The effects of diode and Er:YAG laser applications on the surface topography of titanium grade 4 and titanium zirconium discs with sand-blasted and acid-etched (SLA) surfaces.

BACKGROUND: Laser application for the treatment of peri­implantitis provides a variety of advantages; however, depending on the laser type and parameters, it may also have adverse effects on the implant surface qualities. This study's objective is to assess the effects of laser type and parameters on the surface properties of two different titanium-based implant materials: titanium Grade 4 (Ti-Grade 4) and titanium zirconium (Ti-Zr) discs with sand-blasted and acid-etched (SLA) surfaces under in vitro conditions. MATERIAL & METHOD: Sand-blasted and acid-etched discs made of titanium grade 4 (Ti-Grade 4) and titanium zirconium (Ti-Zr) were treated using 808 nm AlGaAs (diode) and 2940 nm Er:YAG lasers with varying parameters (i.e., diode laser in continuous wave mode, Er:YAG in short pulse mode, and Er:YAG in variable square pulse mode with four different doses). Then, the surface morphology and topography of the treated discs were characterized using scanning electron microscopy and optical profilometry. RESULTS: The 3D surface topographies of discs treated with a high power Er:YAG laser displayed irregular peaks and deep valleys, indicating surface deterioration. The average surface roughness values (Sa) of both discs varied with laser type and parameters (3.55-4.80 µm for Ti-Grade 4 versus 3.25-4.5 µm for Ti-Zr). With diode laser applications, the topography features of the discs were preserved despite a small number of irregular valleys and peaks. However, the surface morphologies of the discs were dramatically altered by erosion and local melting because of the Er:YAG laser treatment. CONCLUSION: Diode laser application appears to be the most reliable method for treating peri­implantitis, as diode laser-treated implants retained their overall surface quality despite a small number of irregular peaks and valleys.

The effect of triangular cross-section neck design on crestal bone stability in the anterior mandible: A retrospective study with a 5-year follow-up.

OBJECTIVES: The objective of this study, which included a 5-year follow-up, was to compare peri-implant soft tissue health, crestal bone loss (CBL), and buccal bone thickness (BBT) around triangular cross-section neck (TN) or round neck (RN) implants, using cone-beam computed tomography. MATERIALS AND METHODS: This study was initially designed as a prospective 1-year randomized controlled study and then extended with a 5-year retrospective evaluation of clinical and radiographic records. In the initial 1-year study, a total of 20edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN or TN groups using a split-mouth design. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were recorded at postoperative month 12. CBL and BBT at three levels (0, -2, and -4 mm) were evaluated 1 year after insertion. Five years after insertion, PPD, PI, GI, CBL, and BBT were recorded as patients were recalled for clinical and radiographic monitoring. RESULTS: Nineteen patients completed the study. After 5 years, no significant differences in PPD, PI, and GI scores and BBT values between the two groups (p > .05). The mean ± SD CBL values at the final follow-up visit were -0.71 ± 0.69 mm for TN and -1.03 ± 0.86 mm for RN (p < .01). CONCLUSIONS: These results suggest better crestal bone preservation using implants with TN when compared to RN after a 5-year follow-up. However, TN showed similar results to RN regarding peri-implant soft tissue health and BBT.

Effect of Residual Bone Height and Implant Macro-Design on Primary Stability in Sinus Floor Elevation: An Ex Vivo Study.

The objective was to evaluate the influence of residual bone height (RBH) and implant macro-design on the primary stability (PS) of implants using a simultaneous sinus floor elevation (SFE) and implant insertion model. Fresh bovine rib samples that resembled type-IV density that were confirmed by computerized tomography were prepared to represent 4 groups of varying RBHs (3, 6, 9, 15 mm). To simulate simultaneous implant insertion with SFE, 120 implants in different macro-designs (group R: NobelReplace; group P: NobelParallel; group A: NobelActive, Nobel Biocare, Gothenburg, Sweden) were randomly inserted at RBHs of 3, 6, 9, and 15 mm in each rib. The implant stability quotient (ISQ) was measured immediately after implant insertion. RBH and implant macro-design have an impact on ISQ values (P < .001). ISQ values were the highest with RBH of 15 mm, followed by RBHs of 9, 6, and 3 mm. (P < .001). There was no statistically significant difference between different implant macro-designs at RBHs of 3 and 15 mm regarding ISQ values (P = .111, P = .551). ISQ values of group P were higher than those of group R and group A at an RBH of 6 mm (P = .049, P = .029). ISQ values were also higher in group P compared to group A at an RBH of 9 mm (P = .006). A higher PS may be expected in sites with higher RBH, regardless of the macro-design. In addition, cylindric implant design may enhance the PS at RBHs of 6 and 9 mm in simultaneous implant insertion with SFE.

Efficacy of type-1 collagen cones in extraction sockets following surgical removal of semi-impacted mandibular third molars: a randomized controlled trial.

OBJECTIVES: Third molar extractions may affect the periodontal health of the adjacent second molars as well as the patient's comfort. The objective of this study was to evaluate the efficacy of type-1 collagen cone (CC) on periodontal health and postoperative sequelae following extraction of third molars with secondary healing. METHOD AND MATERIALS: This was a randomized, controlled, split-mouth clinical trial. Sixty mandibular third molars (30 patients) were subdivided according to side. A collagen cone was randomly inserted into one side and the other side was the control. Pain was evaluated using a visual analog scale. Trismus and facial swelling were determined on postoperative days 2, 7, and 30. The alveolar osteitis (AO) incidence was recorded on days 2 and 7. The Plaque Index, Gingival Index, clinical attachment level, and pocket probing depth of the second molars were evaluated at postoperative months 1, 3, and 6. RESULTS: No significant differences were found between groups regarding postoperative pain, trismus, facial swelling, or the incidence of AO. However, AO developed in 10% of control side cases, while no sign of AO was observed on the experimental side. Plaque Index, Gingival Index, and clinical attachment level were comparable in both groups. Pocket probing depths for the distobuccal surface of the second molar was significantly higher on the control side at 6 months (P = .017). CONCLUSION: Insertion of a type-1 collagen cone into an extraction socket did not show a significant clinical improvement in extraction socket healing and postoperative sequelae after the third molar extraction.

The effect of triangular cross-section neck design on crestal bone stability in the anterior mandible: A randomized, controlled, split-mouth clinical trial.

OBJECTIVES: This randomized controlled trial aimed to compare crestal bone loss (CBL) and buccal bone thickness (BBT) around triangular cross-section neck (TN) to round neck (RN) implants retaining mandibular overdentures one year after loading, using cone beam computed tomography (CBCT). MATERIAL AND METHODS: Twenty edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN and TN groups. Clinical buccal bone thickness (CBBT) around the implants was measured with a caliper at baseline. A resonance frequency analyzer was used to measure the implant stability quotient (ISQ) at the baseline and two months after insertion. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were also recorded at postoperative months 2, 6, and 12. CBCT was used to evaluate proximal CBL and BBT at three levels (0, -2, and -4 mm) one year after loading. RESULTS: No implant loss was observed during the follow-up period. No significant differences in CBBT, ISQ values, and scores for PPD, PI, and GI between the two groups were observed at any time (p > .05). BBT was also comparable one year after loading (p > .05). The mean ± SD proximal CBL one year after loading was 0.58 ± 0.36 mm for TN and 0.91 ± 0.59 mm for RN (p < .01). CONCLUSIONS: This study found better crestal bone preservation in the implants with the novel neck design than conventional neck design in the anterior mandible after a follow-up of one year. However, it may not be clinically noticeable.

Molecular signatures of chronic periodontitis in gingiva: A genomic and proteomic analysis.

BACKGROUND: To elucidate molecular signatures of chronic periodontitis (CP) using gingival tissue samples through omics-based whole-genome transcriptomic and whole protein profiling. METHODS: Gingival tissues from 18 CP and 25 controls were analyzed using gene expression microarrays to identify gene expression patterns and the proteins isolated from these samples were subjected to comparative proteomic analysis by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The data from transcriptomics and proteomics were integrated to reveal common shared genes and proteins. RESULTS: The most upregulated genes in CP compared with controls were found as MZB1, BMS1P20, IGLL1/IGLL5, TNFRSF17, ALDH1A1, KIAA0125, MMP7, PRL, MGC16025, ADAM11, and the most upregulated proteins in CP compared with controls were BPI, ITGAM, CAP37, PCM1, MMP-9, MZB1, UGTT1, PLG, RAB1B, HSP90B1. Functions of the identified genes were involved cell death/survival, DNA replication, recombination/repair, gene expression, organismal development, cell-to-cell signaling/interaction, cellular development, cellular growth/proliferation, cellular assembly/organization, cellular function/maintenance, cellular movement, B-cell development, and identified proteins were involved in protein folding, response to stress, single-organism catabolic process, regulation of peptidase activity, and negative regulation of cell death. The integration and validation analysis of the transcriptomics and proteomics data revealed two common shared genes and proteins, MZB1 and ECH1. CONCLUSION: Integrative data from transcriptomics and proteomics revealed MZB1 as a potent candidate for chronic periodontitis.

Dentofacial traumatic injuries: A survey of knowledge and attitudes among emergency medicine physicians in Turkey.

BACKGROUND/AIM: Emergency department (ED) visits for dental issues are mostly related to traumatic injuries. The knowledge of ED physicians about the diagnosis and treatment of dentofacial injuries is crucial for prognosis. The aim of this study was to evaluate the attitude and knowledge as well as education and self-confidence levels of emergency medicine physicians in ED regarding the diagnosis and treatment of dentofacial traumatic injuries. MATERIAL AND METHODS: A total of 109 emergency medicine physicians participated in the study. Participants were residents and specialists who attended a national emergency medicine symposium held in Turkey. A questionnaire was distributed during the symposium relating to general data about physicians, their attitudes, basic knowledge, and confidence levels which were believed to be indicative of their capabilities in managing of traumatic dental and maxillofacial injuries. RESULTS: The questionnaire was answered by 109 physicians who were general practitioners (11%), emergency medicine residents (56.8%), and emergency medicine specialists (32.2%). The most experienced group of physicians were emergency medicine specialists. Regardless of the physicians' titles, dentofacial trauma knowledge levels of ED physicians were found to be insufficient. Having a dentist in the family (P < 0.01), the duration of emergency service experience (P = 0.04), and the age of the physicians (P < 0.001) were significantly related to the knowledge level. CONCLUSIONS: The majority of ED physicians had low knowledge regarding the diagnosis and treatment of dentofacial traumatic injuries. There is a need for education during and after medical training for ED physicians to provide appropriate primary management of dentofacial trauma.

Evaluation of biopsies of oral and maxillofacial lesions: a retrospective study.

OBJECTIVES: This study aimed to determine the prevalence of odontogenic cysts, tumors, and other lesions among reports in the archives of the Department of Oral and Maxillofacial Surgery at the Faculty of Dentistry affiliated with Kocaeli University collected over a four-year period. MATERIALS AND METHODS: In this retrospective study, patient records from the archive of the Department of Oral and Maxillofacial Surgery from 2014 to 2018 were reviewed. Patient demographic information (age and sex) and lesion location were recorded and analyzed. RESULTS: From a total of 475 files reviewed, odontogenic cyst was confirmed in 340 cases (71.6%), and odontogenic tumor was confirmed in 52 cases (10.9%). Regarding odontogenic cyst type, the most common was radicular cyst (216 cases), followed by dentigerous cyst (77 cases) and odontogenic keratocyst (23 cases). Among odontogenic tumors, the most frequent was odontoma (19 cases), followed by ossifying fibroma (18 cases) and ameloblastoma (9 cases). Giant cell granuloma was also reported in 35 cases. CONCLUSION: The distribution pattern of odontogenic cysts and tumors in our retrospective study is relatively similar to that reported in the literature. Complete clinical reports for final diagnosis of these lesions and routine follow-up examinations are very important for treatment.

Gene-Expression Profiles in Generalized Aggressive Periodontitis: A Gene Network-Based Microarray Analysis.

BACKGROUND: In this study, molecular biomarkers that play a role in the development of generalized aggressive periodontitis (GAgP) are investigated using gingival tissue samples through omics-based whole-genome transcriptomics while using healthy individuals as background controls. METHODS: Gingival tissue biopsies from 23 patients with GAgP and 25 healthy individuals were analyzed using gene-expression microarrays with network and pathway analyses to identify gene-expression patterns. To substantiate the results of the microarray studies, real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to assess the messenger RNA (mRNA) expression of MZB1 and DSC1. The microarrays and qRT-PCR resulted in similar gene-expression changes, confirming the reliability of the microarray results at the mRNA level. RESULTS: As a result of the gene-expression microarray studies, four significant gene networks were identified. The most upregulated genes were found as MZB1, TNFRSF17, PNOC, FCRL5, LAX1, BMS1P20, IGLL5, MMP7, SPAG4, and MEI1; the most downregulated genes were found as LOR, LAMB4, AADACL2, MAPT, ARG1, NPR3, AADAC, DSC1, LRRC4, and CHP2. CONCLUSIONS: Functions of the identified genes that were involved in gene networks were cellular development, cell growth and proliferation, cellular movement, cell-cell signaling and interaction, humoral immune response, protein synthesis, cell death and survival, cell population and organization, organismal injury and abnormalities, molecular transport, and small-molecule biochemistry. The data suggest new networks that have important functions as humoral immune response and organismal injury/abnormalities. Future analyses may facilitate proteomic profiling analyses to identify gene-expression patterns related to clinical outcome.

Evaluation of prebent miniplates in fixation of Le Fort I advancement osteotomy with the finite element method.

The stability of segments after Le Fort I osteotomy first attracted the researcher's interest when the surgical concept was conceived. Prebent plates are the ultimate modification of plate systems in craniofacial surgery; they have two right angles and are available in different lengths for use in maxillary advancement surgery. For this research, cone-beam computed tomography (CBCT) images of a male patient were obtained and scanned, and a 3D maxillary bone was created. Conventional Le Fort I osteotomies with 5 and 10 mm advancements were performed on both the cortical and trabecular bone using the Surgical Simulation Module of Mimics software; 1.7 mm Leibinger standard orthognathic 5-hole L plates and 1.7 mm Leibinger orthognathic advancement 11-hole prebent plates were adapted to the fragments. Displacement of the segment, the von Mises (VM) stresses (on the titanium miniplates) and the maximum principal (MP) stresses (on the bone) were evaluated for each configuration. Prebent plates offer a good alternative to the conventional two plate system, except in operations where maxillary advancement exceeds 5 mm. Surgical procedures that include advancement exceeding 5 mm or vertical position changes remain controversial and further studies are needed.

Histomorphometric and microtomographic evaluation of the effects of hyperbaric oxygen and systemic ozone, used alone and in combination, on calvarial defect healing in rats.

PURPOSE: The aim of this study was to compare the efficacy of hyperbaric oxygen and systemic ozone, used separately and in combination, on the healing of bone defects. MATERIAL AND METHODS: Sixty male Wistar rats were divided into 4 groups (n = 15) according to treatment (control, hyperbaric oxygen [HBO], ozone [O], and HBO plus O [HBO-O]) and divided further into 3 subgroups according to day of sacrifice (postsurgical days 5, 15, and 30). Surgery was performed under general anesthesia to create a critical-size bone defect (5 mm in diameter) in the cranium. After sacrifice, microtomographic images of all samples were recorded, and histomorphometric analysis was performed. RESULTS: Histologic and radiologic measurements showed that the values of all experimental groups were higher than those of the control group. Histologic scores for all experimental groups were statistically higher than those for the control group day 30 (O, P = .045; HBO, P = .049; HBO-O, P = .042). Histologic scores also were statistically higher for the HBO group on day 5 (P = .045) and day 15 (P = .009) compared with the control group. Microtomographic scores were higher for the experimental groups than for the control group, with statistically significant differences for group O on day 5 (P = .033) and day 30 (P = .0045) and for group HBO on day 15 (P = .005). Histologic and radiologic analyses showed positive correlations. CONCLUSION: Within the limitations of this study, the use of hyperbaric oxygen and ozone, separately and in combination, were shown to be effective in increasing bone healing. Combined usage was no more effective in stimulating bone healing than separate usage.

Low-level laser therapy supported surgical treatment of bisphosphonate related osteonecrosis of jaws: a retrospective analysis of 11 cases.

OBJECTIVE: The aim of this study is to evaluate and report on low-level laser therapy (LLLT) supported medical-surgical treatment outcomes of 11 patients with bisphosphonate related osteonecrosis of the jaws (BRONJ) lesions. BACKGROUND DATA: BRONJ is a severe clinical condition, which adversely affects patients' lives. Even though various treatment modalities have been proposed, the ideal approach still remains to be debated. LLLT stands out among supportive approaches because of its favorable effects on tissue healing. MATERIALS AND METHODS: Eleven patients diagnosed with Stage II or III lesions (American Association of Oral and Maxillofacial Surgeons [AAOMS] classification) were included in the study. All patients received LLLT applications during the postoperative period in addition to medical and surgical treatment. Laser applications covering the entirety of the surgical site were performed with GaAlAs diode laser with the following parameters: 808 nm wavelength, 0.5 W power, continuous wave, noncontact mode at 0.5-1 cm distance from the oral mucosa, spot size 0.28 cm(2) (R=6 mm), for 3 sec per point (10 sec per cm(2)), and energy density of 5 J/cm(2) (energy per point,1.4 J). RESULTS: Elimination of previously recorded symptoms and a stable mucosal closure was achieved in all patients. Primary healing was achieved in seven patients and secondary healing course was observed in four patients. Permanence of obtained positive outcomes was noted in follow-up periods. CONCLUSIONS: Treatment of advanced BRONJ lesions with a combination of antibiotic therapy, surgical removal of the lesion, and consecutive low-level diode laser applications provided favorable results in all patients. In consideration of our findings, it can be assumed that LLLT may serve as a safe and effective adjunct to medical-surgical treatment of BRONJ lesions.

Histomorphometrical and radiological comparison of low-level laser therapy effects on distraction osteogenesis: experimental study.

Distraction osteogenesis (DO) is the application of traction to the callus formed between bone segments and stimulation of bone formation by creating stress on the callus with this traction. Shorten the duration of DO and increasing the capacity of bone formation is important to prevent the possible complications of DO. For this reason, it was considered that low-level laser therapy (LLLT) may affect positively DO and it can decrease the complication range by shortening the period. Unilateral mandibular distractors were applied on 16 female white New Zealand rabbit to prove this hypothesis with micro CT, plain radiograph and histomorphometric analyses. Eight rabbits were applied LLLT with GaAlAs laser on the distraction area during the distraction period. On the post-distraction 28th day, four rabbits from study group and four rabbits from control groups were sacrificed. The rest of the rabbits were sacrificed on post-distraction 56th day. As a result of this study, significant positive effects of LLLT on post-distraction 28th day were revealed with all analyses. In histomorphometrical analyses, new bone formation was significantly higher in short-term laser applied group comparing to that of short-term control group (p = 0.029). In both microCT and plain radiograph, the highest radioopacity values were observed in short-term laser group when compared with that of the controls (p = 0.043 and p = 0.025, respectively). Even though LLLT increased the healing capacity on short-term, it was not sufficient on long-term (post-distraction 56th day) healing. LLLT application on distraction period, activate healing on bone so it may decrease DO period. The result of this study should be supported with clinical studies and the most effective laser source, dose and application time should be revealed with experimental and clinical studies.

Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study.

OBJECTIVE: To describe the dentoskeletal and soft tissue effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions (Alt-RAMEC) in maxillary retrusion patients. MATERIALS AND METHODS: The sample consisted of 15 patients with a mean skeletal age of 11.6 ± 1.59 years undergoing 8 weeks of Alt-RAMEC followed by maxillary protraction. Three hundred fifty to 400 g of force per side was applied to the facemask from the titanium miniplates inserted on the lateral nasal wall of the maxilla. Total treatment time was 9.9 ± 2.63 months. Treatment changes were evaluated cephalometrically and analyzed by means of the dependent t-test and the Wilcoxon signed rank test. RESULTS: The miniplates withstood the orthopedic forces exerted during the treatment. Cephalometric findings showed that the maxilla moved forward by 2 mm, with an 0.8° counterclockwise rotation and without maxillary incisor movement. The mandible moved slightly in a downward and backward direction (1.2°). The inclinations of the mandibular incisors decreased significantly (2°). Statistically significant increases were observed in the vertical dimension (1°-1.3°). Soft tissue changes were more marked in the upper lip and soft tissue pogonion than in the lower lip. CONCLUSIONS: This treatment approach can offer an advantage for correcting mild/moderate maxillary retrusion in Class III patients.

Low-level laser therapy supported teeth extractions of two patients receiving IV zolendronate.

BRONJ (bisphosphonate-related osteonecrosis of jaws) is a frequently encountered disease, particularly in the maxillofacial region, and a consequence of bisphosphonate use. Treatment of BRONJ remains controversial, as efficiency of medical and surgical approaches as well as a combination of these methods with supportive treatments have not been clearly demonstrated in the literature. In recent years, laser usage alone or in combination with the main therapy methods, has become popular for the treatment of bisphosphonate-related osteo-necrosis of jaws. In this article, we present the successful management of two dental patients who had high potentials for BRONJ development as a result of chemo and radiotherapy combined with IV zoledronic acid application. Multiple consecutive teeth extractions followed with primary wound closure and LLLT applications were performed under high doses of antibiotics prophylaxis. Satisfactory wound healing in both the surrounding soft and hard tissues was achieved. LLLT application combined with atraumatic surgical interventions under antibiotics prophylaxis is a preferable approach in patients with a risk of BRONJ development. Adjunctive effect of LLLT in addition to careful infection control on preventing BRONJ was reported and concluded.