Histological comparison of different compressive forces on particulate grafts during alveolar ridge preservation: a prospective proof-of-concept study

Purpose@#The aim of this study was to determine the impact of different compressive forces on deproteinized bovine bone mineral (DBBM) particles covered by native bilayer collagen membrane (NBCM) during alveolar ridge preservation (ARP) in the molar area, and to identify any histomorphometric and clinical differences according to the compressive force applied. @*Methods@#Sockets were filled with DBBM after tooth extraction, and different compressive forces (30 N and 5 N, respectively) were applied to the graft material in the test (30 N) and control (5 N) groups. The DBBM in both groups was covered with NBCM in a double-layered fashion. A crossed horizontal mattress suture (hidden X) was then made. A core biopsy was performed using a trephine bur without flap elevation at the implant placement site for histomorphometric evaluations after 4 months. The change of the marginal bone level was measured using radiography. @*Results@#Twelve patients completed the study. The histomorphometric analysis demonstrated that the mean ratios of the areas of new bone, residual graft material, and soft tissue and the implant stability quotient did not differ significantly between the groups (P>0.05). However, the mean size of the residual graft material showed a significant intergroup difference (P<0.05). @*Conclusions@#The application of 2 compressive forces (5 N, 30 N) on particulate DBBM grafts during open-healing ARP in the posterior area led to comparable new bone formation, implant feasibility and peri-implant bone level.

A clinical study on the effect of attachable periodontal wound dressing on postoperative pain and healing

Purpose@#After periodontal surgery, studies have found that the use of periodontal wound dressing reduces the risk of wound infection and increases healing. The purpose of this study is to evaluate the effect of attachable periodontal wound dressing on the healing and patient satisfaction after periodontal flap surgery. @*Materials and Methods@#Twenty-eight patients requiring periodontal surgery underwent periodontal flap surgery on both quadrants of maxilla or mandible. Postoperative pain, bleeding, dietary discomfort and hypersensitivity in relation to attachable periodontal wound dressing was assessed using Visual Analogue Scale (VAS). Additional survey on frequency of burning sensation and overall satisfaction rates were assessed. @*Results@#VAS mean values for pain, bleeding, and dietary discomfort depending on the presence and absence of attachable wound dressing were; pain: 2.82, 3.96 (P = 0.002), bleeding: 1.61, 2.54 (P = 0.008), dietary discomfort: 2.82, 4.18 (P < 0.001), respectively. Test groups with attachable wound dressing reported significantly lower rates of discomfort. No significant difference was observed in burning sensation and hypersensitivity related with wound dressing. Satisfaction was higher in 75% of patients who received wound dressing. @*Conclusion@#According to the results of this study, patients who received attachable periodontal wound dressing reported less postoperative pain, bleeding, and dietary discomfort. There was no statistical significance related to the use of wound dressing with burning sensation and hypersensitivity.

A clinical study on the effect of attachable periodontal wound dressing on postoperative pain and healing

Purpose@#After periodontal surgery, studies have found that the use of periodontal wound dressing reduces the risk of wound infection and increases healing. The purpose of this study is to evaluate the effect of attachable periodontal wound dressing on the healing and patient satisfaction after periodontal flap surgery. @*Materials and Methods@#Twenty-eight patients requiring periodontal surgery underwent periodontal flap surgery on both quadrants of maxilla or mandible. Postoperative pain, bleeding, dietary discomfort and hypersensitivity in relation to attachable periodontal wound dressing was assessed using Visual Analogue Scale (VAS). Additional survey on frequency of burning sensation and overall satisfaction rates were assessed. @*Results@#VAS mean values for pain, bleeding, and dietary discomfort depending on the presence and absence of attachable wound dressing were; pain: 2.82, 3.96 (P = 0.002), bleeding: 1.61, 2.54 (P = 0.008), dietary discomfort: 2.82, 4.18 (P < 0.001), respectively. Test groups with attachable wound dressing reported significantly lower rates of discomfort. No significant difference was observed in burning sensation and hypersensitivity related with wound dressing. Satisfaction was higher in 75% of patients who received wound dressing. @*Conclusion@#According to the results of this study, patients who received attachable periodontal wound dressing reported less postoperative pain, bleeding, and dietary discomfort. There was no statistical significance related to the use of wound dressing with burning sensation and hypersensitivity.

Histological analysis of explanted implant-bone interface: a case report

Osseointegration has been reported to be a dynamic process in which the alveolar bone comes in direct contact with the implant. Various methods were tried to evaluate degree of osseointegration and the measurement of bone-implant contact (BIC) have been commonly used among them. To properly assess the BIC, only histologic analysis is available. However, few studies evaluated BIC of successfully osseointegrated implants in humans. Thus, this is a unique opportunity when implants should be explanted due to inappropriate positioning of implant, presence of pain or sensory disturbance, or broken screw or fixture. This report presents a case of the implant underwent 3-year functional load and a histologic analysis after the fixture fracture. The histomorphometric analysis revealed 53.1% of BIC measured along the whole implant and 70.9% measured only in subcrestal area, respectively. In the present study, although the implant was fractured, a high degree of BIC was observed.

Early implant failure: a retrospective analysis of contributing factors

PURPOSE: The aim of this retrospective study was to determine the prevalence of early implant failure using a single implant system and to identify the factors contributing to early implant failure. METHODS: Patients who received implant treatment with a single implant system (Luna®, Shinhung, Seoul, Korea) at Dankook University Dental Hospital from 2015 to 2017 were enrolled. The following data were collected for analysis: sex and age of the patient, seniority of the surgeon, diameter and length of the implant, position in the dental arch, access approach for sinus-floor elevation, and type of guided bone regeneration (GBR) procedure. The effect of each predictor was evaluated using the crude hazard ratio and the adjusted hazard ratio (aHR) in univariate and multivariate Cox regression analyses, respectively. RESULTS: This study analyzed 1,031 implants in 409 patients, who comprised 169 females and 240 males with a median age of 54 years (interquartile range [IQR], 47–61 years) and were followed up for a median of 7.2 months (IQR, 5.6–9.9 months) after implant placement. Thirty-five implants were removed prior to final prosthesis delivery, and the cumulative survival rate in the early phase at the implant level was 95.6%. Multivariate regression analysis revealed that seniority of the surgeon (residents: aHR=2.86; 95% confidence interval [CI], 1.37–5.94) and the jaw in which the implant was placed (mandible: aHR=2.31; 95% CI, 1.12–4.76) exerted statistically significant effects on early implant failure after adjusting for sex, age, dimensions of the implant, and type of GBR procedure (preoperative and/or simultaneous) (P<0.05). CONCLUSIONS: Prospective studies are warranted to further elucidate the factors contributing to early implant failure. In the meantime, surgeons should receive appropriate training and carefully select the bone bed in order to minimize the risk of early implant failure.

A 3 year prospective study of survival rate of narrow diameter implants

PURPOSE: The purpose of present study was to retrospectively analyze the survival rate of narrow diameter implant less than 3.6 mm by initial stability and radiographic measurements. MATERIALS AND METHODS: In total, 24 patients who received 38 narrow diameter implants (≤ 3.6 mm in diameter, ≥ 7 mm in length) were enrolled in this retrospective study. The cumulative survival rate was calculated and various factors were investigated according to the implant platform diameter, body diameter, length, position, concomitant use of guided bone regeneration in implant placement and final prosthesis type. Initial stability was investigated with implant stability quotient (ISQ) value. The mesial and distal marginal bone level (MBL) change was calculated with radiography. RESULTS: The overall survival rate was 92.11%. Mean ISQ value and MBL change of survival implants was 66.26 and 0.14 ± 0.31 mm, respectively. None of the implants with platform diameters larger than the body diameter failed. CONCLUSION: In conclusion, the findings of present study suggest that narrow diameter implant could be predictable treatment in narrow alveolar ridge.

A comparison of different compressive forces on graft materials during alveolar ridge preservation

PURPOSE: Following tooth extraction, alveolar ridge preservation (ARP) can maintain the dimensions of ridge height and width. Although previous studies have demonstrated the effects of ARP, few if any studies have investigated the compressive force applied during grafting. The aim of this study was to determine the effects of different compressive forces on the graft materials during ARP. METHODS: After tooth extraction, sockets were filled with deproteinized bovine bone mineral with 10% porcine collagen and covered by a resorbable collagen membrane in a double-layered fashion. The graft materials were compressed using a force of 5 N in the test group (n=12) and a force of 30 N in the control group (n=12). A hidden X suture was performed to secure the graft without primary closure. Cone-beam computed tomography (CBCT) was performed immediately after grafting and 4 months later, just before implant surgery. Tissue samples were retrieved using a trephine bur from the grafted sites during implant surgery for histologic and histomorphometric evaluations. Periotest values (PTVs) were measured to assess the initial stability of the dental implants. RESULTS: Four patients dropped out from the control group and 20 patients finished the study. Both groups healed without any complications. The CBCT measurements showed that the ridge volume was comparably preserved vertically and horizontally in both groups (P>0.05). Histomorphometric analysis demonstrated that the ratio of new bone formation was significantly greater in the test group (P0.05). CONCLUSIONS: The application of a greater compressive force on biomaterials during ARP significantly enhanced new bone formation while preserving the horizontal and vertical dimensions of the alveolar ridge. Further studies are required to identity the optimal compressive force for ARP.

Alveolar ridge preservation with an open-healing approach using single-layer or double-layer coverage with collagen membranes

PURPOSE: The aim of this prospective pilot study was to compare alveolar ridge preservation (ARP) procedures with open-healing approach using a single-layer and a double-layer coverage with collagen membranes using radiographic and clinical analyses. METHODS: Eleven molars from 9 healthy patients requiring extraction of the maxillary or mandibular posterior teeth were included and allocated into 2 groups. After tooth extraction, deproteinized bovine bone mineral mixed with 10% collagen was grafted into the socket and covered either with a double-layer of resorbable non-cross-linked collagen membranes (DL group, n=6) or with a single-layer (SL group, n=5). Primary closure was not obtained. Cone-beam computed tomography images were taken immediately after the ARP procedure and after a healing period of 4 months before implant placement. Radiographic measurements were made of the width and height changes of the alveolar ridge. RESULTS: All sites healed without any complications, and dental implants were placed at all operated sites with acceptable initial stability. The measurements showed that the reductions in width at the level 1 mm apical from the alveolar crest (including the bone graft) were −1.7±0.5 mm in the SL group and −1.8±0.4 mm in the DL group, and the horizontal changes in the other areas were also similar in the DL and SL groups. The reductions in height were also comparable between groups. CONCLUSIONS: Within the limitations of this study, single-layer and double-layer coverage with collagen membranes after ARP failed to show substantial differences in the preservation of horizontal or vertical dimensions or in clinical healing. Thus, both approaches seem to be suitable for open-healing ridge preservation procedures.

Effects of host modulation by nonsteroidal anti-inflammatory drugs on periodontal disease: a systematic review and meta-analysis

PURPOSE: Nonsteroidal anti-inflammatory drugs that prohibit biosynthesis of arachidonic acid metabolites have been considered potent host modulation agents. The aim of this review was to determine the effect of nonsteroidal anti-inflammatory drugs adjunctive with nonsurgical periodontal treatment in patients with periodontal disease. MATERIALS AND METHODS: Three electronic databases were searched to identify relevant studies. The methodological quality and mean differences of the change in clinical attachment level and probing depth were analyzed according to Cochrane review methods. RESULTS: Twelve studies were included in the methodological assessment and nine studies were suitable for inclusion in the meta-analysis. The mean difference in the clinical attachment level gain did not differ significantly between the nonsteroidal anti-inflammatory drugs and control groups at any observation time. The highest mean difference in clinical attachment level gain was 0.30 mm at 4 weeks (95% confidence interval = -0.37 to 0.97). There was a significant mean difference in the probing depth reduction, of 0.34 mm (95% confidence interval = 0.29 to 0.40) at 6 weeks. CONCLUSION: Therefore, nonsteroidal anti-inflammatory drugs have additional therapeutic effect when administrated with nonsurgical periodontal treatment.

Use of hypnosis in dentistry for improving patient satisfaction: as a means of non-phamaceutical approach

Patient management is considered an important factor in dental field. The aim of this review is to analyze the efficacy of hypnosis to treat fear, anxiety, pain, stress of dental patients, and see how it can be adopted in dentistry for improving patient satisfaction. Medline research was carried out to find the use of hypnosis in dentistry and other aspects of hypnosis in medical area. It can help patient more comfortable, relax, and accordingly reduce patient's negative feelings such as fear, anxiety, pain, stress during dental treatment. Also, it affects patient recovery after surgery by accelerating healing speed and reinforce immune system. When hypnosis is used with other anesthetic method, it can reduce the use of main medication, leading to reduce possibility of side effect. Therefore, using Hypnosis can give patients more comfortable dental experience, both mentally and physically, ultimately making patients more satisfied with the dental treatment.

Patient-reported outcome measures on intake of nutrition drink for nutritional supplements after periodontal surgery

PURPOSE: Patients usually suffer from pain and discomfort after oral surgery and their consumption of food is severely affected. Accordingly, the patients' quality of life reduce significantly. The aim of this study was to analyze patient satisfaction on the nutritional supplement drinks following periodontal surgery. MATERIALS AND METHODS: Total 90 patients who underwent periodontal surgery were recruited and commercially available nutritional drinks were provided. Group I received two bottles per each meal for 2 days, Group II had one bottle per each meal for 3 days, and Group III had no drinks. The survey for the patient-reported outcome measures (PROMs) were given at the next visit for the removal of sutures. RESULTS: The result of PROMs showed the nutrition drink was easy to intake, appeared to help the healing and can be a satisfying supplement for the meals. CONCLUSION: Nutritional drinks appeared to help the healing after periodontal surgeries and supported the food intake. Also, it was helpful for the patients in nutritional supply and psychological stability.

Geographic information system (GIS) analysis on the distribution of patients visiting at a dental college hospital: a pilot study

PURPOSE: The aims of this study are to analyze and to visualize distribution of patients visiting at a dental college hospital, using geographic information system (GIS). The visualized data can be utilized in patient care and treatment planning, ultimately leading to the assessment of risk evaluation and prevention of dental diseases. MATERIALS AND METHODS: Patient information data was obtained from Dankook University Dental Hospital including the unit number, gender, date of birth, and address from 2007 to 2014. Patient distribution was visualized using GIS. Statistical analyses were performed using SAS 9.3 and ArcGIS 10.1. Five factors including proximity, accessibility, age, gender, and socioeconomic status were investigated as the explanatory variables of the patient distribution. RESULTS: The visualized patient data showed a nationwide scale of the patient distribution. There was a little difference in characteristics for each department. As closer at Dankook University Dental Hospital, visitors increased. And it strongly showed that elderly patients in rural areas tend to visit more. CONCLUSION: The distribution of patients has been shown to be significantly affected by the proximity, accessibility, age, gender and socioeconomic status. The underlying reason remains to be further studied.

Studies on patient's perception and awareness of health insurance coverage for smoking cessation treatment in dentistry

PURPOSE: Recently, smoking cessation treatment at dental clinic can be covered by national health insurance. The aim of this study is to evaluate the awareness on the health insurance coverage for smoking cessation treatment in dentistry. MATERIALS AND METHODS: The survey was carried out on 100 new patients of the patients in Dankook Dental Hospital from March to April 2015. The Questionnaire consists of 18 items. RESULTS: The results show that many of patients expect positive effects of the treatment but most of the respondents were not aware of the initiation of health insurance coverage smoking cessation treatment in dentistry. CONCLUSION: The government and ministry of health should pay more attention to the promotion of the smoking cessation treatment in dentistry.