Salivary elemental signature of dental caries: a systematic review and meta-analysis of ionomics studies.

Trace- and macro-chemical elements are crucial for cellular physiological functioning, and their alterations in biological fluids might be associated with an underlying pathological state. Hence, this study aimed to examine and summarize the published literature concerning the application of salivary ionomics for caries diagnosis. An extensive search of studies was conducted using PubMed, EMBASE, Web of Science, and Scopus, without any language and year restriction for answering the following PECO question: "In subjects (i.e., children, adolescents, or adults) with good systematic health, are there any variations in the salivary concentrations of trace- or macro-elements between caries-free (CF) individuals and caries-active (CA) subjects?" A modified version of the QUADOMICS tool was used to assess the quality of the included studies. The Review Manager Version 5.4.1. was used for data analyses. The analysis of salivary chemical elements that significantly differed between CF and CA subjects was also performed. Thirty-four studies were included, involving 2299 CA and 1669 CF subjects, having an age range from 3 to 64 years in over 16 countries. The meta-analysis revealed a statistically significant difference (p < 0.05) in the salivary levels of calcium, phosphorus, chloride, magnesium, potassium, sodium, and zinc between CA and CF subjects, suggesting higher levels of calcium, phosphorus, potassium, and sodium in CF subjects while higher levels of chloride, magnesium, and zinc in CA patients. Half of the included studies (17/34) were considered high quality, while the remaining half were considered medium quality. Only zinc and chloride ions were found to be higher significantly and consistent in CF and CA subjects, respectively. Conflicting outcomes were observed for all other salivary chemical elements including aluminum, bromine, calcium, copper, fluoride, iron, potassium, magnesium, manganese, sodium, ammonia, nitrite, nitrate, phosphorus, lead, selenium, and sulfate ions.

Clinical and radiographic outcomes of adjunctive photodynamic therapy for treating peri-implantitis among diabetics and cigarette smokers: a systematic review of randomized controlled trials.

Photodynamic therapy (PDT) has been suggested as an adjunctive therapeutic approach for peri-implantitis. This systematic review aimed to assess the clinical and radiographic outcomes of adjunctive PDT (aPDT) for the treatment of peri-implantitis among diabetics and cigarette smokers. Randomized controlled trials (RCTs), which assessed the clinical and radiographic outcomes of aPDT versus other intervention(s) and/or MD alone among diabetics and smokers with peri-implantitis, were considered eligible for the review. Meta-analysis was performed for calculating the standard mean difference (SMD) with a 95% confidence interval (CI). The methodological quality of the included studies was evaluated using the modified Jadad quality scale. The meta-analysis revealed no significant differences between the influence of aPDT and other intervention/MD alone on the peri-implant PI among diabetics at the final follow-up. However, statistically significant improvements in the peri-implant PD, BOP, and CBL were observed after the application of aPDT among diabetics. Similarly, no significant differences were found between the influence of aPDT and other interventions/MD alone on the peri-implant PD among smokers with peri-implant diseases at the final follow-up. However, statistically significant improvements in the peri-implant PI, BOP, and CBL were observed after the application of aPDT among smokers. Significant improvements in the peri-implant PD, BOP, and CBL among diabetics and the peri-implant PI, BOP, and CBL among smokers after the application of aPDT at the final follow-up. However, large-scale, well-designed, and long-term RCTs are recommended in this domain.

Periodontists' perceptions and attitudes toward the use of social media for professional purposes in Saudi Arabia.

BACKGROUND: There is a notable increase in the usage of social media platforms, especially for health communication, as more clinicians and patients count on this kind of technology. Therefore, this research aimed to investigate the perception and attitude toward social media (SM) use for professionalism and dental practice promotion among periodontal specialists working in Saudi Arabia (KSA). METHODS: Electronic surveys were distributed in person or online using WhatsApp, Snapchat or Email from October 2022 until March 2023. The questionnaire was targeting periodontists in KSA, and it consists of three parts: the first part includes sociodemographic and professional data; the second part asks about the daily usage of SM in dental practice; and the third part asks about the periodontist's opinion about SM usage. Descriptive data were presented as numbers and percentages. The association between the demographic variables and the means of periodontists' opinions was tested using Pearson's chi-square test. Any value equal to or less than 0.05 was considered statistically significant. RESULTS: A total of 121 responses were received from the periodontists. Most of the participants were in the 36-45 age group, with a percentage of 40.5%. In terms of gender, males made up 52.9% of the population, while females made up 47.1%, and the majority of the participants were consultants. The most common SM platform used by periodontists for daily using and dental practice promotion was Snapchat (56.2%), followed by Instagram and Twitter (54.5% and 49.6%, respectively). There was a significant difference in proportions among Twitter, Snapchat and TikTok between older and younger periodontists, with a p value < 0.05. There was no significant difference between the gender of the participants and their opinions regarding the usage of SM. CONCLUSIONS: This study highlighted the effectiveness of SM in the promotion of dental practices and the discipline of periodontics, as more clinicians and patients rely on this kind of technology. These online platforms can improve periodontal practice in terms of dental health education, counseling, advertising, and oral health services.

Investigating the impact of diameters and thread designs on the Biomechanics of short implants placed in D4 bone: a 3D finite element analysis.

BACKGROUND: Dental implants emerge as a dependable and efficacious alternative for patients experiencing partial or complete tooth loss. The stability of these implants is influenced by surface topography and macro-level design. In cases where the height of the maxillary posterior region is diminished, employing short implants can prove advantageous. With the aim of examining the distribution of von Mises stress, strain, and micromovement in D4 bone quality surrounding platform-switched short implants, measuring 6 mm in length and featuring diameters ranging from 4 to 6 mm, as well as different thread designs, an in-depth finite element analysis was conducted under immediate loading conditions. METHODOLOGY: A 3D finite element model was constructed to simulate maxillary molar crowns, incorporating an implant with a length of 6 mm and varying diameters and thread designs. The diameters utilized were 4/3.6 mm, 5/4 mm, and 6/4.8 mm, while the thread designs included buttress, square, and triangle patterns. Each model underwent analysis with a 100 N force applied in two directions: vertical and oblique, relative to the long axis of the implant. Stress, strain, and micromovement in the peri-implant region were recorded, employing the Ansys Workbench R v.18.1 software for modelling and analysis. RESULTS: When comparing all three diameters, the wide diameter (6 mm threads) exhibited the lowest values of peri-implant von Mises stresses (3.3 MPa and 35.1 MPa), strains (194 Ɛ and 484 Ɛ), and micromovements (0.7 µm and 1.3 Ɛ) subjected to axial and non-axial loading of a 100 N force. Notably, square microthreads yielded the most favorable stress parameters among the different thread shapes, manifesting the minimum values of stress, strains, and micromovements in their vicinity. CONCLUSION: For the treatment of atrophic ridges or in scenarios necessitating extensive surgical preparation of the implant site, a combination of short implants, wide diameters, and platform switching can be employed. In situations with reduced bone height and the requirement for an implant-supported prosthesis to replace a missing permanent maxillary molar, the utilization of wide-diameter platform-switched short implants measuring 6 mm in length, featuring a square thread design, should be taken into consideration.

Pain Assessment and Need for Analgesics after Scaling and Root Planing in Patients with Stage II and Stage III Periodontitis.

Background and Objectives: The most common treatment procedure for periodontitis and gingivitis is scaling and root planing, which is perceived as a painful dental treatment. The current study aimed to assess pain perception and analgesics consumption after scaling and root planing (SRP) in patients with stage II and stage III periodontitis. Materials and Methods: Before starting the SRP, all the periodontal parameters, such as probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL), were measured. The anxiety level of the patients was also assessed using the modified dental anxiety scale (MDAS) questionnaire. Pain perception of the patients was recorded with the visual analog scale (VAS) after performing the SRP. Patients were asked to mark their pain level on the VAS sheet after two hours, four hours, eight hours, 24 h, and 48 h after the periodontal treatment. The following cut-off points were used for the pain intensity in the VAS: 0 = no pain, 1-4 = mild pain, 4-6 = moderate pain, and 7-10 = severe pain. Patients were advised to take analgesics if the pain was intolerable. Multivariate logistic regression was performed to conduct the association of all dependent variables and the pain perception of patients. A nonparametric Friedman test was conducted to assess pain perception at different times. Results: A total of 52 patients including 32 males and 20 females participated in the current study, with a mean age of 43.10 ± 12.33 years. Multivariate analyses showed that MDAS and analgesic consumption is significantly associated with pain perception. Other clinical variables are not associated with pain perception. The Friedman test exhibited that pain perception is significantly associated (p < 0.05) with time. Conclusions: Analgesic consumption and anxiety level are significantly associated with pain perception after SRP treatment.

Pre-Treatment and Post-Treatment Dental Anxiety in Patients Visiting Intern Dental Clinic.

Background and Objectives: This study aimed to assess the dental anxiety of patients using the modified dental anxiety scale (MDAS) questionnaire along with examining the possible relationship between dental anxiety and sociodemographic factors. Materials and Methods: The MDAS questionnaire was used to assess the anxiety level of the patients which included a total of five questions and five options to respond to each question. MDAS questionnaire was filled out by all the patients before the dental treatment. After finishing the treatment, all the patients were given a post-treatment questionnaire to assess their anxiety levels after treatment. Descriptive statistics were performed for measuring the frequency of responses. Mann-Whitney U test was used to compare the anxiety between the gender. The chi-square test was used to identify the distribution of pre-treatment with gender and post-treatment questionnaire with gender and treatment modalities. Linear regression was used to identify the association between clinical variables and different levels of anxiety. Results: A total of 115 patients including 59 males and 56 females with a mean age of 35 ± 11.34 years were included in the current study. Female patients were significantly more anxious about dental treatment compared to male patients. Linear regression showed that age and gender have a significant association with the pre-treatment anxiety level; however, types of treatment is not associated with the MDAS. Anxiety levels decreased for the majority of the patients after the treatment and types of treatment did not show any differences with the post-treatment anxiety level. Conclusions: Age and gender play an important role in dental anxiety; however, types of treatment are not associated with pre-treatment and post-treatment dental anxiety.

Different Designs of Deep Marginal Elevation and Its Influence on Fracture Resistance of Teeth with Monolith Zirconia Full-Contour Crowns.

Background and objectives: Even with the demand for high esthetics, the strength of the material for esthetic applications continues to be important. In this study, monolith zirconia (MZi) crowns fabricated using CAD/CAM were tested for fracture resistance (FR) in teeth with class II cavity designs with varying proximal depths, restored through a deep marginal elevation technique (DME). Materials and Methods: Forty premolars were randomly divided into four groups of ten teeth. In Group A, tooth preparation was conducted and MZi crowns were fabricated. In Group B, mesio-occluso-distal (MOD) cavities were prepared and restored with microhybrid composites before tooth preparation and the fabrication of MZi crowns. In Groups C and D, MOD cavities were prepared, differentiated by the depth of the gingival seat, 2 mm and 4 mm below the cemento-enamel junction (CEJ). Microhybrid composite resin was used for DME on the CEJ and for the restoration of the MOD cavities; beforehand, tooth preparations were conducted and MZi crowns were and cemented using resin cement. The maximum load to fracture (in newtons (N)) and FR (in megapascals (MPa)) were measured using the universal testing machine. Results: The average scores indicate a gradual decrease in the load required to fracture the samples from Groups A to D, with mean values of 3415.61 N, 2494.11 N, 2108.25 N and 1891.95 N, respectively. ANOVA revealed highly significant differences between the groups. Multiple group comparisons using the Tukey HSD post hoc test revealed that Group D had greater DME depths and showed significant differences compared with Group B. Conclusions: FR in teeth decreased when more tooth structure was involved, even with MZi crowns. However, DME up to 2 mm below the CEJ did not negatively influence the FR. Strengthening the DME-treated teeth with MZi crowns could be a reasonable clinical option, as the force required to fracture the samples far exceeded the maximum recorded biting force for posterior teeth.

Histopathologic Oral Cancer Prediction Using Oral Squamous Cell Carcinoma Biopsy Empowered with Transfer Learning.

Oral cancer is a dangerous and extensive cancer with a high death ratio. Oral cancer is the most usual cancer in the world, with more than 300,335 deaths every year. The cancerous tumor appears in the neck, oral glands, face, and mouth. To overcome this dangerous cancer, there are many ways to detect like a biopsy, in which small chunks of tissues are taken from the mouth and tested under a secure and hygienic microscope. However, microscope results of tissues to detect oral cancer are not up to the mark, a microscope cannot easily identify the cancerous cells and normal cells. Detection of cancerous cells using microscopic biopsy images helps in allaying and predicting the issues and gives better results if biologically approaches apply accurately for the prediction of cancerous cells, but during the physical examinations microscopic biopsy images for cancer detection there are major chances for human error and mistake. So, with the development of technology deep learning algorithms plays a major role in medical image diagnosing. Deep learning algorithms are efficiently developed to predict breast cancer, oral cancer, lung cancer, or any other type of medical image. In this study, the proposed model of transfer learning model using AlexNet in the convolutional neural network to extract rank features from oral squamous cell carcinoma (OSCC) biopsy images to train the model. Simulation results have shown that the proposed model achieved higher classification accuracy 97.66% and 90.06% of training and testing, respectively.

Salivary MMP-9 Levels in Chronic Periodontitis Patients with Type-II Diabetes Mellitus.

Chronic periodontitis and diabetes mellitus share a two-way relationship, the common factor being the inflammatory-mediated pathway, and various cytokines are released during this inflammatory cascade, one of which being matrix metalloproteinase-9. The aim of this study was to identify whether the levels of matrix metalloproteinase-9 are increased due to type-II diabetes mellitus in chronic periodontitis patients. It was an observational, analytical, case-control study. Thirty subjects were recruited in the test group, who were suffering from type-II diabetes mellitus and chronic periodontitis, and 30 subjects in the control group, who were subjects with chronic periodontitis but systemically healthy. Periodontal parameters, including the plaque score, gingival bleeding index, probing pocket depth and clinical attachment level of the subjects, were measured, saliva samples of all of the subjects were collected and salivary matrix metalloproteinase-9 levels were analyzed by an enzyme-linked immunosorbent assay (ELISA) technique. The statistical analysis was performed using SPSS 24. Overall, the matrix metalloproteinase-9 levels of the diabetic patients with chronic periodontitis were increased almost twofold (156.95 ± 29.80 ng/mL) compared to the levels in the controls (74.96 ± 6.32 ng/mL) (p < 0.001). Similarly, the periodontal parameters were far worse in diabetics with chronic periodontitis compared to the controls. The average gingivitis score for the test subjects was 78.45 ± 8.93%), compared to 29.32 ± 12.96% in the controls (p < 0.001). The mean probing pocket depth for the test group was 5.39 ± 0.60 mm, and, for the control group, it was 4.35 ± 0.31 mm (p < 0.001). For the test subjects, the average clinical attachment level was 5.86 ± 0.58 mm, and it was 4.66 ± 0.32 mm for the controls (p < 0.001). It was ascertained that there is a two-fold increase in the levels of salivary matrix metalloproteinase-9 in the test group compared to the control group. In addition, the level of periodontal apparatus destruction was greater in the test group. This proved that type-II diabetes mellitus influences the levels of matrix metalloproteinase-9 in humans and elevates them, causing further periodontal destruction.

A randomized clinical trial compared the effect of intra-alveolar 0.2 % Chlorohexidine bio-adhesive gel versus 0.12% Chlorohexidine rinse in reducing alveolar osteitis following molar teeth extractions.

OBJECTIVES: To evaluate socket healing, incidence of acute alveolar ostieitis (AO) and associated pain following single molar tooth extraction in patients who receive intra-alveolar 0.2% chlorhexidine (CHX) gel, and those who rinsed with 0.12 % CHX rinse. STUDY DESIGN: A prospective randomized clinical trial was conducted on two parallel groups of patients. Group 1 (141 patients): Rinsed with 0.12 % CHX rinse from the second postoperative day, two times daily for a week. Group2 (160 patients): Who had direct intra-alveolar application of 0.2% CHX gel and day 3 post-operatively. The socket was evaluated 3 and 7 day postoperatively for the presence of AO by checking probing tenderness in the socket, empty socket, food debris, halitosis and pain assessment by VAS. RESULTS: Forty-eight AO cases were diagnosed out of 301 extractions (15.9%). In Group 1, 25 cases were found (17.7%) while 23 cases were found in Group 2 (14.4%). The difference was not statistically significant (p=0.428). Presence of empty socket and food debris in Group 1 were higher than in Group 2 but the difference was not statistically significant (p= 0.390 & p = 0.415). Occurrence of halitosis in Group 2 was more than Group 1, but the difference was not significant (p= 0.440). Statistical significance was found between AO in extraction done by root separation (29%) and those routinely extracted (12.3 %) (p=0.001). CONCLUSION: Postoperative evaluation of molar extraction sockets that received direct intra-alveolar application of 0.2% CHX gel showed insignificant less occurrence of AO when compared with 0.12 % CHX rinse.

Prevalence and Association of Calcified Pulp Stones with Periodontitis: A Cone-Beam Computed Tomography Study in Saudi Arabian Population.

This study aimed to identify the prevalence and association of periodontitis and pulp stone (PS) along with the clinical variables. This study assessed the cone-beam computed tomography (CBCT) records to identify the presence of PS and clinical periodontitis records were used to determine the stages of periodontitis. The Chi-square test was used to evaluate the relationship between study parameters. Logistic regression was used to determine the association between PS and periodontitis. A total of 228 CBCT records were conveniently selected for this study based on the inclusion and exclusion criteria. Cohen's kappa analysis showed near to perfect scores for both examiners. The Chi-square test showed that CBCT records from the age range 41-50 years, male patients, and stage II of periodontitis prevalently showed pulp stones; however, there were no significant differences observed between the PS and clinical variables. However, gender, involvement of tooth, and stages of periodontitis showed significant distribution of the PS. Logistic regression showed that the stages of periodontitis showed no significant association with PS in patients with periodontitis. Moreover, multivariate odds ratio adjustment did not alter the outcome. Periodontitis is not associated with the presence of PS in the current population.

Actinomycosis of the paranasal sinuses: case report and literature review.

Actinomycosis is a chronic granulomatous condition caused by filamentous gram-positive anaerobic bacteria that colonizes the mouth, gastrointestinal tract and urogenital tract. Infection occurs through the mucosal surfaces, often resulting from dental procedures or trauma, primarily affecting the maxillary sinus. We report a case of Actinomyces sinusitis affecting the right maxillary and right ethmoidal sinuses of a 41-year-old woman. The diagnosis was made through a combination of histopathological report and computed tomography scan. The patient underwent endoscopic sinus surgery followed by long-term antibiotics for 6 months and reported improvement of her symptoms.

Denoised encoder-based residual U-net for precise teeth image segmentation and damage prediction on panoramic radiographs.

OBJECTIVES: This research focuses on performing teeth segmentation with panoramic radiograph images using a denoised encoder-based residual U-Net model, which enhances segmentation techniques and has the capacity to adapt to predictions with different and new data in the dataset, making the proposed model more robust and assisting in the accurate identification of damages in individual teeth. METHODS: The effective segmentation starts with pre-processing the Tufts dataset to resize images to avoid computational complexities. Subsequently, the prediction of the defect in teeth is performed with the denoised encoder block in the residual U-Net model, in which a modified identity block is provided in the encoder section for finer segmentation on specific regions in images, and features are identified optimally. The denoised block aids in handling noisy ground truth images effectively. RESULTS: Proposed module achieved greater values of mean dice and mean IoU with 98.90075 and 98.74147 CONCLUSIONS: Proposed AI enabled model permitted a precise approach to segment the teeth on Tuffs dental dataset in spite of the existence of densed dental filling and the kind of tooth. CLINICAL SIGNIFICANCE: The proposed model is pivotal for improved dental diagnostics, offering precise identification of dental anomalies. This could revolutionize clinical dental settings by facilitating more accurate treatments and safer examination processes with lower radiation exposure, thus enhancing overall patient care.

Prevalence of Middle Mesial Canal in Mandibular Molars of a Saudi Subpopulation: A Prospective Cone-Beam Computed Tomography Study.

BACKGROUND: Root canal treatment is compromised when one or more root canals are left unmanaged, especially in the case of multirooted teeth. Cone-beam computed tomography (CBCT) has the advantage of clearly recognizing the anatomical structures without any blurring and superimposition. There are few studies that assess the middle mesial canal (MMC) prevalence in the Saudi population using CBCT imaging. Thus, the present study was conducted to assess the MMC prevalence in the first and second mandibular molars in the Saudi population using CBCT imaging. MATERIALS AND METHODS: Data from 616 patients and 1014 teeth were assessed. The mesial roots of the mandibular first and second molars were examined using CBCT to assess the presence of the MMC in both axial and coronal sections. The potential correlation between the prevalence of MMC was assessed with gender and age. The data collected were subjected to statistical analysis using IBM SPSS version 20.0 software (IBM Corp., Armonk, NY). RESULTS: The mean age was 34.39 ± 12.12 years, showing male predominance. A total of 2.6% and 0.2% cases of MMC were found in the first and second molars, respectively. A significant difference (p-value < 0.05) was observed among both genders in relation to age groups and the presence of MMC. MMC in the first molar was seen mainly in patients aged <20 years and only one case was reported with MMC in the second molar among patients aged 41-60 years. CONCLUSION: A higher incidence of MMC was found in the first than the second mandibular molar. For accessing the MMC, the patient's age, high magnification, and troughing are some influential factors. In the future, clinical studies with long-term follow-ups are required to assess the influence of biomechanical preparation of MMC on the result of nonsurgical endodontic management in mandibular first as well as second molars.

Oral Healthcare Practices and Awareness among the Parents of Autism Spectrum Disorder Children: A Multi-Center Study.

This study aimed to evaluate the knowledge and attitudes of the parents of autistic children toward oral health and the practice of oral hygiene habits. A questionnaire was constructed, validated, and distributed to the parents of autistic children at different autistic centers. The questionnaire was divided into three parts: demographic information on the parents of autistic children, the knowledge and attitudes of parents toward oral health, and the practice of oral hygiene habits in the current population. A total of 206 responses were collected. Irrespective of the parents' educational and employment statuses, most second children were diagnosed with autism, and most of the parents have four or more children. In terms of knowledge and attitudes toward oral health, a total of 90.30% of the patients were aware of the oral healthcare of their child, and 55.80% of parents take them to the dentist for checkups. Moreover, the response to the practice of oral hygiene habits from the parents was positive, and most of the parents assist in the oral hygiene practices of their autistic children. This study showed that most of the parents appeared to have satisfactory knowledge about oral health practices for autistic children. However, additional studies should also be conducted.

Ozone Therapy as an Adjuvant in the Treatment of Periodontitis.

The current study aimed to assess the efficacy of ozone therapy in the treatment of stage II and stage III periodontitis. This prospective split-mouth study selected patients who were diagnosed with either stage II or stage III periodontitis. All patients were treated with scaling and root-planing (SRP) on the control side and SRP with ozone therapy on the test side. Probing depth (PD), clinical attachment loss (CAL), O'Leary plaque index (PI), and bleeding on probing (BOP) scores were recorded at baseline and six weeks after the SRP treatment. A total of 46 patients were selected for this study, including 31 males and 15 females. All periodontal variables (PD, CAL, PI, and BOP) showed significant changes (p < 0.0001) from baseline to six weeks. Moreover, significant changes (PD = 0.0001, CAL = 0.0001, PI = 0.042 and BOP = 0.0001) were also observed between the control and test sides. Gender showed no significance on periodontal variables (p > 0.05) except PD on the test side (p = 0.030). In addition, periodontal stages and grades showed no significant changes (p > 0.05) in any periodontal variables on both sides. Ozone therapy significantly improves the periodontal condition compared to SRP treatment alone. However, the stages and grades of periodontitis do not influence the outcome of ozone therapy.

Three-Dimensional FEA Analysis of the Stress Distribution on Titanium and Graphene Frameworks Supported by 3 or 6-Implant Models.

Titanium is the main component of dental implants. It is also routinely used as a framework material for implant-supported full-arch prostheses due to its low density, biocompatibility, and other mechanical properties. Remarkable mechanical properties such as lesser mass density and higher young's modulus of graphene have gained popularity among scientists, improving the properties of biomedical implants. Thus, our study aimed to compare the outcome through the von Mises stresses generated on All-on-6 and All-on-3 implant models, as well as on the framework, and evaluate the effect of stress patterns on the crestal bone around implants in the mandible. FEA (Finite Element Analysis) study was carried out using edentulous mandible models. Four 3D FEA models with 3 and 6 implants were used (Model 1: Titanium bar-supported 6 straight implants; Model 2: Graphene bar-supported 6 straight implants; Model 3: Titanium bar-supported 3 implants with 30 degrees-tilted; Model 4: Graphene bar-supported 3 implants with 30 degrees-tilted) in order to simulate endosseous implant designs. The implant measuring 4.2 mm in diameter and 11.5 mm in length were used. The most distal implants in the 3-implant models were placed with angulation of 30 degrees; in 6 implants, they were vertically placed. All the models were analyzed for vertical and oblique axis with a single force magnitude of 100 N. In all four implant models and under loading conditions, the peak stress points were always on the neck of the most distal implant. von Mises stresses were within the normal stress range. In a conventional six-straight implant model supported by a titanium framework, the cortical stress in the region of implants was 25.27 MPa, whereas, in the graphene framework, it was 12.18 MPa. Under vertical load, there was a significant difference in the cortical stress around the tilted implants (30 degrees) in the 3-implant system of titanium and graphene frameworks, respectively, 70.31 MPa and 21.27 MPa. The graphene framework demonstrated better results than the titanium framework for the conventional six-implant system under vertical load, achieving stress of 30.09 MPa and 76.60 MPa, respectively. In the case of the 3-implant system, a significant difference in the bar stress was observed between graphene and titanium, respectively, 256.32 MPa and 180.1 MPa of bar stress. Within the limitation of this study, the peri-implant stresses were decreased using graphene framework models. Hence, it was possible to conclude that the best load-bearing capacity results were found in the graphene framework group compared to the titanium framework for All-on-6 and All-on-3 implant models, even though both materials are reliable options used as framework materials in implant-supported full-arch prostheses.

Awareness and practice of dentists in gulf cooperation council countries regarding medication-related osteonecrosis of the jaw - A web-based survey.

Background/purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication among dental patients undergoing treatment with antiresorptive medications such as bisphosphonate and denosumab. The present survey investigated the awareness and practice of dentists in the Gulf Cooperation Council (GCC) countries regarding MRONJ. Materials and methods: This questionnaire-based study was conducted among dental practitioners in all six GCC countries. A questionnaire was designed and distributed among all potential participants via different social media platforms. SPSS version 22 was used for data analysis, and P-value <0.05 was considered statistically significant. Results: Overall, 1685 dentists from the six GCC countries participated in the present study. The surveyed dentists revealed relatively fair practices and awareness regarding MRONJ and its prevention, with the majority reported asking their patients about history of anti-osteoporotic medications (67.8%), recording name of the medication (73.1%) and duration of treatment (75.5%). However, the majority of the participants were unconfident about the duration of drug holiday prior to dental surgical interventions (70.6%) and the overall good level of knowledge/practice related to MRONJ was just 50.6%. The regression analysis revealed that previous exposure to MRONJ cases and attending a seminar, course, meeting, or conference about osteonecrosis of the jaw were independent predictors for positive awareness/good practice regarding MRONJ (P < 0.05). Conclusion: The results show inadequate awareness and practices of dentists practicing in GCC countries regarding MRONJ, with significant variations among the countries. Therefore, appropriate interventions such as periodic continuous education courses are required to improve dentists' knowledge and practices regarding MRONJ.

Accuracy and Reliability of CBCT Compared to Clinical Probing in Detection of Trifurcation Defects: An In Vivo Study.

Background: Furcation defects are areas of pathological bone resorption in multirooted teeth. The aim of the study was to compare the measurements of trifurcation bone loss, measured using CBCT, versus clinical measurements in order to evaluate the efficacy of CBCT as an adjunctive diagnostic tool. Material and Methods. The included patients had both CBCT scans for maxillary molars and completed periodontal charts. Clinical examination consisted of probing and detection of vertical and horizontal furcation defects. These were measured and recorded. CBCT measurements were then evaluated using the linear measuring tool in Carestream imaging software (Carestream, Rochester, USA) and iCAT (Imaging Sciences, Hatfield, USA). These measurements of the CBCT images were then documented and compared to clinical findings. The two examiners were blinded to each other's measurements. Results: The most common tooth with a detected furcation defect was tooth #2 (31.7%), followed by tooth #15 (26.8%) and #3 (21.9%). The least common tooth with a detected furcation defect was #14 (19.5%). The mean values of buccal furcation for clinical and CBCT measurements were 3.01 mm and 2.6 mm, respectively. The measurements of mesial furcation were 2.5 mm and 2.2 mm for CBCT. The distal measurement of clinical examination was 2.7 mm and for CBCT was 2.44 mm. Conclusion: CBCT can be used as an adjunct to clinical furcation measurements and adds useful diagnostic information to assess trifurcation defects. In addition, CBCT limited field of view (FOV) can provide relatively high-resolution images at a reduced dose that is comparable to two-dimensional imaging.

Clinical Assessment of the Bone Width Following Lateral Ridge Expansion in Augmentation of Narrow Alveolar Ridges for Placing Immediate Dental Implants.

Background: Less residual alveolar bone at extraction site at esthetic and functional tooth position is the main limitation in placing a dental implant, especially at long-span edentulous ridges. This needs ridge augmentation. Aims: To assess bone width gain and implant stability following narrow ridge augmentation using the vertical ridge split technique. Materials and Methods: In 22 subjects within the age group of 20-60 years and the mean age of 38.46 years. The vertical ridge split technique was done in all subjects for horizontal ridge augmentation. Paraesthesia, pain/discomfort, mobility, and radiographic crestal bone width were assessed 6 months postoperatively. The data were described as mean and standard deviation along with number and percentage. Paired t-test was also used keeping the level of significance at P < 0.05. Results: Implant stability was seen in 86.36% (n = 19) study subjects and were not stable in 13.63% (n = 3) subjects. Bone width preoperatively was in the range of 3.1-4.4 mm with the mean value of 3.64 ± 0.41. Postoperatively, the bone width increased and was in the range of 5.2-6.3 mm with the mean value of 5.62 ± 0.45 mm. This increase postoperatively was statistically significant with a P value of <0.001. Conclusion: The present study concludes that acceptable success results are seen using the ridge split technique with simultaneous dental implants placement in both atrophic maxilla and mandible.