Long-term results of regenerative treatment of intrabony defects: a cohort study with 5-year follow-up.

BACKGROUND: The aim of this retrospective cohort study was to evaluate the long-term clinical and radiographic outcomes and survival of teeth in periodontal regenerative treatment of intrabony defects using combined enamel matrix protein derivative (EMD) and deproteinized porcine bone mineral (DPBM) compared to EMD alone. METHODS: A total of 333 intrabony defects in 176 patients (mean age: 54.7 ± 8.9 years) were followed-up for 58.6 ± 11.2 (range, 25-78) months after periodontal regenerative treatment. Changes in clinical (pocket probing depth and clinical attachment level) and radiographic (defect depth and defect width) parameters were analyzed using serial periapical radiographs. Kaplan-Meier and multivariate Cox proportional-hazards regression analyses for tooth loss were also performed. RESULTS: Compared to periodontal surgery with EMD alone with a mean follow-up of 5 years, combined EMD and DPBM showed significantly better gain in clinical attachment level (EMD and DPBM: 2.8 ± 2.3 mm vs. EMD alone: 2.2 ± 2.2 mm) and reduction in probing pocket depth (EMD and DPBM: 2.8 ± 1.8 mm vs. EMD alone: 2.3 ± 1.8 mm), defect depth (EMD and DPBM: 2.5 ± 2.4 mm vs. EMD alone: 2.0 ± 2.4 mm) and defect width (EMD and DPBM: 0.6 ± 1.0 mm vs. EMD alone: 0.2 ± 1.3 mm). The overall survival rates of the teeth were 91.48% and 95.20% in the patient- and tooth-based analyses, respectively, showing no statistically significant difference. CONCLUSIONS: Within the limitations of the current study, combined EMD and DPBM offered additional clinical and radiographic benefits over a mean of 5 years compared to EMD alone. However, tooth loss did not differ significantly between the two groups. CLINICAL RELEVANCE: Compared to EMD alone, combined EMD and DPBM for intrabony defects has additional clinical advantages; however, patient- and tooth-related risk factors must be considered when performing periodontal regenerative surgery.

Alveolar ridge preservation of damaged or periodontally compromised extraction sockets with bovine- and porcine-derived block bone substitutes: A retrospective case-control study.

PURPOSE: Alveolar ridge preservation (ARP) was introduced to minimize postextraction alveolar bone loss and extraction socket remodeling; however, current knowledge of the ARP procedure for nonintact extraction sockets is still limited and inconclusive. This retrospective study aimed to evaluate the difference between using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and deproteinized porcine bone mineral with 10% collagen (DPBM-C) when performing ARP procedures in damaged or periodontally compromised extraction sockets based on clinical, radiographic, and profilometric outcomes. METHODS: In total, 108 extraction sockets were grafted with 67 DBBM-C and 41 DPBM-C. Changes in radiographic (horizontal width and vertical height) and profilometric outcomes were measured after the ARP procedure and before the implant surgery. Postoperative discomfort (including the severity and duration of pain and swelling), early wound healing outcomes (including spontaneous bleeding and persistent swelling), implant stability, and treatment modalities for implant placement were also assessed. RESULTS: Radiographically, the DBBM-C group decreased by -1.70 ± 2.26 mm (-21.50%) and - 1.39 ± 1.85 mm (-30.47%) horizontally and vertically, and the corresponding DPBM-C group decreased by -1.66 ± 1.80 mm (-20.82%) and -1.44 ± 1.97 mm (-27.89%) horizontally and vertically at an average of 5.6 months. There were no serious or adverse complications in any of the cases, and none of the measured parameters differed significantly between the groups. CONCLUSION: Within the limitations of this study, ARP with DBBM-C and DPBM-C showed similar clinical, radiographic, and profilometric outcomes in nonintact extraction sockets.

Porcine-derived soft block bone substitutes for the treatment of severe class II furcation-involved mandibular molars: a prospective controlled follow-up study.

PURPOSE: No evidence exists regarding the advantages of periodontal regeneration treatment for furcation defects using soft block bone substitutes. Therefore, this randomized controlled trial aimed to assess the clinical and radiographic outcomes of regenerative therapy using porcine-derived soft block bone substitutes (DPBM-C, test group) compared with porcine-derived particulate bone substitutes (DPBM, control group) for the treatment of severe class II furcation defects in the mandibular molar regions. METHODS: Thirty-five enrolled patients (test group, n=17; control group, n=18) were available for a 12-month follow-up assessment. Clinical (probing pocket depth [PPD] and clinical attachment level [CAL]) and radiographic (vertical furcation defect; VFD) parameters were evaluated at baseline and 6 and 12 months after regenerative treatment. Early postoperative discomfort (severity and duration of pain and swelling) and wound healing outcomes (dehiscence, suppuration, abscess formation, and swelling) were also assessed 2 weeks after surgery. RESULTS: For both treatment modalities, significant improvements in PPD, CAL, and VFD were found in the test group (PPD reduction of 4.1±3.0 mm, CAL gain of 4.4±2.9 mm, and VFD reduction of 4.1±2.5 mm) and control group (PPD reduction of 2.7±2.0 mm, CAL gain of 2.0±2.8 mm, and VFD reduction of 2.4±2.5 mm) 12 months after the regenerative treatment of furcation defects (P<0.05). However, no statistically significant differences were found in any of the measured clinical and radiographic parameters, and no significant differences were observed in any early postoperative discomfort and wound healing outcomes between the 2 groups. CONCLUSIONS: Similar to DPBM, DPBM-C showed favorable clinical and radiographic outcomes for periodontal regeneration of severe class II furcation defects in a 12-month follow-up period. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0007305.

A retrospective epidemiological investigation of periodontitis risk and current smoking status based on the number of cigarettes per day and the Fagerström Test for Nicotine Dependence: a preliminary pilot study.

PURPOSE: The aim of this study was to investigate the risk of periodontitis according to current smoking status based on the number of cigarettes smoked per day (CPD) and the Fagerström Test for Nicotine Dependence (FTND). METHODS: All enrolled patients were diagnosed and classified according to the new periodontal classification scheme, and current smoking status was investigated via a self-reported questionnaire. The correlation between smoking status (CPD and FTND) and periodontitis risk (severity of periodontitis and tooth loss due to periodontal reasons) was statistically assessed using Spearman correlation coefficients. Moreover, partial correlation analyses between smoking and periodontal status were performed after adjusting for age, sex, and diabetes mellitus. RESULTS: Overall, data from 74 men and 16 women (mean age: 48.1±10.8 years) were evaluated. The mean number of missing teeth, CPD, and FTND score were 3.5±5.2, 24.6±15.5, and 3.5±2, respectively. CPD and the FTND were significantly positively correlated with each other (r=0.741, P<0.001). CPD and the FTND were also significantly correlated with the severity of periodontitis (CPD: r=0.457, P<0.05 and FTND: r=0.326, P<0.05) and the number of missing teeth due to periodontal reasons (CPD: r=0.525, P<0.05 and FTND: r=0.480, P<0.05), respectively. CONCLUSIONS: Within the limitations of this study, both CPD and the FTND were significantly correlated with the severity of periodontitis and the number of periodontally compromised extracted teeth.

Comparison of the oral microbial composition between healthy individuals and periodontitis patients in different oral sampling sites using 16S metagenome profiling.

PURPOSE: The purpose of this study was to compare the microbial composition of 3 types of oral samples through 16S metagenomic sequencing to determine how to resolve some sampling issues that occur during the collection of sub-gingival plaque samples. METHODS: In total, 20 subjects were recruited. In both the healthy and periodontitis groups, samples of saliva and supra-gingival plaque were collected. Additionally, in the periodontitis group, sub-gingival plaque samples were collected from the deepest periodontal pocket. After DNA extraction from each sample, polymerase chain reaction amplification was performed on the V3-V4 hypervariable region on the 16S rRNA gene, followed by metagenomic sequencing and a bioinformatics analysis. RESULTS: When comparing the healthy and periodontitis groups in terms of alpha-diversity, the saliva samples demonstrated much more substantial differences in bacterial diversity than the supra-gingival plaque samples. Moreover, in a comparison between the samples in the case group, the diversity score of the saliva samples was higher than that of the supra-gingival plaque samples, and it was similar to that of the sub-gingival plaque samples. In the beta-diversity analysis, the sub-gingival plaque samples exhibited a clustering pattern similar to that of the periodontitis group. Bacterial relative abundance analysis at the species level indicated lower relative frequencies of bacteria in the healthy group than in the periodontitis group. A statistically significant difference in frequency was observed in the saliva samples for specific pathogenic species (Porphyromonas gingivalis, Treponema denticola, and Prevotella intermedia). The saliva samples exhibited a similar relative richness of bacterial communities to that of sub-gingival plaque samples. CONCLUSIONS: In this 16S oral microbiome study, we confirmed that saliva samples had a microbial composition that was more similar to that of sub-gingival plaque samples than to that of supra-gingival plaque samples within the periodontitis group.

Deep learning improves implant classification by dental professionals: a multi-center evaluation of accuracy and efficiency.

PURPOSE: The aim of this study was to evaluate and compare the accuracy performance of dental professionals in the classification of different types of dental implant systems (DISs) using panoramic radiographic images with and without the assistance of a deep learning (DL) algorithm. METHODS: Using a self-reported questionnaire, the classification accuracy of dental professionals (including 5 board-certified periodontists, 8 periodontology residents, and 31 dentists not specialized in implantology working at 3 dental hospitals) with and without the assistance of an automated DL algorithm were determined and compared. The accuracy, sensitivity, specificity, confusion matrix, receiver operating characteristic (ROC) curves, and area under the ROC curves were calculated to evaluate the classification performance of the DL algorithm and dental professionals. RESULTS: Using the DL algorithm led to a statistically significant improvement in the average classification accuracy of DISs (mean accuracy: 78.88%) compared to that without the assistance of the DL algorithm (mean accuracy: 63.13%, P<0.05). In particular, when assisted by the DL algorithm, board-certified periodontists (mean accuracy: 88.56%) showed higher average accuracy than did the DL algorithm, and dentists not specialized in implantology (mean accuracy: 77.83%) showed the largest improvement, reaching an average accuracy similar to that of the algorithm (mean accuracy: 80.56%). CONCLUSIONS: The automated DL algorithm classified DISs with accuracy and performance comparable to those of board-certified periodontists, and it may be useful for dental professionals for the classification of various types of DISs encountered in clinical practice.

Profilometric, volumetric, and esthetic analysis of guided bone regeneration with L-shaped collagenated bone substitute and connective tissue graft in the maxillary esthetic zone: A case series with 1-year observational study.

PURPOSE: The aim of this study was to evaluate 1-year stability and maintenance of peri-implant soft and hard tissues after guided bone regeneration (GBR) with L-shaped collagenated bone substitute and subepithelial connective tissue graft (CTG) in the maxillary anterior region using profilometric, volumetric, and esthetic analyses. METHODS: Fourteen peri-implant defects were grafted with L-shaped collagenated bone substitute, and 5 months after implant placement with GBR, reentry surgery in combination with CTG was performed in all participants. CBCT scans and STL files were acquired at baseline (after implant surgery, T1), reentry surgery (T2), and 1-year follow-up (T3). The profilometric and volumetric changes of the peri-implant tissues were measured, and the pink esthetic score (PES) was assessed at T3. RESULTS: One year after GBR and CTG at the buccal aspect of the maxillary esthetic zone, the mean thickness of the hard tissue (HT) decreased (HT0: -0.87 ± 0.67 mm, HT1: -0.74 ± 0.75 mm, HT2: -0.92 ± 0.48 mm, 45-HT: -0.87 ± 0.73 mm) and the corresponding thickness of the soft tissue (ST) increased (ST0: 0.96 ± 1.06 mm, ST1: 0.85 ± 0.95 mm, ST2: 0.38 ± 0.82 mm, 45-ST: 0.12 ± 0.62 mm), and as a result, there was no statistically significant difference in the total tissue thickness between T1 and T3 (p < 0.05). The mean volumetric changes of the peri-implant tissues increased after 1-year of implant surgery (T1-T2: 1.52 ± 0.83 mm, T2-T3: -0.88 ± 1.04 mm, T1-T3: 0.64 ± 0.90 mm), and a statistically significant difference was shown in all compared time periods (p < 0.05). The mean PES score was 8.07 ± 1.54 at T3 (range, 6-10). CONCLUSION: Within the limitations of this 1-year follow-up study, GBR with an L-shaped collagenated bone substitute and subepithelial CTG in the maxillary esthetic zone was beneficial for stable and maintainable peri-implant hard and soft tissues.

Long-term stability of adjunctive use of enamel matrix protein derivative on porcine-derived xenograft for the treatment of one-wall intrabony defects: A 4-year extended follow-up of a randomized controlled trial.

BACKGROUND: The long-term outcomes of demineralized porcine bone matrix (DPBM) in combination with enamel matrix protein derivative (EMD) for the treatment of one-wall intrabony defects have not yet been evaluated. Therefore, this study aimed to assess the clinical, radiographic, and patient-reported outcomes of regenerative therapy using DPBM with EMD (test group) in comparison with DPBM alone (control group) for the treatment of one-wall intrabony defects in the molar regions. METHODS: Thirty-four patients (control group, n = 18, and test group, n = 16) were available at the 4-year follow-up assessment. Clinical (probing pocket depth and clinical attachment level [CAL]), radiographic (defect depth and width), and patient-reported (Oral Health Impact Profile [OHIP]-14) parameters were evaluated at baseline, 2 years, and 4 years after regenerative treatment. RESULTS: Both treatment modalities, with and without adjunctive use of EMD, resulted in significant improvement of clinical (mean gain in CAL of 1.58 ± 1.34 mm), radiographic (mean defect width fill of 2.41 ± 0.90 mm), and oral health-related quality of life outcomes at 2 years after regenerative treatment of one-wall intrabony defects (P < 0.001), which has been sustained over a 4-year follow-up period. Particularly, OHIP-14 scores revealed a statistically significant reduction in physical pain, psychological discomfort, and physical disability (P < 0.05). CONCLUSIONS: The clinical, radiographic, and patient-reported outcomes were significantly improved when DPBM was used in the regenerative treatment, but no additional benefits were observed with the adjunctive use of EMD.

Augmentation Stability of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with L-shaped Porcine-Derived Block Bone Substitute.

Block bone substitutes have better augmentation stability for guided bone regeneration (GBR) than particulate bone substitutes. This study sought to determine whether GBR with an L-shaped porcine block bone (DPBM-C) differs from GBR with an L-shaped bovine block bone (DBBM-C) based on clinical, radiographic, and volumetric outcomes for peri-implant dehiscence defects. A total of 42 peri-implant defects were grafted with 20 L-shaped DPBM-C and 22 DBBM-C groups. The horizontal and vertical thicknesses of the augmented hard tissue were measured using sagittal cone-beam computed tomography, and the volumetric tissue change was evaluated by stereolithography image superimposition. Postoperative discomfort, early wound healing outcomes, and implant stability were also assessed. Among the clinical (subjective pain and swelling, wound dehiscence, membrane exposure, and periotest values), radiographic (changes in horizontal and vertical hard tissue thickness), and volumetric parameters of the L-shaped DPBM-C and DBBM-C groups during the healing period, only the periotest values showed a statistically significant difference (0.67 ± 1.19, p = 0.042). Within the limitations of this study, an L-shaped DPBM-C is not inferior to an L-shaped DBBM-C based on their clinical, radiographic, and volumetric outcomes for GBR of peri-implant dehiscence defects.

Augmentation stability and early wound healing outcomes of guided bone regeneration in peri-implant dehiscence defects with L- and I-shaped soft block bone substitutes: A clinical and radiographic study.

OBJECTIVES: To retrospectively evaluate whether guided bone regeneration (GBR) with L- and I-shaped demineralized bovine bone mineral with 10% collagen (DBBM-C) differs from GBR with DBBM in terms of augmentation stability and early wound healing outcomes in peri-implant dehiscence defects. METHODS: A total of 91 peri-implant defects were grafted with 24 L- (GBR-L), 22 I (GBR-I)-shaped DBBM-C, and 45 DBBM (GBR-P). Cone-beam computed tomography images were obtained after surgery and at 5 months follow-up. The horizontal thickness (HT0, HT2, HT4), vertical thickness (VT), and VT at 45° angle (45-VT) of the augmented hard tissue were measured. Early postoperative discomfort and wound healing outcomes were assessed 2 weeks after surgery, and periotest values were also measured at 5 months in all groups. RESULTS: At 5 months follow-up, the change at HT0 and VT of the GBR-L (HT0: -0.63 ± 0.55 mm, VT: -0.77 ± 0.60 mm) and GBR-I (HT0: -0.68 ± 0.53 mm, VT: -0.91 ± 0.73 mm) groups was significantly more stable than that of the GBR-P (HT0: -1.30 ± 0.77 mm, VT: -1.57 ± 0.67 mm) group (p < .05). The GBR-L group (-0.74 ± 0.54 mm) showed better augmentation stability than the other two groups at the change at 45-VT. Early postoperative discomfort, wound healing outcomes, and periotest values did not differ significantly between the three groups. CONCLUSION: Within the limitations of this study, L- and I-shaped DBBM-Cs used for GBR were more beneficial in terms of horizontal augmentation stability than DBBM after a 5-month healing period.

Effectiveness of porcine-derived xenograft with enamel matrix derivative for periodontal regenerative treatment of intrabony defects associated with a fixed dental prosthesis: a 2-year follow-up retrospective study.

PURPOSE: Due to the difficulty of the hygienic care and sanitary management of abutment teeth and subpontic areas associated with fixed dental prostheses (FDPs), intrabony defects occur and accelerate due to the accumulation of plaque and calculus. This study aimed to evaluate the efficacy of regenerative periodontal surgery for intrabony defects associated with FDPs. METHODS: The study inclusion criteria were met by 60 patients who underwent regenerative treatment between 2016 and 2018, involving a total of 82 intrabony defects associated with FDPs. Periodontal osseous lesions were classified as 1-, 2-, and 3-wall intrabony defects and were treated with an enamel matrix derivative in combination with bone graft material. The changes in clinical (pocket probing depth [PPD] and clinical attachment level [CAL]) and radiographic (defect depth and width) outcomes were measured at baseline and at 6, 12, and 24 months. RESULTS: Six months after regenerative treatment, a significant reduction was observed in the PPD of 1-wall (P<0.001), 2-wall (P<0.001), and 3-wall (P<0.001) defects, as well as a significant reduction in the CAL of 2-wall (P<0.001) and 3-wall (P<0.001) intrabony defects. However, there was a significant increase in the CAL of 1-wall intrabony defects (P=0.003). Radiographically, a significant reduction in the depth of the 3-wall (P<0.001) defects and a significant reduction in the width of 2-wall (P=0.008) and 3-wall (P<0.001) defects were observed. The depth decreased in 1-wall defects; however, this change was not statistically significant (P=0.066). CONCLUSIONS: Within the limitations of the current study, regenerative treatment of 2- and 3-wall intrabony defects associated with FDPs improved clinical and radiological outcomes. Additional prospective studies are necessary to confirm our findings and to assess long-term outcomes.

Artificial Intelligence in Fractured Dental Implant Detection and Classification: Evaluation Using Dataset from Two Dental Hospitals.

Fracture of a dental implant (DI) is a rare mechanical complication that is a critical cause of DI failure and explantation. The purpose of this study was to evaluate the reliability and validity of a three different deep convolutional neural network (DCNN) architectures (VGGNet-19, GoogLeNet Inception-v3, and automated DCNN) for the detection and classification of fractured DI using panoramic and periapical radiographic images. A total of 21,398 DIs were reviewed at two dental hospitals, and 251 intact and 194 fractured DI radiographic images were identified and included as the dataset in this study. All three DCNN architectures achieved a fractured DI detection and classification accuracy of over 0.80 AUC. In particular, automated DCNN architecture using periapical images showed the highest and most reliable detection (AUC = 0.984, 95% CI = 0.900-1.000) and classification (AUC = 0.869, 95% CI = 0.778-0.929) accuracy performance compared to fine-tuned and pre-trained VGGNet-19 and GoogLeNet Inception-v3 architectures. The three DCNN architectures showed acceptable accuracy in the detection and classification of fractured DIs, with the best accuracy performance achieved by the automated DCNN architecture using only periapical images.

A Population-Based Study on the Association between Periodontal Disease and Major Lifestyle-Related Comorbidities in South Korea: An Elderly Cohort Study from 2002-2015.

This study determined the association between periodontal disease (PD) and major lifestyle-related comorbidities (LCs) using the database of the nationwide population-based National Health Insurance Service-Elderly Cohort 2002-2015. A nationwide representative sample comprising 558,147 participants, aged 60 years, was analyzed. Univariate and multivariate logistic regression analyses adjusted for sociodemographic and economic factors (sex, age, household income, insurance status, health status, and living area) and major LCs (hypertension, diabetes mellitus, rheumatoid arthritis, osteoporosis, cerebral infarction, angina pectoris, myocardial infarction, erectile dysfunction, lipoprotein disorder, and obesity) were used to determine the association between PD and major LCs. Elderly participants with PD had a higher risk of major LCs (hypertension: odds ratio (OR) = 1.40, diabetes mellitus: OR = 1.22, rheumatoid arthritis: OR = 1.16, osteoporosis: OR = 1.37, erectile dysfunction: OR = 1.73, lipoprotein disorder: OR = 1.50, and obesity: OR = 1.59). Our longitudinal cohort study provided evidence that PD was significantly associated with major LCs in elderly participants. In particular, the association between PD and erectile dysfunction had the highest OR in the multivariate analyses.

A Performance Comparison between Automated Deep Learning and Dental Professionals in Classification of Dental Implant Systems from Dental Imaging: A Multi-Center Study.

In this study, the efficacy of the automated deep convolutional neural network (DCNN) was evaluated for the classification of dental implant systems (DISs) and the accuracy of the performance was compared against that of dental professionals using dental radiographic images collected from three dental hospitals. A total of 11,980 panoramic and periapical radiographic images with six different types of DISs were divided into training (n = 9584) and testing (n = 2396) datasets. To compare the accuracy of the trained automated DCNN with dental professionals (including six board-certified periodontists, eight periodontology residents, and 11 residents not specialized in periodontology), 180 images were randomly selected from the test dataset. The accuracy of the automated DCNN based on the AUC, Youden index, sensitivity, and specificity, were 0.954, 0.808, 0.955, and 0.853, respectively. The automated DCNN outperformed most of the participating dental professionals, including board-certified periodontists, periodontal residents, and residents not specialized in periodontology. The automated DCNN was highly effective in classifying similar shapes of different types of DISs based on dental radiographic images. Further studies are necessary to determine the efficacy and feasibility of applying an automated DCNN in clinical practice.

Severe periodontitis with tooth loss as a modifiable risk factor for the development of Alzheimer, vascular, and mixed dementia: National Health Insurance Service-National Health Screening Retrospective Cohort 2002-2015.

PURPOSE: The purpose of this study was to evaluate severe periodontitis with tooth loss as a modifiable risk factor for Alzheimer dementia (AD), vascular dementia (VaD), and mixed dementia (MD) using the National Health Insurance Service-National Health Screening Retrospective Cohort database with long-term follow-up over 14 years. METHODS: Multivariate Cox hazards regression analysis was applied to a longitudinal retrospective database, which was updated in 2018, to evaluate the association between severe periodontitis with few remaining teeth and dementia after adjusting for potential risk factors, including sociodemographic factors and comorbid diseases. RESULTS: Among 514,866 individuals in South Korea, 237,940 (46.2%) participants satisfying the inclusion criteria were selected. A total of 10,115 age- and sex-matched participants with severe periodontitis and 10,115 periodontally healthy participants were randomly selected and evenly assigned. The results showed that the risks of AD (hazard ratio [HR], 1.08), VaD (HR, 1.24), and MD (HR, 1.16) were significantly higher in patients with severe periodontitis with 1-9 remaining teeth after adjustment for sociodemographic factors, anthropomorphic measurements, lifestyle factors, and comorbidities. CONCLUSIONS: Severe periodontitis with few remaining teeth (1-9) may be considered a modifiable risk factor for the development of AD, VaD, and MD in Korean adults.

Effect of enamel matrix derivative on alveolar ridge preservation in the posterior maxilla: A randomized controlled clinical trial.

BACKGROUND: EMD has been considered to exert positive effects on wound healing, postoperative discomfort, and bone regeneration. PURPOSE: The aim of this randomized controlled clinical trial was to investigate and compare (a) horizontal and vertical bone dimensional changes, (b) early postoperative discomfort and soft tissue wound healing outcomes, and (c) treatment modalities for implant placement, following posterior maxillary alveolar ridge preservation (ARP) with and without adjunctive use of EMD. METHODS: Twenty-eight participants were randomly assigned to three groups: extraction sockets filled with bovine bone mineral and membrane with EMD (test group 1, n = 10) and without EMD (test group 2, n = 10) and spontaneous healing (control group, n = 8). Alveolar bone dimensional changes were measured using cone-beam computed tomography 5 months after ARP, and postoperative pain and wound healing outcomes were also evaluated. RESULTS: There were no significant differences in horizontal or vertical bone dimensional changes between test groups 1 (horizontal width changes at 1 mm apically below the alveolar ridge crest [HW]: -1.44 ± 0.54 mm) and 2 (HW: -1.42 ± 0.26 mm), but the changes at HW (-2.36 ± 1.03 mm) in the control group were significantly greater than those in test groups 1 and 2 (P < .05). Early postoperative discomfort and soft tissue wound healing outcomes were not significantly different between the two test groups. Furthermore, unlike the control group, both the test groups 1 and 2 were implanted without sinus floor elevation using the lateral approach. CONCLUSION: Within the limitations of this study, EMD failed to provide additional benefits in ARP in the posterior maxilla.

Chronic Periodontal Disease increases risk for Prostate Cancer in Elderly individuals in South Korea: a Retrospective Nationwide Population-based Cohort Study.

Objectives: The association between prostate cancer (PC) and chronic periodontal disease (PD) has been evaluated in previous studies, but results have been inconsistent. This study aimed to determine whether the presence of chronic PD in old age increases the risk of PC using data in the large-scale elderly cohort. Materials and Methods: This nationwide population-based cohort study examined data of 121,240 South Korean individuals aged ≥ 60 years from the National Health Insurance Service-Elderly Cohort database who completed a national program between 2002 and 2015. For a maximum 10 years' observation period, patients with incident PC with chronic PD compared with those without chronic PD were retrospectively tracked, and Cox proportional hazard ratios and 95% confidence intervals (CIs) were calculated, adjusted for potential confounding factors, including age, household income, insurance status, Charlson Comorbidity Index, hypertension, diabetes mellitus, cerebral infarction, angina pectoris, myocardial infarction, prostatitis, smoking status, daily smoking, alcohol intake habits, one-time alcohol intake, and regular exercise. Results: The overall incidence of PC with chronic PD in 10 years was 3.0% (n = 2,063). In the multivariate Cox analysis with adjustment for confounding factors, chronic PD was associated with a 24% higher risk of PC (95% CI = 1.16-1.32, P < 0.001). Conclusion: Our results suggest that chronic PD is significantly and positively associated with PC. Larger and better-controlled studies are needed to strengthen this evidence of association and explain the underlying biological mechanisms.

Efficacy of deep convolutional neural network algorithm for the identification and classification of dental implant systems, using panoramic and periapical radiographs: A pilot study.

Convolutional neural networks (CNNs), a particular type of deep learning architecture, are positioned to become one of the most transformative technologies for medical applications. The aim of the current study was to evaluate the efficacy of deep CNN algorithm for the identification and classification of dental implant systems.A total of 5390 panoramic and 5380 periapical radiographic images from 3 types of dental implant systems, with similar shape and internal conical connection, were randomly divided into training and validation dataset (80%) and a test dataset (20%). We performed image preprocessing and transfer learning techniques, based on fine-tuned and pre-trained deep CNN architecture (GoogLeNet Inception-v3). The test dataset was used to assess the accuracy, sensitivity, specificity, receiver operating characteristic curve, area under the receiver operating characteristic curve (AUC), and confusion matrix compared between deep CNN and periodontal specialist.We found that the deep CNN architecture (AUC = 0.971, 95% confidence interval 0.963-0.978) and board-certified periodontist (AUC = 0.925, 95% confidence interval 0.913-0.935) showed reliable classification accuracies.This study demonstrated that deep CNN architecture is useful for the identification and classification of dental implant systems using panoramic and periapical radiographic images.

Three-dimensional observations of the incisive foramen on cone-beam computed tomography image analysis.

PURPOSE: The purpose of this study was to utilize cone-beam computed tomography (CBCT) image analysis to obtain anatomical information related to the morphology of the incisive foramen to provide useful data regarding implant placement and clinical procedures such as anesthesia. METHODS: The study included 167 patients who underwent CBCT scans over 20 years. Three components were measured: 1) the anteroposterior and mediolateral diameter of the incisive foramen, 2) the horizontal bone thickness anterior to the incisive foramen, and 3) the vertical bone height coronal to the incisive foramen. All measurements were expressed as mean±standard deviation and were analyzed by a single examiner. RESULTS: The anteroposterior diameter of the incisive foramen was wider than the mediolateral diameter (P<0.001). The diameter of the incisive foramen in patients in whom the central incisors were present was smaller than that in those in whom at least one central incisor was absent, but no statistically significant difference between the groups was observed. The horizontal bone thickness in the patients with central incisors was statistically significantly larger than that in the patients without at least one central incisor (P<0.001). The same pattern was observed with regard to vertical height, but that difference was not statistically significant. CONCLUSIONS: The buccal bone thickness anterior to the incisive foramen was significantly decreased after central incisor loss. It is necessary to identify the morphology of the bone and the location of the incisive foramen via CBCT to avoid invasion of the incisive foramen and nasopalatine canal.

Adjunctive use of enamel matrix derivatives to porcine-derived xenograft for the treatment of one-wall intrabony defects: Two-year longitudinal results of a randomized controlled clinical trial.

BACKGROUND: The purpose of this study was to evaluate the potential advantages of adjunctive use of enamel matrix protein derivative (EMD) in combination with demineralized porcine bone matrix (DPBM) for the treatment of one-wall intrabony defects in the molar regions, in comparison with the use of DPBM alone, through a randomized controlled clinical trial. METHODS: Forty-two participants were randomly assigned to two groups: one where DPBM with the adjunctive use of EMD (test group, n = 20) was applied and the other without EMD (control group, n = 22). Changes in the clinical and radiographic parameters from baseline at 6, 12, and 24 months were measured (probing pocket depth, clinical attachment loss, defect depth, and defect width). Postoperative discomfort (severity/duration of pain and swelling) and early soft tissue wound healing (dehiscence/fenestration, persistent swelling, spontaneous bleeding, and ulceration) were also assessed. RESULTS: Both treatment modalities, with and without EMD, resulted in significant improvement of clinical and radiographic outcomes without any severe adverse events. However, no statistically significant differences in any of the measured parameters were found when the two groups were compared. Early wound healing outcomes and the severity of swelling did not differ between the groups, but the severity of pain (P = 0.046), duration (P = 0.033), and swelling (P = 0.022) were significantly lower in the test group. CONCLUSIONS: DPBM has been verified for biocompatibility and can be used as a scaffold to enhance the clinical and radiographic outcomes of periodontal regeneration of one-wall intrabony defects. In particular, the adjunctive use of EMD significantly reduced the postoperative discomfort.