Use of Leukocyte-rich and Platelet-rich Fibrin (L-PRF) Adjunct to Surgical Debridement in the Treatment of Stage 2 and 3 Medication-Related Osteonecrosis of the Jaw.

Medication-related osteonecrosis of the jaw (MRONJ) is characterized by exposed necrotic bone persisting for more than 8 weeks in the maxillofacial region in patients using antiresorptive or antiangiogenetic drugs for several treatment options like bone metastasis or osteoporosis. There are several treatment options studied in scientific literature, and one of them with promising results is using platelet concentrates adjunct to surgical therapy. The aim of this study is to examine the therapeutic effect of leukocyte and platelet-rich fibrin (L-PRF) on patients with MRONJ. This 2-centered study investigated patients referred to oral and maxillofacial surgery departments of 2 university clinics between the years 2014 and 2020 with the diagnosis of MRONJ. Demographic data, the indication of the drug usage, drug type, duration, administration route, and systemic comorbidities of the patients were recorded. L-PRF was applied to 20 osteonecrotic lesions of 19 patients following surgical debridement. The male/female ratio was 5/14. Except 1 of the patients, all of the indications of medication were neoplasia-related. The mean follow-up period of patients was 27.9±9.2 months. Most common antirezorptive drug was zoledronate (84.2%). Complete resolution was observed in 16 necrosis sites (80%). It could be concluded that the use of L-PRF may represent an important adjunct in the surgical management of MRONJ.

Effect of Residual Bone Height and Implant Macro-Design on Primary Stability in Sinus Floor Elevation: An Ex Vivo Study.

The objective was to evaluate the influence of residual bone height (RBH) and implant macro-design on the primary stability (PS) of implants using a simultaneous sinus floor elevation (SFE) and implant insertion model. Fresh bovine rib samples that resembled type-IV density that were confirmed by computerized tomography were prepared to represent 4 groups of varying RBHs (3, 6, 9, 15 mm). To simulate simultaneous implant insertion with SFE, 120 implants in different macro-designs (group R: NobelReplace; group P: NobelParallel; group A: NobelActive, Nobel Biocare, Gothenburg, Sweden) were randomly inserted at RBHs of 3, 6, 9, and 15 mm in each rib. The implant stability quotient (ISQ) was measured immediately after implant insertion. RBH and implant macro-design have an impact on ISQ values (P < .001). ISQ values were the highest with RBH of 15 mm, followed by RBHs of 9, 6, and 3 mm. (P < .001). There was no statistically significant difference between different implant macro-designs at RBHs of 3 and 15 mm regarding ISQ values (P = .111, P = .551). ISQ values of group P were higher than those of group R and group A at an RBH of 6 mm (P = .049, P = .029). ISQ values were also higher in group P compared to group A at an RBH of 9 mm (P = .006). A higher PS may be expected in sites with higher RBH, regardless of the macro-design. In addition, cylindric implant design may enhance the PS at RBHs of 6 and 9 mm in simultaneous implant insertion with SFE.

Influence of the Localization of Frontal Bone Defects on Primary Stability Values of 2 Different Implant Designs: An In Vitro Study.

OBJECTIVES: The aim of this study was to determine the influence of different frontal bone defect localizations on primary stability values of 2 different implant designs. MATERIALS AND METHODS: Eight cow rib segments were prepared before implant installation, as 2 segments with coronal, 2 with middle, and 2 with apical defects and 2 with control. Thirty-two cylindrical and 32 tapered implants were placed in the remaining 4 segments. Implant stability measurements were performed using electronic percussive testing and resonance frequency analysis. RESULTS: No significance was detected between the stability values of the 2 implant designs except the implant stability quotient (ISQ) of control groups. The tapered implants control group showed significantly higher lateral ISQs compared with cylindrical implants (P = 0.033). For both implant types, stability values were significantly lower in coronal defects (P < 0.01). No significant differences were detected in other defect types. CONCLUSION: Within the limitations of this study, it may be concluded that coronal defects may influence primary stability negatively, compared with middle and apical defects. Although statistically not significant, coronal defects caused lower primary stability values with the tapered design compared with parallel design.

Is there any predictive bone parameter for implant stability in 2-dimensional and 3-dimensional radiologic images?

OBJECTIVES: This ex vivo study aimed to compare radiomorphometric parameters between 2-dimensional (2-D) and 3-dimensional (3-D) radiographs and evaluate the influence of preoperative radiologic bone parameters on the clinical outcomes of implant stability. STUDY DESIGN: Implant recipient sites in fresh bovine blocks were evaluated on panoramic radiographs for gray value (GV), fractal dimension (FD), number of connected trabeculae (Co), and density of connected trabeculae (CoD). Cone beam computed tomography (CBCT) scans were evaluated for trabecular thickness (TbTh), cortical thickness (CTh), degree of anisotropy (DA), FD, and Co. Insertion torque (IT) and implant stability quotient (ISQ) were measured. RESULTS: GV was significantly correlated with all parameters in 2-D and 3-D images except FD in 2-D and Co in 3-D, and with all surgical parameters (P ≤ .029). Co and CoD values on panoramic radiographs had significant correlation with TbTh, CTh, and DA values on CBCT images (P < .001). All 2-D parameters and TbTh and CTh in the CBCT data were significantly correlated with IT only (P ≤ .047). Only GV was correlated with ISQ measurements (P ≤ .029). CONCLUSIONS: GV, Co, and CoD values on panoramic radiographs reflect the architecture of trabecular bone and the thickness of cortical bone, and might help predict implant stability in clinical situations.

Antibiotic prescribing habits of the clinicians dealing with dental implant surgery in Turkey: a questionnaire study.

PURPOSE: Although various prophylactic and/or postoperative systemic antibiotic regimens have been suggested to minimize failure after dental implant placement and postoperative infection, the role of antibiotics in implant dentistry is still controversial. The purposes of this questionnaire study were to determine the current antibiotic prescribing habits of clinicians in conjunction with dental implant placement and to understand whether any consensus has been reached among implant surgery performing clinicians. METHODS: An electronic questionnaire was sent by electronic mail to all members of the Turkish Dental Society. The questions were related to whether antibiotics were routinely prescribed either pre- or/and postoperatively during routine dental implant placement. The respondents were also asked to specify their workplace and education. The results were analyzed using SPSS software. Descriptive and chi-square analyses were used to compare categorical data; Kruskal-Wallis test was used to compare the quantitative data by category. RESULTS: A total of 429 members responded to the questionnaire. The clinicians having more experience had a greater tendency to prescribe preoperative antibiotics (p < 0.001), but there was no statistically significant difference between the postoperative antibiotic prescription choice of the clinician according to the clinicians' experience (p > 0.05). A total of 175 of the clinicians preferred to prescribe preoperative antibiotics when there was systemic comorbidity; 99 of the clinicians preferred to prescribe antibiotics before every implant surgery. The aminopenicillins were the most commonly prescribed antibiotics by the clinicians. A total of 38.58% of the respondents (n = 130) who were prescribing preoperative antibiotics, 2000 mg aminopenicillin was given 1 h before the surgical procedure. Dentists and solo private practitioners were prescribing more preoperative antibiotics (p < 0,05). CONCLUSIONS: There was no consensus among clinicians regarding the use of antibiotics in association with routine dental implant placement. Aminopenicillins were the most commonly prescribed antibiotics for both pre- and postoperatively. Furthermore, most of the antibiotic regimens being used are not in accordance with the current published data.

Comparison of the effect of postoperative care agents on human gingival fibroblasts: a preliminary study.

PURPOSE: The aim of this study is to compare effects of postoperative care agents; chlorhexidine, octenidine dihydrochloride and hyaluronic acid on human gingival fibroblasts' viability, proliferation, apoptosis and migration. MATERIALS AND METHODS: After cell culturing; chlorhexidine, octenidine dihydrochloride and hyaluronic acid solutions were applied on cells and nothing was applied for control group. The cells were monitored to investigate cytotoxicity; the percentage of apoptotic, living and dead cells at the time of 24, 48, and 72 hours (h). A scratch wound assay was performed to detect cell migration and cells were monitored at baseline, at 24 and 48h. RESULTS: At 24h, chlorhexidine showed statistically lower percentage of total apoptotic cells' than octenidine dihydrochloride (p=0.049), hyaluronic acid (p=0.049) and control (p=0.049). At 48h, hyaluronic acid showed statistically lower percentage than chlorhexidine (p=0.049), and control (p=0.049). All agents were found to have statistically and significantly more cytotoxic than control. However, there was no difference between experimental groups for proliferation rate. Octenidine dihydrochloride showed statistically negative effects on cell migration than chlorhexidine and hyaluronic acid at 24h. Chlorhexidine and hyaluronic acid maintained migration ability of cells than octenidine dihydrochloride at 48h. CONCLUSION: All agents have similar effects on cell behavior such as viability, apoptosis and cell proliferation. However, octenidine dihydrochloride showed statistically negative effects on migration ability than chlorhexidine and hyaluronic acid.