Comparative Evaluation of Accuracy of Adjacent Parallel Implant Placements Between Dynamic Navigation and Static Guide: A Prospective Study.

Aim The study aims to compare the accuracy of dynamic navigation (DN) and static guides (SGs) for simultaneous adjacent parallel placement of implants, the time taken for the surgery, and the ease of handling the instruments. Materials and methods This prospective trial was carried out at the Department of Implantology of Saveetha Dental College from October 2022 to February 2023. A total of 20 patients who needed simultaneous adjacent dental implants were allocated randomly into two groups: Group 1 SG surgery and Group 2 DN surgery. Forty implants were placed, 20 under DN and 20 under SG. Bucco-lingual displacement, apico-coronal displacement, mesiodistal displacement, and mesiodistal angulation were compared between the two groups. The patients' data in both groups were evaluated by operating surgeons along with the surgical time taken and the ease of handling of instruments. Results The 20 patients who underwent implant placement in the DN and SG groups all had adjacent missing teeth in posterior sites, including lower posteriors (70%) and upper posteriors (30%). There was improved precision in relation to the mesiodistal displacement and angulation of the anterior implant of the adjacent parallel implants. The mesiodistal displacement in Group 1 (SG) was 5.61 + 3.1 mm, which was higher than Group 2 (DN), which was 0.55 + 0.56 mm. The mesiodistal angulation was 3.1 + 2.9 degrees in Group 2 and 0.42 + 0.5 degrees in Group 1. The second implant had a significant difference (p < 0.005) in mesiodistal displacement, mesiodistal angulation, and bucco-lingual displacement. The difference between the intergroup surgical time (mean + SD) in Group 1 was 30 + 4.5 mins and in Group 2 was 60.7 + 10.1 mins, with p < 0.05 statistically significant. The comfort of the operator was better in the SG group. Conclusion Any digitally aided implant placement technique can improve placement accuracy but each has its downfalls. Achieving the highest levels of precision and long-lasting prosthetic results hinges on both the suitability of the chosen case and the expertise of the surgeon performing the implant placement.

Dynamic Navigation Protocol for Direct Sinus Lift and Simultaneous Implant Placement: A Case Report.

AIM: This study aims to evaluate the accuracy associated with the use of a dynamic navigation system for the lateral window opening for a direct sinus floor elevation (SFE) procedure with simultaneous implant placement. MATERIALS AND METHODS: A female patient, aged 27 years, reported to the Department of Implantology seeking treatment for her lost tooth. On radiographic examination, the residual alveolar ridge height was 6 mm in the 26 (left upper first molar) region. For the implant placement, the case was planned to be carried out under dynamic navigation (Navident, Claronav, Canada). To make the lateral window accessible to the sinus floor, an implant trajectory resembling the required window dimensions and prosthetic implant position was planned. Post-surgery cone beam computed tomography (CBCT) was taken to assess the accuracy of the lateral window and implant trajectories using Evalunav (Navident, Claronav, Canada) analysis with dynamic navigation software. RESULTS: There was improved accuracy of the lateral window opening, and the visualization of the lateral window was maintained in real-time throughout the procedure, which was advantageous to eliminate the tearing of the thin sinus membrane. The deviations found in the trajectory of the lateral window in comparison between the planning and post-procedure were: (a) entry was deviated by 2.83 mm; (b) the apex was deviated by 2.52 mm; (c) vertically, the apex was deviated by 0.29 mm; and (d) there was an 8.93° deviation in the angulation of the trajectory. The implant that was placed simultaneously with the SFE's accuracy was in comparison with the position that was planned: (a) entry was deviated by 0.03 mm, (b) the apex was deviated by 0.82 mm, (c) vertically, the apex was deviated by 0.82 mm, and (d) there was a 0° deviation in the angulation of the trajectory. CONCLUSION: Dynamic navigation technology can help overcome complications associated with direct sinus lift procedures by providing highly accurate and precise planning and execution of the surgical procedure. This can lead to improved implant stability and a reduced risk of complications.

Efficacy of copper oxide nanoparticles using Piper longum and Piper betle.

It is of interest to evaluate the antibacterial, anti-inflammatory, and antioxidant effects of copper nanoparticles synthesized using Piper longum and Piper betle. The copper nanoparticles were characterized using various techniques and found to have a diameter between 30 and 90 nm. The nanoparticles exhibited significant antibacterial activity against E. faecalis, S. aureus, C. albicans, and S. Mutans, comparable to gold standards. They also demonstrated anti-inflammatory effects similar to the gold standard values. Furthermore, the copper nanoparticles displayed antioxidant capabilities, with maximum inhibition of 85.16% at 50 g/ml and a minimum inhibition of 50.62% at 10 g/ml. Overall, the study suggests that Piper longum and Piper betle mediated copper nanoparticles possess promising antibacterial, anti-inflammatory, and antioxidant properties, indicating their potential use in various applications.

Hybrid Navigation Technique for Improved Precision in Implantology.

The hybrid navigation technique involves the merging of the Dynamic navigation (DN) system (Navident, Claronav, Canada) and static navigation technique (3Shape, Copenhagen, Denmark). Combining the advantages of both techniques, devising a protocol of hybrid navigation will be advantageous to eliminate the difficulties faced by operators in using either methods separately. Three patients requiring dental implants were included in this study. This requires the cone beam computed tomography (CBCT) (Digital Imaging and Communications in Medicine (DICOM) data) and intra-oral scan (Standard Tessellation Language (STL) format) data for the accurate planning of the implant positions in both the static and dynamic approaches. The steps carried out were repeated for each of the patients, the accuracy of the implant placement was verified postoperatively by merging the CBCT data pre and post through the Evalunav software (NaviDent, Claronav). The accuracy of the implants placed were assessed based on the mesio-distal, bucco-lingual, apical deviations in distance and in angulation. The semi-robotic DN and static guide combination as a hybrid technique is an interesting method to improve the accuracy of flapless implant surgeries and can be used in cases where the anatomical landmarks are determinant factors for the implant placement.

Effect of different drugs for controlling post-operative swelling after implant surgery among Indians.

Pain and swelling are common complications associated with dental implant surgery. Forty five patients were included in this study (Group 1: Paracetamol+ amoxicillin (n=15), Group 2: Paracetamol+ Cold packs (n=15), Group 3: Paracetamol (n=15)). Post op drugs were given based on the group, and Pre and post-operative photographs were evaluated with Adobe photoshop software. The photographs were evaluated with Adobe Photoshop for Statistical analysis was done by repeated measures ANOVA. The first day post-surgery, there was increased swelling in group 1 with mean surface area of swelling of 47.6±2.1 mm2 and considerable decrease in group 2, 42.1±3.5 mm2. The surface area of swelling in this group was maintained in the same range till Day 7.

Gene expression analysis of alkaline phosphatase in peri-implantitis tissue.

Peri-implantitis is a condition that causes inflammation and bone loss around dental implants. Alkaline phosphatase (ALP) is a gene involved in the inflammation of the tissue. Therefore, it is of interest to evaluate the expression of the ALP gene around the peri-implantitis site. 20 samples were collected and analyzed using qRT-PCR, and statistical analysis was performed. The results showed a significant decrease in ALP expression in infected peri-implantitis tissue compared to normal tissue, indicating that ALP gene is involved in the inflammation of peri-implantitis and correlates with clinical findings.

Evaluation of neo-implant abutment junction sealing gel among Indian patients.

With the advent of various implant abutment junctions, the ultimate aim is to develop a precise implant abutment junction with negligible micro-leakage. However precise the mechanical connection is, there seems to be a negligible amount of micro-leakage that is present that can be addressed with the help of sealing gel. This study aims to assess the micro-leakage between the neo-sealing gel and the commercially available implant sealing gel. The study was conducted on implants (n=15) with internal hex connections, group 1 (No gel, n=5), group 2 (Neo gel, n=5) and group 3 (commercial gel, n=5). Mean dE*ab values of 0.28± 0.02, 0.04± 0.01 and 0.17±0.01 were noted for the 3 groups, and there was statistically significant difference between the 3 groups (p≤0.05). The study suggests that the neo sealing gel may be a promising material to prevent bacterial ingress and micro-leakage at the implant abutment junction.

STITCH enabled protein-protein interactions between Phyllanthus emblica and peri-implant microbiome.

It is of interest to document the protein-protein interaction between Phyllanthus emblica and peri implant pathogens in the context of peri implant illness. The peri implant pathogens includes Aggregatibacter actinomycetemcomitans (D7S-1), Centipeda periodontii, Campylobacter gracilis, Fusobacterium nucleatum, Slackia exigua, Prevotella intermedia, Tannerella forsythia, Staphylococcus aureus, Bacteroides fragilis, and Bacteroides fragilis. Hence, a user-defined query was used to conduct analysis on the provided bacterial strains whose molecular data available in the STITCH database. Thus, we used the STITCH tool to examine protein interactions and the VirulentPred tool to assess pathogenicity using the known molecular data on Phyllanthus emblica and peri implant pathogens. Data shows that Phyllanthus emblica interacts with peri implant pathogens.

STITCH enabled molecular interaction of glycrhizzin with peri-implant microbiota.

Glycyrrhizin is present in the root extract of the licorice plant used for various conditions, including gastric ulcers. Therefore, it is of interest to document the STITCH enabled molecular interaction of glycrhizzin with peri-implant microbiota. The peri implant pathogens includes Aggregatibacter actinomycetemcomitans (D7S-1), Centipeda periodontii, Campylobacter gracilisi, Fusobacterium nucleatumi, Slackia exigua, Prevotella intermedia, Tannerella forsythia, Staphylococcus aureus, Bacteroides fragilis, and Bacteroides fragilis. Hence, a user-defined query was used to conduct analysis on the provided bacterial strains whose molecular data available in the STITCH database. Thus, we used the STITCH tool to examine protein interactions and the VirulentPred tool to assess pathogenicity using the known molecular data on glycrhizzin and peri implant pathogens. Data shows that glycyrrhizin interacts with peri implant pathogens.

Correlation between CT - derived bone density and optimal bone densities acquired from CBCT scans.

It is of interest to explore the correlation between preoperative bone density, assessed via CBCTT, and primary stability of dental implants, assessed by torque ratchet. A total of 100 patients who had implant placed were taken a sample for this retrospective study. The Hounsfield units (HU) derived preoperative bone densities at implant sites that were acquired with the help of the CBCT and the primary stability was achieved during the day of surgery. Both were compared to optimum bone densities. Statistical correlation was done between the HU and Bone density. Data suggests that evaluating HU values, along with other parameters, before performing implant surgery could lead to better primary implant stability.

Post-operative pain management using two drugs following dental implant surgery among Indians.

It is of interest to assess two drug regimens for managing pain and swelling in 40 dental implant surgery patients. Visual analogue scale readings were taken at 24 hours, 72 hours and 1 week. Data shows that a combination of acetaminophen and aceclofenac with trypsin - chymotrypsin was found to be more effective than acetaminophen alone.

Efficacy of mucolytics and steam therapy in the management of sinusitis among Indians

It is of interest to compare the treatment modalities of sinus membrane thickening, by analyzing the difference in pre and post-intervention radiographic measurement of sinus membrane thickness. Results showed that combination therapy of steam and mucolytics decreased the sinus thickening in a statistically significant manner compared to mucolytics alone. Thus, there is a correlation between maxillary sinus membrane thickening and patency of maxillary ostium radiographically.

Influence of antagonist tooth on mandibular implant positioning during surgery among Indians

A retrospective radiographic analysis of cone beam computed tomographic radiographs of 42 patients who had undergone dental implant therapy at the department of implantology, Saveetha Dental College Hospitals, India. The mean angular deviation was 3.17 ° in the anterior, 1.6° in the premolar and 0.81° in the molar region. Data shows that free hand placement could be done with minimal deviation taking the opposing dentition as a guide.

Bridging the Gap with Nanoparticles: A Novel Approach.

Two-piece implants unavoidably present a microgap between the implant and the abutment interface. Although numerous modalities have been attempted to overcome this situation, the implant abutment interface still remains a critical point for microbial colonization, which starts an inflammatory cascade of events eventually compromising the implants. Throughout our life, cells in all biological systems are unprotected to oxidative stress leading to the formation of Reactive oxygen species which is of concern when it comes to placing implants in patients who are periodontally compromised. This necessitates the development of alternative therapeutic modalities, which could counteract as well as prevent the microbial overload and ROS generation thereby improving the longevity of implants. To evaluate and assess the antibacterial, antioxidant and anti inflammatory effectiveness of quercetin-loaded titanium nanocomposites as coatings over healing abutments. Quercetin-loaded titanium nanocomposites were synthesized using green synthesis and confirmation was done using UV spectroscopy. Healing abutments were coated with the formulated nanocomposites, an intra-oral environment was simulated by thermocycling. Their antibacterial, antioxidant, anti-inflammatory, and cytotoxicity were assessed using standard tests. Healing abutments were coated with the formulated nanocomposites, an intra-oral environment was simulated by thermocycling. They showed potent antibacterial, antioxidant, and anti-inflammatory properties, which could prove beneficial in a variety of clinical scenarios in which there is a high risk for implant failure during early osseointegration.

Chitosan-Reinforced Gelatin Microspheres-Modified Glass Ionomer Cement (GIC): A Novel Bone Alloplast Graft Material Synthesis and an In Vivo Analysis.

Aim and objective The study aimed to assess and evaluate the efficacy of glass ionomer modified with chitosan-reinforced gelatin microspheres on bone formation. Materials and methods  The study involved three groups: Group I comprised plain glass ionomer cement; Group II comprised glass ionomer cement/gelatin (70:30 wt%); in Group III, glass ionomer cement/gelatin/chitosan (70:30%) scaffold were made into discs; the gelatin microspheres were synthesized by oil emulsion method. The synthesized scaffold was subjected to the following in vitro testing, Instron Universal Testing Machine (UTM), U3000, (Instron Corporation, Norwood, Massachusetts, United States) to assess compressive strength, scanning electron microscope (SEM) examination, and biocompatibility testing using hemocompatibility assay. The material was then tested in vivo; male Wistar albino rats, a total of nine animals, were utilized for this purpose. Three animals were used in each group; a femoral defect model was the model of choice for the experiment and the animals were observed for a period of four weeks, following which the animals were sacrificed and sent for histopathological analysis. Results The compression testing was carried out using UTM; test group I was 33 MPa, test group II was 2.3 MPa, and test group III was 25.75 MPa. SEM (JSM-IT800 Schottky Field Emission NANO SEM (JEOL, Tokyo, Japan)) analysis was done to observe the porosity of the fabricated scaffold with the average measurement of 0.12 ± 0.2 µm in test group II and 0.29 ± 0.4 µm in test group III. Hemocompatibility reports noted 0.4-0.8% lysis for the synthesized scaffolds. Histopathology staining of the femur defects showed that group III favoured bone formation. One-way analysis of variance (ANOVA) and post hoc Bonferroni test was done on the data. The optical density values of the alizarin red stained slide showed statistical significance for group III. Conclusion In conclusion, the synthesized scaffolds are biocompatible, distribution of porosity and pore characteristics in the glass ionomer cement/gelatin/chitosan group is better than that of the glass ionomer cement/gelatin group. The glass ionomer cement/gelatin/chitosan group had better compressive strength and induced more bone formation compared to the other test group and the control. Thus, the novel glass ionomer modified with chitosan-reinforced gelatin microspheres has optimal properties to be used as a bone graft material.

Workflow for the full-mouth rehabilitation of a patient with different prosthetic materials in opposing arches: A bold move in desperate scenario.

Fixed rehabilitation is an exhaustive approach for most dental practitioners to treat partial or complete edentulism. In recent years, we are witnessing a digital transformation in prosthodontics and smile makeovers. This requires an in-depth understanding of concepts and the skills to achieve desired clinical results. Many situations of the oral cavity often need fixed rehabilitation treatment. This extensive treatment primarily solves two goals: maintains crown integrity and also achieves optimal esthetics. To restore lost parts of the stomatognathic system, a multidisciplinary approach is of utmost importance. The treatment options may range from removable implant-supported dentures to fixed implant-supported prostheses. The choice of treatment relies on the limitations of anatomic structures and existing. Partial or complete edentulousness can inadvertently reduce the quality of life of the patient and may hinder physiology. This report narrates a combination of two types of dental prosthetic material to obtain a desirable outcome in fixed rehabilitation of a patient. Furthermore, it highlights the management of complete treatment in a limited period and patient appointments.

Comparison of clinical efficacy of diode laser and erbium, chromium: Yttrium, scandium, gallium, and garnet for implant stage 2 recovery procedure - A randomized control clinical study.

AIM: The aim is to compare the clinical efficacy of diode laser and erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er, Cr:YSGG) laser for implant stage 2 recovery procedure. MATERIALS AND METHODS: A total of 30 patients who had undergone dental implant placement were included in this study. The subjects were randomly allocated into three groups. Group 1 patients (n = 10) had implant recovery using diode laser, Group 2 (n = 10) implant recovery with Er, Cr:YSGG and conventional scalpel method (n = 10) was the third group. The pain assessment was recorded using visual analog scale (VAS scale), time taken for the procedure, intra-operative bleeding, time taken for healing were recorded for the three groups. RESULTS: Data were tabulated and the results were analyzed using SPSS software version 26. Mann-Whitney U-test was used to compare the postoperative analgesic used, postoperative VAS score, the time taken for recovery and time taken for healing between the three study groups. Results were considered to be statistically significant when P < 0.05. Operation duration under Er, Cr:YSGG were much faster than the diode laser, however the results were not statistically significant (P = 0.051). The operation time under Er, Ch: YSGG and laser were faster than the conventional scalpel group (P = 0.000). The time taken for healing was faster in the Er, Cr:YSGG laser group than the diode laser and the scalpel group (P = 0.000). VAS scale at day 0 was higher in the conventional group than the two laser groups (P = 0.000). CONCLUSION: Considering the advantages of both these laser systems such as less anesthesia, less surgical trauma and faster healing, and post-operative comfort, lasers are an effective tool for implant stage two recovery techniques. However, since diode lasers are more cost effective when compared to Er, Cr:YSGG, diode lasers may meet the clinical needs when compared to hard-tissue lasers.

Comparing Closed Tray Implant Impression Techniques Using Snap-On and Impression Analogues on a Clinical Radiographic Scale.

Several impression techniques have been proposed to achieve passive fitness between the prosthesis and the osseointegrated implant. The aim of this study was to compare closed tray implant impression techniques using snap-on and impression analogues on a clinical radiographic scale. The current study was comparative, descriptive, and retrospective, performed in a university setting in 2020. The data of patients reporting to the Department of Implantology between June 2019 to March 2020 were collected from patient records, and the data of 1000 plus patients were analyzed for snap-on impressions and impression analogue accuracy in seating and associated jig trial seating. A comparison of closed tray implant impression techniques using snap-on and impression analogues on a clinical radiographic scale found both to be perfect. The impression recorded with snappy with abutment and the impression recorded using impression coping exhibited no differences during jig trial seating verification. This study showed that both impression procedures are accurate and can be used for implant impressions.

In vitro evaluation of fracture resistance and cyclic fatigue resistance of computer-aided design-on and hand-layered zirconia crowns following cementation on epoxy dies.

AIM: This in vitro study was to compare the fracture resistance and cyclic fatigue resistance of hand-layered zirconia crowns and computer-aided design (CAD)-on crowns (lithium disilicate with zirconium oxide). SETTINGS AND DESIGN: Comparative -Invitro study design. MATERIALS AND METHODS: All ceramic crown preparation was done on a mandibular molar ivorine tooth, impression made, and duplicated. Twenty hand-layered zirconia crowns and twenty CAD-on crowns were fabricated using CAD/computer-aided manufacturing (CAD/CAM) technique. All crowns were cemented to their respective dies using resin cement for evaluating fracture resistance and cyclic fatigue resistance using universal testing machine. STATISTICAL ANALYSIS USED: Independent samples t-test, Mann-Whitney U-test, and Shapiro-Wilk test were used. RESULTS: The mean fracture resistance of CAD-on crowns (2660.50 ± 501.303 N) was significantly more than that of hand-layered zirconia crowns (1963.60 ± 452.895 N) (independent samples t-test, P < 0.023). Cyclic fatigue resistance test results showed that the mean number of cycles before failure for hand-layered zirconia crowns was 175,297 and for CAD-on crowns was 212,097 (Mann-Whitney U-test, P < 0.012). CONCLUSION: CAD-on crowns were found to have significantly higher fracture resistance and cyclic fatigue resistance properties than hand-layered zirconia crowns.

Impact of Level of Crestal Placement on Marginal Bone Loss: A Retrospective Institutional Study.

A dental implant is an alloplastic material that is used to replace the tooth root. There is frequently marginal bone loss after implant placement at two months and mainly after loading. A number of factors are responsible for bone loss. One is the level of implant placement. Hence, this study aimed to evaluate the impact of placement level on marginal bone loss. A retrospective study was done in which 149 patients who had undergone 172 single-implant placements from September 1, 2019, to March 1, 2020, were included. Data from 86,000 patient records from June 2019 to March 2020 were reviewed and analyzed. The data were collected by recalling the patient and reviewing. Statistical analysis was performed using unpaired t-testing to assess the difference between bone loss in implants placed at different crestal levels. Marginal bone loss in group 1 was 2.23 ± 0.714 mm and in group 2 was 2 ± 0.00 mm. There was no statistically significant difference in bone loss between males and females. However, when placement level and bone loss were correlated, a statistically significant difference was seen.