Evaluation of Gingival Pigmentation and Related Factors on Former Smokers.

Objectives: Gingival pigmentation, the most common etiological factor of which is smoking, is a clinical condition that causes aesthetic complaints. Due to the dose-dependent effect of smoking, gingival pigmentation may present regression following cessation. This cross-sectional study aimed to evaluate gingival pigmentation in former tobacco consumers and compare with current ones. Material and Methods: A total of 110 people, 70 of whom were current smokers (Group CS) and 40 of whom were former smokers (Group FS), were included in the study. Participants filled out the data collection forms containing questions on demographic features and information related to tobacco consumption. In addition, all individuals were examined with Hedin's melanin index (HMI) to evaluate gingival pigmentation. Statistical significance was set at the P < 0.05 level. Results: The population consisted of 57.3% male, and the mean age of all participants was 39.43 (SD 12.3) years. The mean duration of tobacco consumption did not differ between groups, whereas the mean HMI score of Group FS was significantly lower (P = 0.001). The correlation analyses showed that while the HMI score of Group CS was in relation to both daily consumption amount and duration of consumption (for both, P < 0.01), the HMI score of Group FS showed a negative association with only time elapsed after cessation (P = 0.000). Conclusions: Considering the limitations of this study, the outcomes revealed a dose- and a time-dependent relation of gingival pigmentation in smokers. However, gingival pigmentation in former tobacco consumers was negatively correlated only with time elapsed after cessation.

Assessment of Radiodensity at Mandibular Periapical Bone Sites using Three-Dimensional Cone-Beam Computed Tomography.

Objectives: The aims of this retrospective study were to objectively assess bone density values obtained by cone-beam computed tomography and to map the periapical and inter-radicular regions of the mandibular bone. Material and Methods: In total, periapical bone regions of 6898 roots scanned by cone-beam computed tomography were evaluated retrospectively, and the results were recorded using Hounsfield units (HU). Results: The correlation between periapical HU values of adjacent mandibular teeth were strongly positive (P ˂ 0.01). The anterior region of the mandible yielded highest mean HU value (633.55). The mean periapical HU value of the premolar region (470.58) was higher than that was measured for molar region (374.58). The difference between furcation HU values of the first and second molars was unnoticeable. Conclusions: The results of this study have tried to evaluate the periapical regions of all mandibular teeth, which could ease to predict the bone radiodensity before implant surgery. Even though the Hounsfield units provide the average radio-bone density, a site-specific bone tissue evaluation of each case is essential for appropriate cone-beam computed tomography preoperative planning.

The Radiological Evaluation of Mandibular Canal Related Variables in Mandibular Third Molar Region: a Retrospective Multicenter Study.

Objectives: The aim of this retrospective study was to investigate anatomical structure of mandibular canal and the factors those increase the possibility of inferior alveolar nerve damage in mandibular third molar region of Turkish population. Material and Methods: Overall 320 participants with 436 mandibular third molars were included from four different study centers. Following variables were measured: type and depth of third molar impaction, position of mandibular canal in relation to third molars, morphology of mandibular canal, cortication status of mandibular canal, possible contact between the third molars and mandibular canal, thickness and density of superior, buccal, and lingual mandibular canal wall, bucco-lingual and apico-coronal mandibular canal diameters on cone-beam computed tomography scans. Results: Lingual mandibular canal wall density and thickness were decreased significantly as the impaction depth of mandibular third molar was increased (P = 0.045, P = 0.001 respectively). Highest buccal mandibular canal wall density and thickness were observed in lingual position of mandibular canal in relation to mandibular third molar (P = 0.021, P = 0.034 respectively). Mandibular canal with oval/round morphology had higher apico-coronal diameter in comparison to tear drop and dumbbell morphologies (P = 0.018). Additionally, mandibular canals with observed cortication border and no contact with mandibular third molar had denser and thicker lingual mandibular canal wall (P = 0.003, P = 0.001 respectively). Conclusions: Buccal and lingual mandibular canal wall density, thickness and mandibular canal diameter may be related with high-risk indicators of inferior alveolar nerve injury.

An alternative treatment for hopeless implants: Coronal resection.

Dental implant surgery is a highly reliable therapy with widespread use all over the world. However, various accidental symptoms and complications such as peri-implantitis have been reported, and occasionally necessitate implant removal. This alternative technique was performed to minimize the harmful effect of conventional resective explantation procedures. The present case concerns a 55-year-old woman who had two dental implants in the mandibular incisor regions who apparently developed severe marginal peri-implantitis. Presence of lesion was confirmed by two and three-dimensional radiographic images. Explantation was indicated because of the excessive ongoing bone loss around implants. Due to avoid serious complications such as jaw fracture, coronal resection technique (partial explantation) was suggested. After the full thickness flap was elevated, affected part of both implants were resected, and osseointegrated healthy apical parts were left in the basal bone. Wound healing was uneventful at one week follow-up. Proper locater abutments were tightened after 5 months of the partial explantation procedure, and final denture was applied in the oral cavity. The radiologic and clinical examinations showed successful outcome at 12-months follow-up. Minimally resective peri-implantitis therapy may be achieved using this non-traumatic coronal implant resection approach.

Elevated Interleukin-17A expression in amlodipine-induced gingival overgrowth.

BACKGROUND AND OBJECTIVES: Amlodipine, a calcium channel blocker derivative, is frequently used by patients with high blood pressure. Studies reported that it can induce gingival overgrowth. However, the underlying mechanism is not fully described yet. Interleukin-17A (IL-17A) is known as a proinflammatory cytokine, but current studies indicate that it has a role in fibrotic disorders and epithelial-mesenchymal transition (EMT). The aim of this study was to figure out the possible role of IL-17A in amlodipine-induced gingival overgrowth. MATERIALS AND METHODS: Twenty-nine (29) individuals participated in the study, and they were assigned into 3 groups based on medical status and clinical periodontal examination; 9 patients with amlodipine-induced gingival overgrowth, 11 patients with inflammatory gingival overgrowth, and 9 healthy individuals as a control group. Clinical periodontal parameters including plaque index (PI), gingival index (GI), and gingival overgrowth index (GOI) were recorded. Blood and gingival crevicular fluid (GCF) samples were obtained. Gingival tissues were taken by appropriate periodontal surgery following initial periodontal therapy. To detect IL-17A on tissue samples, immunohistochemistry (IHC) was performed. Quantitative analysis was done, and the expression level of IL-17A was given as the percent positively stained cells. Enzyme-linked immunosorbent assay (ELISA) kits were used to analyze IL-17A in serum and GCF samples. RESULTS: All recorded clinical parameters were significantly higher in gingival overgrowth groups compared with control. Evaluation of inflammation on tissue sections did not show any significant change within the groups. Immunohistochemistry findings showed that IL-17A expression was increased in amlodipine samples (81.90%) compared with control samples (42.35%) (P < .001). There was an increase in the inflammatory group (66.08%) which is significantly less than the amlodipine group (P < .05). IL-17A levels in serum and GCF samples were not different within the study groups. CONCLUSION: In this study, elevated IL-17A expression regardless of inflammation shows that amlodipine might cause an increase of IL-17A in gingival tissues. This increase might induce fibrotic changes and EMT in gingival overgrowth tissues. The association of IL-17A with fibrosis and EMT in gingival tissues requires further investigation.

Morphological Classification of Extraction Sockets and Clinical Decision Tree for Socket Preservation/Augmentation after Tooth Extraction: a Systematic Review.

OBJECTIVES: The aim of present study was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. MATERIAL AND METHODS: The search protocol used the electronic MEDLINE (PubMed) and EMBASE databases for articles published between January 1 2009 and May 1 2019. The search included only human studies published in English. Outcomes were the indications and reasons for socket preservation/augmentation and classification of extraction sockets. RESULTS: Ten studies fulfilled the inclusion criteria and were selected for the study. Although there are various types of extraction socket classifications none of them could completely evaluate all morphological parameters of alveolar ridge. Furthermore, present study revealed that indications for extraction socket preservation/augmentation have wider spectrum than socket morphology and are related to surrounding tissue anatomy or dental implantation operation indications and timing. Based on currently proposed extraction socket classifications and rationales, a novel decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic area was suggested. CONCLUSIONS: The need of extraction socket preservation/augmentation immediately after tooth extraction should be determined by the aesthetic, functional and risk-related viewpoint. A novel clinical decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic zones can be useful tool in socket preservation/augmentation procedures.

Assessment of morphological and anatomical characteristics of mental foramen using cone beam computed tomography.

PURPOSE: To determine the shape, position, vertical height, surrounding bone characteristics, and opening angle of mental foramen (MF) using dental cone beam computed tomography (CBCT). METHODS: A retrospective study was performed on 663 patients. CBCT records analyzed for the shape, position, and surrounding bone measurements of the MF using Simplant 3D software (Hasselt, Belgium). Opening angle of MF was also assessed. Kruskal-Wallis and Mann-Whitney U tests were employed to test significant differences between parameters, genders and ages. RESULTS: All mental foramina were visualized. Regarding location, 49.2% of the MFs were located between first and second premolars, 7.7 distal and 39.7% coincident to the apex of the mandibular second premolar. The mean MF opening angle was 45.4° on the right side, and 45.9° on the left. There were no statistically differences between gender groups with regard to the opening angle degrees. CONCLUSIONS: This study may provide useful information about variations in the position, shape and size, angle of mental foramen, which may help the practitioners to perform safer mental nerve blocks and surgical procedures.

Transplantation of Autogenous Bone Block With an Osseointegrated Implant: Seedling Technique With Twelve-Month Follow-Up.

OBJECTIVE: Loss of teeth frequently results in compound horizontal and vertical alveolar bone defects. An appropriate bone structure is the key for implant placement and bony support of soft tissues. Advanced bone augmentation techniques are required for the reconstruction of these defects. This report will present a new bone block grafting technique with 12-month follow-up. METHOD: The seedling technique was used to augment the alveolar bone 3-dimensionally with autologous bone block and an osseointegrated implant in a 2-stage procedure. Horizontal and vertical bone loss is revealed after cone beam radiographic examination in the right maxillary lateral incisor area. Initially, the implant was placed at the right maxillary tuber area, where the bone was abundant. After 2-months healing phase, the osseointegrated implant was harvested with the surrounding bone and transplanted to the anterior region of maxilla to augment the horizontal and the vertical components of the recipient site. Transplanted implant inserted into autogenous bone block was fixed with mini plate to the adjacent native bone. Prosthetic restoration was applied 4 months after the transplantation. RESULTS: Seven months after the first surgery, treatment of anterior bone deficiency was accomplished. The patient was fully satisfied with the function and the esthetics of the restoration. The radiological and clinical examinations at 1-year follow-up evaluation showed successful outcome of transplanted autogenous bone block without any resorption. CONCLUSION: This clinical report demonstrated that anterior maxillary single-tooth replacement, according to seedling concept of autogenous bone block with osseointegrated implant, is a successful and predictable treatment modality.