Exploring the Most Effective Apical Seal for Contemporary Bioceramic and Conventional Endodontic Sealers Using Three Obturation Techniques.

Background and Objective: Despite a plethora of studies conducted to date, researchers continue to investigate the best sealer and obturation technique combinations. The aim of this study is to compare the apical seal provided by two bioceramic sealers (Endoseal and Endosequence) with that provided by a calcium hydroxide sealer (Sealapex), and to evaluate the effect of different obturation techniques (cold lateral condensation, continuous wave compaction and single cone) on the apical seal under a stereomicroscope. Materials and Methods: A total of 110 single-rooted mandibular premolar teeth were decoronated, cleaned and shaped using the Endosequence filing system to tip size 30/0.04 taper. Canals were irrigated with 5.25% NaOCl and 17% EDTA. The samples were randomly divided into 11 groups (9 experimental and 2 control groups) according to the designated sealer and technique. Samples were stored in an incubator for 7 days at 37 °C under 100% humidity. Samples were coated with nail varnish except for apical 2 mm and vertically placed in 0.2% rhodamine B dye solution for 48 h. Samples were split longitudinally and viewed under a stereomicroscope at 40× magnification. Results: Insignificant results were obtained between obturation techniques (p = 0.499) whereas statistically significant results were attained based on the type of endodontic sealer (p < 0.001). The overall lowest mean apical microleakage and best sealing ability was demonstrated by Sealapex (2.59 ± 1.20 mm) and amongst techniques by continuous wave compaction (3.90 ± 2.51 mm). Conclusions: Endosequence produced the best apical seal with the continuous wave compaction technique, whereas Endoseal did so with the bioceramic-coated single-cone technique. For the Sealapex sealer, the most effective apical seal was observed using cold lateral condensation. The quality and effectiveness of apical seal differed with the type of endodontic sealer and obturation technique used, and vice versa.

Comparison of the postoperative anti-inflammatory efficacy of chlorhexidine, saline rinses and herbal mouthwashes after mechanical debridement in patients with peri-implant mucositis: A randomized controlled trial.

AIM: The null hypothesis is that there is no difference in the post-operative anti-inflammatory efficacy of chlorhexidine (CHX), 2% saline rinses (SR) and a herbal mouthwash (MW) after non-surgical mechanical debridement (MD) for treatment of peri-implant mucositis (PiM). The aim was to compare the post-operative anti-inflammatory efficacy of CHX, 2% SR and a herbal oral rinse after non-surgical MD of PiM. MATERIALS AND METHODS: The present randomized controlled trial had a single-blinded parallel arm design. Patients diagnosed with PiM were enrolled. Demographic information was recorded. All patients underwent MD and were randomly divided into 4 groups: CHX-group: 0.12% non-alcoholic CHX; Sodium chloride (NaCl) group: 2% NaCl rinses; Herbal MW group: Herbal-based MW and H2 O group: distilled water with peppermint flavour. After MD, all the participants were advised to rinse twice daily (every 12 hrs) for 2 weeks with their respective MWs. In all groups, peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 12 weeks of follow-up. Sample size was estimated using data from a pilot investigation; and group-comparisons were performed. Statistical significance was confirmed when P-values were below 0.01. RESULTS: Sixty individuals (15 patients/group) were included. At baseline, mPI, mGI and PD were comparable in all groups. At baseline, there was no significant difference in peri-implant mPI, mGI and PD in all groups. At 12-weeks' follow-up, there was a statistically significant reduction in peri-implant mPI (p < 0.01), mGI (p < 0.01) and PD (p < 0.01) in CHX, NaCl and herbal MW groups compared with H2 O group. There was no significant relation between implant location, duration for which, implants were functional, gender and peri-implant clinical parameters in all groups. CONCLUSION: After non-surgical MD, post-operative use of CHX and herbal and NaCl MWs is useful for the management of PiM in the short-term.

Evaluation of serum neuron specific enolase levels among patients with primary and secondary burning mouth syndrome.

INTRODUCTION: Burning mouth syndrome is a painful condition of the oral cavity with ambiguous pathogenesis and diagnosis. Neuron-specific enolase is increased in several conditions including peripheral neuropathy of diabetes, ophthalmopathies, spinal cord injuries and tumors. Evidence on association of burning mouth syndrome and neuron-specific enolase is limited. AIM: This study aims to evaluate neuron-specific enolase levels in primary and secondary burning mouth syndrome patients and compare the levels of neuron-specific enolase with associated conditions in secondary burning mouth syndrome. METHODS: One hundred and twenty-eight patients of more than 18 years of age with no gender predilection and having clinical symptoms of burning mouth syndrome and 135 healthy subjects were included. All the patients fulfilled Scala's criteria for the diagnosis of burning mouth syndrome, including "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) burning mouth syndrome patients. Blood samples were obtained from burning mouth syndrome patients. Serum neuron-specific enolase was evaluated using enzyme-linked immunosorbent assay. To compare means and standard deviations, among primary and secondary burning mouth syndrome, data was analysed with analysis of variance and multiple comparisons test. RESULTS: The mean age of the study participants for burning mouth syndrome and healthy subjects was 53.30 and 51.6 years, respectively. Amongst the secondary burning mouth syndrome group, 32 (25%) of the patients had menopause, 15 (11.7%) had diabetes, eight (6.2%) of the patients had nutritional deficiency, seven (5.4%) had combined diabetes, menopause, and depression, six (4.6%) had combined diabetes and depression, four (3.1%) were diagnosed with Sjögren's syndrome. A minor percentage of 2.3% (three) had gastroesophageal reflux disease, while the remaining three (2.3%) patients in the secondary burning mouth syndrome group were on anti-depressants. There was a statistically significant increase in the levels of neuron-specific enolase in primary burning mouth syndrome as compared to the secondary burning mouth syndrome and healthy groups. Among the subgroups of secondary burning mouth syndrome, diabetic individuals showed a significant increase in neuron-specific enolase level when compared with other conditions in the secondary burning mouth syndrome patients.Discussion and conclusion: The raised serum neuron-specific enolase levels in patients suffering from primary burning mouth syndrome highlight a possible neuropathic mechanism. It was also increased in the sub-group of secondary burning mouth syndrome patients having diabetes. Although it cannot be ascertained whether the deranged values in the diabetic group were due to burning mouth syndrome or due to diabetes, the raised quantity of neuron-specific enolase in the primary burning mouth syndrome group is a reliable diagnostic indicator. Future studies on the assessment of neuron-specific enolase levels as a diagnostic tool for onset and management of primary and secondary burning mouth syndrome are recommended.

Effect of photobiomodulation after non-surgical mechanical debridement on cortisol levels in the peri-implant sulcular fluid among patients with peri-implant mucositis.

OBJECTIVE: The aim of this was to compare the efficacy of photobiomodulation after non-surgical mechanical debridement (MD) on cortisol levels (CL) in peri-implant sulcular fluid (PISF) among patients with peri-implant mucositis. METHODS: Patients with peri-implant mucositis were encompassed. All patients underwent non-surgical MD with (test group) and without (control group) a single application of photobiomodulation. Demographic data were collected and PISF was collected. Peri-implant modified plaque index (mPI), modified gingival index (mGI), probing depth and crestal bone loss were measured, and CL in PISF were recorded. All clinical parameters and PISF CL were re-assessed at 4 months of follow-up. p < .05 showed statistical significance. RESULTS: Seventeen (14 males and 3 females) and 17 (15 males and 2 females) patients with peri-implant mucositis were recruited in test and control groups. The mean age of patients in the test and control groups was 46.1 ± 6.5 and 50.2 ± 2.7 years respectively. At baseline, mPI, mGI, PD and PISF volume and CL in control and test groups were similar. At follow-up, there was a significant reduction in mPI (p < .001), mGI (p < .001), PD (p < .001) and PISF volume (p < .001) and CL (p < .001) in both groups compared with baseline. There was no difference in mPI, mGI, PD and PISF volume and CL in test and control groups at follow-up. CONCLUSION: In short term, non-surgical MD with photobiomodulation does not offer additional benefits in terms of reducing soft-tissue inflammatory parameters and PISF CL in patients with peri-implant mucositis.

Analysis of recurrent esthetic dental proportion of natural maxillary anterior teeth: A systematic review.

STATEMENT OF PROBLEM: The recurrent esthetic dental (RED) proportion has been a benchmark for the rehabilitation of the maxillary anterior teeth of North American patients. While it has been evaluated in other populations, the global application of RED proportions in the rehabilitation of maxillary anterior teeth is unclear. PURPOSE: The purpose of this systematic review was to examine the existing evidence on dental proportion to evaluate the existence of RED proportions in the esthetic smile in different geographic regions. MATERIAL AND METHODS: A systematic search was conducted by reviewing different databases. The focused question was "Does RED proportion exist in esthetically pleasing smiles in different populations around the world?" The search included articles with a combination of MeSH keywords based on dental proportion from January 2000 to July 2020. The titles and abstracts were identified by using a search protocol. Full text of the articles was independently evaluated. The systematic review was modified to summarize the relevant data. The general characteristics, outcomes, and quality of studies were reviewed and analyzed systematically. RESULTS: Seventeen studies were selected from the reviewed articles. Three studies were conducted in Europe, 10 in South Asia, and 4 in Western Asia. Eleven studies found that the mean perceived ratio of anterior teeth was not constant when progressing distally. Five studies reported that the ratio was constant in a small percentage of their populations, and 1 suggested that the ratio was constant if it remains between 60% and 80%. The central-to-LI and Ca-to-LI proportion values were not constant. Overall, the Ca-to-LI proportion values were higher than the central-to-LI proportions. CONCLUSIONS: RED proportions were not found in the successive widths of maxillary anterior teeth among the reviewed data from different geographic regions. RED proportions are not the only standard for restoring esthetic smiles worldwide, and anterior tooth proportions differ among populations based on their race and ethnicity.

Influence of Glycemic Control on the Survival of Implants Placed in the Zygomatic Bone of Edentulous Patients With and Without Type 2 Diabetes Mellitus: 10-Year Follow-Up Results.

It is hypothesized that under optimal glycemic control (GC), there is no difference in the survival of implants placed in the zygomatic bone of edentulous patient with and without type 2 diabetes mellitus (T2DM). The aim was to assess the influence of GC on survival of implants placed in the zygomatic bone of an edentulous patient with and without T2DM at the 10-year follow-up. Twenty patients with T2DM (10 with poorly controlled T2DM and 10 with well-controlled T2DM) and 12 patients without T2DM were included. Hemoglobin A1c (HbA1c) levels were recorded, and demographic data were collected from all participants. Peri-implant inflammatory parameters (plaque index [PI], probing depth [PD], crestal bone loss [BL], and gingival index [GI]) were measured in all patients. Group comparisons were done, and P values, which were less than .01, were indicative of statistical significance. Twenty and 12 male patients with and without T2DM, respectively, were included. Among patients with T2DM, 10 and 10 individuals had poorly and well-controlled T2DM, respectively. The mean HbA1c levels were significantly higher in patients with poorly controlled T2DM (9.2 ± 0.7%) compared with well-controlled T2DM (4.8 ± 0.3%; P < .01) and nondiabetic individuals (4.6 ± 0.3%; P < .01). The crestal BL on the mesial (P < .01) and distal (P < .01) surfaces, PD (P < .01), PI (P < .01), and GI (P < .01) were significantly higher around all zygoma implants placed in patients with poorly controlled T2DM compared with patients with well-controlled T2DM and patients without T2DM. These clinicoradiographic parameters were comparable around zygoma implants placed in patient with well-controlled T2DM and in subjects without T2DM. Optimal GC is essential for the long-term stability of zygomatic plants in patients with T2DM.

Osteogenic Differentiation of Periodontal Ligament Stem Cells Seeded on Equine-Derived Xenograft in Osteogenic Growth Media.

Background and Objectives: The duration of bone turnover is critical, and different time points help in identifying the optimal endpoint of treatment duration. However, investigating the combination of xenograft and stem cells to allow tissue regeneration within an ideal time duration remains an under-investigated topic. The current study aimed to assess the impact of equine-derived xenograft bone blocks in assisting the human periodontal ligament stem cells (PDLSCs) to demonstrate osteogenic differentiation (collagen type 1 expression and calcium deposition) within an osteogenic growth media. Materials and Methods: Human PDLSCs were acquired commercially and seeded onto xenograft bone blocks. After the 14th and 21st day of culture, enzyme-linked immunoassay (ELISA) was utilized for the detection and quantification of levels of collagen type I, while the mineralization assessment (deposition of calcium) was conducted by staining the PDLSCs with Alizarin Red S (ARS). The statistical comparison between the means and standard deviations of study groups were evaluated using analysis of variance (ANOVA). Results: ELISA assessment revealed an upsurge in the expression of collagen type I for PDLSCs cultured with xenograft after 14 and 21 days compared to the controls (intergroup comparisons significant at p < 0.05). Similar findings were obtained for mineralization assessment and on ARS staining. PDLSCs cultured with xenograft bone blocks presented an increased deposition of calcium compared to their control counterparts (intergroup comparisons significant at p < 0.05). Conclusions: PDLSCs embedded in xenograft bone blocks inside an osteogenic growth medium demonstrated greater osteogenic differentiation potential after 14 and 21 days. This superior osteogenic differentiation capability was evident by increased collagen type I expression and more significant calcium deposition at the 14th and 21st days after culture.

Clinical Evaluation of Short Tuberosity Implants among Type 2 Diabetic and Non-Diabetic Patients: A 5 Year Follow-Up.

Aim: To assess clinical and radiographic parameters including bleeding on probing (BoP); probing depth (PD), plaque index (PI) and crestal bone loss (CBL) around short tuberosity implants (STI) supporting fixed partial dentures in patients with Type 2 diabetes mellitus (T2DM) and non-diabetics. Material and Methods: Participants with T2DM and without T2DM with at least one STI (6 mm) posteriorly restored with a fixed partial denture splinting premolar implant were included. A questionnaire collected demographic details including gender, age, duration of diabetes, habits of brushing, the total number of dental implants and location, implant loading after placement, restoration type, and family history of DM. Clinical and radiographic assessment of peri-implant parameters, i.e., bleeding on probing (BoP), probing depth (PD), plaque index (PI), and crestal bone loss (CBL) was performed. The restorative success of STI was determined by no sensation of the foreign body, lack of pain and dysesthesia, lack of infection, no radiolucency around the implant, and no mobility. The Kruskal-Wallis test was used for statistical analysis. A p-value of less than 0.05 was considered statistically significant. Results: Twenty-five T2DM (19 males and 6 females) and 25 non-diabetic (18 males and 7 females) participants were included. The number of STIs in T2DM was 41, whereas in non-diabetic it was 38. At 1 year follow-up, mean PI% in T2DM participants was 18.9% (19.2-21.4%) and in non-diabetics it was 17.6% (16.3-18.5%). The mean PD was recorded in diabetics (1.3 ± 5.0 mm) and non-diabetics (1.1 ± 3.2 mm). The BoP value in diabetics was 44.9% (39.8-46.4%) and 28.2% in non-diabetics (17.2-24.6%). At 5 years of follow-up, the mean PI% range in T2DM participants was 26.18% (25.4-29.1%) and 24.42% in non-diabetic (20.1-25.5%). The mean PD in millimeters around STI in T2DM was observed to be 2.3 ± 4.8 mm and 1.4 ± 3.4 mm in non-diabetics. In addition, BoP in diabetic participants was 39.54% (27.7-42.1%) and 24.42% in non-diabetics (20.1-25.5%). A total of six STIs failed, i.e., two in the non-diabetic and four in the T2DM group. Conclusions: Patients with T2DM have poor periodontal (BoP, PD, CBL) and restorative peri-implant parameters around STIs when compared to healthy (non-diabetic) participants at five years of follow-up. For long-term stability, glycemic control is pivotal along with following good plaque control.

Clinical, Radiographic, and Inflammatory Peri-Implant Parameters around Narrow Diameter Implant Crowns among Prediabetic and Non-Diabetic Subjects.

Background and Objectives: To compare the clinical, radiographic, and inflammatory peri-implant parameters around narrow diameter implants (NDI) supported single and splinted crowns in non-diabetics and prediabetes. Materials and Methods: The clinical and radiographic parameters and the levels of IL-6 and TNF-α in the peri-implant crevicular fluid (PICF) of narrow diameter single (NDISCs) and splinted (NDISPs) crown implants were assessed both in non-diabetics and participants with prediabetes. The glycemic state of the patient was assessed using glycated hemoglobin (HbA1c) levels. The peri-implant soft tissue indices (Plaque index (PI), bleeding on probing (BoP), probing depth (PD)) and marginal bone loss were recorded and compared between the groups. Success of the prosthesis was assessed by the frequency of technical complications and patient satisfaction. Inter-group comparison was performed using ANOVA (one-way analysis of variance) while the normal distribution of dependent variables was calculated using Shapiro-Wilk. A p-value of less than 0.05 was considered to be statistically significant. Results: Sixty participants (30 non-diabetics and 30 with prediabetes) with a total of 178 (118 NDISCs and 60 NDISPs) platform-switched NDIs were a part of the study. Of the 118 NDISCs, 56 were placed in the non-diabetic individuals and 62 were placed in the prediabetes group whereas 30 NDISPs each were placed in both the study groups. The clinical parameters of PI, BoP and PD in the single crown and splinted crown groups showed comparable results. However, a statistically significant difference (p-value of less than 0.05) in PI, BoP and PD and in the values of IL-6 and TNF-α was found when a comparison was made between the non-diabetes and prediabetes group. A total of 91% of the patients were satisfied with the esthetics of the implants while 79% of the patients showed satisfaction with function. Conclusions: All the clinical and radiographic parameters were statistically similar in both single and splinted types of narrow diameter implants. However, the bone loss, probing depth, plaque index, and levels of inflammatory markers were statistically higher in prediabetes as compared to non-diabetes implying that a slight hyperglycemic state impacts peri-implant health.

Marginal Misfit of 3D-Printed (Selective Laser Sintered), CAD-CAM and Lost Wax Technique Cobalt Chromium Copings with Shoulder and Chamfer Finish Lines: An In-Vitro Study.

Background and Objectives: The aim was to compare the Misfit of 3D-Printed, Selective laser melting (SLM), milled (Computer aided design-Computer aided manufacture CAD-CAM) and Lost wax technique (LWT) fabricated Cobalt chromium (CoCr) alloy copings on shoulder (SH), radial shoulder (R-SH) and chamfer (CH) finish line configuration. Materials and Methods: Ninety resin, second maxillary premolar teeth were prepared for metal-ceramic crowns, equally divided into (n = 30) SH, R-SH and CH margin preparations. For each preparation design (SH, R-SH and CH), CoCr copings were prepared using SLM, CAD-CAM and LWT. This resulted in nine study groups with 10 CoCr copings each. The marginal misfit of specimens was assessed with a high-resolution digital microscope. Misfit was evaluated in vertical and horizontal dimensions in µm. Data were analyzed using ANOVA and a post hoc multiple comparisons test. Results: For vertical misfit, the highest was observed in SLM samples with chamfer margin (167.96 ± 24.1), and the least was shown by CAD-CAM samples with radial shoulder (58.8 ± 12.53). CAD-CAM and shoulder margins showed the least vertical misfit. For horizontal misfit, the maximum was observed in SLM samples with shoulder margin (137.94 ± 37.85) and the least by LWT samples with chamfer (89.38 ± 14.81). Chamfer margins and LWT samples showed the least horizontal misfit among the group samples. Fabrication technique and finish line design play a critical role in reducing the marginal misfit of CoCr copings. Conclusions: For vertical misfit, SLM copings showed poor outcomes compared to CAD-CAM specimens, however comparable outcomes to Cast specimens. SLM copings showed comparable horizontal misfit outcomes to CAD-CAM specimens and low misfit compared to Cast copings, respectively. Vertical misfit was low with shoulder margins, and horizontal misfit was better with chamfer marginal configuration.

Cortisol levels in the peri-implant sulcular fluid among patients with and without peri-implantitis.

BACKGROUND AND OBJECTIVE: Cortisol levels remain uninvestigated in peri-implant sulcular fluid (PISF) of patients with and without peri-implantitis. The present investigation investigated levels of cortisol in PISF among controls (individuals without peri-implantitis) and patients with peri-implantitis. METHODS: The patient population comprised of participants with and without peri-implantitis (groups 1 and 2, respectively). Demographic information and data related to implant characteristics was recorded. Peri-implant radiographic (crestal bone loss [CBL]) and clinical (modified plaque and bleeding on probing indices [PI and BOP], and probing depth [PD]) and parameters were assessed. In all patients, levels of cortisol were measured in the PISF, which was collected using standard methods. Data normality and group comparisons were assessed, and multiple logistic regression was performed. Probability values less than 0.01 were nominated as being significant. RESULTS: Eighty-eight individuals (44 and 44 in groups 1 and 2, correspondingly) were included. In group 1, 24 and 20 participants were males and females, and there were 22 and 22 males and females in group 2. Mean ages were analogous in both groups. Peri-implant BOP (p < .001); CBL (p < .001); PI (p < .001); and PD (p < .001) were higher among patients in group 1 compared with group 2. The volume of PISF (p < .001) collected and its concentrations of cortisol (p < .001) were significantly higher among patients in group 1 compared with group 2. Regression analysis showed that CBL and PD directly correlated with increased PISF levels of cortisol among participants with peri-implantitis. CONCLUSION: Within the limits of the present study, it remains debatable whether or not PISF cortisol levels vary among patients with and without peri-implantitis. Further studies are needed to evaluate the role of PISF levels of cortisol in the diagnosis of peri-implantitis.

Clinical, radiographic and restorative parameters for short tuberosity implants placed in smokers: a retrospective study with 5 year follow-up.

This study aimed to estimate and compare the clinical, radiographic, and restorative parameters around short tuberosity implants (STIs) placed in cigarette smokers (CS) and never smokers (NS). In this 60-month follow-up retrospective study, a total of 50 (37 males + 13 females) individuals who had received 82 dental implants were included. These participants were categorized into two groups as follows: (i) Group-1: 25 self-reported systemically healthy CS with 43 STIs; and (ii) Group-2: 25 self-reported systemically healthy NS with 39 STIs. In both groups, peri-implant plaque index (PI), probing depth (PD), bleeding on probing (BOP), and crestal bone loss (CBL) and restorative parameters were measured at 12 and 60 months of follow-up. Group comparisons were performed utilizing the Kruskal-Wallis test. The significance level was set at p < 0.05. In CS and NS, the mean age of participants was 58.5 and 60.7 years, respectively. No statistically significant differences were observed in the overall mean levels of PD and CBL around STIs among CS and NS. However, a statistically significant increase was observed in the mean scores of BOP and PI around STIs in the NS and CS at 12 and 60 months follow-up, respectively. In both groups, the loosening of the implant was the most frequently encountered type of STI failure. The outcomes of the present study suggest that STIs placed in maxillary tuberosity can show reliable clinical, radiographic, and restorative stability among cigarettes smokers and non-smokers. However, the role of smoking status and oral hygiene cannot be disregarded in this scenario.

Evaluation of the implant diameter on the initial-stability of narrow- and standard-diameter implants placed in simulated Type-I and Type-IV bone-blocks.

OBJECTIVE: A comparison of the initial stability of narrow- and standard-diameter implants (SDIs) placed in Type-I and Type-IV bone-blocks is not yet reported. The aim was to evaluate in-vitro the influence of implant diameter on the initial stability of narrow- and standard-diameter implants (SDIs) placed in simulated Type-I and Type-IV bone-blocks. METHODS: The present experimental in-vitro study was performed between July and September 2020 at the Specialist Dental Practice, Riyadh, Saudi Arabia. Narrow- and standard-diameter implants were placed 3-mm apart in simulated soft (Type-IV) and dense (Type-I) bone blocks by a trained and calibrated investigator. In groups A (Type-IV bone blocks) and B (Type-I bone blocks), implants were inserted using an insertion-torque and drilling-speed of 15-30 Ncm and 1000-1500 rpm, respectively with the implant collar at the crest of simulated bone blocks. In all samples, initial-stability was recorded using resonance frequency analysis (RFA). Sample-size estimation was done and group-comparisons were carried out. A P-value of 0.01 or less reflected statistical significance. RESULTS: In Groups-A and -B, 44 (22 NDIs and 22 SDIs) and 44 (22 NDIs and 22 SDIs) were placed. In group-A, the mean RFA values for NDIs and SDIs were 68.5 ± 3.5 and 69.1 ± 2.4, respectively. In Group-B, the mean RFA values for NDIs and SDIs were 78.06 ± 9.6 and 75.3 ± 5.2. RFA values among NDIs and SDIs in groups A and B were similar. CONCLUSION: The NDIs and SDIs show comparable initial-stability when positioned in simulated Type-I and Type-IV bone blocks.

Effectiveness of Chlorhexidine and Metronidazole Gels in the management of gingivitis. A clinical trial.

OBJECTIVES: The purpose of the present study was to compare the topical application of chlorohexidine (CHX) and Metronidazole (MTZ) gels, individually and in combination in patients with gingivitis for up to 12 weeks follow-up. METHODS: The clinical trial was conducted at Liaquat University of Medical Health Sciences (LUMHS) Jamshoro and Hyderabad, Institute of Dentistry from 1st March 2019 to 1st March 2020. Patients were selected based on inclusion criteria. Out of 125 screened patients, ninety-nine patients agreed to participate in the study. At the beginning of study all patients were assessed for gingival inflammation by using gingival index (GI) (Loe and silness, 1963). Scaling root planning (SRP) was performed in all patients. Subjects were randomly selected in three groups (n=33 each). In Group-A CHX gel was applied, Group-B Metronidazole gel was applied and the combination of two was applied to patients of Group-C. Patient follow up was done and gingival parameters were assessed at baseline, fourth week and twelve weeks. Apart from the clinical evaluation, a subjective evaluation was also undertaken. Significance level of 0.05 and a desired study power of at least 80% was estimated. Analysis of Variance (ANOVA) test for comparison was used within groups. RESULTS: A significant improvement in gingival scores was noted in all groups from baseline. At 4 weeks CHX (1.25±0.21) MTZ (1.81±0.38) CHX+MTZ (1.29±0.34) compared to baseline CHX (2.77±0.24) MTZ (2.84±0.54) CHX+MTZ (2.74±0.31) demonstrated substantial improvement (p<0.001). However, gingival scores showed inclination at 12 weeks CHX (1.18±0.41) MTZ (1.21±0.48) CHX+MTZ (1.11±0.14) with no significant difference to week 4 (p>0.001). CONCLUSION: Local MTZ gel and MTZ+CHX gel showed effectiveness similar to CHX gel application adjunct to scaling and root planning in the treatment of gingivitis.

Influence of contemporary CAD-CAM milling systems on the fit and adaptation of partially stabilized Zirconia fixed partial dentures.

OBJECTIVE: To evaluate marginal fit and internal adaptation of three-unit Zr frameworks fabricated from four Zr CAD/CAM milling systems. METHODS: Fixed partial denture models were replicated (40 stone models) using Polyvinyl Siloxane impression material (PVS) and type IV stone for Zr framework fabrication. FPDs were milled with four CAD/CAM systems, Group-II: LAVAL Zirconia milled by LAVA , Group-2: Vita In-Ceram YZ milled by Cerec®, Group-3: Zirconia milled by GM1000 and Group-4: Zirconia milled by DWX-50N. Twelve marginal gap measurements per framework were performed at pre-established points, with a metallurgical microscope (Zeiss, Germany) at 500X magnification. Eight measurements of cement space per section were performed for adaptation. Data was analyzed using ANOVA and Tukey post hoc test. RESULTS: Zirconia FPD frameworks exhibited gaps ranging from 16 to 50.1 µm for marginal fit and 26.8 to 102.5 µm for internal adaptation. Group-3 [20.8 (8.3) µm & 50.3 (11.4) µm] and Group-4 [16.0 (4.0) µm & 40.2 (8.8) µm] specimens showed significantly lower marginal fit and internal adaptation gaps compared to Group-I [50.1 (13.4) µm & 100.5 (16.7) µm] and Group-2 [38.9 (8.2) µm & 102.5 (13.4) µm] specimens respectively. CONCLUSIONS: Different CAD-CAM systems for fabrication of Zr FPD frameworks displayed a significant influence on marginal fit and internal adaptation of restorations.

Influence of time and hydration (ageing) on flexural strength of Yttrium stabilized Zirconia polycrystals (Y-TZP) fabricated with different CAD-CAM Systems.

OBJECTIVES: To evaluate the effect of time and hydration (ageing) on flexural strength of yttrium-stabilized zirconia polycrystals (Y-TZP) zirconia fabricated from three different materials. METHODS: This in-vitro study was performed from June to September 2019. Y-TZP bars, measuring 2 x 3 x 20 mm were prepared and sintered from three different materials, Group-1: LAVA™ Zirconia (3M ESPE, US) (control) Group-2: Vita In-Ceram YZ (VITA, Germany) and Group-3: Aadva™ Zirconia (Zr) (GC Advanced technologies Inc.). 30 zirconia bars per group were prepared using sectioning of blocks with isomet saw. Followed by sintering in furnaces for recommended temperature cycles. One side of bars were polished and beveled for flexural testing. Groups of specimens were divided into subgroups of 3 (n=10) based on the ageing (distilled water in the incubator at 37ºC) durations (48 Hrs and two and half years). Ten specimens in each material groups were not aged (controls). Samples were exposed to a static force in a three-point bend test using a universal instron-testing machine until fracture. Scanning electron microscopic assessment was performed for fractured specimens for ageing. Data was analyzed using ANOVA and Tukey post hoc test. RESULTS: The mean flexural strength at baseline for Group-1: LAVA™ Zirconia, group (632.7 ± 136.5 MPa) 2: Vita In-Ceram YZ (1036.3 ± 229.6 MPa), and Group-3: Aadva™ Zirconia (1171.3 ± 266.3 MPa) were significantly different. Group-2 and Group-3 specimens showed higher strength compared to Group-1 specimens, irrespective of the ageing duration (p<0.05). Analysis of pooled data for flexural strength for materials by aging period (baseline, after 48 hours and after 2 and ½ years) showed that there was significant reduction of strength with increasing duration (p<0.05). CONCLUSIONS: Y-TZP showed variations in flexural strength depending on the material type. Ageing duration exhibited significant influence on the flexural strength of Y-TZP when comparing no ageing to two and half years. Vita In-Ceram YZ and Aadva Zirconia (Zr) showed higher and clinically acceptable flexural strength outcomes.

Current weight of evidence of viruses associated with peri-implantitis and peri-implant health: A systematic review and meta-analysis.

The pathological role of human herpesviruses (HHVs) (Epstein-Barr virus [EBV], Human cytomegalovirus [CMV], and Herpes simplex virus [HSV]) in peri-implant health needs clarification quantitatively. To determine the weight of evidence for HHVs in patients with peri-implantitis (PI) and substantiate the significance of HHVs in peri-implant inflammation, electronic databases including EMBASE, MEDLINE, Cochrane Oral Health Group Trials Register, and Cochrane Central Register of Controlled Trials were searched from 1964 up to and including November 2018. Meta-analyses were conducted for prevalence of HHVs in PI and healthy controls. Forest plots were generated that recorded risk difference (RD) of outcomes and 95% confidence intervals (CI). Five clinical studies were considered and included. Four clinical studies reported data on EBV while three clinical studies reported data on CMV. Considering the risk of these viruses in PI, significant heterogeneity for CMV (χ2  = 53.37, p < 0.0001, I2  = 96.25%) and EBV (χ2  = 14.14, p = 0.002, I2  = 78.79%) prevalence was noticed between PI and healthy control sites. The overall RD for only EBV (RD = 0.20, 95% CI, 0.01-0.40, p = 0.03) was statistically significant between both groups. Frequencies of the viruses were increased in patients with PI compared with healthy nondiseased sites. However, the findings of the present study should be interpreted with caution because of significant heterogeneity and small number of included studies.

Assessment of factors influencing oral health-related quality of life (OHRQoL) of patients with removable dental prosthesis.

OBJECTIVE: The aim of this study was to evaluate factors affecting oral health related quality of life (OHRQoL) of patients using removable dental prosthesis. METHODS: The present study employed a cross sectional analytical design. A total of 200 patients participated and interviewed using a cross sectional analytical design. In the first section of the questionnaire patients were asked about demographic data whereas the second part of the questionnaire assessed medical history, oral habits, smoking status, oral hygiene habits and frequency of dental visit. The questionnaire also collected information regarding patient's removable prosthesis. Questionnaire of OHIP-DENT (Oral Health Impact Profile) was also employed to measure oral health quality of life (OHRQoL) on the domains of functional limitation (FL), physical pain (P1), psychological discomfort (P2), physical disability (D1), psychological disability (D2), social disability (D3) and handicap (H). Relationships between the demographic, socio-economic and education variables and others OHIP-EDENT scores were explored by comparing mean scores by applying ANOVA. RESULTS: The study participants comprised of 107 males (53.5%) and 93 females (46.5%). Regarding oral care, participants reporting to visit their dentist within one year were 40.0%. The highest score was recorded for the functional limitation (FL) domain (15.62±6.6), followed by social disability (D3) (15.23±5.06) and physical pain (P1) (14.28±4.8). The respective scores for physical (D1) and psychological disability (D2) and handicap (H) were 10.47±4.84, 11.32±5.38 and 12.45±4.50 respectively. CONCLUSIONS: Removable partial denture patients showed minimum problems with mastication, social compromise and functional discomfort. The oral health quality of life of removable denture patients is significantly influenced by patient education level, socio-economic status, medical conditions, smoking and tobacco use habits.

Tobacco Smoking a Potential Risk Factor in Transmission of COVID-19 Infection.

Corona Virus disease 2019 (COVID-19) is a global pandemic and is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) group of viruses. To date, April 25, 2020, more than 2.4 million humans are infected and more than a hundred thousand deaths have been reported from more than 200 countries from COVID-19. There is no evidence-based treatment for the infection and prevention of transmission using social distancing, isolation and hygiene measures is widely recommended. Tobacco smoking is rampant in communities around the globe and the addiction to tobacco results in deaths of more than 8 million individuals each year. As COVID-19 transmits through salivary droplets and causes severe lung pneumonia, tobacco smokers are also at high risk of severe COVID-19 infection due to poor lung function, cross-infection and susceptible hygiene habits. Smoking tobacco (cigarette, e-cigarettes or waterpipe) produces exhaled smoke, coughing or sneezing, aerosols containing SARS-CoV-2 in the surroundings and contaminating surfaces. Therefore, smoking tobacco is a possible mode of transmission for the virus for both active and passive smokers. Smoking should be considered a risk factor for the disease transmission until further availability of evidence and measures to limit its direct and indirect effects should be implemented within the community.

Comparison of failure loads and compressive stress in Press on metal and Press on Y-TZP copings.

OBJECTIVE: The aim of the study was to assess the failure loads and compressive stresses among bilayered press on Y-TZP (POZ) and press on metal (POM) crowns with different core-veneer thickness. METHODS: Thirty metal and Y-TZP copings were fabricated using CAD-CAM technology with specified thickness. All copings were veneered with ceramic materials using hot pressing technique, with 2mm and 2.5mm thickness. The different coping veneer thickness of crowns resulted in six study groups, including, POM: Coping/ veneer thickness of 0.7/2mm (Gp1), 0.7/2.5mm (Gp 2) and 1mm/2mm (Gp 3)-POZ: 0.7/2mm (Gp A), 0.7/2.5mm (Gp B) and 1mm/2mm (Gp C). Crowns were cemented to a standard implant analog and failure loads (FL) and compressive stress (CS) was ascertained by controlled load application in a universal testing machine. Data was analysed using ANOVA and multiple comparisons test. RESULTS: The maximum FL were observed in the POM specimens with a C/V ratio of 1/2 (Group 3-1880.67± 256.78 N), however the lowest FL were exhibited by POZ crowns with 1/2 C/V ratio (Group C-611.89± 72.79 N). Mean FL and CS were significantly higher in POM compared to POZ crowns in respective groups. Increasing the coping-veneer thickness increased FL and CS among POM crowns. Increasing veneer and decreasing coping thickness improved FL and CS among POZ crowns. CONCLUSIONS: Press on metal specimen showed higher resistance to fracture than Press on Y-TZP specimens. Improved failure loads were observed in thin coping and thick veneers among Press on Y-TZP crowns.