Effect of preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes on bacterial contamination during dental implant surgery: A randomized controlled clinical trial.

Background: Although the role of chlorhexidine and other mouthwashes in periodontal therapy has been elucidated, little information is available on their use as routine preoperative mouth rinses before surgery, especially in periodontal procedures such as dental implant surgery. Objective: This study aimed to compare the efficacy of preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes in reducing bacterial contamination at the time of implant placement. Materials and Methods: Eligible patients who underwent dental implant surgery were randomly divided into four groups based on the mouthwash used: (1) 0.12 % chlorhexidine, (2) essential oil, (3) cetylpyridinium chloride, and (4) saline (served as the control group). All the patients of each group rinsed preoperatively with 15 mL of the respective mouthwash for 60 s. Saliva samples before (pre) and immediately after rinsing with the mouthwash (post) and after suturing the flap (end) were collected on the day of the implant placement. Real-time quantitative polymerase chain reaction (qPCR) was performed to analyze the samples and quantify the targeted periodontal pathogens using a propidium monoazide (PMA) dye. Results: Forty patients were included in the study. Real-time qPCR demonstrated a significant reduction in the number of pathogens in the saliva samples of the mouthwash groups compared to that of the control group. A statistically significant difference was observed between the groups for the pre-post and pre-end samples (p < 0.001) but not for the post-end samples (p = 0.203). A statistically significant difference was observed between the chlorhexidine, essential oil, and cetylpyridinium chloride mouthwash groups and the saline group (P < 0.001). The bacterial counts significantly differed with and without the use of the PMA dye. Conclusions: Preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes can reduce the bacterial load at the time of implant placement, thereby reducing the incidence of implant-related complications.

Histological and histomorphometric evaluation of alveolar ridge preservation using an allograft and nonresorbable membrane with and without primary closure: A pilot randomized controlled clinical trial.

The aim of this article is to assess the formation of new vital bone (VB) using histomorphometric analysis in alveolar ridge preservation (ARP), with and without primary closure. Eight patients needed bilateral tooth extraction and planned for ARP. All patients had a nonresorbable membrane with freeze-dried bone allograft after the extractions. Biopsies were obtained 6 months after ARP and were evaluated using histomorphometric analysis. The study included 6 males and 2 females, with an average age of 54.2 years (standard deviation, 9.7). The teeth requiring extraction included a bilateral canine (1 case), premolars (5 cases), and molars (2 cases). Histomorphometric values of new VB, residual bone (RB) substitute particles, and marrow tissue formation were 71.1 %, 16.2%, and 9.69% for closed flap and 50.9%, 15.3%, and 8.19 for open flap. P values were 0.066, 0.878, and 0.326, respectively. The present findings indicate that leaving the flap without primary closure did not have any effect on new VB, RB particles, and immature bone marrow compared with closed flap. However, the results favored the closed-flap technique.

Laser therapy for dentinal hypersensitivity.

BACKGROUND: Dentinal hypersensitivity is characterized by short, sharp pain from exposed dentine that occurs in response to external stimuli such as cold, heat, osmotic, tactile or chemicals, and cannot be explained by any other form of dental defect or pathology. Laser therapy has become a commonly used intervention and might be effective for dentinal hypersensitivity. OBJECTIVES: To assess the effects of in-office employed lasers versus placebo laser, placebo agents or no treatment for relieving pain of dentinal hypersensitivity. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2020, Issue 9), MEDLINE Ovid (1946 to 20 October 2020), Embase Ovid (1980 to 20 October 2020), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 20 October 2020), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; from 1982 to 20 October 2020). Conference proceedings were searched via the ISI Web of Science and ZETOC, and OpenGrey was searched for grey literature. The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomized controlled trials (RCTs) in which in-office lasers were compared to placebo or no treatment on patients aged above 12 years with tooth hypersensitivity. DATA COLLECTION AND ANALYSIS: Two review authors independently and in duplicate screened the search results, extracted data, and assessed the risk of bias of the included studies. Disagreement was resolved by discussion. For continuous outcomes, we used mean differences (MD) and 95% confidence intervals (CI). We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS: We included a total of 23 studies with 936 participants and 2296 teeth. We assessed five studies at overall low risk of bias, 13 at unclear, and five at high risk of bias. 17 studies contributed data to the meta-analyses. We divided the studies into six subgroups based on the type of laser and the primary outcome measure. We assessed the change in intensity of pain using quantitative pain scale (visual analogue scale (VAS) of 0 to 10 (no pain to worst possible pain)) when tested through air blast and tactile stimuli in three categories of short (0 to 24 hours), medium (more than 24 hours to 2 months), and long term (more than 2 months). Results demonstrated that compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through air blast stimuli at short term (MD -2.24, 95% CI -3.55 to -0.93; P = 0.0008; 13 studies, 978 teeth; low-certainty evidence), medium term (MD -2.46, 95% CI -3.57 to -1.35; P < 0.0001; 11 studies, 1007 teeth; very low-certainty evidence), and long term (MD -2.60, 95% CI -4.47 to -0.73; P = 0.006; 5 studies, 564 teeth; very low-certainty evidence). Similarly, compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through tactile stimuli at short term (MD -0.67, 95% CI -1.31 to -0.03; P = 0.04; 8 studies, 506 teeth; low-certainty evidence) and medium term (MD -1.73, 95% CI -3.17 to -0.30; P = 0.02; 9 studies, 591 teeth; very low-certainty evidence). However, there was insufficient evidence of a difference in pain intensity for all types of lasers when tested through tactile stimuli in the long term (MD -3.52, 95% CI -10.37 to 3.33; P = 0.31; 2 studies, 184 teeth; very low-certainty evidence). Most included studies assessed adverse events and reported that no obvious adverse events were observed during the trials. No studies investigated the impact of laser treatment on participants' quality of life. AUTHORS' CONCLUSIONS: Limited and uncertain evidence from meta-analyses suggests that the application of laser overall may improve pain intensity when tested through air blast or tactile stimuli at short, medium, or long term when compared to placebo/no treatment. Overall, laser therapy appears to be safe. Future studies including well-designed double-blinded RCTs are necessary to further investigate the clinical efficacy of lasers as well as their cost-effectiveness.

Volumetric Changes Following Lateral Guided Bone Regeneration.

Resorbable membranes are well described and employed for horizontal guided bone regeneration (GBR). However, the currently available literature does not provide information on the bone volumetric changes during the healing that follows GBR procedures and dental implant placement. Therefore, the aim of this pilot study was to initially analyze the volumetric bone changes after treating pristine edentulous mandibular defects with lateral GBR using freeze-dried bone allograft (FDBA) and collagen resorbable membrane. Six patients were selected for the analysis. Clinical changes in bone volume before and after GBR were measured. In addition, digital volumetric analysis of the augmented ridges was performed preoperatively, as well as 4 and 6 months after the GBR procedure. At the time of dental implant placement, bone cores were collected during the osteotomy for histologic analysis. Data on volume changes showed a mean of 297.5 ± 134 mm3 augmented bone volume at 4 months with 5% ± 3.78% resorption from 4 to ≥ 6 months. Histologic bone core analysis showed 44.9% plusmn; 5.1% mineralization in the area of augmentation. Within the limitations of this pilot study, resorbable membranes exhibited reliability for GBR in intercalated mandibular defects, providing sufficient bone volume gain at ≥ 6 months for implant stabilization and limited resorption during graft healing.

A Comparison between Primary and Secondary Flap Coverage in Ridge Preservation Procedures: A Pilot Randomized Controlled Clinical Trial.

AIMS: To assess the bone dimensional changes after extraction and alveolar ridge preservation (ARP) using primary coverage (closed flap technique, CFT) or healing by secondary intention (open flap technique, OFT). MATERIALS AND METHODS: Ten patients (split mouth design) were planned for extraction and ARP. All sites received ARP with freeze-dried bone allograft (FDBA) and nonresorbable membrane after extraction. Clinical standardized measurements were used to assess the dimensional alterations of the alveolar ridge. RESULTS: All patients completed the study, and a total of 20 sites were randomized to CFT or OFT group. Center height (mean difference of 8.1 mm, SD =1.9 CFT, and 7.5 mm, SD= 1.8 OFT) and buccal height (mean difference of 0.8 mm, SD =1.0 CFT, and 0.3 mm, SD= 1.1 OFT) were significantly different within the same group. However, there was no statistically significant difference between groups. In the OFT group, the keratinized tissue width was higher and the pain VAS scores at 24 hours were lower compared with the CFT (p = 0.004 and p = 0.006, respectively). CONCLUSIONS: Leaving the flap open did not have any effects on the dimensional changes of bone height or width. However, there was a wider band of keratinized tissue and less pain with the CFT compared with the OFT. The study protocol was registered at ClinicalTrials.gov, Identifier NCT03136913.

Bone Resorption During Submerged Healing After Guided Bone Regeneration: A Prospective Case Series.

OBJECTIVE: The aim of this study was to evaluate bone resorption quantitatively during the healing period subsequent to ridge augmentation. MATERIALS AND METHODS: Sixteen patients requiring vertical ridge augmentation before implant placement were recruited in the study. The study used an allograft and nonresorbable membrane. A custom acrylic stent was used to measure changes in bone volume. Augmented bone was compared with remaining bone 6 months after guided bone regeneration (α = 0.05 by means of the paired t test). RESULTS: All sites following the six months post-surgery were analyzed. Overall changes in alveolar bone were observed with a mean resorption rate of 19.8% (p<0.001). The vertical bone measurement indicated a mean resorption rate of 22.8% (range = 18.5% - 26.5%). The horizontal measurement indicated a mean resorption rate of 18.7% (range = 12.6% - 26.0%). Among the sixteen sites, four sites with post-operative complications including membrane exposure showed an average of 42.1% resorption rates. CONCLUSION: Loss in graft quantity was observed after ridge augmentation using an allograft and nonresorbable membrane during submerged healing before implant placement. Further studies with larger sample sizes are recommended to confirm its findings.

Association Between Sinus Membrane Thickness and Membrane Perforation in Lateral Window Sinus Augmentation: A Retrospective Study.

BACKGROUND: Association between Schneiderian membrane thickness and membrane perforation is examined in lateral window sinus augmentation. METHODS: This retrospective study reviewed records of 551 patients who underwent lateral sinus augmentation at Tufts University School of Dental Medicine, Boston, Massachusetts, from June 1, 2006 to May 31, 2015. Preoperative cone-beam computed tomography images were analyzed to evaluate possible association among membrane thickness, residual bone height, and membrane perforation. Data were evaluated using Mann-Whitney U test at P <0.05. RESULTS: Total 167 patients (95 males and 72 females) met the eligibility criteria and were included in the study. Among them, 47 patients had Schneiderian membrane perforation (perforation group). Mean membrane thickness was 0.84 ± 0.67 mm in the perforation group and 2.65 ± 4.02 mm in the non-perforation group. There was a statistically significant difference in membrane thickness between groups (P <0.001). Mean residual ridge thickness was 2.78 ± 1.37 mm in the perforation group and 4.21 ± 2.09 mm in the non-perforation group. There was a statistically significant difference in residual alveolar bone height (P <0.001). CONCLUSIONS: Patients who experienced membrane perforation had a thinner membrane compared with patients without membrane perforation. Schneiderian membrane perforation was associated with decreased residual bone height.

Use of Allograft with Platelet Concentrate in the Treatment of Multiple Miller Class III Gingival Recession Defects: Report of Three Cases.

Three patients with multiple Miller Class III recession defects with substantial bone loss were treated with hard tissue augmentation with the goal to prevent future recessions. The surgery involved a full-thickness mucoperiosteal coronally advanced flap, bone grafting, and primary flap closure. Freeze-dried bone allograft (FDBA) in combination with plasma rich in growth factors (PRGF) was grafted during the procedure. After more than 6 months, the treated sites showed soft tissue maturation and esthetic tissue blending. Clinically, an increase in convexity of alveolar ridge and soft tissue was observed, as well as a marked reduction in recession depth and gain in width of keratinized mucosa. Cone beam computed tomography showed a gain in buccal bone thickness. The use of FDBA in combination with PRGF appears to have potential for the treatment of Miller Class III defects by providing improved hard and soft tissue profiles.

Crestal bone resorption in augmented bone using mineralized freeze-dried bone allograft or pristine bone during submerged implant healing: a prospective study in humans.

BACKGROUND: There is limited evidence on the crestal bone level changes around implants placed in bone augmented by guided bone regeneration (GBR) during submerged healing. The purpose of this study was to prospectively compare radiographic crestal bone changes around implants placed in augmented bone with changes around implants placed in pristine bone. MATERIALS AND METHODS: Patients receiving dental implants in the augmented or pristine mandibular posterior edentulous ridge were included in the study. The digital standardized radiographs from the implant placement procedure were compared to the radiographs from the second-stage procedure to evaluate the peri-implant marginal bone level changes. The soft tissue thickness (ST), width of keratinized mucosa (wKM), and early cover screw exposure (eIE) were measured at the time of the second-stage procedure. RESULTS: A total of 29 implants in 26 patients, 11 in augmented bone (test group) and 18 in pristine bone (control group), were analyzed. The mean peri-implant bone loss (ΔBL) was 0.74 ± 0.74 mm (mean ± SD) in the test group and 0.25 ± 0.55 mm (mean ± SD) in the control group. The differences between the test and control groups in the mesial, distal, and mean peri-implant crestal bone level changes were statistically significant (P = 0.009, P = 0.004, and P = 0.001, respectively). The confounding factors (ST, wKM, and eIE) were adjusted. CONCLUSIONS: More peri-implant crestal bone loss during the submerged healing period was observed in augmented bone than in pristine bone. Augmented bone may not exhibit the same characteristics as pristine bone during the implant submerged healing period.

Microbiologic Findings in Relation to Risk Assessment for Periodontal Disease: A Cross-Sectional Study.

BACKGROUND: In this study, an association between a computerized risk calculator and microbiologic testing is examined in patients with periodontitis. METHODS: Seventy-four patients with moderate and severe periodontitis were selected from patients receiving treatment at Tufts University School of Dental Medicine. Their periodontal risk was analyzed with a periodontitis risk assessment tool, and microbiologic testing was performed. Periodontitis risk assessment and microbiologic testing were examined for a possible association. The data were evaluated by the χ(2) test at P <0.05 levels. RESULTS: Forty-six patients scored as having a "very high" risk of periodontitis and 22 patients scored as having a "high" risk of periodontitis by the risk assessment tool. Patients with a risk score of very high risk showed a higher detection of each bacterium except Capnocytophaga species than the rest of the study population. Treponema denticola and Prevotella intermedia (P = 0.01 and P = 0.02, respectively) were two bacteria that showed a statistically significant difference between patients at very high risk and those at high risk. CONCLUSIONS: Patients with periodontitis were identified as high risk and very high risk compared with the rest of the risk categories by the risk assessment tool. The study population, categorized mostly as very high risk, showed high detection of putative periodontal bacteria.

Comparison of double-flap incision to periosteal releasing incision for flap advancement: a prospective clinical trial.

PURPOSE: The aim of this study was to evaluate the efficacy and morbidity of two periodontal releasing incision techniques in vertical ridge augmentation. MATERIALS AND METHODS: Twenty-three vertical and horizontal defects (Seibert Class III) were selected to compare the double-flap incision (DFI) to the conventional periosteal releasing incision (PRI). An incision technique was randomly assigned for flap advancement. The amount of flap advancement, the incidence of postsurgical complications, and the level of patient discomfort were compared. Flap advancement was measured with a UNC-15 probe as the difference between the initial elevated flap and the final advanced flap. Postsurgical complications including premature membrane exposure, infection, paresthesia, and continuous discomfort were noted at follow-up visits. A visual analog scale (VAS) was used to quantify the amount of pain, swelling, and bleeding in the patients. RESULTS: An average of 9.64 ± 0.92 mm flap advancement was accomplished for DFI, whereas PRI advancement averaged 7.13 ± 1.45 mm (P < .001). Premature membrane exposures occurred in two sites in the PRI group and one site in the DFI group. Paresthesia, infection, and continuous discomfort were noted in one site each in the PRI group. The difference between groups in the incidence of postoperative complications (PRI, 5; DFI, 1) was not significant (P < .082). The mean pain, swelling, and bleeding scores for DFI (1.55 ± 1.21, 1.91 ± 0.94, and 0.40 ± 0.12, respectively) were lower than those of the PRI group (3.75 ± 2.63, 3.25 ± 1.29, and 1.16 ± 0.34, respectively) (P = .019, P = .010, and P = .061, respectively). CONCLUSIONS: Flap advancement was facilitated and morbidity was decreased in the DFI group. The technique may have potential to serve as an alternative to PRI to overcome some of the latter's limitations.