Comparison of the Effect of Implant Abutment Surface Modifications on the Retention of Implant-Supported Restorations.

PURPOSE: To evaluate and compare the difference in retention between implant-supported restorations with and without surface modification of the implant abutments. MATERIALS AND METHODS: A total of 30 patients with singletooth implants were restored with cement-retained (Multilink N, Ivoclar) restorations using titanium base abutments (Variobase, Straumann) and randomly assigned surface modifications. Group 1 used nonmodified abutments, group 2 used sandblasted abutments, and group 3 used sandblasted abutments followed by an application of metal primer. All patients were recalled for a baseline examination 6 months after crown placement. The pull-out strength and intergroup distribution of mean pull-out strength were assessed. To assess differences between the three groups, intergroup statistical comparison of continuous variables was done using one-way ANOVA with Tukey correction for multiple group comparisons. RESULTS: The results of the intergroup mean pull-out strength distribution revealed that the distribution of mean ± SD pull-out strength in group 1, group 2, and group 3 were 220.79 ± 94.23, 488.64 ± 84.12, and 705.46 ± 112.75 Ncm, respectively. CONCLUSIONS: Sandblasting followed by the application of metal primer produced the highest retention of porcelain-fused-to-metal (PFM) crowns to titanium base abutments, followed by sandblasting alone, with the least retention being observed with no surface treatment.

Feasibility of Immediate Implant Placement in Maxillary First Premolars: Prediction of Implant Locations Using Restorations- A Radiographic Study.

BACKGROUND: Maxillary premolars have a unique anatomical location. This is an CBCT based study where the suitability of maxillary premolars for immediate implant placement (IIP) is evaluated. Based on prosthetically driven treatment treatment planning a simple classification system is put forth. MATERIALS AND METHODS: 150 CBCTs of maxillary first premolars were analysed in BlueskyBio software. The topographic position of the tooth was determined by analysing the dimensions of the buccal and lingual cortical plates, the distance between the bucco-lingual plates and the residual bone height from the root apex to the floor of the sinus. Virtual placement of an implant was carried out such that the implant would be positioned 1 mm apical to the buccal bone crest, would engage 3 mm of bone apical to the root apex, and would have a trajectory so that the abutment access was from the central fossa. Four categories were identified and the classification was proposed. RESULTS: It was observed that 74% of cases had buccal bone<1mm,26% had buccal bone >1mm. 79% cases had an average distance >3mm between root apex and maxillary sinus, 21% had an average distance of root apex and maxillary sinus <3mm. The categorizations of implant placement were as follows -Type 1- 24%, Type 2- 56.6%, Type 3-43.3%, Type 4- 0%. CONCLUSIONS: In majority of maxillary 1st premolars an IIP is possible with the implants to be placed in the palatal sockets or the furcation area. In cases were the buccal plate thickness is inadequate, simultaneous grafting should be considered between the implant position and buccal plate.

Angiogenic Potential of Various Oral Cavity-Derived Mesenchymal Stem Cells and Cell-Derived Secretome: A Systematic Review and Meta-Analysis.

Recent evidence suggests the immense potential of human mesenchymal stem cell (hMSC) secretome conditioned medium-mediated augmentation of angiogenesis. However, angiogenesis potential varies from source and origin. The hMSCs derived from the oral cavity share an exceptional quality due to their origin from a hypoxic environment. Our systematic review aimed to compare the mesenchymal stem cells (MSCs) derived from various oral cavity sources and cell-derived secretomes, and evaluate their angiogenic potential. A literature search was conducted using PubMed and Scopus from January 2000 to September 2020. Source-wise outcomes were systematically analyzed using in vitro, in vivo, and in ovo studies, emphasizing endothelial cell migration, tube formation, and blood vessel formation. Ninety-four studies were included in the systematic review, out of which 4 studies were subsequently included in the meta-analysis. Prominent growth factors and other bioactive components implicated in improving angiogenesis were included in the respective studies. The findings suggest that oral tissues are a rich source of hMSCs. The meta-analysis revealed a positive correlation between dental pulp-derived MSCs (DPMSCs) and stem cells derived from apical papilla (SCAP) compared to human umbilical cord-derived endothelial cell lines as a control. It shows a statistically significant positive correlation between the co-culture of human umbilical vein endothelial cells (HUVECs) and DPMSCs with tubule length formation and total branching points. Our meta-analysis revealed that oral-derived MSCs (dental pulp stem cells and SCAP) carry a better angiogenic potential in vitro than endothelial cell lines alone. The reviewed literature illustrates that oral cavity-derived MSCs (OC-MSCs) increased angiogenesis. The present literature reveals a dearth of investigations involving sources other than dental pulp. Even though OC-MSCs have revealed more significant potential than other MSCs, more comprehensive, target-oriented interinstitutional prospective studies are warranted to determine whether oral cavity-derived stem cells are the most excellent sources of significant angiogenic potential.

The 'One Customized Abutment One Time' concept - An innovative technique for optimizing immediacy and digital protocols.

Disconnection and reconnection of abutments multiple times have known to affect the mucosal barrier around implants leading to marginal bone loss. This clinical report describes a novel technique that amalgamates the benefits of digital technologies encompassing the fabrication of surgical guides for implant placement, customized hybrid zirconia abutments and all ceramic lithium disilicate crowns prior to implant placement. A correct 3-dimensional implant positioning along with immediate placement of the definitive hybrid customized abutment and a lithium disilicate crown has the potential to reduce treatment time, visits and costs while delivering optimal esthetic outcomes.

Comparative Evaluation of Marginal Bone Levels, ISQ Trends, and Implant Survival Rates Between Conventional Drilling and Osteotome Technique Using Implants of Varied Lengths: A Split-Mouth Randomized Controlled Clinical Trial.

PURPOSE: To assess marginal bone loss (MBL) and implant stability when implant site preparation is performed with conventional drilling and the osteotome technique in the posterior maxilla. MATERIALS AND METHODS: In total, 30 patients (mean age: 46.97 + 7.48 years) receiving 60 implants were enrolled in this study. In each patient, implant site preparation was done using either conventional drilling (conventional group; n = 30) or the osteotome technique (osteotome group; n = 30). The implant sites were further divided into groups based on the implant length used (implant length < 10 mm, implant length ≥ 10 mm). Marginal bone levels and implant stability quotient (ISQ) values were evaluated at the time of crown insertion and 1 year later. Independent t test and paired t test were used for intergroup and intragroup comparison, respectively. RESULTS: The osteotome group showed statistically significant higher initial ISQ (ISQi) and final ISQ (ISQf) values (ISQi: 61 ± 3.6; ISQf: 64.08 ± 3.7) compared to the conventional group (ISQi: 58.01 ± 4.6; ISQf: 61.32 ± 4.8). Statistically significant higher mean MBL was noted in the conventional group (-0.33 ± 0.12 mm) compared to the osteotome group (-0.26 ± 0.10 mm). Higher MBL was noted in the osteotome group (-0.32 ± 0.09 mm) compared to the conventional group (-0.30 ± 0.14 mm) for implants shorter than 10 mm. For implants ≥ 10 mm in length, significantly higher MBL was noted in the conventional group (-0.37 ± 0.09 mm) compared to the osteotome group (-0.19 ± .06 mm). CONCLUSIONS: Osteotome technique could be used as an alternative to conventional drilling, especially when implants longer than 10 mm are planned in the posterior maxilla.

Evaluation of shear bond strength and translucency of zirconia-reinforced lithium silicate and lithium disilicate: An in vitro study.

Aim: To analyze the effect of various surface treatment protocols on shear bond strength between the ceramic and resin cement (RC) and influence of zirconia on the translucency of LD as compared to zirconia-reinforced lithium silicate (ZLS). Setting and Design: In-Vitro Study. Materials and Methods: Specimens (14 mm × 12 mm × 2 mm) (n = 135) and (14 mm × 12 mm × 1 mm) (n = 45) of ZLS computer-aided design/computer-aided manufacturing glass ceramic block and LD were fabricated, respectively. All the ZLS specimens were crystallized and were tested for the translucency parameter and ceramic-resin shear bond strength. Two different types of surface treatment were used on the ZLS and LD samples. The specimens were treated using the hydrofluoric acid (HF) etching or air abrasion with diamond particles (DPs). The specimens were then bonded using self-adhesive RC to a composite disc of 10 mm and thermocycling was performed. A universal testing machine was used to evaluate ceramic-resin shear bond strength after 24 h. The translucency of the specimens was evaluated using the spectrophotometer by calculating the difference in color between the readings over a black background and a white background. Statistical Analysis Used: Data were statistically analyzed using the independent sample t-test and analysis of variance with Bonferroni's correction and comparison was made between the specimens. Results: Independent sample t-test demonstrated statistically significantly higher translucency for group ZLS (61.44 ± 22) as compared to group LD (20.16 ± 8.39) (P < 0.001). Group ZLS showed statistically significant higher shear bond strength when surface treatment using HF or air abrasion with synthetic DPs was performed as compared to untreated group (3.58 ± 0.45) (P < 0.001). Moreover, air abrasion group (16.79 ± 2.11 megapascal [MPa]) demonstrated statistically significant higher shear bond strength as compared to HF etched group (8.25 ± 0.30 MPa) (P < 0.001). Furthermore, statistically significant higher shear bond strength was noted when air abrasion was done for group ZLS (16.79 ± 2.11 MPa) as compared to group LD (10.82 ± 1.92 MPa) (P < 0.001). However, on surface treatment with HF, a statistically significantly lower shear bond strength was noted for group ZLS (8.25 ± 0.30 MPa) as compared to group LD (11.29 ± 0.58 MPa) (P = 0.001). Conclusion: ZLS demonstrated higher translucency compared to LD restorations. DP abrasion of ZLS is recommended to achieve higher shear bond strength between the ceramic and RC.

In-Vitro Evaluation of Photofunctionalized Implant Surfaces in a High-Glucose Microenvironment Simulating Diabetics.

The present study aimed to assess the efficacy of photofunctionalization on commercially available dental implant surfaces in a high-glucose environment. Discs of three commercially available implant surfaces were selected with various nano- and microstructural alterations (Group 1-laser-etched implant surface, Group 2-titanium-zirconium alloy surface, Group 3-air-abraded, large grit, acid-etched surface). They were subjected to photo-functionalization through UV irradiation for 60 and 90 min. X-ray photoelectron spectroscopy (XPS) was used to analyze the implant surface chemical composition before and after photo-functionalization. The growth and bioactivity of MG63 osteoblasts in the presence of photofunctionalized discs was assessed in cell culture medium containing elevated glucose concentration. The normal osteoblast morphology and spreading behavior were assessed under fluorescence and phase-contrast microscope. MTT (3-(4,5 Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and alizarin red assay were performed to assess the osteoblastic cell viability and mineralization efficiency. Following photofunctionalization, all three implant groups exhibited a reduced carbon content, conversion of Ti4+ to Ti3+, increased osteoblastic adhesion, viability, and increased mineralization. The best osteoblastic adhesion in the medium with increased glucose was seen in Group 3. Photofunctionalization altered the implant surface chemistry by reducing the surface carbon content, probably rendering the surfaces more hydrophilic and conducive for osteoblastic adherence and subsequent mineralization in high-glucose environment.

Evaluation of Oral Health-Related Quality of Life and Patient Satisfaction in Three-Implant-Retained Mandibular Overdentures: A Randomized Crossover Clinical Trial.

PURPOSE: To assess oral health-related quality of life (OHRQoL) and patient satisfaction with a three-implant-retained mandibular overdenture. MATERIALS AND METHODS: In this randomized crossover clinical trial, 20 edentulous patients received a new set of conventional complete dentures (CDs; baseline). Subsequently, three implants were placed in the anterior mandible: two were placed in the canine regions bilaterally and one in the midline. After successful osseointegration, CDs were attached to the implants using resilient attachments. The overdenture was retained either by three implants (test group) or two implants (control group). The sequence of treatment was randomized such that each patient experienced both treatment options for 6 months each. OHRQoL was assessed at baseline and after 6 months of function for each treatment option using the Oral Health Impact Profile (OHIP-14) and visual analog scale (VAS) scores. Statistical analyses were performed using Friedman and Wilcoxon signed rank tests. RESULTS: CD resulted in significantly higher OHIP-14 and VAS scores (25.25 + 6.42, 8.55 + 1.73) compared to both the control group (11.15 + 5.39, 4 + 2; P < .001) and the test group (6.25 + 4.02, 2.06 + 1.48; P < .001). Similarly, significantly higher mean OHIP-14 and VAS scores were noted for the control group compared to the test group (P < .001). CONCLUSIONS: Overdentures retained by three implants resulted in better OHRQoL scores and higher patient satisfaction compared to overdentures retained by two implants and CDs. Int J Prosthodont 2023;36:554-56.

Do digital impressions have a greater accuracy for full-arch implant-supported reconstructions compared to conventional impressions? An in vitro study.

Aim: The purpose of this study was to compare the accuracy of conventional implant impressions with digital impression techniques made using two different intraoral scanners. Setting and Design: In-Vitro study. Material and Methods: A scan of master cast containing four implants was made using two intraoral scanners: CEREC Primescan (Dentsply Sirona, USA) and 3Shape Trios (Copenhagen, Denmark) with PEEK scan bodies attached to the implants. Model was scanned ten times using different scanners. The accuracy of the chairside scanners was compared with highly accurate laboratory scanner. The scans were transferred into the software (Geomagic Control X 20, 3D Systems, Rock Hill, SC, USA) for analysis. The linear deviations and the angular deviations between the scans (scan of each model made using high-definition scanner and the master model scan) were calculated to determine the accuracy. Trueness was used as a parameter to compare the accuracy of different scanners (comparing test and reference). Statistical Analysis: Analysis of variance was performed with Bonferroni's post hoc test for multiple group comparisons. Results: Distribution of the mean overall absolute linear deviation was significantly lower in the conventional impression group compared to the CEREC Primescan scanner group and 3Shape Trios group (P < 0.05 for both). Distribution of the mean overall absolute linear deviation was significantly lower in the CEREC Primescan scanner group compared to the 3Shape Trios group (P < 0.05). Distribution of the mean overall absolute angular deviation did not differ between the three groups (P > 0.05 for all). Conclusion: Conventional impressions showed significantly greater accuracy compared to the digital impressions made with both the above intraoral scanners for implant-supported restoration of an edentulous arch. In addition, the digital impressions with the CEREC Primescan scanner showed greater accuracy as compared to the 3Shape Trios scanner.

Assessment of angiogenic potential of mesenchymal stem cells derived conditioned medium from various oral sources.

Background: Abnormal angiogenesis hamper blood vessel proliferation implicated in various biological processes. The current method available to clinically treat patients to enhance angiogenesis is administering the angiogenic growth factors. However, due to a lack of spatiotemporal control over the substantial release of these factors, numerous drawbacks are faced such as leaky vasculature. Hence, stem-cell-based therapeutic applications are running their race to evolve as potential targets for deranged angiogenesis. In clinical dentistry, adequate tissue vascularization is essential for successful endodontic therapies such as apexogenesis and apexification. Furthermore, wound healing of the extraction socket and tissue regeneration post-surgical phase of treatment including implant placement require angiogenesis as a foundation for the ultimate success of treatment. Mesenchymal stem cells (MSCs) secrete certain growth factors and cytokines in the culture medium during the proliferation. These factors and cytokines are responsible for various biological activities inside human body. Oral cavity-derived stem cells can secrete growth factors that enhance angiogenesis. Aim: The aim of the study was to investigate the angiogenic potential of conditioned medium (CM) of MSCs derived from different oral sources. Methods: Oral tissues such as dental pulp of adult and deciduous teeth, gingiva, and buccal fat were used to isolate dental pulp MSCs (DPSCs), exfoliated deciduous teeth, gingival MSCs, and buccal fat derived MSCs. MSCs conditioned medium (CM) from passage four cells from all the sources were obtained at 48 h interval and growth factor analysis was performed using flow cytometry. To assess the functionality of the CM, Chick Yolk Sac Membrane (YSM) assay was performed. Results: CM obtained from DPSCs showed higher levels of vascular endothelial growth factor, fibroblast growth factor, and hepatocyte growth factor as evidenced by flow cytometry. Furthermore, DPSC-CM exhibited significantly higher pro-angiogenic potential when assessed in in-ovo YSM assay. Conclusion: DPSCs so far seems to be the best source as compare to the rest of oral sources in promoting angiogenesis. A novel source of CM derived from buccal fat stem cells was used to assess angiogenic potential. Thus, the present study shows that CM derived from oral cavity-derived-MSCs has a dynamic and influential role in angiogenesis. Relevance for Patients: CM derived from various oral sources of MSCs could be used along with existing therapies in medical practice where patients have compromised blood supply like in diabetes and in patients with debilitating disorders. In clinical dentistry, adequate tissue vascularization is essential for successful wound healing, grafting procedures, and endodontic therapies. DPSCs-CM shows better angiogenic potential in comparison with other oral sources of MSCs-CM. Our findings could be a turning point in the management of all surgical and regenerative procedures requiring increased angiogenesis.

A Comparative Study on Simulated Chairside Grinding and Polishing of Monolithic Zirconia.

This study evaluated the effects of different simulated chairside grinding and polishing protocols on the physical and mechanical properties of surface roughness, hardness, and flexural strength of monolithic zirconia. Sintered monolithic zirconia specimens (15 mm × 3 mm × 3 mm) were abraded using three different burs: diamond bur, modified diamond bur (zirconia specified), and tungsten carbide bur, along with a group of unprepared specimens that served as a control group. The study was divided into two phases, Phase 1 and Phase 2. Surface roughness, surface hardness, and flexural strength were assessed before and after the grinding procedure to determine the 'best test group' in Phase 1. The best abrasive agent was selected for Phase 2 of the study. The specimens in Phase 2 underwent grinding with the best abrasive agent selected. Following the grinding, the specimens were then polished using commercially available diamond polishing paste, a porcelain polishing kit, and an indigenously developed low-temperature sintered zirconia slurry. The physical and mechanical properties were again assessed. Results were analyzed using one-way ANOVA test. Specimens were observed under scanning electron microscopy (SEM) and X-ray diffraction (XRD) for their microstructure and crystalline phases, respectively. Grinding with diamond burs did not weaken zirconia (p > 0.05) but produced rougher surfaces than the control group (p < 0.05). Tungsten carbide burs did not significantly roughen the zirconia surface. However, specimens ground by tungsten carbide burs had a significantly reduced mean flexural strength (p < 0.05) and SEM revealed fine surface cracks. Phase transformation was not detected by XRD. Polishing with commercially available polishing agents, however, restored the surface roughness levels to the control group. Dental monolithic zirconia ground with tungsten carbide burs had a significantly reduced flexural strength and a smooth but defective surface. However, grinding with diamond burs roughened the zirconia surface. These defects may be reduced by polishing with commercially available polishing agents. The use of tungsten carbide burs for grinding dental zirconia should not be advocated. Grinding with diamond abrasives does not weaken zirconia but requires further polishing with commercially available polishing agents.

Comparative evaluation of implant stability quotient trends, crestal bone loss and survival of photofunctionalised and untreated dental implants: A split-mouth randomised controlled clinical trial.

PURPOSE: To evaluate the crestal bone loss and implant stability quotient trends of photofunctionalised versus untreated implants. MATERIALS AND METHODS: A total of 34 patients (age 46.94 ± 12.03 years) with bilateral single missing teeth in the same arch were enrolled in this study. Each patient received an untreated implant on one side (control group, n = 34) and a photofunctionalised implant on the contralateral side (test group, n = 34). Crestal bone loss was assessed at the time of crown insertion and 1 year later. The osseointegration speed index was evaluated for both the control and test group. An independent t test was used for intergroup comparisons of crestal bone loss and osseointegration speed index. Bivariate analysis was performed for the confounding variables. RESULTS: The test group showed a statistically significantly higher osseointegration speed index (3.07) as compared to the control group (1.29) (P < 0.01). Statistically significantly higher crestal bone loss was observed in the control group (-0.57 ± 0.41 mm) as compared to the test group (-0.27 ± 0.35 mm) (P < 0.01). The difference between mean Plaque Index and Bleeding Index in the control (0.74/0.38) and test group (0.73/0.35) was statistically insignificant (P > 0.05). A negative correlation (r = -0.272) was noted between implant diameter and crestal bone loss. A positive correlation (r = 0.402) was observed between implant length and osseointegration speed index. CONCLUSION: Implants with photofunctionalised surfaces reduce overall healing time and crestal bone loss. Photofunctionalisation is an effective aid for chairside conditioning of implant surfaces to achieve faster osseointegration with good crestal bone stability.

Comparing the sub-gingival levels of Cytomegalovirus, Epstein-Barr virus, Porphyromonas gingivalis in human immunodeficiency virus-1 seropositive patients with and without antiretroviral therapy.

OBJECTIVES: The effect of antiretroviral therapy (ART) on the oral pathogenic microbes in human immunodeficiency virus-1 seropositive patients remains relatively unexplored. Thus, the present study assessed the effect of ART on the sub-gingival levels of 3 pathogenic microbes. MATERIALS AND METHODS: The study groups consisted of 60 human immunodeficiency virus-1 seropositive patients divided into 3 groups of 20 each. Group 1 had periodontitis and did not start with the ART. Group 2 had periodontitis and started with ART (Tenofovir Disoproxil Fumarate 300 mg + Lamivudine 300 mg + Efavirenz 600 mg) at least 6 months before the study. Group 3 with normal periodontium, and have not started ART. The sub-gingival loads of Cytomegalovirus, Epstein-Barr virus, and the Porphyromonas gingivalis levels were assessed, along with the CD4 counts. RESULTS: The cytomegalovirus load was highest in group 1, followed by groups 2, and 3 (p-value of 0.271). The Epstein-Barr load was highest for group 2, followed by group 3, and 1 (p-value of 0.022). The P.gingivalis load was highest in group 2, followed by groups 1 and 3, (p-value of 0.028). The Epstein-Barr and Cytomegalovirus counts were significantly higher (p-value < 0.02) when the CD4 counts were less than 500 cells/cu3. CONCLUSION: ART did not cause any significant reduction in the sub-gingival levels of any of the 3 examined microbes. Given the lack of any significant effect on the sub-gingival microbial loads by the ART, human immunodeficiency virus patients may require additional anti-microbial agents and regular mechanical plaque removal to maintain their periodontal status.

Comparison of salivary total protein and electrolyte profile in HIV patients with and without antiretroviral therapy.

BACKGROUND: Saliva provides a primary defense mechanism against several infectious diseases through its numerous immunological and non-immunological factors. Alteration in the composition of saliva often compromises its defense mechanisms, predisposing the oral cavity to disease entities. HIV patients under antiretroviral therapy (ART) have shown to exhibit altered salivary composition. These changes are postulated to be a result of the effect of ART on the salivary protein and electrolytes levels. OBJECTIVES: The present study aims to assess the potential difference in the salivary total protein and electrolyte levels in HIV patients with and without ART. METHODS: Patients were divided into 3 groups- Group A (HIV-1 positive patient under ART for at least 6 months)-66, Group B (HIV-1 positive patient not started on ART)-66, Group C (HIV negative patients)-66. Saliva samples were collected and evaluated for total salivary protein and electrolyte levels in all the 3 groups. RESULTS: There was a statistically significant difference in the salivary protein (p = 0.000) and electrolyte (Sodium, p = 0.000; Potassium, p = 0.039; chlorine, p = 0.027; ionized calcium, p = 0.002) levels among the three groups. CONCLUSION: HIV positive individuals with and without ART have alteration in the salivary composition. Some of these alterations (total protein and iCa levels) are due to the HIV infection, while others (Na, K, Cl) could be due to ART or a combined effect of both. Salivary changes in HIV positive individuals could predispose them to oral diseases. Thus, regular oral examination and prophylactic regimen must be formulated to maintain their oral hygiene and quality of life.

Ultrasound and CBCT analysis of blood flow and dimensions of the lingual vascular canal: A case control study.

OBJECTIVE: To assess the correlation between the diameter of the mandibular lingual vascular canal (MLVC) as determined on CBCT examination to blood flow and arterial diameter as determined by ultrasound Doppler analysis (USG) in dentate and edentulous patients. METHODS: 20 subjects were equally distributed into two groups based on the status of their dentition. Group 1 included dentate subjects (DE) and Group 2 included edentulous subjects (ED).The subjects from both the groups underwent CBCT scan for the assesement of the diameter of the MLVC.Similarly, USG was done to assess the diameter of the sublingual artery anastomosis and blood flow in the anterior mandible. Data was analysed using Karl Pearson's Correlation coefficient test and Student's unpaired 't' test. RESULTS: Irrespective of the status of the dentition and age, a positive correlation was noted between the diameter of foramen on CBCT examination and the diameter of anastomosing artery as studied by the USG (r â€‹= â€‹0.290).Similarly, a positive correlation was observed between the diameter of foramen on CBCT and the volume of blood entering the mandible (r â€‹= â€‹0.447).A positive correlation (r â€‹= â€‹0.138) was observed between the diameter of the anastomosing artery and the volume of blood entering the mandible. CONCLUSION: The anterior mandible has a rich vascular supply independent of age and status of the dentition.The dimensions and location of MVLC could be assessed on a CBCT prior to implant placement so that the operating surgeon has an idea about the vascularity of the region. Further studies with higher sample size should be undertaken to confirm these findings.

Hypothesizing the therapeutic potential of mesenchymal stem cells in oral submucous fibrosis.

Oral submucous fibrosis is the direct consequence of a sustained pro-inflammatory environment characterized by excessive collagen deposition causing tissue fibrosis, and progressive degeneration of vital structures including muscle. The pathogenesis of oral submucous fibrosis is largely mediated by the pro-inflammatory, pro-fibrotic cytokines, excessive oxidative stress, abnormal angiogenesis, and epithelial to mesenchymal transition. Mesenchymal stem cells largely known for their regenerative potential have shown to have an immunomodulatory, anti-fibrotic, anti-oxidative, and angiogenic potential. Thus, mesenchymal stem cells, when introduced in an oral submucous fibrosis micro-environment, could potentially counter the progressive fibrosis. The present hypotheses discuss the various pathogenic aspects of oral submucous fibrosis and the properties of mesenchymal stem cells which could aid in halting the disease progression.

Effect of crown-to-implant ratio on the marginal bone level changes and implant survival - A systematic review and meta-analysis.

The purpose of the systematic review and meta-analysis was to analyze the existing evidence regarding the effect of crown-to-implant ratio (CIR) on the peri-implant crestal bone level change and implant survival. Randomized controlled clinical trials, prospective as well as retrospective studies with a minimum follow-up period of 12 months and 10 patients per group were included for this systematic review. Statistical analysis was performed to determine CIR effects on the peri-implant marginal bone level changes and implant survival. A total of 28 articles (14 prospective studies and 14 retrospective studies) from a database of 201 articles, with 2097 patients and 4350 implants, were included. A mean CIR ranging from 0.6 to 2.44 was presented by the study groups. A weighted mean implant loss of 0.19% per year and peri-implant marginal bone level change of 0.63 mm ± 0.55 over 46.8 ± 5.2 months was calculated from the included studies. The peri-implant marginal bone level change (p = 0.155) and the rate of implant loss (p = 0.245) showed a statistically insignificant difference between implant restorations of a high (>1.5:1) and low (<1.5:1) CIR. Within its limitations, this review concludes that a high (>1.5:1) or a low (<1.5:1) CIR does not significantly affect the peri-implant marginal bone level change and implant survival rate. However, until further evidence becomes available, extrapolation to long term clinical success cannot be ascertained.

Modified 'Cul-De-Sac' approach for management of a large perforation during maxillary sinus elevation- (A case report).

Dental implants have been in used as a successful mode of rehabilitation of lost dentition for over three decades. Science and techniques have undergone significant progress with time and clinical situations that were deemed unfit for insertion of dental implants due to lack of sufficient bone are now being treated using implants with predictable long term results. Clinicians can now rehabilitate the posterior maxilla with a wide variety of implant-based solutions. There are complications associated with this procedure which may be attributed to diagnostics or the surgical protocol itself and a multitude of management approaches have been suggested in the literature. This report elucidates one such case of management of a large perforation in the Schnederian membrane during elevation using a staged approach.