Does Graft Particle Type and Size Affect Ridge Dimensional Changes After Alveolar Ridge Split Procedure?

PURPOSE: The absence of an adequate volume of bone at implant sites requires augmentation procedures before the placement of implants. The aim of the present study was to assess the ridge width gain with the use of allografts and biphasic ß-tricalcium phosphate with hydroxyapatite (alloplast) in ridge split procedures, when each were used in small (0.25 to 1 mm) and large (1 to 2 mm) particle sizes. PATIENTS AND METHODS: A randomized controlled trial of 23 subjects with severe atrophy of the mandible in the horizontal dimension was conducted in a private institute. The patients underwent placement of 49 dental implants after a staged ridge split procedure. The patients were randomly allocated to alloplast and allograft groups (predictor variable). In each group, the patients were randomly assigned to either small graft particle or large graft particle size (predictor variable). The gain in ridge width (outcome variable) was assessed before implant placement. A 2-way analysis of variance test and the Student unpaired t test were used for evaluation of the ridge width gain between the allograft and alloplast groups (predictor variable). Differences were considered significant if P values were < .05. RESULTS: The sample included 23 patients (14 men and 9 women). The patients were randomly allocated to the alloplast (n = 11) or allograft (n = 12) group before the ridge split procedure. In each group, they were assigned to a small graft particle or large graft particle size (alloplast group, small particle in 5 and large particle size in 6 patients; allograft group, small particle in 6 and large particle size in 6). A statistically significant difference was observed between the 2 graft types. The average ridge width gain was significantly greater in the alloplast group (large, 4.40 ± 0.24 mm; small, 3.52 ± 0.59 mm) than in the allograft group (large, 3.82 ± 0.19 mm; small, 2.57 ± 0.16 mm). For both graft types (alloplast and allograft), the large particle size graft resulted in a greater ridge width gain compared with the small particle size graft (P < .05). CONCLUSIONS: Within the limitations of the present study, we suggest the use of large particle alloplast as the graft material of choice for staged ridge split procedures in the posterior mandible.

Nanoscale silver depositions inhibit microbial colonization and improve biocompatibility of titanium abutments.

Although titanium dental implants are biocompatible, exhibit excellent corrosion resistance and high mechanical resistance, the material fails in providing resistance to infection because it exhibits poor antimicrobial activity. To address these issues, we deposited silver onto titanium abutments (Grade 5 titanium discs) using direct current (DC) sputtering and assessed the antimicrobial activity and biocompatibility of the modified implant material. Atomic absorption spectrometry and X-ray photoelectron spectroscopy were employed to investigate the concentration and elemental composition of the deposited silver. As expected, silver deposited using DC plasma was uniform and good control over the deposition could be achieved by varying the sputtering time. Moderate biocompatible responses (up to 69% viability) were observed in primary human gingival fibroblast cells incubated in the presence of Ti sputtered with Ag for 5min. Silver deposited titanium (Ti-Ag) showed excellent antibacterial effects on Pseudomonas aeruginosa and Streptococcus mutans at a very low concentration (Ag content 1.2 and 2.1µg/mm2). However, higher concentration of silver (6µg/mm2) was required to achieve a reduction in cell viability of Staphylococcus aureus and Candida albicans. The silver sputtered Ti abutments could maintain a long-term antibacterial activity as evidenced by the release of silver up to 22days in simulated body fluid. Our study illustrates that silver deposited titanium is indeed a promising candidate for soft tissue integration on dental abutments and prevents initial microbial adhesion.

Prevalence of bony septa, antral pathology, and dimensions of the maxillary sinus from a sinus augmentation perspective: A retrospective cone-beam computed tomography study.

PURPOSE: Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement. RESULTS: Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology. CONCLUSION: Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.

Access to abutment screw in cement retained restorations: a clinical tip.

Abutment screw loosening has been reported to be the most common prosthetic complications occurring in screw retained as well as cement retained implant restorations. Different methods to treat this issue have been reported in the literature so far; however these have their own short-comings. Retrievability of an implant restoration intact becomes a clinical challenge when the restoration is cement retained especially with an angulated abutment. This technique is aimed at accurately determining the position of the abutment screw in 3 dimensional relationships using a vacuum formed clear stent. This technique can be used as a viable protocol for management of screw loosening in cement retained implant restorations.

Clinical and histologic outcomes of socket grafting after flapless tooth extraction: a systematic review of randomized controlled clinical trials.

STATEMENT OF PROBLEM: Several biomaterials and techniques have been reported for socket grafting and alveolar ridge preservation. However, the evidence for clinical and histologic outcomes for socket grafting with different types of materials in flapless extraction is not clear. PURPOSE: The purpose of this systematic review was to analyze the outcomes of a socket grafting procedure performed with flapless extraction of teeth in order to determine which graft material results in the least loss of socket dimensions, the maximum amount of vital bone, the least remnant graft material, and the least amount of connective tissue after a minimum of 12 weeks of healing. Secondary outcomes, including the predictability of regenerating deficient buccal bone, necessity of barrier membranes, and coverage with autogenous soft tissue graft, were also evaluated. MATERIAL AND METHODS: An electronic search for articles in the English-language literature was performed independently by multiple investigators using a systematic search process with the PubMed search engine. After applying predetermined inclusion and exclusion criteria, the final list of randomized controlled clinical trials (RCTs) for flapless extraction and socket grafting was analyzed to derive results for the various objectives of the study. RESULTS: The initial electronic search resulted in 2898 titles. The systematic application of inclusion and exclusion criteria resulted in 32 RCTs studying 1354 sockets, which addressed the clinical and histologic outcomes of flapless extraction with socket grafting and provided dimensional and histologic information at or beyond the 12-week reentry period. From these RCTs, the mean loss of buccolingual width at the ridge crest was lowest for xenografts (1.3 mm), followed by allografts (1.63 mm), alloplasts (2.13 mm), and sockets without any socket grafting (2.79 mm). Only 3 studies reported on loss of width at 3 mm below the ridge crest. The mean loss of buccal wall height from the ridge crest was lowest for xenografts (0.57 mm) and allografts (0.58 mm), followed by alloplasts (0.77 mm) and sockets without any grafting (1.74 mm). The mean histologic outcomes at or beyond the 12-week reentry period revealed the highest vital bone content for sockets grafted with alloplasts (45.53%), followed by sockets with no graft material (41.07%), xenografts (35.72%), and allografts (29.93%). The amount of remnant graft material was highest for sockets grafted with allografts (21.75%), followed by xenografts (19.3%) and alloplasts (13.67%). The highest connective tissue content at the time of reentry was seen for sockets with no grafting (52.53%), followed by allografts (51.03%), xenografts (44.42%), and alloplast (38.39%). Data for new and emerging biomaterials such as cell therapy and tissue regenerative materials were not amenable to calculations because of biomaterial heterogeneity and small sample sizes. CONCLUSIONS: After flapless extraction of teeth, and using a minimum healing period of 12 weeks as a temporal measure, xenografts and allografts resulted in the least loss of socket dimensions compared to alloplasts or sockets with no grafting. Histologic outcomes after a minimum of 12 weeks of healing showed that sockets grafted with alloplasts had the maximum amount of vital bone and the least amount of remnant graft material and remnant connective tissue. There is a limited but emerging body of evidence for the predictable regeneration of deficient buccal bone with socket grafting materials, need for barrier membranes, use of tissue engineering, and use of autogenous soft tissue grafts from the palate to cover the socket.

Evaluation of experimental coating to improve the zirconia-veneering ceramic bond strength.

PURPOSE: To evaluate the shear bond strength (SBS) between zirconia and veneering ceramic following different surface treatments of zirconia. The efficacy of an experimental zirconia coating to improve the bond strength was also evaluated. MATERIALS AND METHODS: Zirconia strips were fabricated and were divided into four groups as per their surface treatment: polished (control), airborne-particle abrasion, laser irradiation, and application of the experimental coating. The surface roughness and the residual monoclinic content were evaluated before and after the respective surface treatments. A scanning electron microscope (SEM) analysis of the experimental surfaces was performed. All specimens were subjected to shear force in a universal testing machine. The SBS values were analyzed with one-way ANOVA followed by Bonferroni post hoc for groupwise comparisons. The fractured specimens were examined to observe the failure mode. RESULTS: The SBS (29.17 MPa) and roughness values (0.80) of the experimental coating group were the highest among the groups. The residual monoclinic content was minimal (0.32) when compared to the remaining test groups. SEM analysis revealed a homogenous surface well adhered to an undamaged zirconia base. The other test groups showed destruction of the zirconia surface. The analysis of failure following bond strength testing showed entirely cohesive failures in the veneering ceramic in all study groups. CONCLUSION: The experimental zirconia surface coating is a simple technique to increase the microroughness of the zirconia surface, and thereby improve the SBS to the veneering ceramic. It results in the least monoclinic content and produces no structural damage to the zirconia substructure.

The Anatomic Inter Relationship of the Neurovascular Structures Within the Inferior Alveolar Canal: A Cadaveric and Histological Study.

OBJECTIVE: The location and inter relationship of the structures of the inferior alveolar neurovascular bundle within the mandibular canal has not been clearly defined. The knowledge of the same is important while planning surgeries in the posterior mandible. METHODS: Eight cadaveric mandibles were dissected and sections were made at the distal aspect of every tooth. The inferior alveolar neurovascular bundle was identified and examined for the location of the inferior alveolar artery, vein and nerve. Hematoxylin and Eosin sections were made for each specimen to confirm the position of these structures. RESULTS: All the sections in all the specimens confirmed that a blood vessel lies superior to the nerve. This position appeared consistent in all the positions relative to all the posterior teeth. There was a variation in the bucco-lingual positioning of these structures relative to each other for the various mandibles. CONCLUSION: A blood vessel is found to always lie superior to the inferior alveolar nerve within the mandibular canal. Variations in the inter relationship of the structures is present. SIGNIFICANCE: This cadaveric study proves that all along the course of the neurovascular bundle, at various cross-sections studied, the inferior nerve is always inferior to a blood vessel. There can be great variations to the positioning of the structures within the neurovascular bundle in the bucco-lingual dimension and also in the exit of the nerve in various mandibles. Knowledge of the location of the structures is of importance during surgical procedures carried out in the vicinity of these structures.

Zirconia Intra Mucosal Inserts as a Retentive Aid for Maxillary Complete Dentures: A Case Report.

Complete dentures fabricated for edentulous patients with resorbed ridges generally have compromised retention and stability. The use of intramucosal inserts in order to aid retention of a maxillary denture has been reported in the past. Zirconia is a tissue compatible biomaterial whose scope and application in dentistry is on the rise. This paper reports the fabrication of zirconia intramucosal inserts and the technique of its incorporation in the maxillary complete denture in order to enhance retention, stability and thereby oral function.

Easy Accurate Transfer of the Sculpted Soft Tissue Contours to the Working Cast: A Clinical Tip.

Tooth replacement in the esthetic zone presents a myriad of challenges for the clinician. An ovate pontic accurately duplicates the emergence profile of the natural tooth it replaces in order to provide an esthetic, yet cleansable prosthesis. The accurate transfer of this sculpted tissue beneath the pontic of the provisional restoration is critical to provide the dental laboratory technician with the necessary information to fabricate a definitive restoration with an appropriate emergence profile. This article presents an innovative, simple and convenient impression technique for easy and accurate transfer of the tissue contours to the working cast, avoiding tissue collapse and tissue compression produced due to the impression material.

An in vitro investigation to compare the surface roughness of auto glazed, reglazed and chair side polished surfaces of Ivoclar and Vita feldspathic porcelain.

The change in surface roughness after different surface finishing techniques has attracted the attention of several prosthodontists regarding wear of opposing teeth or restorative material and the strength; plaque retention and appearance of the restoration. However, there is considerable controversy concerning the best methods to achieve the smoothest and strongest porcelain restorations after chair side clinical adjustments. The purpose of this in vitro study was to compare the average surface roughness of a self-glazed surface, a chair side polished surface and a reglazed surface of ceramic. Two feldspathic porcelain, namely VITA VMK94 (Vita Zahnfabrik, Bad Sachingen, Germany) and IVOCLAR CLASSIC (Vivadent AG, FL-9494 Schaan, Liechtenstein) were selected to fabricate 20 specimens of each in the shape of shade guide tabs. A medium-grit diamond rotary cutting instrument was used to remove the glaze layer, and then the surface of half the specimens were re-glazed and the other half were polished using a well-defined sequence of polishing comprising of: Shofu porcelain polishing system, White gloss disc/polishing wheel, Silicone cone with diamond polishing paste and finally with small buff wheel with pumice slurry. The surface roughness (Ra) (µm) of the specimens was evaluated using a profilometer and scanning electron microscope. The data were statistically analyzed by using Student's t test. The results had shown that there is no statistically significant difference both quantitatively and qualitatively, between the surface roughness of reglazed and chair-side polished surface. In addition, both reglazed and chair-side polished surfaces are better than the autoglazed surface. Within all the groups, there is no significant difference between companies. Polishing an adjusted porcelain surface with the suggested sequence of polishing will lead to a finish similar to a re-glazed surface. Therefore chair-side polishing can be a good alternative to reglazing for finishing adjusted porcelain surface.