The Effect of Concentrated Growth Factor on Calvarial Bone in Diabetic Healing.

The aim of this study was to evaluate the effect of Concentrated Growth Factor (CGF) on bone healing in diabetic rat model. Experimental diabetes was induced in 24 male Sprague-Dawley rats by streptozotocin. Twenty-four animals served as healthy controls. The animals were divided into 4 subgroups; empty bone defect, grafting with xenogenous graft (Geno-os, OsteoBiol, Turin-Italy), CGF administration, and combined application of the CGF with the xenogenous graft in critical-sized defects in the calvaria of the rats. The diabetic group was given 4 units of Neutral Protamin Hagedorn per day. After 6 weeks, all animals were sacrificed and bone healing was histologically and histomorphometrically analyzed, and the evaluation revealed that the new bone formation in diabetic animals was significantly lower than in healthy group (P: 0.001, P: 0.023). In both groups, the highest rate of ossification was observed in the combined use of xenogenous graft and CGF. When the new bone formation was examined in the graft and CGF group, no significant difference was found between control and diabetic group (P = 0.562; P > 0.05). In conclusion, in patients with diabetes mellitus, combination therapy of CGF with graft is expected to contribute positively to the healing of bone defect.

Two Composite Bone Graft Substitutes for Maxillary Sinus Floor Augmentation: Histological, Histomorphometric, and Radiographic Analyses.

OBJECTIVE: To histologically, histomorphometrically, and radiographically compare clinical performance of 2 composite bone graft substitutes for maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS: Partially or totally edentulous patients requiring MSFA underwent grafting procedures using a 2:1 mixture of biphasic calcium sulfate (CS) and deproteinized bovine bone (group CB) or biphasic CS and alloplast (group CA). Grafts were allowed to heal for 5 months before placing the implants. During implant surgery, bone samples were collected from grafted areas for histology and histomorphometry. Graft height was analyzed using cone beam computed tomography. RESULTS: Sixteen patients completed the study. Mean percentages of new bone were 34.40% ± 18.91% and 36.71% ± 15.32% for the CA and CB groups, respectively; percentages of residual graft particles were 6.98% ± 5.09% and 5.52% ± 4.12%, respectively. The only significant finding was a greater graft height loss in the CA group (24.44% ± 6.52% vs 14.60% ± 4.58%). CONCLUSION: Both graft substitutes were integrated in bone, confirming their biocompatibility and effectiveness for MSFA. The CB group showed less bone height loss than the CA group.

Photocatalytical Antibacterial Activity of Mixed-Phase TiO2 Nanocomposite Thin Films against Aggregatibacter actinomycetemcomitans.

Mixed-phase TiO2 nanocomposite thin films consisting of anatase and rutile prepared on commercially pure Ti sheets via the electrochemical anodization and annealing treatments were investigated in terms of their photocatalytic activity for antibacterial use around dental implants. The resulting films were characterized by scanning electron microscopy (SEM), and X-ray diffraction (XRD). The topology was assessed by White Light Optical Profiling (WLOP) in the Vertical Scanning Interferometer (VSI) mode. Representative height descriptive parameters of roughness R a and R z were calculated. The photocatalytic activity of the resulting TiO2 films was evaluated by the photodegradation of Rhodamine B (RhB) dye solution. The antibacterial ability of the photocatalyst was examined by Aggregatibacter actinomycetemcomitans suspensions in a colony-forming assay. XRD showed that anatase/rutile mixed-phase TiO2 thin films were predominantly in anatase and rutile that were 54.6 wt% and 41.9 wt%, respectively. Craters (2-5 µm) and protruding hills (10-50 µm) on Ti substrates were produced after electrochemical anodization with higher R a and R z surface roughness values. Anatase/rutile mixed-phase TiO2 thin films showed 26% photocatalytic decolorization toward RhB dye solution. The number of colonizing bacteria on anatase/rutile mixed-phase TiO2 thin films was decreased significantly in vitro. The photocatalyst was effective against A. actinomycetemcomitans colonization.

A randomized clinical trial of an adjunct diode laser application for the nonsurgical treatment of peri-implantitis.

OBJECTIVE: In this radiographic and microbiologic split-mouth clinical trial, efficacy of a diode laser as an adjunct to conventional scaling in the nonsurgical treatment of peri-implantitis was investigated. BACKGROUND DATA: Eradication of pathogenic bacteria and infected sulcular epithelium presents a significant challenge in the nonsurgical treatment of peri-implantitis. MATERIALS AND METHODS: Ten patients (mean age, 55.1 years; SD, 11.4) with 48 two piece, rough-surface implants and diagnosed with peri-implantitis were recruited (NCT02362854). In addition to conventional scaling and debridement (control group), crevicular sulci and the corresponding surfaces of 24 random implants were lased by a diode laser running at 1.0 W power at the pulsed mode (λ, 810 nm; energy density, 3 J/cm(2); time, 1 min; power density, 400 mW/cm2; energy, 1.5 J; and spot diameter, 1 mm); (laser group). Healing was assessed via periodontal indexes (baseline and after 1 and 6 months after the intervention), microbiologic specimens (baseline and after 1 month), and radiographs (baseline and after 6 months). RESULTS: Baseline mean pocket depths (4.71, SD, 0.67; and 4.38, SD 0.42 mm) and marginal bone loss (2.71, SD 0.11; and 2.88, SD 0.18 mm) were similar (p = 0.09 and p = 0.12) between the control and laser groups, respectively. After 6 months, the laser group revealed higher marginal bone loss (2.79, SD 0.48) than the control groups (2.63, SD 0.53) (p < 0.0001). However, in both groups, the microbiota of the implants was found unchanged after 1 month. CONCLUSIONS: In this clinical trial, adjunct use of diode laser did not yield any additional positive influence on the peri-implant healing compared with conventional scaling alone.

The comparison of acellular dermal matrix allografts with free gingival grafts in the augmentation of peri-implant attached mucosa: a randomised controlled trial.

PURPOSE: The purpose of this randomised controlled trial is to compare the efficacy of two techniques for enhancing peri-implant keratinised mucosa: acellular dermal matrix allograft versus free gingival grafts. MATERIALS AND METHODS: Thirty-six patients having implant sites with less than 1.5 mm of keratinised mucosa width were randomly assigned to two groups. Thirty-six implants placed in 18 patients received acellular dermal matrix allografts (ADM group), while 36 implants placed in 18 individuals received free gingival grafts (FGG group). Plaque index (PI), gingival index (GI), probing depth (PD) and the width of attached mucosa (WAM) were measured at baseline and at 1, 3 and 6 months following surgery. RESULTS: WAM in the FGG group was significantly greater than the ADM group at 3 (P = 0.026) and 6 months (P < 0.001). In the FGG group, final gain of WAM was greater (1.58 mm in ADM group, 2.57 mm in FGG group) (P < 0.001) and postoperative relapse was smaller (2.68 mm in the ADM group, 1.73 mm in the FGG group) (P < 0.001). PI and GI scores were greater in the ADM group at 6 months (P = 0.016 and P = 0.61, respectively). The FGG group demonstrated a greater PD value at 3 months (P < 0.001), however there was no significant difference between the groups at 6 months (P = 0.317). CONCLUSIONS: Although ADM allografts are capable of increasing the width of peri-implant keratinised mucosa, FGGs seem to be more effective. ADM allografts may be the application of choice at implant sites in need of major grafts and in patients where a donor site should be avoided for medical or psychological reasons.

Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-aided implant placement. Part II: reliability of mucosa-supported stereolithographic guides.

PURPOSE: Deviations of implants that were placed by conventional computed tomography (CT)- or cone beam CT (CBCT)-derived mucosa-supported stereolithographic (SLA) surgical guides were analyzed in this study. MATERIALS AND METHODS: Eleven patients were randomly scanned by a multi-slice CT (CT group) or a CBCT scanner (CBCT group). A total of 108 implants were planned on the software and placed using SLA guides. A new CT or CBCT scan was obtained and merged with the planning data to identify the deviations between the planned and placed implants. Results were analyzed by Mann-Whitney U test and multiple regressions (p < .05). RESULTS: Mean angular and linear deviations in the CT group were 3.30° (SD 0.36), and 0.75 (SD 0.32) and 0.80 mm (SD 0.35) at the implant shoulder and tip, respectively. In the CBCT group, mean angular and linear deviations were 3.47° (SD 0.37), and 0.81 (SD 0.32) and 0.87 mm (SD 0.32) at the implant shoulder and tip, respectively. No statistically significant differences were detected between the CT and CBCT groups (p = .169 and p = .551, p = .113 for angular and linear deviations, respectively). CONCLUSIONS: Implant placement via CT- or CBCT-derived mucosa-supported SLA guides yielded similar deviation values. Results should be confirmed on alternative CBCT scanners.

Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-assisted implant placement. Part I: relationship of radiographic gray density and implant stability.

PURPOSE: The relationship of conventional multi-slice computed tomography (CT)- and cone beam CT (CBCT)-based gray density values and the primary stability parameters of implants that were placed by stereolithographic surgical guides were analyzed in this study. MATERIALS AND METHODS: Eighteen edentulous jaws were randomly scanned by a CT (CT group) or a CBCT scanner (CBCT group) and radiographic gray density was measured from the planned implants. A total of 108 implants were placed, and primary stability parameters were measured by insertion torque value (ITV) and resonance frequency analysis (RFA). Radiographic and subjective bone quality classification (BQC) was also classified. Results were analyzed by correlation tests and multiple regressions (p < .05). RESULTS: CBCT-based gray density values (765 ± 97.32 voxel value) outside the implants were significantly higher than those of CT-based values (668.4 ± 110 Hounsfield unit, p < .001). Significant relations were found among the gray density values outside the implants, ITV (adjusted r(2) = 0.6142, p = .001 and adjusted r(2) = 0.5166, p = .0021), and RFA (adjusted r(2) = 0.5642, p = .0017 and adjusted r(2) = 0.5423, p = .0031 for CT and CBCT groups, respectively). Data from radiographic and subjective BQC were also in agreement. CONCLUSIONS: Similar to the gray density values of CT, that of CBCT could also be predictive for the subjective BQC and primary implant stability. Results should be confirmed on different CBCT scanners.

Stability, marginal bone loss and survival of standard and modified sand-blasted, acid-etched implants in bilateral edentulous spaces: a prospective 15-month evaluation.

OBJECTIVES: Chemical modification of the already proven sand-blasted and acid-etched (SLA) implant had increased its surface wettability and consequent early-term osseointegration characteristics. The aim of this clinical trial was to compare the stability changes, success, survival, peri-implant parameters and marginal bone loss (MBL) of the early-loaded standard (SLA) and modified sand-blasted, acid-etched (modSLA) implants. MATERIAL AND METHODS: A total of 96 SLA and modSLA implants were placed in a bi-lateral, cross-arch position to the jaws of 22 patients. Resonance frequency analysis (RFA) was used to measure the implant stability in the surgery and following healing after 1, 3 and 6 weeks. At the stage of loading, a panoramic X-ray was obtained and RFA measurement was repeated for all implants. Implants were restored by metal-ceramic crowns and followed for 1 year to determine the success, survival rate, peri-implant parameters and MBL. Results were compared by one- and two-way ANOVA, log-rank test and generalized linear mixed models (P < 0.05). RESULTS: One modSLA implant was lost after 3 weeks following the surgery yielding to a 100 and 97.91% success rate for SLA and modSLA implants, respectively (P = 0.323). At the loading stage, modSLA implants showed significantly lower MBL (0.18 ± 0.05 mm) than SLA implants (0.22 ± 0.06 mm; P = 0.002). In the loading stage, RFA value of the modSLA implants (60.42 ± 6.82) was significantly higher than the both implant types in the surgical stage (55.46 ± 8.29 and 56.68 ± 8.19), and following 1 (56.08 ± 7.01 and 55.60 ± 9.07) and 3 weeks of healing (55.94 ± 5.95 and 55.40 ± 6.50 for SLA and modSLA implants, respectively). CONCLUSIONS: modSLA implants demonstrated a better stability and a reduced MBL at the loading stage. Both SLA and modSLA implants demonstrated a favorable success and survival at the end of 15-month follow-up.

Injectable calcium phosphate cement as a graft material for maxillary sinus augmentation: an experimental pilot study.

OBJECTIVES: The aim of the present study was to evaluate the efficiency of injectable CaP cement as a graft material around dental implants in the maxillary sinus augmentation procedure. MATERIAL AND METHODS: Bilateral sinus augmentation process was carried out in three sheep and two implants were inserted during the same session. Out of a total of 12 installed implants, eight belonged to the so-called experimental group. In the experimental group, injectable CaP cement was used as augmentation material while autologous bone served as control. RESULTS: Histological examination revealed that newly formed bone surrounded the cement completely without an intervening fibrous tissue layer. Following a healing period of 12 weeks, mean bone-to-implant contact (BIC) values in the experimental and control groups were 36+/-5 and 37+/-3, respectively. The percentage of BIC was comparable with other experimental sinus augmentation studies. Further, it appeared that the thickness of the cortical bone that covered the outer surface of the maxillary sinus was < 2-3 mm, which affected the primary stability of the implants negatively. CONCLUSION: CaP cement is indeed effective to stimulate bone formation in the sinus elevation procedure. Nevertheless, additional improvements in the cement composition are required to allow final clinical utilization of the material.

Comparison of analgesic and anti-inflammatory efficacy of selective and non-selective cyclooxygenase-2 inhibitors in dental implant surgery.

BACKGROUND: The analgesic and anti-inflammatory efficacy of tenoxicam and meloxicam were evaluated in this double-masked, randomized, prospective study by analyzing pain scores and the need for rescue-analgesic agents following dental implant surgery. METHODS: One hundred patients, in whom 241 dental implants were placed, were divided into two groups. For 4 days beginning the day before surgery, the first group received meloxicam, 15 mg daily, and the second group received tenoxicam, 20 mg daily, followed by 1 hour preoperatively and for 2 days thereafter. Pain intensity was rated by the subjects based on a visual analog scale on the operation day and on the following 6 days. The patients were recommended to use a rescue analgesic if the pain score was > or =4. Postoperative complications, such as edema, hematoma, infection, severe pain, paresthesia, or gastrointestinal complaints, were also noted. RESULTS: Statistical analysis revealed that 54% of patients in the tenoxicam group and 66% of patients in the meloxicam group used rescue analgesics on day 1. However, the difference between the groups was not significant (chi(2) = 1.05; P = 0.30). The relationship between the reduction of consumption and time was not significant in either group (Z = 0.84; P = 0.40). The relationship between the use of rescue analgesics and the number of implants placed was not significant. Among patients who reported postoperative complications, there was not a statistically significant difference between the groups (chi(2) = 0.04; P = 0.84). CONCLUSION: Meloxicam and tenoxicam exhibited a similar analgesic and anti-inflammatory efficacy in the present investigation.