced the periodontal condition in orthodontic patients. However, further studies with a larger sample size are needed to ensure long-term stability. CLINICAL SIGNIFICANCE: Hard and soft tissue conditions have paramount importance for long-term periodontal stability. Phenotype modification in orthodontic patients can diminish the probability of adverse consequences and result in optimal esthetic outcomes. The proposed technique using combined bone and soft tissue substitutes indicated promising results and could be recommended in orthodontic patients with thin periodontal phenotypes.

Coverage stability of peri-implant soft tissue dehiscence: A systematic review and meta-analysis.

OBJECTIVE: The occurrence of peri-implant soft tissue dehiscence, especially in the esthetic zone, can be challenging. This study sought to investigate how the passage of time affects the outcomes of treatment for peri-implant soft tissue dehiscence coverage. MATERIALS AND METHODS: A literature search was performed up to April 2023 via PubMed, Scopus, and Web of Science to retrieve studies reporting the data on peri-implant soft tissue dehiscence of at least 2-time points (baseline and follow-up). Clinical trials with a minimum of 5 participants, reporting at least 1 primary outcome, and with a minimum follow-up of 3 months were included. The primary outcomes were the changes in dehiscence depth, complete coverage, and mean coverage at different time points. RESULTS: Seven studies with 112 participants and 119 implants were included. Dehiscence depth increased insignificantly between 3 to 6 months. Although the dehiscence depth increased from 6 to 12 months in the tunnel group, it decreased in the coronally advanced group, and a slight decrease was observed from 12 to 72 months. Soft tissue thickness was the predictor for soft tissue margin stability. However, no significant relationship was found between the baseline dehiscence depth and complete coverage. CONCLUSIONS: Within the limitations of this study, it seems prudent to wait at least 6 months to achieve a stable soft tissue margin. CLINICAL SIGNIFICANCE: The occurrence of peri-implant soft tissue dehiscence, especially in the esthetic zone, can be a challenging complication. It is important not only to achieve coverage but also to ensure that the treatment results remain stable in the long term, in order to satisfy both patients and clinicians. A reasonable approach would be to wait for at least 6 months to achieve a stable soft tissue margin.

Time management in multistep periodontal and implant treatments: a practical guide.

In addition to the proper selection of techniques, appropriate treatment sequencing and prioritization are prerequisites for successful periodontal and implant procedures. The aim of this study was to provide evidence-based time frames for various procedures pertaining to periodontal and implant treatment. A literature review was conducted to collect data on tissue healing; in areas in which data were lacking, the viewpoints of experienced clinicians were solicited to establish a consensus. This review reports recommended time frames for the healing processes associated with surgical crown-lengthening procedures (both functional and esthetic), fresh socket management, alveolar ridge management, soft tissue management, sinus floor augmentation, implant loading, and peri-implant defect management.

Immediate implant placement in compromised sockets: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the treatment outcome in terms of the implant survival rate and success parameters of immediate implant placement in compromised extraction sockets. MATERIAL AND METHODS: An electronic search was conducted in PubMed, Embase, Cochrane Library, and ISI Web of Science up to January 2021. Studies evaluating implant survival rate and main success parameters were included for a qualitative and quantitative analysis (risk ratio and mean difference). RESULTS: In total, 43 studies with analysis of 4825 sockets were included. Compared with the noncompromised sockets, the compromised group showed no significant differences in implant survival rates (risk ratio=0.992; 95% confidence interval (CI)=0.979 to 1.005; P=.246). No significant statistical differences were found in marginal bone level at ≤12 months (mean difference [MD]=0.033; 95% CI=-0.012 to 0.078; P=.154) or esthetic parameters. CONCLUSIONS: Immediate implant placement in compromised sites does not appear to decrease the survival and success rates. However, randomized clinical trials with large sample sizes should be conducted to draw a definite conclusion about the efficacy and safety of this treatment protocol in compromised sockets.

Short-term and long-term success and survival rates of implants supporting single-unit and multiunit fixed prostheses: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Whether placing implants to replace each missing tooth or using implant-supported fixed partial dentures provides better outcomes is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the success and survival rates of implants supporting single-unit and multiunit fixed prostheses by using conventional protocols for placement and loading in short- and long-term follow-ups. MATERIAL AND METHODS: An electronic search was conducted in PubMed, Scopus, and Web of Science for studies published up to March 17, 2022. Comparative studies that reported the success or survival rates of both single-unit and splinted multiunit prostheses were considered for qualitative and quantitative analyses. RESULTS: A total of 68 publications comprising 11 271 implants were included. Compared with the single prostheses, the splinted multiunit group showed no significant differences in implant success rates in the short-term (risk difference=-0.004; 95% confidence interval (CI)=-0.033 to 0.025; P=.780) and long-term (risk difference=0.003; 95% confidence interval (CI)=-0.029 to 0.034; P=.874) follow-ups. Significant statistical differences were also not found in terms of the survival rates of the 2 groups (short-term risk difference=-0.004; 95% CI=-0.031 to 0.023; P=.779, long-term risk difference=-0.002; 95% CI=-0.029 to 0.025; P=.887). CONCLUSIONS: Implants supporting single-unit or splinted multiunit prostheses seem to be a predictable treatment in terms of survival and success over short and long periods. Nonetheless, it seems that cantilever and nonsplinted multiunit prostheses should be used with more caution.

A comparison of human dental pulp stem cell activity cultured on sandblasted titanium discs decontaminated with Er:YAG laser and air-powder abrasion: an in vitro study.

Decontamination of implant surfaces is important to the treatment of peri-implantitis. Er:YAG laser and air-powder abrasion system are regarded as the most effective means of decontamination of implant surfaces. The aim of this in vitro study was to compare the activity of human dental pulp stem cells (hDPSCs) cultured on decontaminated sandblasted titanium discs using Er:YAG laser irradiation and air-powder abrasion. Forty-five titanium discs were contaminated with Escherichia coli (E. coli) bacteria and fifteen titanium discs served as sterile control groups. Thirty contaminated titanium discs were decontaminated with Er:YAG laser or air-powder abrasion system and fifteen contaminated discs were used as contaminated control group. Afterwards, hDPSCs were seeded on all sixty experimental titanium discs. The effects of two decontamination tools on hDPSCs viability were evaluated by MTT assay. Alkaline phosphatase (ALP) activity assay, quantitative real-time PCR analysis and alizarin red staining method were performed to assess hDPSCs osteogenic differentiation. Scanning microscope electron (SEM) was also used to evaluate the effects of two different decontaminated methods on cellular morphology. Our study showed that decontamination using Er:YAG laser caused maximum cell viability. However, the ALP activity was not different in laser and air-abrasion groups. The significant expression of an osteoblastic marker and stronger Alizarin red staining were observed in laser irradiation groups. In addition, SEM observation indicated that grown cells were more stretched and more filopodia in Er:YAG-treated discs. In the present study, Er:YAG laser and air-powder abrasion improved the activity of the cells cultured on the decontaminated titanium discs. However, in comparison with air-powder abrasion, Er:YAG laser was more effective.

Impact of collar laser microtexturing on peri-implant health and disease: a retrospective clinical study.

OBJECTIVES: This retrospective study was aimed to compare the clinical and radiographic outcomes of implants with the same body design but different collar surface (laser-microtextured vs. not laser-microtextured) after functional loading. MATERIALS AND METHODS: Forty-three patients (29 females, 14 males) with 139 implants (60 laser-microtextured and 79 without laser microtexturing) were included in this study. Patients were consecutively included, and the data were collected during their implant maintenance visit. Clinical and radiographic parameters including probing depth (PD), bleeding on probing (BoP), and marginal bone loss (MBL) were recorded. In addition, the implant success index (ISI) score was determined. Statistical analysis was performed using the Mann-Whitney U test, the Kruskal-Wallis rank test, or the Pearson χ2 test, along with binary logistic regression (p < 0.05 was considered to be statistically significant). RESULTS: The median post-loading follow-up was 24 months with 100% survival rate. There was no significant differences in terms of mean PD (3.01 mm vs. 2.63 mm), mean MBL (0.54 vs. 0.49 mm), BoP (56.7% vs. 53.2%), and ISI score between laser-microtextured collars and implants without laser microtexturing. Logistic regression revealed arch as a significant predictor of peri-implantitis (p = 0.02). CONCLUSION: Within the limitations of this study, there was no statistically significant difference between the clinical and radiographic outcomes of implants with laser-microtextured and non-laser-microtextured collar designs. Clinical relevance Prospective studies with larger sample sizes and careful monitoring of implant placement protocols are needed for definite conclusions.

Identification of oral anaerobic bacteria and the beta-lactamase resistance genes from Iranian patients with periodontitis.

OBJECTIVES: The dysbiosis of bacteria and horizontal transfer of antibiotic resistance genes (ARGs) could be highly problematic particularly in the oral environment. Here, we aimed to identify the anaerobic species from patients with periodontitis and to screen the isolates for the ß-lactamase resistance genes, blaTEM, cfxA, its variants, and mobA. METHODS: The 129 samples from periodontal pockets were subjected to anaerobic culture, followed by 16S rRNA gene sequencing, PCR assays for the cfxA, blaTEM, and mobA. The minimum inhibitory concentration (MIC) of amoxicillin, ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, and cefixime was determined against CfxA producing isolates using MIC Test Strips. RESULTS: The species with frequency higher than 10% were Lactobacillus spp. (26.3%), Streptococcus spp. (18.8%), Leptotrichia wadei (14%) and Veillonella spp. (11.4%). The blaTEM was not found in any of the isolates whereas cfxA was found in 12.5% of isolates including V. parvula, V. rogosae, Prevotella nigrescens and Campylobacter concisus. Of CfxA variants, CfxA2 (90%) was the most frequent one. Among the CfxA producing isolates, the resistance to ampicillin and amoxicillin was observed only in two isolates of P. nigrescens and V. rogosae. CONCLUSIONS: This study showed that various anaerobes species may be involved in the development of periodontitis. Of them, Prevotella and Veillonella species were found to commonly carry cfxA even though they are susceptible to beta-lactams and its combination.

A systematic scoring system to determine the long-term prognosis for severely damaged teeth.

Many of the criteria commonly considered in treatment planning for severely damaged teeth are well known to clinicians. However, a systematic approach to decision-making is lacking. The purpose of this article is to introduce a quantitative systematic risk assessment scoring system (RASS) to determine the long-term prognosis for severely damaged teeth based on several important factors. Before any treatment decision is made, the dentist should take into account the role of systemic parameters such as the medical condition of the patient, smoking status, psychological factors, patient expectations with regard to the duration and overall cost of treatment, and periodontal health. In the assessment of local factors, emphasis should be placed on 5 parameters: crown to root ratio, root condition, risk of furcation involvement, complexity of the final restoration, and esthetic results. In the proposed RASS, each of these parameters is ranked using 4 color-coded levels of risk: optimal (green), favorable (blue), unfavorable (yellow), or hopeless (red). The presence of even 1 parameter in the red zone is sufficient to consider tooth extraction. If no parameter is in the red zone, the final decision should be made after the possible effects of all of the clinical conditions are weighed and the overall risk of treatment failure is determined. Clinical decision-making with regard to the preservation or extraction of severely damaged teeth is a challenging, multifactorial process. The RASS introduced in this article focuses on 5 main factors to simplify and organize the decision-making process; however, many other parameters may affect the final treatment decision. Moreover, no decision-making system can be definitively applied to all clinical scenarios, and the entire process depends on the knowledge, experience, and expertise of the clinician.

Variations in bone quantity in the posterior mandible: a cross-sectional cone beam computed tomographic study.

In this retrospective cross-sectional study, cone beam computed tomography (CBCT) was used to assess the bone quantity variations in the posterior mandible of edentulous patients. The crestal cortical bone thickness, buccal cortical bone thickness, lingual cortical bone thickness, ridge height, ridge width, ridge angle, lingual concavity depth, and cortical to cancellous bone surface area ratio were measured at 631 sites on 130 CBCT scans of edentulous patients. The patient sample comprised 87 men and 43 women with a mean (SD) age of 63.0 (11.8) years. One calibrated observer made all of the measurements. The intraobserver agreement was calculated, and the results of the measurements were analyzed with the independent t test and Pearson correlation test. The crestal, buccal, and lingual cortical bone thickness and ridge angle decreased significantly with age, while the ridge width increased significantly with age (P < 0.05). The buccal and lingual cortical bone thickness, ridge height, ridge angle, and lingual concavity depth were significantly greater in men (P < 0.05). The buccal cortical bone thickness, ridge width, ridge angle, and lingual concavity depth increased significantly from the anterior toward the posterior region relative to the mental foramen (P < 0.05). A ridge height of greater than 8.0 mm, a ridge width of greater than 6.0 mm, and a ridge angle of less than 15° were noted in 74%, 80%, and 80% of the sites, respectively (P < 0.05). The anatomical variations found in the mandibular posterior region of edentulous patients necessitate comprehensive CBCT assessment prior to implant placement in this area.

Assessment of IL-10, IL-1ß and TNF-α gene polymorphisms in patients with peri-implantitis and healthy controls.

Peri-implantitis (PI) is a multifactorial condition caused by the interactions of pathogens and the host immune response. Previous studies have demonstrated a relationship between PI and specific gene polymorphisms, particularly cytokine genes involved in the pathogenesis of PI. This study aimed to evaluate the frequency of single nucleotide polymorphisms (SNPs) of interleukin-10 (IL-10), interleukin 1ß (IL-1ß), and tumor necrosis factor-α (TNF-α) genes in PI patients and healthy controls. A total of 50 patients with PI and 89 periodontally healthy controls were recruited for this study. Venous blood samples (5 cc) were collected, and DNA was extracted. After DNA purification, the relevant gene segments were amplified by polymerase chain reaction (PCR). Restriction fragment length polymorphism (RFLP) and electrophoresis were performed to assess the polymorphisms of the related genes. The analysis revealed that allele and genotype frequencies of IL-10 ─ 819 C/T, IL-10 ─ 592 C/A, and IL-1ß + 3954 C/T significantly differed between PI patients and healthy controls. The analysis revealed no significant association between TNF-α ─ 857 G/A and TNF-α ─ 308 G/A polymorphisms and PI. Our results indicated that specific gene polymorphisms of IL-10 ─ 819 C/T, IL-10 ─ 592 C/A, and IL-1ß + 3954 C/T may play a role in the pathogenesis of PI, and increase its risk of occurrence.

Structural and chemical features of xenograft bone substitutes: A systematic review of in vitro studies.

Xenograft bone substitutes are obtained from different species and prepared by various procedures including heat treatment, hydrazine, and chemical and hydrothermal methods. These grafts are utilized widely because of similar structure and properties to human bone, proper bone formation, and biocompatibility. The aim of this systematic review was to evaluate different xenografts from structural and chemical aspects. In vitro studies published in English language, which assessed xenografts' features, met the inclusion criteria. Electronic search of four databases including PubMed, Google Scholar, Scopus, and Web of Science and a hand search until September 2020 were performed. The irrelevant studies were the ones which focused on cell adhesion and effect of growth factors. Finally, 25 studies were included in the review. Nineteen studies used bovine xenografts, and 12 studies applied heat treatment as their preparation method. Particles showed various morphologies, and their largest size was observed at 5 mm. From 18 studies, it is found that the smallest pore size was 1.3 µm and the highest pore size was 1000 µm. There is large heterogeneity of porosity, crystallinity, Ca/P ratio, and osteogenesis based on the preparation method. Proper porosity and the connection between pores affect bone regeneration. Therefore, biomaterial selection and outcomes evaluation should be interpreted separately.

Anatomical variations in the interforaminal regions of candidates for implant-assisted overdentures: a cross-sectional CBCT analysis.

Implant-supported overdentures are becoming a common treatment modality, providing functional and esthetic results for patients in need of full-mouth rehabilitation. Because anatomical variations in the residual ridge affect treatment planning, the aim of this retrospective study was to present quantitative descriptions of the interforaminal region by evaluating a large series of cone beam computed tomographic (CBCT) images of the mandibles of edentulous patients in need of anterior dental implants. The sample included a total of 180 CBCT scans (360 sites) of patients requiring endosseous implant placement in the anterior region of the mandible for implant-assisted overdentures. The CBCT images were evaluated for parameters such as ridge height, width, angulation, and undercuts; crestal height; and corticocancellous bone ratios. The statistical analyses included the independent-samples t test and chi-square analysis. The mean (SD) ridge height was 18.16 (0.36) mm on the right side and 17.79 (0.38) mm on the left side and was significantly greater in men than in women (P = 0.02). Men also had a significantly greater cortical crest height than women (P = 0.01). The prevalence of ridge undercuts in the buccal cortex was 10.0% on the right side and 7.2% on the left side, and these undercuts had mean (SD) depths of 1.52 (0.62) mm and 1.48 (0.60) mm on the right and left sides, respectively. The ratio of cortical bone to cancellous bone was significantly greater in men than in women (P = 0.03). The mean (SD) ridge angle was 14.51 (6.54) degrees on the right side of the mandible and 13.05 (6.47) degrees on the left side, a statistically significant difference (P = 0.00). Moderate positive correlations were detected between the patient age and both the ridge widths (P = 0.00) and cancellous bone widths (P = 0.01). Moderate negative correlations were detected between the patient age and both ridge height and cortical crest height (P = 0.00). The widest ranges of variation belonged to ridge angle and ridge height, respectively, but the differentiation between the right and left sides was clinically insignificant. Knowledge of the patient's anatomical variations will allow the clinician to formulate an individualized treatment plan.

Marginal Bone Loss Around One-Piece Implants: A 10-Year Radiological and Clinical Follow-up Evaluation.

PURPOSE: This study was conducted to investigate one-piece narrow-diameter implants installed in maxillary lateral and mandibular incisor sites using immediate nonfunctional loading. MATERIALS AND METHODS: In this 10-year clinical trial study, 42 narrow-diameter (3.0-mm) one-piece implants for 35 patients were inserted. Clinical and radiographic measurements were recorded in 10 years and analyzed statistically using t test. RESULTS: A total of 26 patients (20 females and 6 males) with 30 implants were available for the 10-year follow-up. The 10-year implant survival rate was 100%. A statistically significant mean marginal bone loss was observed between 12 months and 10 years (0.18 ± 0.29 mm). The mean pocket depth increase was statistically significant (0.68 ± 0.83 mm). No bleeding on probing was observed around 90% of the implants. Full-mouth plaque index was registered at 20% of the implants. CONCLUSION: The results obtained in this analysis suggest that modest marginal bone loss was observed around the implants. One-piece narrow-diameter implants (Maximus 3.0; BioHorizons) can predictably restore missing maxillary lateral incisors and mandibular incisors in cases of careful patient selection.

In Vitro Comparison of Microbial Leakage of the Implant-Healing Abutment Interface in Four Connection Systems.

This study sought to assess microbial leakage through the implant-healing abutment interface in 4 dental implant connection systems. Ten implants of each of the 3i (double hexagon + flat to flat; group 1), IDI (internal hexagon + Morse taper; group 2), Swiss Plus (external bevel + internal octagon; group 3), and Tapered Screw-Vent (internal bevel + internal hexagon; group 4) systems were used in this in vitro, experimental study. Healing abutments were screwed to the implants with 10 Ncm torque. Implants were immersed in Escherichia coli suspension for 24 hours. Samples were taken of the internal surface of implants and cultured. The number of grown colonies was counted after 24 hours of culture and after 7 and 14 days of immersion in microbial suspension. The same was repeated with healing abutments torqued to 10 and 20 Ncm. With 10 Ncm torque, all specimens in all groups showed microleakage at one day with the highest microleakage in one sample in group 3. At 7 days, the highest microleakage was noted in one specimen in group 2. With 20 Ncm torque, group 3 showed significantly higher microleakage than other groups at 1 and 7 days (P < .05). Increasing the torque decreased microleakage in all groups except for group 3. Microbial leakage occurred in almost all implant systems in our study. In one-stage implant placement, healing abutments should be preferably torqued to 20 Ncm to minimize microleakage. Optimal torque for healing abutment insertion should be analyzed individually for each system.

Comparison of Stress and Strain Distribution Around Splinted and Nonsplinted 6-mm Short Implants in Posterior Mandible: A Finite Element Analysis Study.

PURPOSE: This study was designed to compare the biomechanical performance of splinted and nonsplinted short implants, in the posterior mandible, using finite element analysis. MATERIALS AND METHODS: Three-dimensional models of short implants with 2 different diameters (4 × 6 mm or 5 × 6 mm) were scanned, and CATIA (R21) was used to simulate the model of an edentulous lower jaw. Experimental groups were designed as follows: (1) D4L6-splinted (three 4 × 6-mm splinted implants), (2) D4L6-nonsplinted, (3) D5L6-splinted, and (4) D5L6-nonsplinted. A 100 N load was applied, and stress and strain values in surrounding bone were analyzed in specific nodes using ANSYS software (16.1). RESULTS: The maximum stress values under axial load were found in D5L6-splinted model, and under oblique load, D5L6-nonsplinted model had the maximum stress values. Under axial load, D4L6-splinted model showed maximum strain values, but when oblique load was applied, D4L6-nonsplinted model had the maximum strain values. CONCLUSION: Splinting adjacent short implants may provide less bone strain and stress, especially at the presence of lateral forces. Increasing the implant diameter may be effective in strain reduction, but does not seem to reduce the bone stress, regardless of the direction of the load applied.

A modified frenectomy technique: a new surgical approach.

The frenum is a mucosal fold that attaches the lips or cheeks to the alveolar mucosa, gingiva, and underlying periosteum. Consequences of an abnormal frenal attachment include gingival recession, decreased vestibular depth, decreased range of lip movement, and involvement of interdental papilla, causing a diastema. Several methods to eliminate ectopic frenal attachments have been suggested, including frenectomy (elimination) and frenotomy (repositioning). This case report describes the use of a modified frenectomy technique in a 15-year-old girl with excess gingiva between the maxillary central incisors, which exhibited a 3-mm diastema. First, a semilunar primary incision was made in the palatal surface at a 5-mm distance from the tip of the papilla. Next, sulcular incisions were made around the tooth, and the papilla was transposed to the buccal via a papilla preservation flap. After complete elimination of frenal attachments in the bone, the flap was repositioned and sutured to the palatal surface. Afterward, the frenum was classically cut and sutured. Through this approach, the position of the frenum was changed apically without invading the papilla. At the 3-month follow-up, it was found that the modified technique (combination of papilla preservation flap and frenotomy) had minimized the surgical scar on the buccal surface, preserved the papilla, and yielded optimal esthetic results.

Timing of soft tissue management around dental implants: a suggested protocol.

Survival of dental implants depends on several factors; soft tissue (ST) management around dental implants is one of the foremost. Several studies have suggested techniques for ST management around dental implants, but none of them has discussed a suitable timetable for this process. This study aimed to review published articles related to the timing of ST management around dental implants and suggest a customized treatment protocol. A search of the PubMed database was conducted; the search was limited to English-language articles published from January 1995 to July 2015 with available full texts. Only in vivo studies and clinical trials in relation to the terms soft tissue management, management timing, keratinized mucosa, free gingival graft, connective tissue graft, soft tissue, augmentation, and dental implant were included. A total of 492 articles were reviewed, and eventually 42 articles were thoroughly evaluated. Those with treatment protocols in terms of the timing of ST grafting were selected and classified. ST management around dental implants may be done prior to the surgical phase, after the surgical phase, before loading, or even after loading. A thick gingival biotype is more suitable for implant placement, providing more favorable esthetic results. A treatment plan should be based on individual patient needs as well as the knowledge and experience of the clinician. The width and thickness of keratinized tissues, the need for bone management, and local risk factors that influence esthetic results determine the appropriate time for ST augmentation procedures.

Effects of Er,Cr:YSGG Laser Treatment on Human Gingival Fibroblast Attachment, Viability and Morphology of Root Surface: An In Vitro Study.

Rehabilitation of periodontal support is the main goal of therapies for periodontitis. Hand instrumentation with curettes, piezoelectric ultrasonic scalers and lasers, such as Er,Cr:YSGG, are used for this purpose. This study was designed to evaluate human gingival fibroblast viability attachment to root surfac after modification with the mentioned therapeutic alternatives. Lasers showed significantly lower cell viability after 72 hours compared to hand instrumentation and ultrasound, probably due to more irregular root surfaces after treatment.

Potentials of pure xenograft materials in maxillary ridge augmentation: A case series.

Many patients require edentulous ridge augmentation for dental implant placement. The main objective of this study was to evaluate the results of maxillary edentulous ridge augmentation exclusively with xenograft materials with and without simultaneous sinus floor elevation. This study reports the data retrieved from the records of 16 patients. The treatment outcome was assessed at least 6 months, postoperatively. Paired samples t-test or Wilcoxon Signed Rank test was used to compare the pre-and postoperative ridge dimensions. Dental implants were placed simultaneously in 7 patients, while 9 patients underwent delayed implant placement. In total, 68 implants were placed, and 12 patients also underwent maxillary sinus floor augmentation. A significant bone gain was achieved in both horizontal and vertical dimensions of edentulous maxillary ridges (P < 0.001). Ridge width increased by an average of 4.35 ± 1.90 mm (95% CI: 3.84 to 4.85 mm) while ridge height in areas of sinus floor augmentation increased by 8.19 ± 2.91 mm (95% CI: 7.33 to 9.05 mm). Within the study limitations, it appears that maxillary ridge augmentation according to the guided bone regeneration (GBR) protocols with exclusive use of xenograft particulate materials can provide optimal bone quantity for dental implant placement.