Ridge augmentation planning, wound healing evaluation, and peri-implant tissue phenotype assessment with ultrasonography: A case report.

BACKGROUND: Ridge regeneration for implant therapy requires comprehensive site evaluation and wound healing monitoring. This case report aimed to demonstrate ultrasound (US) can image soft and hard tissues for surgical planning and assess longitudinal outcomes. METHODS AND RESULTS: US was used in a patient planned for ridge augmentation to evaluate soft tissue thickness, location of muscle attachment, and hard tissue defect features presurgically. US were obtained at 1, 2.5, and 5 months afterward to assess tissue healing. Preoperatively, US showed ∼2.5 mm and ∼0.8 mm soft tissue thickness on the facial and lingual sides, respectively. The crestal bone width was ∼2 mm, with severe facial bone deficiency and high muscle attachment. US showed wound approximation and ridge width gain to 4.5 and 4.0 mm at 1 and 5 months, respectively. US tissue perfusion increased to ∼two-fold and ∼4-fold at 1 and 2.5 months and reduced below the baseline at 5 months. An implant with simultaneous bone augmentation was performed accordingly. Tissue phenotype around the implant was measured on US images at 1-year visit. CONCLUSIONS: This case report demonstrated that US parameters could be valuable for planning and wound healing outcome assessment of ridge augmentation in clinical as well as research settings. KEY POINTS: Why is this case new information? Novel high-resolution, chairside ultrasound was proposed to facilitate treatment planning and wound healing outcome assessment of ridge augmentation in clinical as well as research settings. What are the keys to successful use of this technology? Proper training in imaging acquisition and interpretation Adhere to high-level disinfection protocol Patient education and explanation What are the primary limitations to success in using this technology? Investment in this technology Learning curve in imaging acquisition and reading Insurance reimbursement strategy.

Operating microscope-assisted reconstructive strategy for peri-implantitis: A case series report.

BACKGROUND: Treating peri-implantitis with reconstructive means has been largely unpredictable due to access limitations for surface decontamination, unfavorable bony topography, difficulty in achieving wound stability, and inferior soft tissue qualities. A microsurgical approach with the use of the operating microscope (OM) that provides adjustable higher magnification (∼5-30 times) and coaxial illumination, coupled with the use of microsurgical instruments, may overcome, or alleviate some of the abovementioned obstacles, resulting in more predictable outcomes. METHODS: Three patients received reconstructive therapy for correcting peri-implant defects under OM in private practice settings. After precise incisions to preserve soft tissue volume, the flaps were dissected prudently from underlying granulomatous tissues, which were subsequently removed, followed by controlled flap releasing under ∼10-15x magnification. Surface decontamination was performed using a piezoelectric ultrasonic device, air polishing, and hand instruments at ∼30x magnification. The biomaterial selections were dehydrated human de-epithelialized amnion-chorion membrane with mineralized allograft particulates in two cases and xenografts in one case, based on the surgeons' preference. Wound closure followed the non-submerged approach. RESULTS: These cases demonstrated uneventful soft tissue healing, favorable radiographic bone fill, and disease resolution with follow-ups ranging from 2 to 4 years. CONCLUSIONS: Preliminary data suggest encouraging outcomes after the microsurgical approach following biological as well as biomechanical principles for peri-implant defect reconstruction.

Effects of crown contour on artificial biofilm removal efficacy with interdental cleaning aids: An in vitro study.

OBJECTIVES: To evaluate the efficacy of various interdental cleaning aids for artificial biofilm removal on different implant-supported crown designs. METHODS: Mandibular models with missing first molar were fabricated and installed with single implant analogs and loaded with crowns of different designs (concave, straight, and convex). Artificial biofilm was made with occlusion spray. Thirty volunteers (periodontists, dental hygienists, and laypersons) were asked to clean the interproximal areas. The crowns were unscrewed and photographed in a standardized setting. The outcome was measured by the cleaning ratio which represents the cleaned surfaces in relation to the area of the tested surface. RESULTS: A significant difference in favor of concave crown (p < .001) on the basal surface was cleaned by all tools, except the water flosser. There was evidence of an overall effect of "cleaning tool," "surface," and "crown design" (p < .0001) except for the "participant" factor. The mean cleaning ratio for each cleaning tool and overall combined surfaces were (in%): dental floss: 43.02 ± 23.93, superfloss: 42.51 ± 25.92, electric interspace brush: 36.21 ± 18.78, interdental brush: 29.10 ± 15.95, and electric water flosser: 9.72 ± 8.14. Dental floss and superfloss were significantly better (p < .05) than other tools in removing plaque. CONCLUSIONS: Concave crown contour had the greatest artificial biofilm removal, followed by straight and convex crowns at the basal surface. Dental floss and superfloss were the most effective interdental cleaning devices for artificial biofilm removal. None of the tested cleaning devices were able to completely remove the artificial biofilm from the interproximal/basal surfaces.

Intrasocket reactive tissue: The state of current knowledge.

This review focuses on intrasocket reactive tissue and its impact on extraction socket healing. It summarises the current knowledge about intrasocket reactive tissue from a histopathological and biological perspective and discusses the mechanisms by which residual intrasocket reactive tissue can have a positive or negative effect on healing. Additionally, it provides an overview of the various hand and rotary instruments that are currently used for intrasocket reactive tissue debridement. The review also discusses preserving intrasocket reactive tissue as a socket sealing material and the benefits this may offer. It presents clinical cases where either removal or preservation of intrasocket reactive tissue was adopted following extraction and prior to alveolar ridge preservation. Future studies are needed to investigate the suggested beneficial effects of intrasocket reactive tissue on socket healing outcomes.

Microscope-Assisted Maxillary Sinus Augmentation: A Case Series.

Minimally invasive microsurgery performed using an operating microscope (OM) has shown accelerated and improved wound healing for periodontal plastic and regenerative procedures. This case series aims to demonstrate the potential usefulness of OM for maxillary sinus augmentation in a private practice setting. Twelve vertical sinus augmentations (VSAs) and 8 lateral sinus augmentations (LSAs) were performed with the assistance of OM. Flap reflection, osteotomy, sinus membrane elevation, membrane integrity evaluation, implant placement (if indicated), and wound approximation with sutures were performed under OM. After a minimum healing period of 6 months, radiographic bone height gain was assessed. One sinus membrane perforation was observed during VSA surgery. The mean vertical bone gain was 4.82 ± 1.31 mm and 8.36 ± 1.45 mm for VSA and LSA, respectively, with 100% implant success rate. OM-assisted maxillary sinus augmentation provides favorable clinical visualization, thus facilitating delicate hard and soft tissue manipulation.

Diagnosis of Stage III Periodontitis and Ambiguities of the "Gray Zones" in Between Stage III and Stage IV.

INTRODUCTION: How to best classify the Stage III and IV periodontitis cases that share common features of the most severe clinical attachment loss and the most severe radiographic bone loss? CASE PRESENTATION: Two patients presented features of generalized periodontitis, with severe probing depth and clinical attachment loss that would meet inclusion in both Stage III and IV. The cases retained all teeth but were further complicated by teeth drifting and secondary occlusal trauma. Appropriate disease classification required clinical judgement and led to the final classification of Stage III, Grade C for both cases. CONCLUSION: Patient-based clinical judgement, aiming for long-term preservation of natural dentition, drives the final assignment of staging when the case falls in the "gray zone" that focuses on major differences in Stage III and IV periodontitis.

Effects of Mechanical Instrumentation with Commercially Available Instruments Used in Supportive Peri-implant Therapy: An In Vitro Study.

PURPOSE: To evaluate topographic changes and effectiveness of mechanical instrumentation upon machined (MA) and roughened (RG) surfaces of dental implants. MATERIALS AND METHODS: The coronal one-third of seven RG and seven MA implants was coated with a mixture of cyanoacrylate and toluidine blue dye to resemble calculus. Implants were cleaned with three curettes (SS: stainless steel, PT: plastic, TI: titanium), two ultrasonic tips (UM: metal tip, UP: plastic tip), a titanium brush (TB), and an air-polishing device (AA) until visibly clean. Additionally, a simulation of 1- and 5-year supportive peri-implant therapy (SPT) was performed on 14 implants using the aforementioned instruments with 20 strokes/40 s (T1) or 100 strokes/200 s (T5). Each implant was evaluated using stereomicroscopy, atomic force microscopy, and scanning electron microscopy. RESULTS: UM was the most effective instrument, with 0% average percentage of residual artificial calculus (RAC), followed by TB (2.89%) and UP (4.90%). SS was more effective than TI (15.43% vs 20.12% RAC, respectively), while PT failed to remove any deposit (100% RAC). AA completely removed deposits on RG surfaces but not MA surfaces (26.61% RAC). Noticeable topographic changes were observed between both implant surfaces. RG surfaces became less rough, whereas MA surfaces became rougher at both T1 and T5 with the exception of AA. Plastic- and titanium-like remnants were noted after debridement with PT, SS, and TI, respectively. CONCLUSION: Artificial calculus removal by mechanical instrumentation, with the exception of PT, was proven to be clinically effective. All instruments induced minor to major topographic changes upon dental implant surfaces. AA did not remarkably change MA and RG surfaces at both micrometer and nanometer levels. Findings from this study may impact the selection of instruments or devices used during SPT protocols.

Comparison of platelet-rich fibrin and cellulose in palatal wounds after graft harvesting.

AIM: The aim of the present study was to compare patient morbidity and healing outcomes of free gingival graft (FGG) harvesting at palatal donor sites and after using platelet-rich fibrin (PRF) and oxidized regenerated cellulose (ORC). FGG harvesting leaves open palatal wounds, which heal by secondary intention. Patients might experience discomfort or pain during the first 2 weeks of healing. METHODS: Eighteen participants requiring two FGG were recruited. The test and control sites were covered with PRF membrane and ORC. The complete epithelialization of the palatal wound, the percentage of wound healing, and postoperative pain were evaluated, 1, 3, and 7 days and 2, 3, and 4 weeks after surgery. RESULTS: Similar wound size reduction at 1 week (test: 36.87%, control: 38.78%) was found. At 2 weeks, the majority of the test group (88.89%) showed complete epithelialization, whereas 66.67% of the control group had complete epithelialization (P = .228). Pain was more prevalent in the control group (27.77%) than in the test group (11.1%) on day 1. None of the participants reported any pain or discomfort at the test sites on day 3. CONCLUSIONS: PRF seems to reduce patient morbidity, but there is no difference in palatal wound healing (P > .05).

Reduced ADAM8 levels upon non-surgical periodontal therapy in patients with chronic periodontitis.

OBJECTIVE: To determine effect of non-surgical periodontal treatment on a disintegrin and metalloproteinase 8 (ADAM8) levels in gingival crevicular fluid (GCF) of patients with chronic periodontitis (CP) in comparison with those of patients with gingivitis and to find correlations between ADAM8 levels and clinical parameters. DESIGN: Twenty-two and eleven patients with CP and gingivitis, respectively, were examined for four clinical parameters, probing depth, clinical attachment level, gingival and plaque indices. GCF from the selected gingivitis or periodontitis sites with distinct severities was sampled by Periopaper strips. The non-surgical treatments, including scaling and/or root planing and oral hygiene instruction, were provided for all patients. Clinical measurements and GCF sampling were repeated at three months after the treatments. ADAM8 concentrations were analyzed by ELISA and normalized by GCF volumes or total protein amounts. RESULTS: All patients exhibited significant improvement of almost every clinical parameter after treatment, whereas the median ADAM8 concentrations were significantly decreased at the moderate and severe periodontitis sites of patients with CP (p < 0.05). Moreover, the significantly positive correlations between ADAM8 concentrations and four clinical parameters were found in both moderate and severe groups (p < 0.05). CONCLUSION: ADAM8 concentrations were decreased by non-surgical periodontal therapy in patients with chronic periodontitis at the moderate and severe sites and were correlated with four clinical parameters, implying that GCF ADAM8 levels reflect inflammatory and bone-resorbing activities in the periodontal pocket.

Retrospective Evaluation of the Clinical Outcomes and Patient and Parental Satisfaction with Resin Strip Crowns in Primary Incisors.

Purpose: The purpose of this study was to evaluate the clinical outcomes of resin strip crowns (RSCs) and assess parental and patient satisfaction with RSCs in restoring primary incisors. Methods: The esthetic, functional, and biological properties of RSCs were evaluated using FDI World Dental Federation criteria. Parental and patient satisfaction with RSCs was assessed using interviews. The outcomes were compared between three follow-up periods: 12 to 18, 19 to 24, and 25 to 33 months. Results: Seventy-two RSCs in 41 patients were evaluated after an averagefollowup period of 21.7 months. Most RSCs were clinically acceptable esthetically (79.2 percent) and biologically (84.7 percent) but unacceptable in function (52.8 percent). Parental satisfaction with esthetics was lowest (55.6 percent), while parental satisfaction with functional and biological properties was high (84.7 percent and 93.1 percent, respectively). Overall parental and patient satisfaction with RSCs was high (90.2 percent and 75.6 percent, respectively). Clinical outcomes and satisfaction scores were lower for RSCs with longer follow-up periods. Conclusions: Resin strip crowns were clinically acceptable for restoring primary incisors, with sufficient esthetic and biological properties, but were deficient in function, especially with longer follow-up periods. Overall parental and patient satisfaction with RSCs was high, in spite of parents having low satisfaction with the esthetics of the RSCs.