Evaluation of osteoblastic activity in extraction sockets treated with platelet-rich fibrin

OBJECTIVE: The aim of this study was to determine whether the use of platelet rich fibrin (PRF) improved the healing of extraction sockets. Study DESIGN: A total of 20 patients with bilateral soft tissue impacted mandibular third molars were included in this study. The left and right third molars were extracted during the same session. Subsequently, the PRF membrane was randomly administered to one of the extraction sockets, whereas the contralateral sockets were left without treatment. On postoperative 30. and 90. days, panoramic images and bone scintigrams were taken to evaluate the bone healing between PRF-treated and non-PRF-treated sockets. Also, periodontal evaluation was performed in the same control sessions. Dependent group t test for paired samples was used for statistical analysis. RESULTS: The average increase in technetium-99m methylene diphosphonate uptake as an indication of enhanced bone healing did not differ significantly between PRF-treated and non-PRF-treated sockets 30 and 90 days postoperatively. Radioopacity that can show the bone healing on panoramic images were measured by Image J programme and they did not differ significantly. Also periodontal values did not differ significantly. CONCLUSIONS: PRF might not lead to enhanced bone healing in impacted mandibular third molar extraction sockets30 and 90 days after surgery. It is thought that PRF has the potential characteristics of an autologous fibrin matrix and can accelerate the healing. To better understand the effects of PRF on healing, further research is warranted with larger sample sizes

Evaluation of osteoblastic activity in extraction sockets treated with platelet-rich fibrin.

OBJECTIVE: The aim of this study was to determine whether the use of platelet rich fibrin (PRF) improved the healing of extraction sockets. STUDY DESIGN: A total of 20 patients with bilateral soft tissue impacted mandibular third molars were included in this study. The left and right third molars were extracted during the same session. Subsequently, the PRF membrane was randomly administered to one of the extraction sockets, whereas the contralateral sockets were left without treatment. On postoperative 30. and 90. days, panoramic images and bone scintigrams were taken to evaluate the bone healing between PRF-treated and non-PRF-treated sockets. Also, periodontal evaluation was performed in the same control sessions. Dependent group t test for paired samples was used for statistical analysis. RESULTS: The average increase in technetium-99m methylene diphosphonate uptake as an indication of enhanced bone healing did not differ significantly between PRF-treated and non-PRF-treated sockets 30 and 90 days postoperatively. Radio-opacity that can show the bone healing on panoramic images were measured by Image J programme and they did not differ significantly. Also periodontal values did not differ significantly. CONCLUSIONS: PRF might not lead to enhanced bone healing in impacted mandibular third molar extraction sockets 30 and 90 days after surgery. It is thought that PRF has the potential characteristics of an autologous fibrin matrix and can accelerate the healing. To better understand the effects of PRF on healing, further research is warranted with larger sample sizes.

Inpatient evaluation of periodontal, esthetic and inflammatory parameters around dental implants and natural teeth.

AIM: The use of endosseous dental implants (DI) has become a successful treatment alternative. However, providing periimplant tissue health and achieving a natural esthetic look are important topics in this treatment. The aim of the present study was to evaluate periodontal and esthetic parameters around DI and natural teeth (NT) and also to analyze myeloperoxidase (MPO) levels in gingival crevicular fluid (GCF) and peri-implant sulcus fluid (PISF). MATERIALS AND METHODS: Twenty DI supported fixed prosthesis and contralateral 20 NT were enrolled to the present study. Clinical periodontal parameters (probing depth, clinical attachment level, gingival bleeding time index and gingival index) were recorded and GCF/PISF samples were obtained from mesial (mesiobuccal and mesiolingual) and distal (distobuccal and distolingual) sites of DI and NT. MPO levels were spectrophotometrically determined. Additionally clinical photographs were obtained and esthetical evaluations were performed by using Jemt papilla index. The parameters belong to DI and NT were compared and correlations were evaluated using statistical analysis. RESULTS: A total of 40 samples were evaluated. No statistically significant differences were detected between groups in all periodontal parameters and MPO levels from mesial and distal sites. Jemt papilla index scores were slightly higher in NT however, this difference was not statistically significant (p > 0.05). Total PES score were similiar in DI and NT groups. Significant correlations were detected between MPO and gingival index values as expected. CONCLUSION: These results suggest that DI and NT have similar inflammatory conditions and esthetics, representing DI as a predictable treatment option. CLINICAL SIGNIFICANCE: Dental implants are satisfactory treatments, they provide patient esthetic natural looking, phonetic and masticatory functions.

Seven-year follow-up results of TiUnite implants supporting mandibular overdentures: early versus delayed loading.

BACKGROUND AND PURPOSE: Implant-supported mandibular overdentures have recently become a popular treatment alternative for edentulous patients desiring increased retention of complete dentures. The goal of this study was to evaluate and present treatment outcomes of mandibular overdentures retained by two unsplinted, early-loaded implants and compare these results with those for delayed-loaded implants. MATERIAL AND METHODS: Twenty-six edentulous patients had two interforaminal implants placed with a one-stage protocol. The patients were each treated with a mandibular overdenture supported by ball abutments. In the test group, the overdenture was loaded 1 week after surgery and in the control group, the overdenture was loaded 3 months after surgery. Standardized clinical and radiographic parameters were recorded at surgery, and after 3, 6, 12, and 18 months, and 2, 3, 4, 5, and 7 years. RESULTS: Because two patients did not make the 7-year recall, only 24 patients (48 implants) were evaluated in this study. No implants were lost, and 1.31 ± 0.2 mm marginal bone resorption was noted for all implants after 7 years. Implant stability measurements, clinical peri-implant parameters and marginal bone levels exhibited no statistically significant differences between the two groups over 7 years. CONCLUSION: The results of this clinical trial show that there is no significant difference in the clinical and radiographic outcomes of patients treated with mandibular overdentures supported by TiUnite implants that are either early or delayed loaded.

Familial ring (18) mosaicism in a 23-year-old young adult with 46,XY,r(18) (::p11→q21::)/46,XY karyotype, intellectual disability, motor retardation and single maxillary incisor and in his phenotypically normal mother, karyotype 47,XX,+r(18)(::p11→q21::)/46,XX.

We report on a 23-year-old man with craniofacial findings of the holoprosencephaly spectrum disorder (microcephaly, hypotelorism, depressed nasal bridge, single median maxillary central incisor), fusion of C2-C3 vertebrae, intellectual disability, and severe sleep apnea. Chromosome analysis of blood lymphocytes showed 75% ring (18) cells and 25% normal cells, karyotype mos 46,XY,r(18)(::p11→q21::)[75]/46,XY[25]. His mother was phenotypically normal except for a double ureter and bifid renal pelvis as in his son. She had a supernumerary ring (18) in 10% of blood lymphocytes, karyotype mos 47,XX,+r(18)(::p11→q21::)[10]/46,XX[90]. Familial ring (18) is a rare cytogenetic abnormality. This is the first report of a mother with a supernumerary ring (18) and a son with ring (18) mosaicism. Interestingly, the son showed a true mosaicism (mixoploidy) of ring (18) and normal cells. The mother's 46,XX cells could be easily explained by mitotic instability and ring loss during cell division. However, the coexistence of ring (18) and normal cells in the son is unusual. Possibly, during early postzygotic divisions of a 47,XY,+r(18) zygote, two (possibly subsequent) genetic events could have occurred, one when one normal chromosome 18 was lost (resulting in a cell line with ring 18), and one when the ring 18 was lost (resulting in a cell line without ring, "escape to normal"). Alternatively, the zygote of the son could have been 46,XY,r(18), and postzygotic loss of the ring 18 could have resulted in monosomy 18 cells followed by duplication of chromosome 18 in these cells (a rare mechanism for cell survival previously described as "compensatory" isodisomy).

Early versus delayed loading of mandibular implant-supported overdentures: 5-year results.

BACKGROUND AND PURPOSE: Because of poor retention of complete removable dentures for edentulous patients, implant-supported mandibular overdentures have lately become a popular alternative for them. The aims of this prospective study were to evaluate treatment outcomes of mandibular overdentures supported by two unsplinted early-loaded implants and compare these results with those for delayed-loaded implants. MATERIALS AND METHODS: A total of 26 edentulous patients were treated with two unsplinted implants supporting a mandibular overdenture. All implants were placed in the canine regions of each mandible according to the one-stage surgical protocol. There were two groups: test group, in which the overdenture was connected 1 week after surgery, and control group, in which the overdenture was connected 3 months after surgery. Standardized clinical and radiographic parameters were recorded at surgery, and after 3, 6, 12, and 18 months, and 2, 3, 4, and 5 years. RESULTS: No implants were lost, and 0.93 +/- 0.3 mm marginal bone resorption was noted for all implants after 5 years. Clinical implant stability measurements, clinical peri-implant parameters, and marginal bone resorptions showed no statistically significant differences between the two groups over 5 years. CONCLUSION: The results of this prospective clinical study suggest that there is no significant difference in the clinical and radiographic state of patients treated with implant supported mandibular overdentures loaded either 1 week or 3 months after surgery.

A 12-month evaluation of nitrite oxide metabolism around immediate and conventionally loaded dental implants.

BACKGROUND: During bone remodeling, alignment of bone is affected by loading direction. Considerable amount of data also suggest nitric oxide (NO) to be involved in bone metabolism. This study was conducted to evaluate the potential changes in NO metabolism in relation to the loading style of dental implants by analyzing the nitrite content of peri-implant sulcus fluid. METHODS: Dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient determined as immediately loaded and the other side were conventionally loaded. Clinical parameters were recorded and peri-implant sulcus fluid samples were obtained. Peri-implant sulcus fluid nitrite levels were spectrophoto-metrically determined. Clinical measurements and nitrite analysis were repeated at 1, 3, 6, 9, and 12 months. RESULTS: In both groups, there was a reduction between baseline and 12 months in all clinical parameters, except probing depth. Although, steady decrease was noticed in total nitrite levels during the whole experimental period in immediately loaded implants, more fluctuations were observed in conventionally loaded ones. CONCLUSIONS: The findings of this 12-month follow-up study support the association of NO in the bone metabolism around dental implants and further suggest the impact of different loading regimens on NO metabolism.

Myeloperoxidase as a measure of polymorphonuclear leukocyte response in inflammatory status around immediately and delayed loaded dental implants: a randomized controlled clinical trial.

BACKGROUND: As well as gingival crevicular fluid (GCF), peri-implant sulcus fluid (PISF) may have a potential diagnostic value for the early identification of metabolic and destructive processes. PURPOSE: The aim of this study was to analyze the potential impact of inflammation and loading on PISF myeloperoxidase (MPO) levels, in comparison with GCF. MATERIALS AND METHODS: A total of 220 sites, dental implant (immediately [IL] or delayed loaded [DL]), and natural tooth, either healthy/noninflamed or gingivitis/inflamed, were classified. Clinical parameters were recorded, and GCF/PISF samples were obtained. GCF/PISF MPO levels were spectrophotometrically determined. RESULTS: Clinical parameters demonstrated increases with the presence of gingival/peri-implant inflammation. Total MPO levels were higher at inflamed tooth and implant sites compared to noninflamed/healthy sites (p < .05). Although they did not reach a significance level, inflamed IL sites had higher total MPO levels than inflamed DL sites (p = .401). Gingival index and total MPO levels exhibited significant correlations (p < .05). CONCLUSION: Using implants and natural teeth in the same study design, the findings of the present study support the close relationship between MPO production and inflammation, and may speculate a potential for loading of dental implants, contributing to the MPO content of PISF.

In-patient comparison of immediate and conventional loaded implants in mandibular molar sites within 12 months.

OBJECTIVES: The aim of this prospective clinical study was to evaluate the clinical outcomes of dental implants placed in the mandibular molar sites and immediately functionally restored compared with conventionally loaded controls in an in-patient study. MATERIAL AND METHODS: Twenty-four dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient was determined as immediately loaded (IL) and the other side was conventionally loaded (CL). Resonance frequency analyses for implant stability measurements, radiographic examinations for marginal bone levels and peri-implant evaluations were performed during the clinical follow-up appointments within 12 months. RESULTS: During the 12-month follow-up period, only one implant was lost in the IL group. The mean implant stability quotient values were 74.18+/-5.72 and 75.18+/-3.51 for Groups IL and CL at surgery, respectively, and the corresponding values were 75.36+/-5.88 and 75.64+/-4.84 at 1-year recall, respectively. The difference was not statistically significant between the two groups during the 12-month study period (P>0.05). When peri-implant parameters were evaluated, excellent peri-implant health was demonstrated during the 1-year observation period and all implants showed less than 1 mm of marginal bone resorption during the first year. CONCLUSIONS: In the present study, immediate functionally loading did not negatively affect implant stability, marginal bone levels and peri-implant health when compared with conventional loading of single-tooth implants.

Relations between the bone density values from computerized tomography, and implant stability parameters: a clinical study of 230 regular platform implants.

AIMS: The objective of this study was to determine the relationship between bone density, insertion torque, and implant stability at implant placement. MATERIALS AND METHODS: One-hundred and eight patients were treated with 230 Brånemark System implants. A computerized tomography (CT) machine was used for pre-operative evaluation of the jaw bone for each patient. The maximum insertion torque values were recorded with the OsseoCare equipment. Implant stability measurements were performed with the Osstell machine for only 142 implants. RESULTS: The mean bone density and insertion torque values were 721+/-254 Hounsfield unit (HU) and 39.1+/-7 N cm for 230 implants, and the correlation was significant (r=0.664, p<0.001). The mean bone density, insertion torque, and resonance frequency analysis values were 751+/-257 HU, 39.4+/-7 Nc m, and 70.5+/-7 implant stability quotient (ISQ), respectively, for 142 implants. Statistically significant correlations were found between bone density and insertion torque values (p<0.001); bone density and ISQ values (p<0.001); and insertion torque and ISQ values (p<0.001). CONCLUSION: The bone density values from pre-operative CT examination may provide an objective assessment of bone quality, and significant correlations between bone density and implant stability parameters may help clinicians to predict primary stability before implant insertion.

The effect of delayed versus early loading on nitric oxide metabolism around dental implants: an 18-month comparative follow-up study.

PURPOSE: Nitrite is a stable end-product of nitric oxide oxidation. The aim of the present study was to quantitatively analyze peri-implant sulcular fluid (PISF) nitrite levels in a longitudinal study design to evaluate the potential changes in nitric oxide metabolism in relation to the clinical status of the peri-implant site and the loading style of the dental implants. MATERIALS AND METHODS: A total of 34 implants, either early loaded (EL) or delayed loaded (DL), in 17 patients were followed up for a period of 18 months. Clinical parameters were recorded, PISF samples were obtained, and PISF nitrite levels were spectrophotometrically determined. Clinical measurements and nitrite analysis were repeated at 1, 3, 6, 9, 12, and 18 months. RESULTS: Despite the gradual decrease in clinical parameters, fluctuations in PISF total nitrite levels were observed during follow-up. The pattern of nitric oxide metabolism, as reflected by PISF nitrite levels, also demonstrated differences between EL and DL implants that diminished toward the end of the experimental period. DISCUSSION: Although the presence of clinical and subclinical gingival inflammation contributes to the PISF total nitrite levels, nitric oxide metabolism is also associated with healing and bone remodeling, and the pattern of loading seemed to have an impact on nitric oxide production at dental implant sites. CONCLUSION: Nitric oxide production at dental implant sites seems to be tightly regulated to enable the maintenance of peri-implant bone.

Stability and marginal bone level measurements of unsplinted implants used for mandibular overdentures: a 1-year randomized prospective clinical study comparing early and conventional loading protocols.

OBJECTIVES: The aim of this study was to compare the performance of two non-splinted implants used as retention for a mandibular overdenture when applying conventional or early loading protocols. MATERIAL AND METHODS: Twenty edentulous patients were treated with two unsplinted and non-submerged implants (15 mm long, TiUnite RP, Brånemark System) in the anterior mandible. The patients were randomly allotted into two groups: (i) test group (Group A), in which the overdenture was connected 1 week after surgery, and (ii) control group (Group B), in which the overdenture was connected after 12 weeks of healing. Resonance frequency analyses (RFA) for implant stability measurements were performed at implant surgery and after 1, 3, 6, 9 and 12 months. Marginal bone levels were evaluated at implant surgery and after 6 and 12 months. RESULTS: No implant from either group was lost and all implants showed less than 1 mm of marginal bone resorption during the first year. The mean implant stability quotient (ISQ) values at implant surgery were 76.2+/-2.8 for Group A and 75.6+/-4.5 for Group B. The 12-month measurements showed 76.4+/-2.5 ISQ and 76.4+/-2.8 ISQ for Groups A and B, respectively. There were no statistically significant changes between or within the groups with time. There were no differences in marginal bone loss, which was on average 0.3 mm for both groups after 1 year. CONCLUSION: Although a limited number of patients were followed for 1 year only, the results of the present study indicate that early loading of two unsplinted 15 mm long implants with an overdenture does not negatively affect implant stability or marginal bone conditions when compared with implants subjected to 12 weeks of healing before loading.

A 2-year clinical report of patients treated with two loading protocols for mandibular overdentures: early versus conventional loading.

BACKGROUND: The original Brånemark protocol for dental implant treatment was based on submerged healing prior to loading. In recent years, immediate/early functional loading has been reported to be possible with high success for various indications including two splinted mandibular implants supporting an overdenture. However, there are a limited number of studies regarding the early loading protocol for two unsplinted mandibular implants supporting an overdenture. METHODS: A total of 26 edentulous patients were treated with two unsplinted dental implants supporting mandibular overdentures. All implants were placed in the canine regions of each mandible according to the one-stage surgery. For the test group, overdentures were connected 1 week after surgery, and for the control group, overdentures were connected 3 months after surgery. Peri-implant parameters were recorded 1, 6, 12, 18, and 24 months after surgery. Marginal bone levels were evaluated at implant placement and after 6, 12, 18, and 24 months. Clinical stability measurements were performed at surgery, and after 3, 6, 12, 18, and 24 months. RESULTS: No implant from either group was lost during 2 years. Clinical peri-implant parameters, clinical implant stability measurements, and marginal bone resorptions showed no statistically significant differences between the two groups during 24 months. CONCLUSION: The results of this clinical trial suggest that the early loading approach of two dental implants supporting a mandibular overdenture does not jeopardize peri-implant soft tissue health, marginal bone resorption, and implant stability.

A short-term clinical trial on selected outcomes for immediately loaded implant-supported mandibular overdentures.

PURPOSE: This clinical trial aimed to evaluate the outcomes of implant-supported mandibular overdentures (ISMOs) using 2 different loading protocols. MATERIALS AND METHODS: Two groups of 10 edentulous patients each were selected for the study. Each patient received 2 implants placed in the mandibular canine sites. After 1 week, ISMOs were delivered to the 10 patients in the test group, while conventional mandibular dentures were delivered to the 10 patients in the control group. The conventional prostheses were converted to ISMOs after 3 months. Treatment outcomes for the ISMOs were evaluated 1 year after implant surgery. RESULTS: The number of appointments and time needed for fabrication of ISMOs revealed statistically significant differences between the patient groups. The requirements for prosthodontic maintenance of ISMOs in the test group were higher than those in the control group; however, these differences were not statistically significant. The mean marginal bone resorption for each group was 0.3 mm after 1 year. CONCLUSION: The results of this clinical trial suggest that early loading of a specific length of implants used to support mandibular overdentures does not jeopardize treatment outcomes during the first year of service.

Analysis of thte possible impact of inflammation severity and early and delayed loading on nitric oxide metabolism around dental implants.

PURPOSE: The aim of the present study was to analyze the possible impact of clinical status, presence and severity of inflammation, and loading on nitric oxide (NO) metabolism around mandibular dental implants. MATERIALS AND METHODS: A total of 34 implants in 17 patients, loaded either early (EL) or after a delay (DL), were classified according to the presence and severity of clinical inflammation in the peri-implant sites. Clinical parameters were recorded, peri-implant sulcular fluid (PISF) samples were obtained, and PISF nitrite levels were spectrophotometrically determined. Clinical measurements and nitrite analysis were repeated at 1, 3, 6, and 9 months postloading at available sites. RESULTS: Compared to noninflamed sites, inflamed sites demonstrated higher mean total nitrite levels (P = .032) that tended to increase with the severity of inflammation at both EL and DL implants. At noninflamed sites, EL implants provided significantly higher PISF volume than DL implants (P = .001). At noninflamed sites, EL implants revealed higher total nitrite levels; on the contrary, at inflamed sites, DL implants revealed higher total nitrite levels. In general, nitrite levels demonstrated a pattern of decrease followed by an increase during follow-up. DISCUSSION: Increased NO production with the presence and the severity of inflammation supports the contribution of NO in the peri-implant inflammatory process. Loading is also likely to have an impact on NO metabolism, which suggests a role for NO in remodeling and adaptation of bone around dental implants. CONCLUSION: Besides the presence of inflammation, the severity of inflammation and loading also seem to have an impact on NO metabolism around dental implants.

Micromorphology of sialoliths in submandibular salivary gland: a scanning electron microscope and X-ray diffraction analysis.

PURPOSE: Sialoliths are common in the submandibular gland and its duct system. The exact cause of formation of a sialolith is still a matter of debate. The aim of this study was to analyze 6 sialoliths ultrastructurally to determine their development mechanism in the submandibular salivary glands. MATERIALS AND METHODS: Six sialoliths retrieved from the hilus and duct of the submandibular salivary glands of 6 patients with sialadenitis were analyzed ultrastructurally by scanning electron microscope and x-ray diffractometer. RESULTS: Scanning electron microscope revealed mainly irregular, partly rudely hexagonal, needle-like and plate-shaped crystals. The cross-section from the surface to the inner part of the sialoliths showed no organic material. X-ray diffraction showed that the sialoliths were composed of hydroxyapatite crystals. Energy dispersive x-ray microanalysis showed that all of the samples contained high levels of Ca and P, and small amounts of Mg, Na, Cl, Si, Fe, and K. CONCLUSION: The main structures of the submandibular sialoliths were found to be hydroxyapatite crystals. No organic cores were observed in the central parts of the sialoliths. In accordance with these preliminary results, sialoliths in the submandibular salivary glands may arise secondary to sialadenitis, but not via a luminal organic nidus.

Familial syndrome of unusual triangular facies associated with cleft palate, malocclusion, midfacial hypoplasia and sensorineural hearing loss in two siblings. Is it a new autosomal recessive syndrome?

We present a previously undescribed syndrome characterized by triangular facial appearance, mid-facial hypoplasia, cleft palate and mild sensorineural hearing loss in two siblings. The parents were unrelated. The patients' stature and intelligence were normal. We suggest that the inheritance is autosomal recessive.

Neuroradiological findings in a mother and daughter with Gorlin syndrome.

A mother and daughter with Gorlin syndrome with similar neuroradiological findings are reported. These include calcification of the falx cerebri and tentorium cerebelli and dysgenesis of the corpus callosum and vermis. Vermian dysgenesis was detected in both mother and daughter suggesting a previously unrecognized finding associated with Gorlin syndrome.

Ectopic impacted mandibular third molar in the subcondylar region associated with a dentigerous cyst: a case report.

An impacted third molar in the subcondylar region is extremely rare. This case report describes an impacted mandibular third molar in the subcondylar region associated with a dentigerous cyst.