Use of Laser in Sleep Disorders: A Review on Low Laser Uvulopalatoplasty.

METHODS: A comprehensive and systematic literature review was conducted using PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, Embase, Web of Science, the US National Institutes of Health Trials Registry, WHO Library, and Medline. The search strategies were developed to cover publications from January 2010 through March 2020. The past 10 years of the search were performed to report the data following systematic review and meta-analysis protocol (PRISMA-P) 2015 statement. RESULTS: With the help of keywords, the total number of abstracts identified was 946. These abstracts were further reviewed as per inclusion and exclusion criteria, and 106 abstracts were identified to match the selection criteria. Further review of full articles resulted in 12 articles that matched the inclusion criteria for the study. CONCLUSION: Er:YAG can be a good alternative and least invasive therapy for managing snoring and obstructive sleep apnea. Er:YAG therapy is considered to nonsurgical intervention with minimum side effects and can be performed chairside.

Evaluation of jawbone morphology and bone density indices in panoramic radiographs of selective serotonin reuptake inhibitor users: a preliminary study.

OBJECTIVES:: To assess the influence of selective serotonin reuptake inhibitor (SSRI) use on jawbone and bone mineral density by retrospective analysis of panoramic radiographs. METHODS:: Radiographic and clinical records were sourced from the Division of Orthodontics and TMJD, Eastman Institute for Oral Health, University of Rochester. Randomly selected adults (20-65 years) were categorized into: "Active" (with history of SSRI use of >6 months) and a "Control" group. Panoramic indices: Klemetti index (KI), panoramic mandibular index, antegonial notching index, condylar pathology, mandibular cortical width (MCW)⁠ and mean ramus height were recorded. Frequency-weighted Χ2 tests and multinomial regression controlling for age and gender were applied to categorical indices (KI, condylar pathology, antegonial notching index). Multivariate generalized linear modeling was applied to mean ramus height, MCW and panoramic mandibular index. Multiple regression analyses determined: (a) panoramic indices that best predicted SSRI use, and (b) independent predictors of KI category. RESULTS:: 64 SSRI users and 48 Controls were assessed. SSRI users had significantly higher odds of having worse KI status than normal [mildly to moderately eroded cortex: odds ratio (OR) = 2.926, 95% CI (1.07-8.04) and severely eroded cortex: OR = 19.86, 95% CI (3.91-100.69)], more frequent flat condylar anatomy (right side: p = 0.009, left side: p < 0.001) but greater ramus height (p = 0.001) and mandibular cortical width (p = 0.032). Age, gender, SSRI use each significantly impacted KI. Only SSRI use significantly impacted condylar pathology, ramus height and MCW. KI category (OR = 1.3) was the best panoramic predictor of SSRI use. Conversely, KI category C3 was significantly predicted by SSRI use (OR = 31.2, p = 0.002), female gender (17.5, p = 0.006), and severe antegonial notching (OR = 1289, p < 0.001). CONCLUSIONS:: SRRI use was significantly associated with worse panoramic morphometric indices: KI, condylar pathology, ramus height, and MCW, where KI was its strongest predictor. Worse KI was independently predicted by SSRI use.

Selective serotonin reuptake inhibitors and dental implant failure-A significant concern in elders?

OBJECTIVE: Depression is a significantly prevalent health concern in geriatric populations. Selective serotonin reuptake inhibitor drugs (SSRI) are the most commonly prescribed antidepressant agents, with increasing rates of prescription. The present report aimed to present a concise review of the current understanding regarding SSRI effects on bone and dental implant outcomes. MATERIALS AND METHODS: A broad-based review and summary of literature pertaining to the effects of SSRI on bone metabolism and on dental implant survival was performed. RESULTS: The available literature indicates that serotonin plays a significant role in bone metabolism and experimental reports demonstrate adverse impacts of SSRI on multiple pathways of bone metabolism. Early clinical reports suggest detrimental effects of SSRI on dental implant survival. The type of SSRI drug, dosage and host-related genetic and metabolic factors could be potential modulating factors. There is a paucity of data regarding SSRI usage and dental implant survival specific to geriatric cohorts. CONCLUSION: As older individuals comprise a high-risk group for both high oral rehabilitation and SSRI use, clinicians should be aware the potential association between SSRI and dental implant failures. Well-designed investigations specific to geriatric cohorts are essential to understand the implications of SSRI use on dental implant prognosis.

Success rate of short dental implants supporting single crowns and fixed bridges.

OBJECTIVE: Bone grafts (sinus lift and/or ridge augmentation) may become an obstacle for some patients who desire implant treatment. The objective of this study was to evaluate the success of six- and eight-millimeters rough surface design short dental implants, for up to 2 years in function, when compared to conventional length (11 mm) implants. MATERIALS AND METHODS: A total of 25.6-, 20.8- and 35.11-mm length implants were placed and restored in 30 subjects (11 males, 19 females) between the age of 22 and 80, following a standard protocol. Implant mobility, crestal bone loss as well as periodontal parameters were evaluated immediately after restoration placement, at 6, 12 and 24 months. RESULTS: There was one failure of one 6-mm implant during the healing phase and one restorative failure. The median crestal bone loss at 24 months was 0.45 mm for the 6-mm implants, 0.55 mm for the 8 mm implants and 0.65 mm for the 11-mm implants. The success rate for 6-mm implants was 97% and for 8-mm and 11-mm implants 100%. CONCLUSIONS: Based on this preliminary data, we conclude that rough surface design short dental implants (6 and 8 mm in length) have similar success rate when compared to 11-mm implants. Long-term data with larger number of implants and subjects are needed to confirm these results.

Primary stability of implants placed at different angulations in artificial bone.

INTRODUCTION: The aim of this study was to evaluate the primary stability (PS) of titanium implants with a progressive thread design and more thread stability in the apical threads placed in artificial bone materials. MATERIALS AND METHODS: A total of 120 implants were placed in commercially available polyurethane composite bone blocks. The angulations that were chosen to place the implants in bone types II and IV were 0, 10, and 20 degrees, respectively. The implant dimensions were 11 mm in length and 3.5 mm in diameter. Two clinicians placed all implants, and an independent examiner evaluated the PS using the Osstell (ISQ) and Periotest devices. The χ test was used to evaluate the statistical differences between the PS at different angulations. RESULTS: This study showed that there was a statistically significant difference (P = 0.02) of the PS values, when measured using the Periotest values, among all 3 angulations in both bone qualities. Tilted implants with 10 degrees, angulation had a better stability than conventionally placed implants. CONCLUSIONS: The PS of dental implants is higher for implants placed in type II when compared with type IV artificial bone. A higher stability was found for implants placed with 10-degree angulations.

Oral manifestations in patients with neurofibromatosis type-1: a comprehensive literature review.

UNLABELLED: Oral health status is jeopardized in patients with neurofibromatosis (NF) type-1 (NF-1). The aim of the present study was to comprehensively review the oral manifestations in NF-1 patients. PubMed/Medline and Google-Scholar databases were explored using different keywords. Reviews, commentaries, letters to Editor and articles published in languages other than English were excluded. RESULTS: Neurofibromas of oral and perioral soft tissues with subsequent periodontitis, impacted and supernumerary teeth, enlarged alveolar process with dental spacing, morphological changes in teeth and class III molar relationship have been reported in NF-1 patients. Plexiform neurofibromas were reported both in oral soft tissue, maxilla and mandible with evidence of malignant transformation in some cases. Facial skeletal abnormalities, including enlargement of mandibular foramen, increased dimensions of the coronoid and sigmoid notches and notching of the posterior border of the mandible have also been reported. Association between dental caries and NF-1 remains unclear.

Distal cantilever in full-arch prostheses and immediate loading: a retrospective clinical study.

PURPOSE: The purpose of this study was to analyze and evaluate the clinical success of distal cantilevers of fixed full-arch prostheses for the rehabilitation of edentulous arches in conjunction with immediate loading. MATERIALS AND METHODS: Twenty-seven patients (15 men and 12 women) with a mean age of 59 years received 203 implants (Ankylos, Dentsply), either in edentulous jaws or after extraction and immediate implant placement. All implants were splinted together with provisional restorations and loaded immediately after surgery. After an average of 60 days, the definitive prostheses were fabricated and cemented provisionally. Thirty-one prostheses were delivered. A total of 92 units on distal cantilevers were incorporated into the prostheses. Implant stability was recorded (via percussion testing) after prostheses were removed and crestal bone levels were measured with radiographs. RESULTS: Average crestal bone loss was 0.33 mm. After a follow-up of 5 years, only one prosthesis broke (at the connection between the main part of the denture and the distal extension). A total of five implants were lost because of overloading or peri-implantitis (during early healing). The success rate of implants was 94.5%, the survival rate was 97.5%, and the survival rate of the prostheses was 96.7% after a loading period of 79.30 ± 35.31 months. CONCLUSIONS: Based on the long-term clinical data, distal cantilevers on a full-arch prosthesis can be a successful treatment modality and can be employed in patient treatment planning when posterior support is indicated.

In vitro assessment of primary stability of Straumann® implant designs.

BACKGROUND: Primary implant stability (PS) is one of the main factors influencing implant survival rate. Several methods to determine the PS have been used, such as Periotest values (PVs) and resonance frequency analysis (RFA) with implant stability quotient (ISQ) values. PURPOSE: The aim of this study was to compare different implant designs in regard to PS assessed by Periotest and RFA in vitro. MATERIALS AND METHODS: A total of 90 implants were placed in freshly slaughtered cow ribs. The implants (Straumann®, Institute Straumann AG, Basel, Switzerland; length 10 mm, ø3.3 mm) had the following three designs: Bone Level (BL, 30 implants), Standard Plus (SP, 30 implants), and Tapered Effect (TE, 30 implants). Before implant placement, the investigator was calibrated for every design according to the manufacturer's instructions. An independent observer, blinded to the study, assessed the accuracy of placement. RFA based on the Osstell device and PVs were performed after abutment connection. One-way analysis of variance and Tukey's post hoc test were used for statistical evaluation. RESULTS: All implants were mechanically stable. The mean PV for BL was -4.67(± 1.18), for SP, -6.07(± 0.94), and for TE, -6.57(± 0.57). The mean ISQ values were 75.02(± 3.65), 75.98(± 3.00), and 79.83(± 1.85), respectively. The one-way ANOVA showed significant difference among three implant designs in PV (p < .0001) and for the ISQ between BL/TE or SP/TE implants (p < .0001). In addition, the Tukey's (pair-wise comparison) test showed significant differences in PV and RFA between the BL/T (p < .0001). CONCLUSION: Within the limitations of this study, higher implant stability was found for tapered designed implants.

Role of clinician's experience and implant design on implant stability. An ex vivo study in artificial soft bones.

OBJECTIVES: Clinical experience in implant placement is important in order to prevent implant failures. However, the implant design affects the primary implant stability (PS) especially in poor quality bones. Therefore, the aim of this study was to compare the effect of clinician surgical experience on PS, when placing different type of implant designs. METHODS: A total of 180 implants (90 parallel walled-P and 90 tapered-T) were placed in freshly slaughtered cow ribs. Bone quality was evaluated by two examiners during surgery and considered as 'type IV' bone. Implants (ø 5 mm, length: 15 mm, Osseotite, BIOMET 3i, Palm Beach Gardens, FL, USA) were placed by three different clinicians (master/I, good/II, non-experienced/III, under direct supervision of a manufacturer representative; 30 implants/group). An independent observer assessed the accuracy of placement by resonance frequency analysis (RFA) with implant stability quotient (ISQ) values. Two-way analysis of variance (ANOVA) and Tukey's post hoc test were used to detect the surgical experience of the clinicians and their interaction and effects of implant design on the PS. RESULTS: All implants were mechanically stable. The mean ISQ values were: 49.57(± 18.49) for the P-implants and 67.07(± 8.79) for the T-implants. The two-way ANOVA showed significant effects of implant design (p < .0001), clinician (p < .0001), and their interaction (p < .0001). The Tukey's multiple comparison test showed significant differences in RFA for the clinician group I/II (p = .015) and highly significant (p < .0001) between I/III and II/III. The P-implants presented (for I, II, and III) mean ISQ values 31.25/49.18/68.17 and the T-implants showed higher ISQ values, 70.15/62.08/68.98, respectively. Clinicians I and II did not show extreme differences for T-implants (p = .016). In contrast, clinician III achieved high ISQ values using P- and T-implants following the exact surgical protocol based on the manufacturer guidelines. T-implants provided high stability for experienced clinicians compared with P-implants. CONCLUSION: T-implants achieved greater PS than the P-implants. All clinicians consistently achieved PS; however, experienced clinicians achieved higher ISQ values with T-implants in poor quality bone.

Lasers use in dental implantology.

OBJECTIVE: The purpose of this literature review was to evaluate the present use of different laser systems in implant dentistry. MATERIALS AND METHODS: A literature search of MEDLINE-PubMed for articles published, describing the use of lasers in implant dentistry, was performed and articles were critically reviewed by the investigators to determine the strength of evidence. RESULTS: The literature review reveals a limited number of randomized clinical trials with regard to laser use in dentistry. Although many case studies indicate extensive use of lasers and promising results in dental implantology, lasers may be used for uncovering submerged implants atraumatically to prevent crestal bone loss, recontouring periimplant soft tissues and sculpting emergence profile for prosthetic components, raising surgical flaps, osseous recontouring, and creating parabolic tissue architecture. Additionally, bone harvesting of block grafts, window preparation in sinus lift procedures, ridge splitting, and debridement of extraction sockets for immediate implant placement were described. CONCLUSIONS: Aside from the many benefits associated with the use of lasers in implant-related procedures, there are also risks to consider from the laser irradiation on the implant surface and the periimplant tissues. Therefore, an appropriate training on laser use is mandatory to increase the clinical outcome and to control the potential of complications.

Distal cantilevers and implant dentistry.

PURPOSE: The use of distal cantilevers in fixed implant-supported prostheses is often discussed in dental literature in relation to implant restorations. The aim of this study was to conduct a systematic review of the literature in an effort to identify factors related to the long-term success of distal cantilevers. In addition, a more traditional review was conducted to determine complications associated with this type of prosthetic design. MATERIAL AND METHODS: A systematic literature review was conducted of all published articles identified through a search of MEDLINE from January 1980 through June 2011 using the terms "crestal bone loss," "dental implants," "distal cantilevers," "marginal bone loss," and "periodontal disease." An initial review was conducted of titles and a second review was performed using full abstracts. Articles were thus identified to assess studies that met the inclusion criteria that described fixed complete dental prostheses utilizing distal cantilevers. In vivo studies were included for data extraction while in vitro and animal studies were used for descriptions of clinical or mechanical performance. RESULTS: Following the method described, from an initial identification of 49 studies, a total of 14 human clinical studies were found that met the inclusion criteria and provided data associated with clinical performance. An additional 5 studies detailed in vitro research. It was noted that the majority of studies lacked specific data but, nonetheless, provided subjective and objective information regarding the use of cantilevers. The follow-up period of human studies ranged from 1 to 10 years. Weighted averages demonstrate a prosthetic survival rate of 95% during a follow-up period of 7.3 ± 2.6 years. The descriptive studies demonstrate that the most frequent complication was screw loosening, which was observed equally in virtually all studies, even if controlled torque was used to connect abutments and prostheses. Porcelain chipping and esthetic veneer fracture were described, although data associated with these occurrences were not available for systematic review. CONCLUSIONS: Based on 19 articles (including 14 human studies), it was difficult to derive data-based conclusions regarding the use of cantilever prostheses other than an approximate 95% prosthetic survival rate. Subjective and objective information from these studies demonstrated a distinct preference for the use of distal cantilever prostheses, as few risks are associated with these prostheses. Careful evaluation of the studies shows that cantilevers provide a treatment option without a high risk of complications.

Distribution of endosseous bony canals in the mandibular symphysis as detected with cone beam computed tomography.

PURPOSE: The purpose of this article was to investigate the distribution of endosseous bony canals in the anterior mandible using cone beam computed tomography (CBCT) technology. MATERIALS AND METHODS: Two hundred ninety-nine images based on CBCT of the anterior mandible were analyzed for the presence of endosseous canals. The bony canals were observed in relationship to the adjacent anatomical structures, and relationships between their topographic variability and patient age and gender were analyzed. RESULTS: Bony canals were found in the anterior mandible in almost 86% of the examined patients, independent of age and gender. The highest regional frequency was seen in the midline area, followed by the lateral incisor and canine regions. The length of the canals ranged from 5 to 15 mm (mean, 10.55 mm). Multiple (two or three) canals were also observed in approximately 9% of the scans. Varying appearances of these bony canals in the symphysis region were also demonstrated. CONCLUSIONS: Endosseous canals in the mandibular symphysis were found using CBCT scans. CBCT seems to be an important diagnostic technique for evaluation of the exact distribution of bony canals in the symphysis region that may help reduce the risk of surgical complications.

Endosseous arteries in the anterior mandible: literature review.

PURPOSE: The purpose of this literature review was to investigate the topography of endosseous blood vessels supplying the anterior mandible to prevent complications both during and after oral surgical procedures. MATERIAL AND METHODS: A comprehensive literature search of MEDLINE-PubMed was performed independently for articles describing the anatomical findings of endosseous blood vessels in the anterior part of the mandible. From about 31 related studies, 14 papers were selected based on specific selection criteria. These studies were related to radiologic findings and cadaver studies. RESULTS: There is significant debate concerning the blood vessels supplying the anterior part of the mandible. Hence, in the literature reviewed, no clear consensus was established. There are no reports of severe endosseous bleeding from the mandible during surgical procedures in the symphysis. Based on computed tomographic images, some papers presented an exact intraosseous path of the canals, as well as frequent blood vessel anastomosis in this region. Dissection studies confirmed the presence of sublingual blood vessels penetrating into the bone. CONCLUSIONS: The potential risk of bleeding upon perforation of vessels within the bone needs to be evaluated to avoid such complications. The management of intraoperative surgical problems is of significance.