Success of Dental Implant Influenced by Abutment Types and Loading Protocol.

Background: Dental implants are considered better, latest, and most advanced technique of teeth replacement in present times with more teeth loss and increased related concerns. Aims: The present clinical trial was carried out to assess marginal bone loss and implant failure in immediate and delayed loading implants. The study also evaluated healing using Polymerase Chain Reaction (PCR) and the effect of risk factors on marginal bone loss. Materials and Methods: The 44 subjects were randomly divided into two groups with immediate loading and delayed loading protocols. Various soft-tissue parameters were seen clinically. Quantitative PCR was done to detect biomarkers. The collected data were subjected to statistical evaluation with a level of significance at P < 0.05 and the results were formulated. Results: Concerning marginal bone loss, it was seen that for delayed loading, the bone loss at the implant level was 1.52 ± 0.14, 0.19 ± 0.11, and 0.40 ± 0.12, respectively, at placement, 1 and 2 years. Plaque and mucosal bleeding scores were low at the time of placement with respective values of 0.96 ± 0.12 and 28.42 ± 3.15 for the delayed loading group and 0.98 ± 0.11 and 30.24 ± 3.15 for the immediate loading group. Tartrate-resistant acid phosphatase (TRAP) showing remodeling was high at 3 months in delayed loading (13.3 ± 8.5). Alkaline Phosphatase (ALP) was highest in delayed loading at 3 months (25.2 ± 7.7) and immediate loading at 2 days (32.6 ± 13). Conclusion: Both immediate loading and delayed loading implants show similar results in terms of bone loss, soft-tissue parameters, and biomarkers in sulcular fluids with relatively few and manageable complications.

Assessment of anterior loop of mandibular canal and its implication in implant therapy.

Context: Precise identification of anatomic structures is imperative for presurgical planning for implant installation to ensure effectiveness of procedures, especially in the region of mental foramen, and to prevent iatrogenic complications. Aims: This study aimed to assess the presence of anterior loop of mandibular canal and its approximation to the alveolar crest using cone-beam computed tomography (CBCT). Materials and Methods: CBCT scans of the patients scheduled for implant therapy in the region of mental foramen were retrospectively analyzed for the presence of anterior loop of mandibular canal. Findings were compared based upon gender and side of the mandible. Distance between the most prominent part of anterior loop of mandibular canal and the alveolar crest was measured. Results: Anterior loop of the mandibular canal was identified 66.8% of hemimandibles analyzed with the highest prevalence in the fourth decade of life. Males and females exhibited predilection toward the right and left side, respectively. The presence of anterior loop of mandibular canal is associated with reduced distance between the neurovascular bundle and alveolar crest jeopardizing the placement of standard length dental implant. Conclusion: The current study emphasizes an increased need for precise identification and preservation of anterior loop of mandibular canal in the third and fourth decades of life, especially in females.

A Comparative Study Evaluating Implant Success and Bone Loss in Diabetes and Nondiabetes.

BACKGROUND: Diabetes is seen to be associated with increased rate of failure of implants. The implant failure can be categorized as ailing, failing, and failed implants. The review of literature did not form any consensus on the effect of diabetes on the implant success rates. The reason we found was many confounding factors and nonconsideration of glycemic status of diabetic patients. Hence, in our study, we eliminated the confounding factors and took glycemic index in consideration. MATERIALS AND METHODS: Forty-six participants were included in this study, out of which 26 were nondiabetic and 20 diabetic. Diabetics were further divided into two groups based on the HBA1C values, as controlled and uncontrolled diabetics. RESULTS: We found that the uncontrolled diabetics had highest rate of implant failure as compared to other two groups. Furthermore, the controlled diabetics and nondiabetics had similar implant successes and failure rates. CONCLUSION: This suggests that controlled diabetics are comparable to nondiabetics in terms of implant success rates.

Comparison of two techniques of harvesting connective tissue and its effects on healing pattern at palate and recession coverage at recipient site.

AIM: To compare the healing pattern in palate following harvestation of connective tissue graft by two different techniques and to compare the recession coverage at the recipient sites. MATERIALS AND METHODS: 30 recession sites with Miller's class I and II recession in 16 patients were recruited for this study. Sites were randomly divided into 2 treatment groups. Group I used Unigraft Knife to harvest the connective tissue whereas in group II patients Langer & Langer techniques was used to harvest the connective tissue graft from the palate. Healing was evaluated at the donor site using- wound size(WS), immediate bleeding (iB) and delayed bleeding (dB), complete wound epithelialization (CE), sensibility disorders (S) and post operative pain (PP) at baseline, 1(st), 4(th), and 12(th) week postoperatively. Recession coverage was assessed by measuring Clinical Attachment Level (CAL), vertical recession (VR), width of keratinized gingiva (KT). RESULTS: On comparison between Group I and II, a statistically significant larger wound size was observed in Group I. CWE was higher in Group II. A non significant difference was observed when SD, and delayed bleeding were compared at all time intervals. A non-significant difference was observed in the clinical parameters at the recipient site. CONCLUSION: When evaluating the WS and CWE, the Langer and Langer technique was found to be better than the Unigraft knife technique for harvesting the connective tissue graft, whereas both the techniques were found to be effective in root coverage procedure outcomes.

The use of nanocrystalline and two other forms of calcium sulfate in the treatment of infrabony defects: A clinical and radiographic study.

BACKGROUND: Calcium sulphate(CS) is one of the oldest alloplastic graft materials used because of its biocompatibility, handling characteristics, porosity, different rates of dissolution, chemico-physical resemblance to bone mineral, ability to induce release of growth factors and potentially unlimited supply at a modest cost. Aim of the study was to evaluate the efficacy of 3 forms of calcium sulphate i.e. Nanogen (nCS)(+), BoneGen(+) and Dentogen(+) in treatment of infrabony defects and to compare their efficacy as bone grafting substitutes. MATERIALS AND METHODS: A prospective randomized, double blind controlled study was conducted on 45 sites from 16 subjects having Moderate to Advanced Periodontitis who were divided into 3 groups i.e. Group I (Nanogen), Group II (Dentogen) and Group III (BoneGen) clinical along with radiographic measurements were taken at baseline, 6 and 12 months postoperatively. RESULTS: There was no significant inter-group difference in mean clinical attachment level (CAL) values at different time intervals whereas Intra-group changes in CAL at 6 and 12 months as compared to baseline were significant statistically. In Group I, changes in CAL between 6 and 12 months were found to be statistically significant in comparison with Group II and III. CONCLUSION: Both Nanogen and BoneGen TR can be considered valuable options in the treatment of infra-bony periodontal defects. The faster degradation of Dentogen may negatively affect its bone regeneration potential.

Comparative evaluation of recession coverage with sub-epithelial connective tissue graft using macrosurgical and microsurgical approaches: A randomized split mouth study.

AIMS: The aim was to compare the recession coverage outcomes when done macrosurgically and microsurgically. BACKGROUND: Increasing interest in esthetics and the related problems such as hypersensitivity and root caries have favored the development of many root coverage procedures. Recession coverage up to a certain extent has solved these problems, but these procedures need good maintenance after the surgery for long-term benefits. With increasing advances in the field of recession coverage, microscope has added another dimension in undertaking the surgical procedure. MATERIALS AND METHODS: Thirty Miller's Class I and II recession were treated using the sub-epithelial connective tissue graft from the palate. In 15 sites, the graft was placed at the recipient site with unaided eye (Group A) and in other 15 sites the graft was placed using surgical microscope (Group B). Clinical evaluation was done at baseline, 12 weeks and 24 weeks postoperatively using plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), width of attached gingiva, papilla height (PH) and width, malalignment index (MI) and esthetic appearance. STATISTICAL ANALYSIS USED: Paired and unpaired Student's t-test along with Wilcoxon Z-test were used to analyze the results and probability of P < 0.05 were accepted to reject the null hypothesis. Pearson correlation was used to correlate two parameters such as VR and CAL and MI and VR. RESULTS: Both the techniques demonstrated predictable mean root coverage (Group A 61.78% and Group B 67.58%) at 6 months postsurgery. CAL gain was slightly better in Group B patients when compared to Group A patients. A moderate positive correlation for Group A while a mild correlation in Group B was seen between the MI and VR. CONCLUSION: The use of the microscope enhances the results, but obtaining an expertise in using needs a lot of practice. The periodontal healing by both techniques should be evaluated histologically.

Autogenous bone block in the treatment of teeth with hopeless prognosis.

BACKGROUND: Autogenous bone graft, although considered as a gold standard, has been relegated to background because of limited quantity and donor site morbidity. Revival of interest in its use has been reflected by its tremendous capacity for regeneration in less than ideal situation. Bone blocks have been used for implant site augmentation, with varied success. AIM: Aim of the study was to evaluate the efficacy of autogenous bone block in the regeneration of bone, for saving teeth with a hopeless prognosis. SETTINGS AND DESIGN: A total of six patients and 12 sites with grade II and III mobile teeth were treated with autogenous bone blocks and fiber splinting. SUBJECTS AND METHODS: Attachment loss, probing depths, and radiographic bone loss were recorded at baseline and at 12 months interval. STATISTICAL ANALYSIS USED: The Student paired t test was used for evaluation of the changes from baseline to 12 months. RESULTS: At 12 months post-operatively, there was a highly significant amount of bone gain as compared to the baseline. The mean amount of bone loss reduced from 9.41 ± 1.16 to 5.41 ± 1.01. The clinical attachment loss reduced from 7.37 ± 1.24 mm to 3.79 ± 0.89 mm and probing depth reduced from 7 ± 1.67 mm to 5.5 ± 0.63 mm. The grafted bone was observed to have been incorporated with the host bone in most of the sites as evidenced by radiographs. CONCLUSIONS: For teeth with hopeless prognosis, this method can be considered to be a very viable alternative to extraction and replacement by costly implants.

Tissue engineering: A new vista in periodontal regeneration.

Tissue engineering is a highly promising field of reconstructive biology that draws on recent advances in medicine, surgery, molecular and cellular biology, polymer chemistry, and physiology. The objective of using tissue engineering as therapeutic application has been to harness its ability to exploit selected and primed cells together with an appropriate mix of regulatory factors, to allow growth and specialization of cells and matrix. The authors reviewed controlled clinical trials which also included histological studies that evaluated the potential of tissue engineering as a clinical tool in regeneration. PubMed/MEDLINE databases were searched for studies up to and including June 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility. Articles with authentic controls and proper randomization and pertaining specifically to their role in periodontal regeneration were included. Studies demonstrated that the periodontal regeneration with the use of combination of tissue engineered products with an osteoconductive matrix improve the beneficial effect of these materials by accelerating cellular in growth and revascularization of the wound site. Studies have suggested the use of rh Platelet-derived growth factor + beta tricalcium phosphate for regeneration of the periodontal attachment apparatus in combination with collagen membranes as an acceptable alternative to connective tissue graft for covering gingival recession defects. The studies concluded that growth factors promote true regeneration of the periodontal attachment apparatus and the use of combination protein therapeutics which is commercially available can provide more predictable, faster, less invasive, less traumatic, and efficient outcome for the patient.

Photodynamic therapy--a strategic review.

Mechanical removal of the biofilm and adjunctive use of antibacterial disinfectants or various antibiotics have been conventional methods of the periodontitis therapy. There has been an upsurge of bacterial strains becoming resistant due to the injudicious use of antibiotics, recently. As a result there is pronounced interest and keenness in the development of alternate antimicrobial concepts. As the scientific community seeks alternatives to antibiotic treatment, periodontal researchers have found that photodynamic therapy (PDT) is advantageous to suppress anaerobic bacteria. Hence, PDT could be an alternative to conventional periodontal therapeutic methods. This review elucidates the evolution and use of photo dynamic therapy. The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. Even though PDT is still in the experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology. PDT application has an adjunctive benefit besides mechanical treatment at sites with difficult access. Necessity for flap operations may be reduced, patient comfort may increase and treatment time decrease. Clinical follow-up studies are needed to confirm the efficacy of the procedure.

Success or failure of a dental implant: its relationship to bone density: a case report of a failed implant.

AIM: The purpose of this article is to illustrate the relationship of bone quality and the prognosis of dental implant. BACKGROUND: Reported success rates for dental implants are high. Thus, an implant-supported restoration offers a predictable treatment for tooth replacement. Nevertheless, failures that mandate immediate implant removal do occur. CASE DESCRIPTION: A case involving a 40-year-old male patient who had a missing mandibular left first molar is reported. A mucoperiosteal flap was made using interdental and crevicular incisions. The osteotomy was performed starting with the pilot drill, then the depth of the osteotomy was assessed using the shoulder depth gauge. The site was gradually enlarged using reamers with progressively increasing diameters. The implant (Bicon's Nano Tite™) was then placed. However, three months later at the second stage surgery, the implant was found to be clinically mobile. The surgical site selected in this case had fine trabeculated bone with thin cortical plates (D4 bone) that apparently contributed to the failure of dental implant. SUMMARY: Implant therapy has become common practice and will continue to increase in popularity. This also implies that dental professionals will have to learn more how to deal with implant failure and related complications. Why an implant does not integrate could have a multifactorial etiology. CLINICAL SIGNIFICANCE: The type and quality of bone available to support a dental implant are very important, so attention should be directed to all the factors responsible for the success or failure of a dental implant. In cases involving D4 bone, one must consider other treatment modalities for replacement of a missing tooth or use caution in the placement of the implants, especially in the high-load-bearing molar areas.

Clinical and radiological evaluation of an osseous xenograft for the treatment of infrabony defects.

OBJECTIVE: To evaluate the effectiveness of demineralized bone matrix (DMBM), an osteoconductive and osteoinductive graft material, as a bone graft for the treatment of osseous defects, both clinically and radiographically. MATERIALS AND METHODS: The effectiveness of DMBM was assessed at 40 sites in 30 patients who had infrabony defects. Grafted test sites were compared with control sites treated with open-flap debridement. RESULTS: Significant improvement in all variables was found, including reduction of probing depth, and gain in clinical attachment level and bone fill for test and control sites at 3 months and 6 months postoperatively. For test sites, reduction of probing depth was 2.80 mm at 3 months and 4.05 mm at 6 months, and for control sites, 1.75 mm at 3 months and 2.65 mm at 6 months. Gain in the level of clinical attachment for test sites was 2.80 mm at 3 months and 4.00 mm at 6 months; for control sites, this gain was 1.75 mm at 3 months and 2.60 mm at 6 months. The mean amount of defect resolution was 2.02 mm and 3.27 mm for test sites and 0.82 mm and 1.17 mm for control sites, at 3 months and 6 months, respectively. The mean percentage of defect resolution was 37.1% and 56.5% for test sites compared with 20.5% and 28.6% for control sites, at3 months and 6 months, respectively. CONCLUSIONS: DMBM improves healing outcomes, namely, reduction of probing depth, resolution of osseous defects and gain in clinical attachment, compared with open flap debridement.