Sterility and bioactivity evaluation of two types of bone graft substitutes after removing the original packaging.

Background: Xenograft and allograft bone substitutes are widely used to replace the missing bone in defects. Since removing the packaging of these grafts can nullify their sterilization, this study aimed to evaluate the sterility and bioactivity changes of an allograft and a xenograft following uncapping/recap. Methods: Two types of commercial allograft and xenograft vials were unpacked and further exposed to operating room air, where implant surgery was performed for one second, ten minutes, and one hour. After three repetitions, samples were analyzed using microbiological tests and scanning electron microscopy (SEM) with energy dispersive x-ray analysis (EDX) for sterility and bioactivity evaluation. Results: None of the bone graft samples showed microbial growth or bioactivity-negative changes after seven days of unpacking the vials. Conclusion: Despite the positive results of this study, future studies and more analysis considering influential factors are required. Also, disinfection and air exchange must still be observed during biomaterial application and bone grafting procedures.

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.

Effects of Two Protocols of Low-Level Laser Therapy on the Proliferation and Differentiation of Human Dental Pulp Stem Cells on Sandblasted Titanium Discs: An In Vitro Study.

Introduction: Stem cell activities have different effects on tissue response and its outcomes. Low-level laser therapy (LLLT) can be considered a trigger to modify stem cell activities. The objective of the present experimental investigation was to study the effects of two protocols of LLLT on the proliferation and differentiation of human dental pulp stem cells (hDPSCs) cultured on sandblasted titanium discs. Methods: Cells obtained from human dental pulp were seeded/cultured on titanium discs and were set in 2 main groups: (i) Radiated cells using the gallium-aluminium-arsenide (GaAlAs) diode laser at a continuous wavelength of 808 nm at 3 J/cm2 for 12 sec or 5 J/cm2 for 20 seconds, and (ii) Non-irradiated cells serving as control groups. The impact of LLLTs on hDPSC-proliferation and viability was investigated using the MTT assay after 24, 72 and 96 hours. The alkaline phosphatase activity was studied with p-nitrophenylphosphate after 14 and 28 days. The ability of hDPSCs to express osteocalcin was investigated using real-time polymerase chain reaction after 28 days, while their attachment was observed under a scanning electron microscope (SEM) after 14 and 28 days. Results: Our study showed that LLLTs caused maximum cell proliferation in 96 hours (P<0.001) with 3 J/cm2 resulting in a higher proliferation rate. The highest activity of alkaline phosphatase and osteocalcin expression was observed in the laser radiation groups after 28 days. Conclusion: The outcomes of the current study showed that cultured hDPSCs on sandblasted titanium discs had a tendency towards increased cellular activity in response to LLLTs. Thus, LLLTs could regulate the activities of hDPSCs on bone repair surrounding the sandblasted titanium discs.

Clinical and Radiographic Outcomes of a Novel Transalveolar Sinus Floor Elevation Technique.

Objective: The aim of this study was to evaluate the clinical and radiographic outcomes of the "vertically expander screw" (VES) technique as a novel approach for maxillary sinus floor elevation and simultaneous implant placement. Materials and Methods: Forty-four patients (26 females, 18 males) received 71 implants with simultaneous transalveolar sinus floor elevation via the VES technique. The threaded bone expanders were used to elevate the sinus floor as well as bone expansion. The patients were followed-up on a regular basis, and final clinical and radiographic examinations were performed at least 24 months following functional loading. Statistical analysis was conducted using the Chi-square test, the correlation coefficient, and the independent t test (p < 0.05, 95% confidence interval). Results: All implants showed successful osseointegration. The mean marginal bone loss (MBL; 0.38 ± 0.75 mm) at the site of premolars was not significantly different from the value at the site of molars (0.17 ± 0.50 mm). The mean intrasinus bone gain (IBG) was not significantly different (3.47 ± 1.22 mm and 4.11 ± 1.67 mm, respectively; p = 0.92). Evaluation of implant success index (ISI) score revealed no difference between the premolars and molars (p = 0.12). Conclusion: Despite the limitations of the present study, it seems that the VES technique and simultaneous implant placement in carefully selected cases may result in promising outcomes. Clinical Relevance: Insufficient alveolar bone height and poor bone quality often complicate implant placement in the edentulous posterior maxilla. The VES technique and simultaneous implant placement can bring about favorable clinical and radiographic outcomes and high survival rate in carefully selected cases.

Effect of Enamel Matrix Derivative and N-Acetyl Cysteine on Proliferation and Osteogenic Activity of Dental Pulp Stem Cells.

Successful bone regeneration often requires induction by signaling molecules. Enamel matrix derivative (EMD) is said to enhance initial phases of healing. N-acetyl cysteine (NAC) is a molecule assumed to enhance osteogenesis and induce osteoblastic differentiation. This study sought to compare effects of EMD and NAC on proliferation, mineralization, and enzymatic activity of dental pulp mesenchymal stem cells (DPSCs). DPSCs were cultured on mineralized bone allograft (MBA) powder. After 24 hours, EMD in concentrations of 10, 50, and 100 µg/mL and NAC in 5 mM concentration were added. Methyl thiazolyl tetrazolium (MTT) assay was used for cell proliferation assessment at 1, 2, and 3 days. Osteoblastic differentiation of DPSCs was evaluated at 30 days, by alizarin red staining and assessment of alkaline phosphatase (ALP) activity. Both EMD and NAC caused time-dependent reduction of cell proliferation compared with the negative control. Maximum proliferation of DPSCs was observed in the 10 µg/mL EMD group at all time points, whereas NAC caused higher ALP activity and mineralization of DPSCs compared with EMD. In vitro application of NAC, as a signaling molecule, may effectively enhance bone regeneration by the induction of mineralization and enzymatic activity, despite the resultant reduction in cell proliferation rate.

Soft and Hard Tissue Changes Subsequent to Spontaneous Healing of the Extraction Sockets Using Cone-Beam Computed Tomography: A Cross-Sectional Study.

Objective: This study sought to compare the thickness of hard and soft tissues between edentulous and contralateral tooth sites. Materials and Methods: This split-mouth study evaluated 153 partially edentulous patients. The measurements were made on cone-beam computed tomography (CBCT) scans. The soft tissue thickness was measured at the cementoenamel junctional (CEJ) level, and at 2, 4, and 6 mm apical to the CEJ in the facial and palatal aspects. The bone thickness of the opposite quadrant was also recorded at 2, 4, and 6 mm apical to the CEJ. The Mann-Whitney U test and the Spearman's rank correlation coefficient were applied for further statistical analyses. Results: At the edentulous sites, significant soft tissue loss was noted at the CEJ level (p < 0.0001) and a considerable gain was noted at 2, 4, and 6 mm apical to the CEJ (p = 0.004, p < 0.0001, p ≤ 0.0001, respectively). A significant hard tissue loss was noted at 2 mm apical to the CEJ but a significant hard tissue gain was observed at the edentulous sites (p < 0.0001). The soft tissue gain at 6 mm apical to the CEJ was significantly associated with an increase in buccolingual diameter (p = 0.004) while the hard tissue loss at 2 mm apical to the CEJ was significantly correlated with a reduction in buccolingual diameter (p = 0.020). Conclusion: Different amounts of tissue thickness alterations occurred in different levels of socket.

Determination of the Volume and Density of Mandibular Ramus as a Donor Site Using CBCT.

Introduction: This study aimed to assess the quantity and quality of available bone to provide the autologous bone graft from mandibular ramus. Material and Methods: CBCT scans were collected and mandibular ramus was evaluated by measuring a variety of parameters including volume, bone height, cortical, and cancellous bone thickness. Data analysis was performed using descriptive statistics and inferential statistics. We used the Kolmogorov-Smirnov test for the evaluation of data normality. We then applied Pearson correlation and independent t-test for normal variables, and Spearman and Mann-Whitney correlation tests for abnormal variables. Statistical analysis was performed using SPSS version 19 and P value < 0.05 was considered significant. Results: A total of 52 women and 32 men (aged 21 to 70) were included in this study. The mean bone volume was 2.7 ± 0.70 cm3 [95%confidence interval (CI) 1.3-4.5]. The mean bone density in the middle section was 1016.36 ± 231.58 Gy value (95% CI 475.6-1520.9). Kolmogorov-Smirnov test revealed that the variables such as apical cortical/cancellous ratio (P = 0.005), middle-cancellous bone thickness (P = 0.016), and middle cortical/cancellous ratio (P = 0.005) were abnormal and the rest were normal. Bone density, as well as the amount of cortical bone in the middle and apical regions, had a significant reverse correlation with age (P < 0.001). Conclusion: The volume, density, and cortical/cancellous ratio are independent of sex. The reverse relationship between age and bone density, as well as the amount of cortical bone in several parts, indicates a decrease in bone quality with aging.

Effect of Schneiderian Membrane Thickening on the Maxillary Sinus Augmentation and Implantation Outcomes: A Systematic Review.

BACKGROUND: Schneiderian membrane thickness may influence the final clinical outcome of sinus augmentation and dental implantation. Mucosal thickening has been regarded as a contributing factor for post-treatment complications. This study aimed to systematically review the available literature on the association between mucosal thickening and potential complications related to sinus augmentation and implant placement. METHODS: An electronic search was carried out in MEDLINE, Embase, and Web of Science by two independent reviewers. It was complemented by manual search of the reference lists of all relevant studies. The studies reporting on sinus augmentation and dental implantation in cases with preoperative mucosal thickening were considered eligible for this study. RESULTS: The initial search yielded 1032 articles. Five hundred and sixty-four records were screened by title and abstract, and 57 studies succeeded the inclusion criteria for full-text evaluation. Finally, 10 records remained for data extraction. The included studies assessed sinus augmentation and implantation procedures in 765 patients, 324 (42.3%) of them showed mucosal thickening. Increased membrane thickness did not significantly elevate the frequency of sinus augmentation complications. In addition, the overall implant survival rate was 99.03%. CONCLUSIONS: Within the limitations of the present study, the presence of mucosal thickening might not be a risk factor for sinus augmentation and implant survival rate.

Histopathological characterization of peri-implant diseases: A systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review of the inflammatory elements in peri-implantitis (PI) and peri-implant mucositis (PM) in comparison with healthy peri-implant tissues (HI) and periodontal disease. DESIGN: The PubMed, Embase, Web of Science, and Scopus databases were searched up to December 2020. English articles that evaluated human soft tissue biopsies of PI or PM were included. Values reported for the surface area of the infiltrated connective tissue (ICT) were pooled using the random-effect model meta-analysis to estimate the mean (95% CI). RESULTS: A total of 33 articles were included. Of 30 studies on PI, the majority evidenced significantly increased vascularization and inflammatory cell counts dominated by plasma cells in PI compared with HI. Studies that compared PI with chronic periodontitis primarily reported more severe inflammatory infiltrates in PI. This was confirmed by the meta-analysis results since the surface area of the ICT was significantly larger in PI (p < 0.001). Only seven studies analyzed the PM lesions and reported increased inflammatory infiltrates and vascularization in PM compared with HI. Based on the meta-analysis results, the surface area of the ICT was 3.00 [1.50, 4.51] mm 2 in PI and 0.23 [0.02, 0.44] mm 2 in PM lesions. Based on the available evidence, presence of foreign body particles considerably increased the inflammatory infiltrate; however, smoking did not have a significant effect. CONCLUSIONS: There was controversy regarding the prevalence of various inflammatory cell types in peri-implant diseases; however, a considerably high ICT surface area in PI indicates the aggressive nature of the disease.

Clinical Efficacy of Gingival Thickening Following the Use of Allogeneic Acellular and Xenogeneic Collagen Matrix: A 12-Month Randomized Clinical Trial.

This randomized controlled clinical trial with a 1-year follow-up evaluated gingival thickness changes around teeth after use of dermal allograft and xenograft matrix. A total of 116 teeth (19 patients) were separated into two groups. One group received xenogeneic collagen matrix (n = 48), while the other received allogeneic acellular dermal matrix (n = 68) via a coronally advanced flap (CAF). Gingival thickness (GT), keratinized gingival width (KGW), pocket depth (PD), and clinical attachment loss (CAL) were measured on the day of surgery (baseline) and at 3 weeks, 2 months, 6 months, and 1 year postoperative. The two groups were compared using repeated-measures ANOVA (P < .05). The mean GT at 1 year was 1.59 ± 0.31 mm in the xenogeneic group and 1.63 ± 0.33 mm in the allogeneic group (P = .60). The mean change in GT was 1.08 mm in the xenogeneic group and 1.13 mm in the allogeneic group, which was clinically relevant and statistically significant compared to baseline values (P < .001). However, changes in GT were not significantly different between the two groups at any time point (P > .05). The GT increased in all cases treated with allogeneic and xenogeneic enriched collagen matrix. Both soft tissue substitutes were equally effective in acheiving optimal GT.

In Vitro Activity of Dental Pulp Stem Cells versus the Bone Marrow Stem Cells Cultured in Presence of a Bone Allograft.

Introduction - Scaffolds and cells are two important components in bone tissue engineering. There is a gap of information about stem cell activity next to bone substitutes. Thus, the aim of this in vitro study was to compare the proliferation and differentiation of bone marrow stem cells (BMSCs) and dental pulp stem cells (DPSCs) in presence of freeze-dried bone allograft (FDBA). Method and Materials - DPSCs and BMSCs were cultured and placed on mineralized bone allograft. Cell proliferation was analyzed by the methyl thiazolyl tetrazolium (MTT) assay after 24, 48, and 72 h. To compare the enzymatic activity and mineralization of cells, the alkaline phosphate (ALP) test and alizarin red staining were performed at 30 days. Data were analyzed by ANOVA. Results - The rate of proliferation of DPSCs was higher at 48 and 72 h. ALP activity was significantly higher in DPSCSs (P < 0.05), while alizarin red staining did not show any significant difference between the groups in formation of calcified nodules. DPSCs showed higher cell proliferation and osteoblastic differentiation than BMSCs. Conclusion - Considering the easier and less invasive isolation of DPSCs, a combination of DPSCs and allograft can be a good choice for bone regeneration, especially in the dentoalveolar area.

Management of extensive peri-implant defects with titanium meshes.

PURPOSE: Peri-implantitis is a biofilm-induced pathological condition, and different approaches have been proposed to manage this condition. This study introduces a surgical technique in accordance with the concept of guided bone regeneration for implants with extensive peri-implant defects. METHODS: This pilot study was conducted on 7 patients with 11 implants (4 females and 3 males; 32 to 61 years). In this technique, we used a titanium mesh, a combination of autogenous bone, allogenic graft material, and acellular dermal matrix to reconstruct the peri-implant defects. All implants were placed submerged, and the second-stage surgery was conducted after 8 months. Soft tissue augmentation and vestibuloplasty were performed in the second-stage surgery, if required. RESULTS: The mean function time of implants was 60.5 ± 29.4 months. The mean baseline probing pocket depth was 5.7 ± 1.4 mm, and soft tissue recession was observed at two sites (18%). The mean recession and keratinized tissue width (KTW) values were 0.4 ± 0.8 mm and 3 ± 1.6 mm, respectively. The mean marginal bone loss and bone gain were 4.4 ± 1.2 mm and 2.9 ± 0.9 mm, respectively, which showed a significant improvement. CONCLUSION: Our preliminary evaluations showed favorable results in terms of radiographic defect fill and soft tissue condition. It appears that this technique may lead to promising outcomes in cautiously selected patients seeking to retain their failing implants. However, long-term results following functional loading are required before recommending this technique for daily practice.

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.

Physicochemical Changes of Contaminated Titanium Discs Treated With Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser Irradiation or Air-Flow Abrasion: An In Vitro Study.

Introduction: Peri-implantitis is a common complication of dental implant treatment. A cause-and-effect relationship has been previously documented between microbial plaque and peri-implantitis and implant failure. A difference has been reported in the disinfection efficacy of erbium laser irradiation and air-flow abrasion for contaminated titanium surfaces. Also, the surface changes caused by lasers and air-flow abrasion have not been well studied. Thus, the purpose of this study was to compare the surface changes of contaminated titanium discs following decontamination by erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation and air-flow abrasion. Methods: Twenty-eight intact, sandblasted, and acid-etched (SLA) titanium discs were used. Twenty-four titanium discs were contaminated with Escherichia coli. Then, they were decontaminated by using Er:YAG laser irradiation and air-flow abrasion. Four discs remained intact. The mean and standard deviation of the contact angle and the weight percentage of aluminum, titanium, oxygen, carbon, phosphorus, and calcium were measured. Qualitative changes in surface topography of titanium discs were assessed by scanning electron microscopy (SEM). Results: The mean weight percentage of carbon in the air-flow abrasion group (4.98%) experienced a significant reduction compared with the contaminated (positive control) group (P=0.035). The contact angles were 46.54° and 38.67° in the laser and air-flow abrasion groups respectively, which were significantly lower than the value in the positive control group (75.15°) (P ≤0.001). SEM micrographs showed no significant change in the surface area in either technique. Conclusion: Air-flow abrasion was more successful in improving the surface characteristics of titanium discs with no alteration in surface topography or elements, compared with Er:YAG laser irradiation. Further studies regarding the safety of the Er:YAG laser for the decontamination of titanium surfaces are recommended.

Different techniques in transalveolar maxillary sinus elevation: A literature review.

Dental implant treatment in the posterior maxilla encounters bone quality and quantity problems. Sinus elevation is a predictable technique to overcome height deficiency in this area. Transalveolar sinus elevation is a technique that is less invasive and less time-consuming, first introduced for ridges with at least 5 mm of bone height. Many modifications and innovative equipment have been introduced for this technique. This review aimed to explain the modifications of this technique with their indications and benefits. An exhaustive search in PubMed Central and Scopus electronic databases was performed until December 2020. Articles were selected that introduced new techniques for the transalveolar maxillary sinus approach that had clinical cases with full texts available in the English language. Finally, twenty-six articles were included. The data were categorized and discussed in five groups, including expansion-based techniques, drill-based techniques, hydraulic pressure techniques, piezoelectric surgery, and balloon techniques. The operator's choice for transalveolar approach techniques for sinus floor elevation can be based on the clinician's skill, bone volume, and access to equipment. If possible, a technique with simultaneous implant placement should be preferred.

The lncRNA ANRIL is down-regulated in peripheral blood of patients with periodontitis.

Long non-coding RNAs (lncRNAs) have crucial roles in lncRNAs in periodontal development and disorders of this tissue. A number of lncRNAs especially those regulating immune responses contribute in the pathophysiology of periodontitis. In the current case-control study, we assessed expression levels of two immune response-related lncRNAs namely the antisense non-coding RNA in the INK4 locus (ANRIL) and metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in gingival tissues and blood samples of patients with periodontitis and healthy subjects. Expression of ANRIL was significantly lower in peripheral blood of patients compared with controls (Posterior Beta RE = -1.734, P value = 0.035). However, when diving study participants based on their gender, no significant difference was found between patients and sex-matched controls. Expression of this lncRNA was not different between periodontitis tissues and normal tissues. Expression of MALAT1 was not different between samples obtained from cases and controls. Tissue or blood expressions of ANRIL or MALAT1 were not correlated with age of either patients or controls. There were significant correlations between expression levels of ANRIL and MALAT1 in gingival tissues both in cases (r = 0.62, P < 0.0001) and in controls (r = 0.37, P < 0.0001). However, blood levels of these lncRNAs were not correlated with each other either in cases or in controls. Most notably, there was no significant correlation between expression levels of these lncRNAs in gingival tissues and in the blood of study participants. The current study indicates dysregulation of ANRIL in the peripheral blood of patients with periodontitis in spite of its normal levels in gingival tissues which might reflect disturbance in systemic immune responses in these patients.

Clinical and Radiographic Assessments of Tooth Socket Preservation Using Leukocyte Platelet-Rich Fibrin.

Leukocyte platelet-rich fibrin (L-PRF) has the potential to accelerate wound healing. Here, we assess clinical and radiographic outcomes of socket preservation using L-PRF. For this single-blind, randomized, split-mouth clinical trial, we selected 22 patients (15 males and seven females), who required extraction of single-rooted teeth. Subjects were randomly assigned to two groups. We used L-PRF in the extraction socket on one side and no material on the contralateral side. We obtained cone-beam computed tomographic images and diagnostic casts from tooth extraction sockets before surgery and 3 mo after the procedure. Changes in buccolingual diameter and height of bone at 3 mo after tooth extraction (compared to baseline) were determined and digitized data statistically analyzed using Statistical Package for the Social Sciences software, ver. 25.0 (IBM, Armonk, NY) via the paired t-test. In tooth sockets with/without L-PRF application 3 mo after extraction, bone buccolingual diameter significantly decreased at socket center to 0, 1, and 3 mm from the ridge crest, compared to baseline. A significant reduction occurred in sockets with/without L-PRF application in buccal and lingual bone height at the bony socket midbuccal portion of and mesial and distal septa (p < 0.0001). However, the Mann-Whitney U test showed changes to be significantly greater in controls than the case group (p < 0.0001). Taking into account study limitations, application of L-PRF in tooth extraction sockets significantly decreased reductions in bone height and buccolingual diameter compared to control sockets.

The Clinical Evaluation of the Effects of Low-Level Laser Therapy on the Donor and Recipient Sites of the Free Gingival Graft: A Case Series.

Introduction: Free gingival grafting is among the most foreseeing procedures for increasing the zone of keratinized attached gingiva and enhancing soft tissue around the teeth and dental implants. Nowadays low-level laser therapy (LLLT) is a promising approach in providing patients with more pleasing results in terms of esthetics and comfort. This study aims to investigate the effects of LLLT on gingival recessions treated with free gingival graft (FGG). Methods: This case series was conducted on 12 individuals requiring a bilateral gingival graft in the mandibular region. There was a 30-day interval between the two operations. The test side was selected randomly and irradiated by a low-level laser (LLL) just before surgery. The patients did not know which side was irradiated. LLLT was applied to the donors' as well as recipients' site immediately after the operation and 48 hours later. The patients were instructed to record their post-operative pain in a visual analogue scale (VAS) 3 and 24 hours and 7 days after the surgical procedure. The clinical photographs were taken immediately and 30 days after surgical treatment were graded by three experienced periodontists for color matching to adjacent tissues. Results: Ten individuals could finish the study. The test group presented significantly better shade matching and wound healing at the palatal donor site on days 7, 14 and 21. There was a significant reduction in post-operative pain after 24 hours (P = 0.007). No statistically significant difference was found between both groups in terms of clinical periodontal indices. Conclusion: LLLT could reduce post-operative pain 24 hours after surgical treatment. Furthermore, the application of LLLT could improve the donors' site healing and the recipients' site color matching.

Conservative Maxillary Sinus Floor Elevation via a Crestal Approach Using Vertical Expander Screw Technique (Technical Note).

OBJECTIVE: Contemporary implantology is moving toward less invasive approaches. To date, several techniques have been proposed for maxillary sinus lift surgery. In this article, we introduce a new technique for maxillary sinus floor elevation that is less invasive than the osteotome technique. METHODS AND MATERIALS: In the vertical expander screw (VES) technique, which uses a combination of drilling and bone-expander screws; a primary implant hole is created. Bone expander screws are used in lateral and vertical dimensions to elevate the sinus membrane. RESULTS: The results at the two-year follow-up revealed bone formation around the implant body in the bony sinus cavity for three patients. Accordingly, 100% survival and success rates were reported for implants placed with VES technique. CONCLUSION: The maxillary sinus floor can be elevated to the desired height with a VES technique with minimal invasion. The VES technique can be used as an alternative to elevate the sinus floor with less invasion than the osteotome technique.

In-Office Guided Implant Placement for Prosthetically Driven Implant Surgery.

Application of surgical stents for implant placement via guided flapless surgery is increasing. However, high cost, need for some professional machines, and not taking into account the soft-tissue parameters have limited their application. We sought to design and introduce a technique named in-office guided implant placement (iGIP) to decrease the cost by using available devices in office and enhance the applicability of surgical stents. A customized surgical stent was fabricated based on prosthetic, soft- and hard-tissue parameters by taking into account the amount of available bone (using the computed tomographic [CT] data), soft-tissue thickness and contour (using a composite-covered radiographic stent), and position of the final crown (by diagnostic cast wax up and marking the final crown position with composite). The efficacy of iGIP, in terms of the accuracy of the three-dimensional position of the implant placed in the study cast and in patient's mouth, was confirmed by direct observation and postoperative CT. The iGIP can enhance implant placement in the prosthetically desired position in various types of edentulism. Using this technique minimizes the risk of unwanted consequences, as the soft-tissue thickness and contour are taken into account when fabricating a surgical stent.