Microcomputed tomographic analysis of bone microarchitecture after sinus augmentation with hyaluronic matrix: a case-control study.

BACKGROUND: The aim of this study was to analyze trabecular microarchitecture of augmented sinuses with hyaluronic matrix and xenograft by microcomputed tomography, and to investigate whether hyaluronic matrix has an effect on the newly formed bone quality. MATERIALS AND METHODS: Thirteen patients undergoing maxillary sinus augmentation were included in this split-mouth study. Right and left sinus sites were randomly assigned to test and control group. In test group, the sinus was grafted with hyaluronic matrix and xenograft; in control group, only with xenograft. Four months after augmentation, bone samples were harvested during implant placement and analyzed for the following trabecular microarchitecture parameters using microcomputed tomography: bone volume (BV), total volume (TV), bone volume fraction (BV/TV), bone surface (BS), specific bone surface (BS/BV), bone surface density (BS/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular pattern factor (Tb.Pf), and fractal dimension (FD). RESULTS: There was statistically significant difference only for BS/TV parameter between two groups. BS/TV was higher in hyaluronic matrix group compared with control group. CONCLUSIONS: Addition of hyaluronic matrix to xenograft may enhance bone quality in terms of bone surface density. However, more research investigating the microstructural variation of augmented sinuses is needed with a greater sample.

Mandibular cortical indices and their relation to gender and age in the cone-beam computed tomography.

OBJECTIVES: The purpose of this study is to evaluate normal ranges of cortical bone Hounsfield units indices through cone beam CT images, and to investigate their relationships with age and sex. METHODS: 700 adult human cone beam CT images were evaluated retrospectively, and divided into 4 age groups. Six different cortical bone Hounsfield unit measurements were applied bilaterally, where gender and age were recorded. Collected data were subjected to statistical analysis and ANOVA tests were used for various comparisons. RESULTS: The cortical bone measurements between female and male patients were significantly different (p<0.05). Cortical bone thickness indices showed greater values in male patients compare to female patients (p<0.05). Quantitative mandibular indices were significantly lower in first age group (18-30 years) than other three older age groups (p<0.01). CONCLUSION: The results of this study seems to propose a persistent alteration in the mandibular cortical bone with age and that this influced by sex. Further studies with larger patient groups are needed to clarify and understand these mandibular indices.

Maxillary Sinus and Surrounding Bone Anatomy With Cone Beam Computed Tomography After Multiple Teeth Loss: A Retrospective Multicenter Clinical Study.

PURPOSE: The aim of this multicenter study was to examine the residual alveolar bone anatomy and sinus mucosa pattern at maxillary sinus regions in multiple teeth loss. MATERIALS AND METHODS: This study was conducted with cone beam computed tomography images of 518 patients (267 females and 251 males) with multiple posterior maxillary teeth loss. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height and ridge width, posterior superior alveolar artery, and adjacent roots were evaluated. RESULTS: No (58.2%) or flat (19.3%) thickening morphology was detected at most of the SMs. Membrane thickening and mucosal-like morphology was more prevalent for male patients (P = 0.005). The mean sinus width was relatively low (3.64 ± 3.33 mm) at the 5-mm level and showed an expected increase toward upper levels. Most of the sinus spaces were dimensionally average (39.5%) or wide (44.7%), and no effect of gender was observed in terms of sinus dimensions (P > 0.05). CONCLUSION: Multiple teeth loss plays a role in creating an imaginary sinus anatomy constituted of a relatively narrow space compared with single-tooth loss cases, from 3.6-mm mean coronal width to 11.3 mm in the apical portion.

Evaluation of anatomical structures and variations in the maxilla and the mandible before dental implant treatment.

BACKGROUND: Cone beam computed tomography (CBCT) allows a detailed visualization of the anatomic structures of the jaw. There have been presented variations of the anatomic structures between genders after evaluating the structures in detail. OBJECTIVES: The aim of this study was to investigate the anatomic variations of the jaws according to gender and age in an effort to avoid complications during implant surgeries. MATERIAL AND METHODS: In this retrospective study, a total of 159 scans (87 of the maxilla, 72 of the mandible) were evaluated in order to analyze the effect of age and gender on these anatomic variations. RESULTS: According to statistical analysis, gender affected the crestal dimensions above the mandibular canal and sinus mucosal thickening. The mean value of the width of the mandibular canal, the distance between the mandibular canal and the superior border of the mandible, the distance between the mandibular canal and the inferior border of the mandible, the diameter of the mental foramen, the distance between the mental foramen and the inferior border of the mandible, and the distance between the lingual foramen and the inferior border of the mandible were significantly greater in female patients than in male subjects (p < 0.001). However, sinus mucosal thickening and the diameter of the posterior superior alveolar artery (PSAA) were significantly greater in males as compared to females (p < 0.001). While the configuration of the nasopalatine canal was funnel-shaped in female patients, this configuration was found to be cylinder-shaped in male subjects. A high prevalence of sinus septa (43.7%) and PSAA (87.4%) was detected in the scans. CONCLUSIONS: When planning dental implants, radiographic examinations, alongside clinical examinations, have become necessary to reduce the risk of implant surgery failure and complications. The CBCT imaging is a valuable tool to determine the anatomic structures before carrying out any surgeries, including implant surgery. Gender affects anatomical variations and dimensions significantly, even when they are not affected by age. Large population focused and multicenter studies may provide a better understanding of the need to evaluate the anatomical structures in detail.

Nanofilled and conventional resin-modified glass ionomer fillings combined with connective tissue grafts for treatment of gingival recessions with non-carious cervical lesions.

The aim of this study was to evaluate the clinical root coverage results of subepithelial connective tissue grafts (SCTG) performed on teeth with gingival recessions and non-carious cervical lesions (NCCLs) that were restored with cervical fillings and compare the results of two different filling materials: resin-modified glass ionomer (RMGIC) and nano-ionomer cements (NIC). A total of 54 teeth with Miller Class I gingival recessions with or without NCCLs in 36 patients (28 females, 8 males) were treated with SCTGs. Cervical lesions were randomly treated with RMGIC or NIC restorations. Periodontal clinical parameters, height of gingival recession (HGR), width of gingival recession (WGR), height of keratinized tissue, and dentin sensitivity were measured at baseline and 3, 6, and 12 months postoperatively. HGR and WGR values were statistically significantly reduced at all time points when compared to baseline values in all groups. There were no statistically significant differences between the groups in any clinical periodontal parameter (P > 0.05). The percentage of root coverage at 12 months was 89.5%, 90.1%, and 96.2% in the RMGIC, NIC, and control groups, respectively. Successful root coverage with connective tissue grafts may be achieved on teeth restored with RMGIC or NIC cervical fillings.

A Comparison of Esthetic Features of Pre-existing Natural Tooth Versus Post-Implant Restoration in the Esthetic Zone: A Retrospective 12-month Follow-up.

PURPOSE: To correlate the link between natural teeth located in esthetic regions of the arches before extraction with their definitive dental implant restorations, and to propose a new and contemporary esthetic index based on the natural dentition (EIND) preoperatively. MATERIALS AND METHODS: Patients possessing a high smile line with teeth requiring implant replacement therapy in the maxillary anterior region were included. Clinical intraoral photographs and periapical digital radiographs taken before extraction and 10 ± 1.5 months (range: 9 to 12 months) after the delivery of implant-supported permanent restorations were used to make the measurements and evaluations according to the proposed index. Pink esthetic score (PES) parameters were analyzed. Statistical analyses of preimplant and postimplant parameters between tooth sites and implant sites were carried out with a computer software program. RESULTS: The study included 51 patients (35 women, 16 men), with a mean age of 39.6 years, with a total of 83 dental implants placed in the maxillary anterior region. Of these, there were 6 right canines, 22 right lateral incisors, 11 right central incisors, 22 left central incisors, 17 left lateral incisors, and 5 left canines. Of the 83 included implants, 67 were immediately and 16 were delayed placed. Statistical analyses between tooth sites and implant sites showed significant differences in tissue contour (P = .001), texture (P = .001), alveolar deficiency (P = .001), and total PES (P = .007). No statistically significant difference was detected in mesial papilla, distal papilla, tissue margin, tissue biotype, and the amount of keratinized mucosa. Additionally, R2 value presented a higher variance and lower predictable values of peri-implant tissue parameters compared with those of the natural dentition. CONCLUSION: This study analyzed various periodontal and peri-implant soft and hard tissue parameters, and a new index system, EIND, was proposed. This index could be used to collect the esthetic-related parameters for pre-extraction treatment planning and provide valuable information for esthetic risk assessment.

Injuries Among Recreational Football Players: Results of a Prospective Cohort Study.

OBJECTIVES: To establish the incidence and patterns of football injuries and associated consequences in daily life and labor loss, among public employees. DESIGN: Prospective cohort study. SETTING: Football tournament between public employees in Turkey. PARTICIPANTS: A total of 1821 recreational players from 78 teams. MAIN OUTCOME MEASURES: Injury rates (injuries per 1000 hours of football exposure) during tournament by age group, as well as prevalence, severity, and injury types were recorded. The data regarding the occurrence (eg, location, type, circumstances) and consequences (eg, absenteeism, medical treatment, labor loss) of injuries were collected. RESULTS: Of the 1821 football players registered for participation, 57% (n = 1038) were included in the study with the returned questionnaire forms. In total, 257 matches were played with a total exposure time of 5654 hours. A total of 218 injuries were recorded in 192 players (10.5%), resulting in a mean of 0.85 time-loss injuries per match (38.6 per 1000 hours). Severe injuries constituted 42.6% of all injuries, and 28.9% of all injuries caused the participants to be absent at least 1 day for the next working day. The total labor loss was 1196 days for all injuries. The rate of missing subsequent working day was significantly less for muscle injuries (P < 0.05). CONCLUSIONS: The risk of injury in recreational football players is relatively high causing significant labor loss. The results suggest that prevention programs should consider specific injury characteristics, as there is a greater incidence of muscle and anterior cruciate ligament injuries in this population.

Evaluation of Single Tooth Loss to Maxillary Sinus and Surrounding Bone Anatomy With Cone-Beam Computed Tomography: A Multicenter Study.

BACKGROUND: Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. RESULTS: The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. CONCLUSION: The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

The 1st Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2016. Summary and Consensus Statements: Group II - Peri-Implantitis Diagnostics and Decision Tree.

INTRODUCTION: The task of Group 2 was to review and update the existing data concerning clinical and genetic methods of diagnostics of peri-implantitis. Special interest was paid to the peri-implant crevicular fluid (PICF) overview including analysis of enzymes and biomarkers and microbial profiles from implants. MATERIAL AND METHODS: The main areas of interest were as follows: effect of smoking and history of periodontitis, prosthetic treatment mistakes, excess cement, overloading, general diseases influence on peri-implantitis development. The systematic review and/or meta-analysis were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was searched and reported using the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. The method of preparation of systematic reviews of the literature based on comprehensive search strategies was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic review and/or meta-analysis is presented in Preface chapter. RESULTS: The results and conclusions of the review process are presented in the respective papers. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.

Peri-Implant Crevicular Fluid Analysis, Enzymes and Biomarkers: a Systemetic Review.

OBJECTIVES: To review the current understanding of the biomarkers and enzymes associated with different forms peri-implant diseases and how their level changes influence the pathogenesis of the inflammatory diseases around dental implants. MATERIAL AND METHODS: An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE between 1996 to 2016. Human studies analyse peri-implant crevicular fluid (PICF) biomarker and enzyme levels of implants having peri-implant mucositis and peri-implantitis published in English language, were evaluated. A systematic review was performed to assess which biomarkers and enzymes in PICF were used to identify the inflammatory conditions around dental implants. RESULTS: Fifty-one articles were identified of which 41 were further evaluated and included in the analysis. Due to significant heterogeneity between included studies, a meta-analysis could not be performed. Instead, a systematic descriptive review was performed. CONCLUSIONS: Biomarkers and enzymes in peri-implant crevicular fluid have shown promising results in differentiating from peri-implant disease condition to health. However, due to inconsistent results and acquiring much evidence from cross-sectional studies, additional evidence supported by randomized-controlled trials is needed to validate the links reported.

Radiographic Fractal and Clinical Resonance Frequency Analyses of Posterior Mandibular Dental Implants: Their Possible Association With Mandibular Cortical Index With 12-Month Follow-up.

BACKGROUND: The aim of the present study was to investigate whether the mandibular cortical index (MCI) has a relationship with fractal dimension of bone and/or implant stability, and to justify the possible association between MCI, fractal dimension, and stability. MATERIALS AND METHODS: Eighty-two subjects who received dental implants to replace missing mandibular premolar/molar sites were selected. Three months after surgical placement, implants were restored with fixed ceramic fused metal crowns. MCI was evaluated at baseline; fractal dimensions were measured with fractal analysis (FA) and implant stability quotient (ISQ) with resonance frequency analysis immediately after surgery and 12-month follow-up. RESULTS: FA at mesial and distal regions for Class 1, Class 2, and Class 3 MCI resulted with significant increases at 12-month follow-up compared to baseline. The ISQ in patients with Class 2 and Class 3 MCI resulted with a significant decrease compared to Class 1 MCI at baseline and at 12 months. All MCI classes evaluated with ISQ and FA at baseline values resulted with significant increases at 12 months. Significant correlations were considered for all mandibular posterior implants between baseline and 12-month measurements for ISQ and FA evaluations. CONCLUSIONS: Fractal analysis may be a useful method for understanding the healing process around implants and implant stability quotient values. Mandibular cortical index evaluations should be considered before implant procedures, which may provide a presurgical treatment plan and may provide information about the mandibular bone quality.

Oxidative Stress and Periodontal Disease in Obesity.

Periodontal disease is a chronic inflammatory disease of the jaws and is more prevalent in obesity. Local and systemic oxidative stress may be an early link between periodontal disease and obesity. The primary aim of this study was to detect whether increased periodontal disease susceptibility in obese individuals is associated with local and systemic oxidative stress. Accordingly; we analyzed periodontal status and systemic (serum) and local (gingival crevicular fluid [GCF]) oxidative status markers in young obese women in comparison with age-matched lean women.Twenty obese and 20 lean women participated. Periodontal condition was determined by clinical periodontal indices including probing depth, clinical attachment level, gingival index, gingival bleeding index, and plaque index. Anthropometric, hormonal, and metabolic measurements were also performed. Blood and GCF sampling was performed at the same time after an overnight fasting. Serum and GCF total antioxidant capacity (TAOC), and total oxidant status (TOS) levels were determined, and oxidative stress index (OSI) was calculated.Clinical periodontal analyses showed higher gingival index and gingival bleeding index in the obese group (P = 0.001 for both) with no significant difference in probing depth, clinical attachment level, and plaque index between the obese and the lean women. Oxidant status analyses revealed lower GCF and serum TAOC, and higher GCF and serum OSI values in the obese women (P < 0.05 for all). GCF TOS was higher in the obese women (P < 0.05), whereas there was a nonsignificant trend for higher serum TOS in obese women (P = 0.074). GCF TAOC values showed a negative correlation with body mass index, whereas GCF OSI was positively correlated with fasting insulin and low-density lipoprotein-cholesterol levels (P < 0.05 for all). Clinical periodontal indices showed significant correlations with body mass index, insulin, and lipid levels, and also oxidant status markers.Our results suggest that young obese, otherwise healthy, women show findings of early periodontal disease (gingival inflammation) compared with age-matched healthy lean women, and that local/periodontal oxidative stress generated by obesity seems to be associated with periodontal disease.

Management of Limited Vertical Bone Height in the Posterior Mandible: Short Dental Implants Versus Nerve Lateralization With Standard Length Implants.

Inferior alveolar nerve lateralization (IANL) and short dental implants (SDI) are 2 viable implant-based treatment approaches in the presence of atrophied posterior mandible. Despite the risks of dysfunction, infection, and pathologic fractures in IANL, it becomes possible to place standard implants. The purpose of this study was to compare SDI and IANL approaches from clinical and radiographic aspects. Fifteen subjects having unilateral atrophic mandibles were allocated to SDI and IANL treatment groups. Following surgical procedures, early postoperative complications, implant survival, and periimplant clinical and radiographic parameters including probing pocket depth, attachment level, keratinized tissue amount, vertical tissue recession, and marginal bone loss were recorded at baseline and 1-year after prosthetic rehabilitation. In both groups, no implant was lost. Except usual postoperative complications, 2 patients had transient paraesthesia after IANL. According to time-dependent evaluation, both groups showed significant increase in probing pocket depth and attachment level at 1-year follow-up compared with baseline (P < 0.05). Except a slight but significant increase in mesial surface of SDI group (P < 0.05), no remarkable time-dependent change was identified in vertical tissue recession. Keratinized tissue amount did not exhibit any inter- or intragroup difference during whole study period. Marginal bone loss did not show any difference between IANL and SDI groups at follow-up. SDI placement or standard length implant placement with IANL can be considered promising alternatives in the treatment of atrophic mandibular posterior regions. However, SDI may be preferred in terms of lower complication risk.

Effect of Porous Titanium Granules on Bone Regeneration and Primary Stability in Maxillary Sinus: A Human Clinical, Histomorphometric, and Microcomputed Tomography Analyses.

The aim of this randomized controlled study was to comparatively analyze the new bone (NB), residual bone, and graft-bone association in bone biopsies retrieved from augmented maxillary sinus sites by histomorphometry and microcomputed tomography (MicroCT) in a split-mouth model to test the efficacy of porous titanium granules (PTG) in maxillary sinus augmentation. Fifteen patients were included in the study and each patient was treated with bilateral sinus augmentation procedure using xenograft (equine origine, granule size 1000-2000 µm) and xenograft (1 g) + PTG (granule size 700-1000 µm, pore size >50 µm) (1 g), respectively. After a mean of 8.4 months, 30 bone biopsies were retrieved from the implant sites for three-dimensional MicroCT and two-dimensional histomorphometric analyses. Bone volume and vital NB percentages were calculated. Immediate after core biopsy, implants having standard dimensions were placed and implant stability quotient values were recorded at baseline and 3 months follow-up. There were no significant differences between groups according to residual bone height, residual bone width, implant dimensions, and implant stability quotient values (baseline and 3 months). According to MicroCT and two-dimensional histomorphometric analyses, the volume of newly formed bone was 57.05% and 52.67%, and 56.5% and 55.08% for xenograft + PTG and xenograft groups, respectively. No statistically significant differences found between groups according to NB percentages and higher Hounsfield unit values were found for xenograft + PTG group. The findings of the current study supports that PTG, which is a porous, permanent nonresorbable bone substitute, may have a beneficial osteoconductive effect on mechanical strength of NB in augmented maxillary sinus.

Combined Endodontic and Surgical Treatment of Dens Invaginatus-Associated Extraoral Fistula: A Case Report with Seven-year Follow-up.

Dens invaginatus (dens in dente) is a developmental malformation of permanent or deciduous teeth that has various complex forms. It most commonly affects permanent maxillary lateral incisor teeth, and rarely affects the mandibular teeth. In this report, a rare case of dens invaginatus of a mandibular lateral tooth with an extraoral fistula is presented. A 10-year-old patient was referred to our clinic with extraoral symptoms that could not be diagnosed by medical doctors. Successful treatment with endodontic treatment and periapical surgery is described. Seven-year follow-up of the case is provided.

Prevalence of dental trauma and mouthguard awareness among weekend warrior soccer players.

Traumatic dental and facial injuries are frequent in sports and often cause esthetic, functional, psychological, and economic problems. The term "weekend warrior" is used to describe people who participate in physically demanding activities only on the weekend, or part-time. In this prospective cohort study, we examined the prevalence of dental trauma and knowledge of traumatic dental injuries among weekend warriors in Ankara, Turkey. A detailed questionnaire on mouthguard awareness and knowledge and experience of dental trauma was distributed to 1,007 weekend warrior athletes participating in a soccer tournament. The results showed that 9.8% of participants had experienced orofacial trauma, 21.7% were aware of mouthguards, 2.9% reported using mouthguards, 15.4% were aware of the field of sports dentistry, and 19.6% were aware of emergency treatment for dental trauma. Participation in sports, especially contact sports, greatly increases the risk of dental injury. The present results show that knowledge of traumatic orofacial and dental injuries is limited among weekend warriors. Public health authorities should develop relevant educational programs, including broad dissemination of information on the risks of traumatic dental injuries and methods for protection against such injuries.

Do Porous Titanium Granule Grafts Affect Bone Microarchitecture at Augmented Maxillary Sinus Sites? A Pilot Split-Mouth Human Study.

BACKGROUND: The aim of this randomized controlled clinical study was to analyze the bone microarchitecture at augmented maxillary sinus sites by using different materials in patients to compare the effect of porous titanium granules as a sinus augmentation material with bone microstructural features. MATERIALS AND METHODS: Eight subjects with bilateral atrophic posterior maxilla of residual bone height <4 mm included in this study and each patient was treated with bilateral sinus augmentation procedure using xenograft with equine origin (Apatos, Osteobiol; Tecnoss Dental) and xenograft (1 g) + porous titanium (1 g) granules (Natix; Tigran Technologies AB). Sixteen human bone biopsy samples were taken from patients receiving two-stage sinus augmentation therapy during implant installation and analyzed using microcomputerized tomography. Three-dimensional bone structural parameters were analyzed in details: tissue volume, bone volume, percentage of bone volume, bone surface and bone surface density, bone specific surface, trabecular thickness trabecular separation, trabecular number, trabecular pattern factor, structural model index, fractal dimension, and bone mineral density. RESULTS: No statistically significant differences were found between groups according to bone structural parameters. CONCLUSIONS: Porous titanium grafts may ensure a space for new bone formation in the granules, which may be a clinical advantage for long-term success.

The impact of handicap severity on oral and periodontal status of patients with mental retardation.

AIM: Mental retardation (MR) subjects comprise a considerable amount of the community and are susceptible to oral and periodontal problems due to insufficient oral care. The aim of this cross-sectional study was to determine the oral health and periodontal status of MR patients in Turkey with regard to periodontal indices and Decay missed filling teeth (DMFT) scores and compare findings according to severity of the MR. MATERIALS AND METHODS: One hundred and five MR patients were included to the study and divided into 3 groups according to MR severity diagnoses. Demographic variables like age, gender, disabled sibling, BMI, living an institution and clinical parameters like plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), missing teeth and DMFT scores were recorded from all subjects. Appropriate statistical analyses were used to compare the findings. RESULTS: There were no statistically significant differences between groups according to age, gender, disabled sibling, living status and DMFT scores. Clinical periodontal indices and the number of missing teeth were showed a statistically significant increasing trend with the severity of MR (p < 0.05). Correlation analysis showed significant positive correlations between PI and periodontal disease measures like GI, PD, CAL and BOP and also between PI and DMFT (p < 0.05). CONCLUSION: The deteriorated teeth condition and deprived periodontal health of MR patients may be most likely caused by the poor oral hygiene and may be worsen with the severity of the MR. Clinical significance: Knowledge of oral and periodontal status of mental retardation patients has great importance for public health and family education.

Intraoral use of extraoral implants for oral rehabilitation of a pediatric patient after resection of ewing sarcoma of the mandible and reconstruction with iliac osteocutaneous free flap.

Large osseous defects secondary to resection of the mandibular segment may lead to significant facial deformity, functional disabilities, and associated psychologic problems. The therapeutic approach is more complicated in pediatric patients because it must not interfere with normal craniofacial growth process. Here, we present a clinical report to emphasize the application of extraoral short implants with magnetic abutments used for mandible of a growing patient reconstructed with free iliac flap after resection of Ewing sarcoma. A 5-year-old boy, complaining of an ulcerated mass of the anterior mandibular area and floor of the mouth, was referred to our clinic. Incisional biopsy from the lesion confirmed the diagnosis of Ewing sarcoma. After resection, free iliac osteocutaneous flap, with a 6.5 × 4.0-cm skin paddle and based on the deep circumflex iliac vessels, was used to reconstruct the mandibular integrity and to cover the floor of the mouth simultaneously. Nine months after the operation, the patient was referred for oral rehabilitation. Prosthodontic plan included the placement of 5 extraoral implants with magnetic abutment and fabrication of an implant-retained overdenture. Magnetic abutment was preferred not to interfere with the expected craniofacial growth. During a follow-up period, radiographic images showed no pathologic signs with consideration of overall bone loss and recurrence of the tumor; 12 months after the initiation of prosthetic loading, no peri-implant bone loss was observed. In conclusion, this reported case would be an example for the management of challenging pediatric mandibular tumor cases in terms of resection, reconstruction and dental rehabilitation.

The influence of platform switching on clinical, laboratory, and image-based measures: a prospective clinical study.

PURPOSE: This prospective study was conducted to compare the marginal bone level alterations, stability/mobility measurements, and volume of myeloperoxidase (MPO) and nitric oxide (NO) of peri-implant sulcus fluid (PISF) between platform-switched (PS) and standard platform (SP) implants inserted to mandibular premolar/molar regions with a single-stage protocol. MATERIALS AND METHODS: Thirty-two (16 PS and 16 SP) implants restorated with fixed prosthesis were included in the study. For both implant systems standard implant dimensions were used. Implant abutment connections and final restorations were made after 3 months of osseointegration. Standard parallel periapical radiographs were used to measure marginal bone loss in over time. Resonance frequency analysis (RFA) and mobility measuring (MM) device were used to determine implant stability/mobility. PISF samples were derived with paper strips and PISF MPO and nitrite level analysis were done spectrophotometrically. Peri-implant parameters were assessed by periodontal indices and all parameters were evaluated at baseline, 1, 3, 6, and 12 months follow-up. RESULTS: No healing problems were recorded for all implants at the end of the study period. At 12 months, mean bone loss measures were 0.84 and 0.76 mm, and mean implant stability quotient (ISQ) values were 74.04 and 76 for PS and SP implants, respectively. Mean MM values were found as -4.82 for PS and -6.26 for SP implants. There were no significant differences between implant types according to PISF volume and laboratory biochemical measures including MPO and NO, and clinical peri- implant indices at any time point. CONCLUSION: Platform switching seems not to affect the marginal bone level, clinical peri-implant parameters and MPO and NO metabolism around implants inserted to mandibular premolar/molar regions when using a single-stage protocol.