Evaluation of the relationship between periodontal bone destruction and mesial root concavity of the maxillary first premolar.

BACKGROUND: The purpose of this study was to investigate the morphology of maxillary first premolar mesial root concavity and to analyse its relation to periodontal bone loss (BL) using cone beam computed tomography (CBCT) and panoramic radiographs. METHODS: The mesial root concavity of maxillary premolar teeth was analysed via CBCT. The sex and age of the patients, starting position and depth of the root concavity, apicocoronal length of the concavity on the crown or root starting from the cementoenamel junction (CEJ), total apicocoronal length of the concavity, amount of bone loss both in CBCT images and panoramic radiographs, location of the furcation, length of the buccal and palatinal roots, and buccopalatinal cervical root width were measured. RESULTS: A total of 610 patients' CBCT images were examined, and 100 were included in the study. The total number of upper premolar teeth was 200. The patients were aged between 18 and 65 years, with a mean age of 45.21 ± 13.13 years. All the teeth in the study presented mesial root concavity (100%, n = 200). The starting point of concavity was mostly on the cervical third of the root (58.5%). The mean depth and buccolingual length measurements were 0.96 mm and 4.32 mm, respectively. Depth was significantly related to the amount of alveolar bone loss (F = 5.834, p = 0.001). The highest average concavity depth was 1.29 mm in the group with 50% bone loss. The data indicated a significant relationship between the location of the furcation and bone loss (X2 = 25.215, p = 0.003). Bone loss exceeded 50% in 100% of patients in whom the furcation was in the cervical third and in only 9.5% of patients in whom the furcation was in the apical third (p = 0.003). CONCLUSIONS: According to the results of this study, the depth of the mesial root concavity and the coronal position of the furcation may increase the amount of alveolar bone loss. Clinicians should be aware of these anatomical factors to ensure accurate treatment planning and successful patient management.

In vivo efficacy of low-level laser therapy on bone regeneration.

PURPOSE: In clinical use of low-level laser therapy for bone regeneration (LLLT), application protocol (dose, duration, and repetitions) has not been established. This study aimed to depict a reliable dosage of LLLT by evaluating the efficacy of different dosing of LLLT (diode) on the healing of rabbit cranial defects. METHODS: Critical size defects were prepared in calvarias of 26 New Zealand White Rabbits in such each animal containing both test and control groups. Test groups were irradiated with 4 Joule/cm2 (j/cm2), 6 j/cm2, and 8 j/cm2. The rabbits were subjected to six times of laser treatments in 10 days. At the end of the second week, 5 rabbits were sacrificed for histopathological and immunohistochemical analyses. At the 4th and 8th weeks, 20 rabbits (10 each) were sacrificed for micro-CT and histopathological analyses. RESULTS: Micro-CT evaluation revealed improved new bone formation in all test groups compared to the control group. 6 j/cm2 group demonstrated the highest bone formation. The highest bone morphogenic protein -2 levels were found in the 4 j/cm2 group. Osteocalcin expression was significantly higher in 4 j/cm2 group. CONCLUSIONS: Our findings indicate that LLLT have a positive effect on new bone formation. The high efficacy of doses of 4 j/cm2 and 6 j/cm2 is promising to promote early bone healing.

Gingival tissue human beta-defensin levels in relation to infection and inflammation.

AIM: To profile gingival tissue levels of human beta-defensin (hBD)-2 and hBD-3 in relation to gingival inflammation, Th17-related cytokine concentrations, Porphyromonas gingivalis counts, and gingipain and total protease activities. MATERIALS AND METHODS: Gingival tissue and subgingival plaque samples were collected from 21 periodontitis patients including 48 periodontal pocket sites with marginal, mild, or moderate to severe inflammation. hBD levels were determined by immunodetection, P. gingivalis counts with real-time polymerase chain reaction, protease activities with fluorogenic substrates, and cytokine concentrations with Luminex technique. Data were statistically analysed using Kruskal-Wallis and Mann-Whitney U tests and Spearman correlation coefficients. RESULTS: Subgingival plaque counts of P. gingivalis (p = .001) and gingipain activity (p < .001), as well as interleukin (IL)-1ß (p = .012), IL-10 (p = .024), IL-17A (p = .002), IL-17F (p = .006), and IL-23 (p = .036) concentrations were elevated in severely inflamed sites, whereas no change was observed in hBD-2 and hBD-3 levels. Negative correlations were found between protease activity and hBD-2 (p = .033) and hBD-3(p = .003) levels. CONCLUSIONS: Shift in gingival inflammation from marginal to mild stage is related to elevations in subgingival plaque P. gingivalis counts and gingipain activity, but not to tissue hBD levels. Negative correlations between hBDs and total protease activity suggest the degradation of these antimicrobial peptides in progressed inflammation.

Evaluation of gingival crevicular fluid and peri-implant crevicular fluid levels of sclerostin, TWEAK, RANKL and OPG.

BACKGROUND: The combination of local and systemic factors play role in the pathogenesis of periodontal and peri-implant diseases. Host-derived enzymes, cytokines and other proinflammatory mediators play an integral role in this destruction. The aim of this study is to evaluate gingival crevicular fluid (GCF) and peri-implant crevicular (PICF) fluid levels of sclerostin, TNF-related weak inducer of apoptosis (TWEAK), receptor activator of nuclear factor kappa-beta ligand (RANKL) and osteoprotegerin OPG in periodontal and peri-implant tissues in disease and health conditions and also to assess the potential for use as biomarkers. MATERIALS AND METHODS: The study population was consisted of 50 women and 41 men, in the total of 91 individuals, with a mean age of 51.84 ±â€¯14.05. Periodontitis (n = 22), periodontal health (n = 17), peri-implantitis (n = 27) and peri-implant health (n = 25) groups were established according to clinical and radiographic examination results of 39 teeth and 52 implants restored with fixed prosthetic restorations. In all groups, periodontal and peri-implant parameters (probing depth, gingival recession, gingival bleeding time index, gingival index, and plaque index) were recorded and GCF and PICF samples were also collected. Sclerostin, TWEAK, RANKL and OPG levels in GCF and PICF were measured with ELISA tests. RESULTS: Peri-implantitis group presented significantly higher levels of Sclerostin (p = 0.002), TWEAK(p < 0.0001), RANKL(p < 0.0001), and OPG (p = 0.037) compared to peri-implant health group. Similarly, significantly higher levels of TWEAK (p = 0.001), RANKL(p < 0.0001), and OPG(p = 0.025) were detected in periodontitis group when compared to periodontal health group. Statistically significant correlations were also noted between biochemical parameters and clinical parameters. CONCLUSION: Findings of this study evaluating four different bone metabolism related proteins at the same time, suggests levels of sclerostin may be a biomarker for peri-implant disease presenting significantly higher levels in the peri-implantitis group than in the peri-implant health group. Moreover, levels of TWEAK can be a good indicator for both periodontal and peri-implant disease, due to the correlations with periodontal clinical parameters and the higher levels of TWEAK in diseased sites compared to the healthy sites for both dental implants and teeth.

Gingival crevicular fluid levels of human beta-defensin-1 in type 2 diabetes mellitus and periodontitis.

OBJECTIVES: Human ß-defensin (hBD)-1 is an important gatekeeper of the gingiva against constant bacterial challenge, and glucose levels are involved in its optimal expression. The aims of the study were to investigate hBD-1 levels in gingival crevicular fluid (GCF) and to compare these levels between type 2 diabetics with or without periodontitis and healthy individuals. MATERIALS AND METHODS: Altogether, 81 subjects were included in the study: 21 subjects with type 2 diabetes mellitus (T2DM) suffering from generalized periodontitis (T2DM + GP), 18 systemically healthy generalized periodontitis patients (GP), 18 periodontally healthy T2DM subjects (T2DM + H), and 24 systemically and periodontally healthy subjects (control). Plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded, and GCF samples were collected. hBD-1 levels in GCF were measured using ELISA. RESULTS: hBD-1 levels were significantly reduced in the T2DM + GP and GP groups. Although PI and GI scores were similar in both periodontally healthy groups, hBD-1 levels were lower in the T2DM + H group. In the whole population, hBD-1 levels correlated negatively with all periodontal parameters. CONCLUSIONS: Both diabetes and periodontitis affect hBD-1 levels in GCF. CLINICAL RELEVANCE: The altered levels of hBD-1 in GCF of diabetics might be associated with the susceptibility of diabetics to periodontitis.

Associations of alveolar bone loss and interleukin-1ß levels in one- and two-stage surgical procedures: a randomized prospective trial.

OBJECTIVE: Dental implants have been widely and successfully used in recent years as an alternative treatment for removable and fixed dental prostheses. The aim of this randomized prospective study was to determine the alveolar bone loss rate (ABLR) and IL-1ß levels in one- and two-stage surgical procedures. MATERIALS AND METHODS: This study included 40 patients with a single missing tooth in the posterior mandible; dental implants were inserted using a one-stage surgical procedure (Group I) or a two-stage surgical procedure (Group II). All clinical periodontal parameters were recorded; peri-implant crevicular fluid (PICF) samples were collected before loading (T0) and during the third (T1) and sixth (T2) months after loading. ABLR values were evaluated at T0 and T2 by using dental tomography. PICF was analysed after T2 samples were collected. The study was registered through clinicaltrials.gov; identifier NCT03045458. RESULTS: This study found that, the probing pocket depth was found to be significantly higher in Group I than Group II at both T1 and T2 (p < .05). There was no significant difference in other clinical parameters between the groups (p > .05). There was a significant difference between Group I ABLR values at T0 and T2 (p < .05). The PICF IL-1ß levels were not significantly different between groups (p > .05). CONCLUSIONS: Within the limitations of the short observational period and small sample size of this study, two-stage implant placement shows comparable clinical outcomes to implants placed using a one-stage placement protocol.

Implant-Site Related and Patient-Based Factors With the Potential to Impact Patients' Satisfaction, Quality of Life Measures and Perceptions Toward Dental Implant Treatment.

OBJECTIVES: The present study aimed at evaluating both the implant site-related and patient-based factors with the potential to affect the extent of patients' satisfaction and also their perceptions regarding dental implant treatment. Potential differences between the esthetic evaluations of dental patients and dental specialists were also considered. MATERIALS AND METHODS: Implant-supported fixed prosthesis (n = 164) in 264 anterior esthetic implant sites were included. Patients' satisfaction, esthetic considerations, and perceptions toward dental implants, were evaluated by both Oral Health Impact Profile-14 (OHIP-14) questionnaire and visual analog scale. Pink Esthetic Score/White Esthetic Score were used for the professional esthetic evaluations of dental specialists. RESULTS: Overall patient satisfaction was high (87.42 ± 11.86). Compared with implant supported single-tooth restorations, patients with implant-supported bridges had lower OHIP scores (P = 0.001) and were relatively less satisfied with particular aspects of dental implant treatment (eg, cleanability, phonetics, surgical discomfort, and pretreatment information). Generally, type of prosthesis, history of soft/hard tissue augmentation, and reason for tooth loss had a clear impact on the extent of patients' satisfaction, esthetic considerations regarding treatment outcome, and their perceptions toward dental implant treatment (P < 0.05). CONCLUSIONS: Fixed implant-supported restorations generally provide with high levels of satisfaction and oral health-related quality of life.

Practical Implementation of Evidence-Based Dentistry Into Daily Dental Practice Through a Short Time Dependent Searching Method.

INTRODUCTION: Despite the fact that the benefits of implementation of Evidence-Based Dentistry (EBD) into clinical practice is increasingly being highlighted, there are still clear limitations in its implementation into daily dental practice. One potentially important barrier to effective implementation into practice is the perception of EBD as a time-consuming process. The aim of the present study is to increase the familiarity of dental practitioners with the benefits of different time-dependent 'practical' search strategies important to EBD using a clinical question from the field of dental implantology as an example. MATERIALS AND METHODS: The PICO (population, intervention, comparison, outcome) question used in this study was: "In young adults with anterior single-tooth implant what is the effect of immediate or delayed loading on success?" A bibliographic search according to the Haynes 5S pyramid, together with 3 different time-dependent strategies (5-min, 30-min and more than 60-min), were applied. RESULTS: Both the Haynes 5S Pyramid and time-dependent search strategies revealed promising results for enhancing decision-making for determining the feasibility of immediate or conventional loading of anterior single dental implants. Results clearly showed that selection of the loading protocol would be case (patient)-specific and also indicated high primary implant stability and bone quality as the most important prerequisites for a successful immediate/early loading. From among the 3 different time-dependent strategies (5 min, 30 min and more than 60 min), the 60+ min search results were quite comparable with the Haynes pyramid search results. CONCLUSION: It is likely that the different time-dependent search strategies may have the potential to support the clinical decision making process and may improve the implementation of EBD into daily dental practice. Increased time spent searching naturally seems to increase the extent of this support. However, even with short time-dependent searches, busy dental clinicians may get an improved idea/opinion regarding a clinical question.

Low bone mineral density in young individuals is associated with greater gingival inflammation and recession.

Most patients with osteoporosis are postmenopausal women or senile people who are deemed to have primary osteoporosis. However, young women, males, and atypical cases need further work up to evaluate the risk factors for secondary osteoporosis. A growing body of literature has accumulated regarding the role of osteoporosis in the onset and progression of periodontal disease and tooth loss. We hypothesized that secondary/idiopathic osteoporosis in young patients will be associated with worse periodontal status. Patients and controls who were seen in the general internal medicine outpatient clinic and who were less than 47 years of age were recruited between December 2005 and June 2011. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Blood samples were obtained for bone turnover markers and secondary causes of low BMD. Periodontal variables were assessed. Forty-five women whose mean age was 33.9 ± 7.7 years were enrolled. The osteoporotic group consisted of 12 patients, the osteopenic group 17 patients, and the control group 16 subjects. Significantly higher gingival recession (GR), gingival bleeding time index, and hence gingival inflammation were noted in patients with secondary osteoporosis compared to healthy subjects. In logistic regression analysis, having osteoporosis was determined as the single risk factor for increased bleeding time (b = 0.871, p = 0.008), while having osteoporosis (b = 0.181, p = 0.001) and age (b = 0.010, p < 0.001) were significant parameters with regard to GR. In conclusion, low BMD in young individuals was associated with greater gingival inflammation and recession when compared to those individuals with normal BMD values.

Evaluation of mandibular lingual foramina related to dental implant treatment with computerized tomography: a multicenter clinical study.

BACKGROUND: Bleeding can be one of the severe complications during implant placement or other surgeries. Presurgical assessment of the area should be performed precisely. Thus, we examined lingual vascular canals of the mandible using dental computerized tomography (CT); define the anatomical characteristics of canals and the relationship with mandibular bone. METHODS: One thousand sixty-one foramina in 639 patients, in 5 dental clinics, were included in this multicenter study. Distance between crest and lingual foramen, tooth apex and lingual foramen, distance from mandibular border, diameter of lingual foramen, canal type, anastomosis, and location of foramen were examined. RESULTS: Foramen was 18.33 ± 5.45 mm below the bony crest and 17.40 ± 7.52 mm from the mandibular border, with men showing larger measurements. The mean diameter of lingual foramina was 0.89 ± 0.40 mm; 76.8% canal type was mono; 51.8% patients presented with median lingual canal-foramen (MLC) and 21.1% with lateral lingual foramen. Diameter of MLC was statistically larger. CONCLUSIONS: With a large sample group, results represented that lingual foramina could be visualized with dental CT, providing useful data for mandibular implant surgeries. Findings suggest that vascular canals and several anastomoses exist in the anterior mandible extending through premolar and molar regions as well. It is imperative to consider these vessels with the dental CT before and during the mandibular surgery to prevent threatening hemorrhage.

Is there a gender difference in anatomic features of incisive canal and maxillary environmental bone?

OBJECTIVES: The effect of gender on anatomic structures and various body systems were illustrated in the literature. The purpose of this study was to identify the influence of gender and tooth loss on incisive canal characteristics and buccal bone dimensions in the anterior maxilla. MATERIALS AND METHODS: Computed tomographies (CTs) of 417 male and 516 female patients in four dental clinics were included in this study. The diameter and the length of the incisive canal; width and the length of the bone anterior to the canal; palatal bone length, root length, and root width of the central incisor teeth were measured and recorded from CT sections. RESULTS: Mean incisive canal length was 11.96 ± 2.73 mm and 10.39 ± 2.47 mm in men and women, respectively, (P < 0.05). In men, mean canal diameter was 2.79 ± 0.94 mm whereas in women it was 2.43 ± 0.85 mm and this difference was statistically significant (P < 0.05). Men had significant higher buccal bone dimensions (length and width of the bone anterior to the canal) than women. Absence of teeth in the anterior maxilla decreased incisive canal length and buccal bone dimensions; however, canal diameter remain unchanged. CONCLUSIONS: Present results suggested a gender related differences in anatomic features of incisive canal and surrounding buccal bone. In addition, crestal canal diameter, buccal bone length, and thickness parameters might be different in distinct countries.

Inpatient evaluation of periodontal, esthetic and inflammatory parameters around dental implants and natural teeth.

AIM: The use of endosseous dental implants (DI) has become a successful treatment alternative. However, providing periimplant tissue health and achieving a natural esthetic look are important topics in this treatment. The aim of the present study was to evaluate periodontal and esthetic parameters around DI and natural teeth (NT) and also to analyze myeloperoxidase (MPO) levels in gingival crevicular fluid (GCF) and peri-implant sulcus fluid (PISF). MATERIALS AND METHODS: Twenty DI supported fixed prosthesis and contralateral 20 NT were enrolled to the present study. Clinical periodontal parameters (probing depth, clinical attachment level, gingival bleeding time index and gingival index) were recorded and GCF/PISF samples were obtained from mesial (mesiobuccal and mesiolingual) and distal (distobuccal and distolingual) sites of DI and NT. MPO levels were spectrophotometrically determined. Additionally clinical photographs were obtained and esthetical evaluations were performed by using Jemt papilla index. The parameters belong to DI and NT were compared and correlations were evaluated using statistical analysis. RESULTS: A total of 40 samples were evaluated. No statistically significant differences were detected between groups in all periodontal parameters and MPO levels from mesial and distal sites. Jemt papilla index scores were slightly higher in NT however, this difference was not statistically significant (p > 0.05). Total PES score were similiar in DI and NT groups. Significant correlations were detected between MPO and gingival index values as expected. CONCLUSION: These results suggest that DI and NT have similar inflammatory conditions and esthetics, representing DI as a predictable treatment option. CLINICAL SIGNIFICANCE: Dental implants are satisfactory treatments, they provide patient esthetic natural looking, phonetic and masticatory functions.

Effect of inflammation on cytokine levels and bone remodelling markers in peri-implant sulcus fluid: a preliminary report.

OBJECTIVES: Since ingredients of peri-implant sulcus fluid (PISF) may be related to the bony structure surrounding dental implants, analyze of specific markers related to bone resorption in PISF seems to be suitable for long term monitoring of peri-implant health. It is suggested that analysis of PISF may serve for detection of inflammation. The aim of this study is to analyze PISF interleukin-1 beta (IL-1ß), IL-10, osteoprotegerin (OPG), receptor activator of nuclear factor-kappa B ligand (RANKL) levels to determine whether the diagnostic value of PISF can be used to evaluate early changes around implants. MATERIALS AND METHODS: A total of 47 dental implants either healthy/non-inflamed (n=20) (Group I), or gingivitis/inflamed (n=27) (Group II), were classified. Peri-implant status has been evaluated by clinical evaluation (plaque index, gingival index, probing depth and gingival bleeding time index) were recorded and PISF samples were also obtained. PISF IL-1ß, IL-10, RANKL, and OPG levels were measured by enzyme-linked immunosorbent assay. Potential volumetric changes in PISF were also evaluated. RESULTS: All clinical parameters and volume of PISF were higher in Group II and these differences were statistically significant except volume values. IL-1ß, IL-10 and OPG levels in PISF were significantly higher in Group II. Although the PISF RANKL level in Group II was higher than the level of Group I, the difference between groups did not reach the statistically significant level. CONCLUSIONS: These data suggest that a balance of inflammatory- and osteoclastogenesis related molecules locally produced may play an important role in the development of inflammatory peri-implant lesions.

Comparative analysis of gingival wetness at natural teeth and dental implant sites.

BACKGROUND: "Gingival Wetness (GW)," which is the thickness of residual saliva on gingiva, functions as a moisture retainer and a protective barrier for microbial colonization. Whether dental implant (DI) treatment affects GW scores and whether gingival inflammation has the capacity to alter GW remains unknown. Thus, this study was designed to evaluate the potential impact of DI treatment on GW. METHODS: A total of 118 DIs and natural teeth (NT) sites were comparatively analyzed. Clinical periodontal and periimplant status were determined. Sites were classified into 2 subgroups based on the clinical inflammatory status as inflamed or noninflamed. GW was measured by standardized paper strips and quantified by micromoisture meter. RESULTS: Gingival index, clinical attachment loss, plaque index, and gingival bleeding time index scores were generally lower at DI sites. Significant differences were seen in clinical attachment loss, plaque index, and gingival bleeding time index in inflamed sites, presenting higher scores for NT. Comparable values were observed for DI and NT regarding GW for all sites. No differences were noticed in GW scores between the noninflamed NT and DI sites and also wheninflamed sites were concerned. CONCLUSIONS: DI treatment does not seem to result in any apparent reduction in GW. Thus, it can be speculated that similar protective processes may occur at dental implant and NT sites. Furthermore, GW does not seem to depend on the local inflammatory status of the soft tissues.

Evaluation of GCF IL-17, IL-10, TWEAK, and sclerostin levels after scaling and root planing and adjunctive use of diode laser application in patients with periodontitis.

BACKGROUND: The aim of the present study was to evaluate the clinical efficacy of the diode laser as an adjunct to scaling and root planing (SRP) and also determine the biochemical profile by evaluating the gingival crevicular fluid (GCF) levels of interleukin (IL)-17, IL-10, tumor necrosis factor-related weak inducer of apoptosis (TWEAK), and sclerostin. METHODS: A total of 40 systemically healthy, patients with Stage III periodontitis were included in this randomized controlled study. Participants were randomly divided into two groups as SRP + diode laser (L) (0.80W power, 940 nm wavelength and 0.80J/s energy level) and only SRP group. Recording of periodontal parameters and collecting GCF samples were performed at baseline, first and 3rd months. Biomarker levels in GCF were measured with ELISA RESULTS: At baseline, no significant difference was detected between groups in terms of both clinical and biochemical parameters. All biochemical parameters (except for IL-10 in control group), presented a statistically significant difference for 3 months study period in both groups. When laser and control groups were compared, significant differences were not observed, except the lower GCF IL-17 levels (P = 0.025), bleeding on probing (P = 0.028), and clinical attachment level (CAL) (P = 0.0002) values in laser group at third, first, and third months, respectively. Statistically significant correlations were also noted between biochemical parameters and clinical parameters. CONCLUSIONS: The GCF IL-17, TWEAK, and sclerostin levels may be useful for monitoring response to SRP+L therapy. However, long-term studies on higher populations are needed to evaluate the effectiveness of adjunctive use of diode laser application to SRP.

Clinical, Technical, and Radiologic Outcomes of 182 Implant-Supported Zirconia Single Crowns Using Titanium-Base Abutments: A Retrospective Study.

PURPOSE: To evaluate the biologic, technical, and radiographic outcomes of CAD/CAM-milled bilayer and monolithic zirconia crowns using implants and Ti-base abutments with up to 5 years of follow-up. MATERIALS AND METHODS: A total of 182 implant-supported "screw-mentable" (hybrid screw/cement retention) single crowns were evaluated in 118 patients. Ti-base abutments were selected according to the chimney (3.5 or 5 mm) and gingival (1, 2, or 3 mm) heights in the virtual model. Zirconia crowns were designed using CAD/CAM software and then milled from partially stabilized zirconia blocks. After all crowns were cemented onto Ti-base abutments, they were clinically screwed onto the implants. Both implants and crowns were followed up for up to 5 years, and their clinical, technical, and radiologic results were recorded. RESULTS: A total of 118 patients (86 women and 32 men) who received 182 implant-supported screw-mentable crowns were included in this study. The mean follow-up period was 32 ± 18 months (range: 24 to 60 months) for all implants and crowns. No implant was lost during the follow-up period, yielding a cumulative implant survival rate of 100%. Two technical complications were observed in two bruxer patients, yielding a cumulative restoration survival rate of 98.9%. The marginal bone loss was 0.7 ± 0.5 mm from the baseline radiograph to the radiograph taken at the final recall visit. No implants were diagnosed with peri-implantitis. CONCLUSION: The outcomes of this study suggest that Ti-base abutments are a feasible and affordable alternative to CAD/CAM abutments and that they can successfully support single zirconia crowns.

Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study.

OBJECTIVES: Knowledge and evaluation of the maxillary sinus anatomy before sinus augmentation are essential for avoiding surgical complications. Posterior superior alveolar artery (PSAA) is the branch of maxillary artery that supplies lateral sinus wall and overlying membrane. The aims of this study were to examine the prevalence, diameter, and location of the PSAA and its relationship to the alveolar ridge and to study the prevalence of the sinus pathology and septum using computerized tomography (CT) scans. MATERIALS AND METHODS: One hundred and twenty-one CT scans (242 sinuses) from patients undergoing sinus augmentation procedure and/or implant therapy were included. Lower border of the artery to the alveolar crest, bone height below the sinus floor to the ridge crest, distance of the artery to the medial sinus wall, diameter of the artery, and position of the artery were measured; presence of septa and pathology were recorded from CT sections. RESULTS: Prevalence of sinus septa and sinus pathology was 16.1% and 24.8%, respectively. Artery was seen in 64.5% of all sinuses and was mostly intraosseous (68.2%). Mean diameter of PSAA was found 1.3 ± 0.5 mm. No significant correlation between the diameter of the artery and age was observed. CONCLUSIONS: The results from this study suggested that CT scan is a valuable tool in evaluating presence of sinus pathology, septa, and arteries before maxillary sinus surgery. Although variations exist in every patient, the findings from this study suggest limiting the superior border of the lateral window up to 18 mm from the ridge to avoid any potential vascular damage.

A 12-month evaluation of nitrite oxide metabolism around immediate and conventionally loaded dental implants.

BACKGROUND: During bone remodeling, alignment of bone is affected by loading direction. Considerable amount of data also suggest nitric oxide (NO) to be involved in bone metabolism. This study was conducted to evaluate the potential changes in NO metabolism in relation to the loading style of dental implants by analyzing the nitrite content of peri-implant sulcus fluid. METHODS: Dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient determined as immediately loaded and the other side were conventionally loaded. Clinical parameters were recorded and peri-implant sulcus fluid samples were obtained. Peri-implant sulcus fluid nitrite levels were spectrophoto-metrically determined. Clinical measurements and nitrite analysis were repeated at 1, 3, 6, 9, and 12 months. RESULTS: In both groups, there was a reduction between baseline and 12 months in all clinical parameters, except probing depth. Although, steady decrease was noticed in total nitrite levels during the whole experimental period in immediately loaded implants, more fluctuations were observed in conventionally loaded ones. CONCLUSIONS: The findings of this 12-month follow-up study support the association of NO in the bone metabolism around dental implants and further suggest the impact of different loading regimens on NO metabolism.

The impact of prosthetic design on the stability, marginal bone loss, peri-implant sulcus fluid volume, and nitric oxide metabolism of conventionally loaded endosseous dental implants: a 12-month clinical study.

BACKGROUND: Further clarification of the early and late response of peri-implant tissues to surgical insertion and loading of dental implants and the potential associations among the various implant-related measures are likely to improve the evaluation/monitoring of implant sites. Thus, analyses were made of the volume and nitric oxide (NO) profile of peri-implant sulcus fluid (PISF), implant stability, and marginal bone level in relation to different prosthetic designs. METHODS: Seven totally edentulous subjects and 11 partially edentulous subjects were included. Resonance frequency analysis (RFA), marginal bone level measurements, PISF volume, and spectrophotometrically determined nitrite levels were analyzed comparatively at conventionally loaded (CL) implant sites and at implants with removable prostheses (RP; N = 14) and fixed prostheses (FP; N = 11) for a period of 12 months. RESULTS: At implant sites with RP, PISF volume decreased gradually and its lowest level occurred at the end of the experimental period. The PISF nitrite content increased until 6 months and was followed by a significant decrease at 12 months. Compared to baseline, RFA values exhibited a significant decrease at 1 and 3 months. Marginal bone level was significantly lower at all follow-up visits compared to baseline. More volumetric fluctuations of PISF was noted at implant sites with FP. The PISF nitrite content had decreased, compared to baseline, at 6, 9, and 12 months. A general stability was observed for RFA. The marginal bone loss observed at 6 months was followed by a gain at 12 months. An inverse relationship was noted between RFA values and marginal bone levels. CONCLUSION: The prosthetic design particularly seems to affect the NO metabolism around CL implants, whereas it does not seem to have any impact on the stability of dental implants.

In-patient comparison of immediate and conventional loaded implants in mandibular molar sites within 12 months.

OBJECTIVES: The aim of this prospective clinical study was to evaluate the clinical outcomes of dental implants placed in the mandibular molar sites and immediately functionally restored compared with conventionally loaded controls in an in-patient study. MATERIAL AND METHODS: Twenty-four dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient was determined as immediately loaded (IL) and the other side was conventionally loaded (CL). Resonance frequency analyses for implant stability measurements, radiographic examinations for marginal bone levels and peri-implant evaluations were performed during the clinical follow-up appointments within 12 months. RESULTS: During the 12-month follow-up period, only one implant was lost in the IL group. The mean implant stability quotient values were 74.18+/-5.72 and 75.18+/-3.51 for Groups IL and CL at surgery, respectively, and the corresponding values were 75.36+/-5.88 and 75.64+/-4.84 at 1-year recall, respectively. The difference was not statistically significant between the two groups during the 12-month study period (P>0.05). When peri-implant parameters were evaluated, excellent peri-implant health was demonstrated during the 1-year observation period and all implants showed less than 1 mm of marginal bone resorption during the first year. CONCLUSIONS: In the present study, immediate functionally loading did not negatively affect implant stability, marginal bone levels and peri-implant health when compared with conventional loading of single-tooth implants.