Strontium Effects on Human Gingival Fibroblasts.

Strontium is a naturally occurring alkaline earth metal that has been shown to be useful not only in the treatment and prevention of osteoporosis but also in the treatment of dentinal hypersensitivity in the oral cavity; strontium is also an effective cariostatic, antiplaque, antigingivitis agent. Relatively little is known, however, about the effects of strontium on gingival fibroblasts. The purpose of the present investigation was to conduct in vitro studies on the potential for strontium to positively affect the activity of these cells such that it might be effective in the enhancement of gingival attachment to surfaces, such as healing abutments in implants in the oral cavity. The results indicate that strontium added as strontium citrate (0.5-1.0 mM), both in the absence and presence of a healing abutment, increases human gingival cell activity and decreases apoptosis in these cells. Scanning electron microscopy studies also reveal that the addition of strontium increases attachment of gingival fibroblasts to the surfaces of healing abutments. These studies provide the basis for further investigations on the use of strontium in the prevention and treatment of peri-implantitis by maximizing the formation of a peri-implant soft-tissue barrier.

Effect of diode laser and topical fluoride applications on white-spot lesions in bovine enamel.

This study evaluated the effectiveness of diode laser irradiation combined with topical fluoride application for increasing the hardness of demineralized bovine enamel and esthetically improving white-spot lesions (WSLs). In addition, the study evaluated intrapulpal temperature changes during laser irradiation. One hundred twenty bovine incisors with 4 × 4-mm artificial WSLs were randomly assigned to 8 groups (n = 15): untreated control; fluoride only; LF1, LF2, and LF3, fluoride plus 2-W laser for 15, 30, and 60 seconds, respectively; and LF4, LF5, and LF6, fluoride plus 5-W laser for 15, 30, and 60 seconds, respectively. The Vickers hardness number, CIE L*a*b color space values, and visual analog scale ratings for color improvement were recorded at baseline, after demineralization to create the WSLs, and after treatment. The intrapulpal temperature changes were recorded at completion of irradiation for 30 bovine teeth that were assigned to 6 groups (n = 5) to receive doses of irradiation equivalent to the treatment of the corresponding laser groups described previously. Statistical analysis included 1-way analysis of variance and Tukey multiple comparison tests (α = 0.05) The mean Vickers hardness numbers were significantly greater for the laser groups, and mean visual analog scale scores were significantly greater for all the treatment groups (P < 0.05). The fluoride group had a significantly lower mean color change (ΔE*) value (P < 0.05). The mean intrapulpal temperature changes in the 5-W laser groups were significantly greater than those in the 2-W groups (P < 0.05). Diode laser irradiation combined with topical fluoride application significantly increased the hardness and improved the esthetic appearance of WSLs compared to no treatment (control) and fluoride treatment alone. Intrapulpal temperature changes indicated that diode laser irradiation is safer at a 2-W setting than a 5-W setting.

Is Bone Graft or Guided Bone Regeneration Needed When Placing Immediate Dental Implants? A Systematic Review.

AIMS: To systematically review the effect and type of bone graft and guided bone regeneration around immediate implants on hard and soft tissue changes. METHODS: Three electronic databases were searched up to June 2015. Outcomes consisted of hard and soft tissue dimensional changes. RESULTS: Eight studies were included according to inclusion criteria. Immediate implants with bone grafting had superior soft tissue stability and preserved horizontal ridge dimension and buccal plate thickness, when compared to no grafting. The use of a barrier alone significantly decreased buccal plate resorption and the remaining defects around the implants, and the use of both bone graft and membrane aided in soft tissue preservation. The optimal type of bone graft material was a combination of cortical autogenous and synthetic particulate when compared to each separately, whereas no difference was found between demineralized allograft and hydroxyapatite in decreasing bone loss. CONCLUSIONS: Quantitative data analysis was not possible due to heterogeneity of the included studies. Further randomized clinical trials with homogenous samples and proper controls are needed to support the results of this report.

Primary stability comparison using piezoelectric or conventional implant site preparation systems in cancellous bone: a pilot study.

PURPOSE: This study compares implant primary stability achieved in cancellous bone after placement in piezoelectric prepared sites versus conventionally drilled sites. MATERIALS AND METHODS: Four bovine ribs were randomly assigned and placed in a water bath at 36.5 °C. Five sites per rib (total n = 20 sites) were prepared using piezoelectric system (test) or conventional drills (control) with twenty 10 × 3.6-mm Implantium implants placed. Using Osstell Mentor quantitative analysis, 5 resonance frequency analysis [implant stability quotient {ISQ}] values per implant were recorded at 5 locations for a total of 100 measurements. RESULTS: Independent t test analysis indicated significant difference in primary stabilities between groups: t (17) = 2.637, P = 0.17, with equal variance assumption satisfied (P = 0.196). Examination of means indicated a higher mean ISQ for piezoelectric than for conventional: 58.9 (+8.55) versus 49.2 (+7.33), respectively. Analysis of variance indicated a significant difference in mean ISQ value by rib. Tukey test indicated significantly higher ISQ values for rib A (test) than ribs B, C (control), and D (test). CONCLUSION: Implant site preparation using the piezoelectric system gives higher implant primary stability in cancellous bone. However, variations in quality across bones may have affected the results.

Active implant peri-apical lesion: a case report treated via guided bone regeneration with a 5-year clinical and radiographic follow-up.

Implant peri-apical lesion (IPL) is a periapical lesion, usually asymptomatic, in which the coronal portion of the implant achieves a normal bone to implant interface. A case of IPL following immediate implant placement and treated with guided bone regeneration (GBR) principles is described. Five-year clinical and radiographic follow-up with cone-beam assessment showed complete healing of the bone. GBR principles applied to IPL could completely solve the lesion.

Clinical and radiographic evaluation of single-tooth dental implants placed in grafted extraction sites: a one-year report.

OBJECTIVE: The aim of this report was to clinically and radiographically evaluate changes to the hard and soft tissues around implants placed in extraction sockets grafted with medical grade calcium sulfate hemihydrate (MGCSH) mixed with platelet-rich plasma (PRP) and a collagen resorbable plug after one year of function. METHODS: This evaluation was part of a previous study conducted to evaluate extraction socket grafts. Fourteen subjects out of 16 were evaluated. After tooth extraction, eight subjects received MGCSH mixed with PRP in the extraction sockets (test group), and six subjects received collagen resorbable plug dressing material (control group). After three months of bone healing, dental implants were placed. Three months after implant installation, provisional restorations were placed and implants were loaded in function for one month followed by definitive restorations. Follow-up examinations and intraoral digital radiographs were made at baseline and one year after definitive restorations to evaluate the marginal bone level in each subject. RESULTS: At the one-year follow-up, the survival and success rate was 100% for all implants. There was no statistically significant difference in the amount of vertical bone loss between groups after 1 year (p > 0.05). For the test group, there was a mean mesial bone loss of -0.8 +/- 0.6mm and a mean distal bone loss of -0.5 +/- 0.4mm. For the control group, there was a mean mesial bone loss of -1.1 +/- 0.7mm and a mean distal bone loss of -0.6 +/- 0.6mm. CONCLUSIONS: At the one-year follow-up, the implant placement in grafted sockets was not affected by the type of the graft material. Implants placed in sockets grafted with MGCSH mixed with PRP showed less marginal bone loss after one year in comparison to those with collagen resorbable grafts.

An in vitro evaluation of heat production during osteotomy preparation for dental implants with compressive osteotomes.

BACKGROUND: To assess heat production using osteotomes under conditions simulating implant placement in D3, D4 bone. MATERIAL AND METHODS: Implant osteotomes were tested (Winsix, Biosafin, Italy). Site preparations were performed on porcine ribs through a compressive fashion. The ribs were partially immersed in a custom-made water bath/water pump system that maintained the baseline temperature at 36 °C. Temperatures generated at different depths (2, 5, and 9 mm) during a series of 25 osteotomies were measured using 3 thermocouples connected to a digital thermometer. RESULTS: The mean temperatures never exceeded 37 °C and were all significantly lower than those reported during preparation with standard implant drills. Statistical evaluation of the temperature during implant site preparation showed slight significant variations between the baseline values and those of the different depth preparations. CONCLUSIONS: Within the limits of this study, the production of heat during implant preparation using osteotomes shows significant variations at different depths. However, these variations are not clinically relevant because they never increased over the values that negatively affect bone that may jeopardize osseointegration.

Restoring unfavorably positioned implants in anterior maxilla: case report.

This article describes a clinical case involving a unique solution to restoring implants placed in an unfavorable, labial location in the anterior maxilla. Background information is provided with regard to avoiding compromised situations from the outset, as well as a discussion of issues of restorability, with an emphasis on dental implants. Different treatment options are explored. To complete the case presented, a custom cast framework resembling traditional veneer preparations was selected, with porcelain veneers to cover abutment screw access channels.

Strontium-loaded hydrogel scaffolds to promote gingival fibroblast function.

Dental implant clinical success is dependent on effective peri-implant tissue attachment to the trans-mucosal portion following placement. Modification of transmucosal implant surfaces can improve cellular adhesion and function leading to formation of an effective soft-tissue seal during healing, of which gingival fibroblasts are prominent cells to migrate to repair wounds and crucial for the development of a collagen rich connective tissue. Biocompatible loaded scaffold materials have been developed to allow local release of molecules with effective biological activity. Our previous studies indicate that strontium can promote gingival fibroblast metabolism, decrease apoptosis and support adhesion to titanium healing abutments. In this study, we developed a strontium-loaded alginate hydrogel scaffold which can be easily personalized to fit over any size and shape of implant transmucosal collar or healing abutment. Results indicate that biologically active strontium ions are effectively released from loaded alginate hydrogel material to promote fibroblast viability and migration to repair in vitro wounds similar to that of strontium citrate solution. Overall, this novel strontium-loaded alginate scaffold device displays good biocompatibility and functionality, demonstrating high potential as a system to provide local delivery of strontium to improve peri-implant mucosal healing following implant placement and clinical success.

Piezoelectric vs. conventional implant site preparation: ex vivo implant primary stability.

OBJECTIVES: This study aims to determine differences in primary stability between implants placed in cortical bone following Piezoelectric or conventional site preparation, as assessed by resonance frequency analysis (RFA) and reverse torque testing (RTT). MATERIAL AND METHODS: Four fresh bovine ribs were acquired and surgical guides fabricated with five sites per rib (n = 20), for proper site preparation. Implant sites were prepared via conventional drilling technique as per manufacturer's instruction (Implantium) or via Piezoelectric (Mectron) implant site preparation using the Implant Prep kit. Twenty 10 mm long, 3.6 mm diameter Implantium implants were placed with 35 Ncm torque; 10 implants per preparation method. RFA was assessed via the Osstell Mentor. Five values were taken per implant. All implants where subjected to a reverse torque in increasing increments of 5 until 50 Ncm force was reached. RESULTS: The five RFA values per site were averaged and plotted by placement technique. A paired t-test statistical analysis was run. The average RFA values showed no statistical significance between the 10 test (RFA = 69.04 ± 5.11) and 10 control (RFA = 70.94 ± 6.41) sites (P > 0.05). All implants in both groups withstood RTT up to 50 Ncm force without movement and thus showed no statistical differences. CONCLUSION: Results of this ex vivo study imply that the Piezoelectric implant site preparation affords similar primary implant stability in comparison to conventional rotary instrumentation in cortical bone.

Effect of laser on TNF-alpha expression in inflamed human gingival tissue.

This study sought to evaluate the effect of low-level laser treatment combined with scaling and root planing (SRP) on gingival tissue levels of TNF-alpha in subjects with periodontal disease. Eighty gingival papilla biopsy samples were obtained from 60 patients diagnosed with chronic advanced periodontitis; randomly assigned to three treatment groups (n = 20), as well as 20 subjects with no periodontal disease (group A). Group B received SRP on a single quadrant/day for four consecutive days. On day 5, all quadrants were rescaled. Groups C and D received the same treatment as group B plus laser application with the low-level diode laser (630-670 nm, 1.875 J/cm(2)) for five and ten consecutive days, respectively. Papilla biopsies were obtained from subjects and evaluated by ELISA for levels of TNF-alpha. The values in the control group were 5.2 ± 3.21 pg/mg and baseline values for the examined groups were 46.01 ± 16.69. Significantly decreased level of TNF-alpha for groups C and D was found after treatment, while group B demonstrated reduction of TNF-alpha of 31.34%. The results of this study show suppression of TNF-alpha in gingival tissue after low-level laser treatment as adjunct to SRP. Data may suggest beneficial anti-inflammatory effects of the laser treatment when used as adjunctive periodontal treatment.

Effect of local nifedipine administration on rat gingiva.

BACKGROUND: Nifedipine, a calcium channel-blocking agent, has been associated with gingival enlargement in humans. This enlargement has also been successfully established in animal models. Previous investigators have administered nifedipine through a systemic route, most commonly by oral intake. The aim of the present study was to measure the effects of nifedipine administered directly into rat gingival interproximal papillae. METHODS: Twenty-four adult female rats were assigned to three groups. Each animal received a series of three injections, one week apart; each injection was placed directly into the interdental papilla of the maxillary and mandibular central incisors. Group 1 (control) received only saline. Group 2 received a low (10 microg/ml) concentration of nifedipine, while Group 3 received a higher concentration (500 microg/ml). One week after the last series of injections, gingival specimens were harvested from the injection site and prepared for histological and immunocytochemical analyses. RESULTS: Specimens from Group 3 displayed a significantly greater number of ED2-positive cells compared to the other two groups. Specimens from Group 2 showed a significantly higher mean count of positive cells compared to Group 1. Collectively, our data suggest that repeated local injections of 10 microg/ml and 500 microg/ml nifedipine each elicit an inflammatory response in the gingival connective tissue. CONCLUSIONS: Immunocytochemical analysis revealed dose-dependent increases of resident tissue macrophages in rats receiving nifedipine (p<0.005). An increased inflammatory infiltrate also was observed via routine histology. Gross macroscopic changes consistent with gingival enlargement were not observed.

Esthetic consideration for alveolar socket preservation prior to implant placement: description of a technique and 80-case series report.

An esthetic restoration supported by dental implant rehabilitation is a major challenge to restorative dentists. The ultimate goal of a dental implant is to restore missing or extracted teeth by placing implants in anatomically, esthetically, and long-term functional restorations. Alveolar ridge preservation and site enhancement following tooth extraction has a major impact on the hard and soft tissue volume. Extraction socket preservation is technique sensitive, not 100% successful, and at times unpredictable. Current techniques may delay surgical implant placement for a few months, and the quality of new bone regeneration is questionable. The aim of this report was to describe a minimally traumatic extraction socket preservation technique using different types of bone graft as a preserver prior to implant placement applied for 80 consecutive cases.

Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival.

INTRODUCTION: Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. AIM: This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control. DISCUSSION: Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. CONCLUSION: In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

Clinical recommendation for treatment planning of sinus augmentation procedures by using presurgical CAT scan images: a preliminary report.

PURPOSE: To propose a clinical recommendation based on anatomy of maxillary sinus before sinus augmentation procedure using presurgical computerized axial tomography (CAT) scan images. MATERIALS AND METHODS: CAT scan images were randomly selected from previous completed implant cases. Proposed area for the lateral window osteotomy was outlined on the panorex image of the CAT scan. Sagittal section on the CAT scan that was in the center of the outlined window was selected for sinus measurement analysis. On CAT scan, 2 lines were drawn to measure the dimensions of sinus. One line measured the horizontal width and the other line measured the vertical height. RESULTS: Based on the measurement data, a classification of the maxillary sinus anatomy was proposed. Narrow sinus cavity indicates favorable type anatomy in terms of bone regeneration healing and wide sinus cavity as less favorable anatomy for patient treatment planning. CONCLUSION: A narrow sinus and greater exposure to the blood supply should require shorter healing times after grafting. Conversely, wider sinus cavities and less exposure to the blood supply would require a longer healing time before implant placement.

Treatment of severe sinus infection after sinus lift procedure: a case report.

UNLABELLED: Maxillary sinus floor augmentation may have a variety of postoperative complications including infection, sequestration of bone, and maxillary sinusitis. Complications can also occur due to a preexisting sinus condition called ostium stenosis. This case report presents a complication after sinus lift and grafting procedure due to an unrecognized ostium stenosis. CASE REPORT: A 50-year-old male patient had sinus augmentation on his right side. However, postoperatively, his symptoms were protracted. A CT scan showed thickening of the Schneiderian membrane and scattered graft material. Management included endoscopic nasal examination and ostium enlargement, antibiotic coverage, and full enucleation of the graft and diseased tissue. CONCLUSION: Patency of the sinus ostium should be carefully evaluated before sinus lift/grafting procedure using CT technology. Radiology and otolaryngology consultations may be necessary to rule out ostium stenosis before surgery.

Gingival abscess removal using a soft-tissue laser.

A case of acute inflammatory enlargement of gingival tissue in the form of a gingival abscess is presented in this paper. Its clinical features and histopathologic presentation are described. The etiology of this condition could be a variety of sources such as microbial plaque infection, trauma, and foreign body impaction. In this case, treatment included complete excision by the means of a 810-nm soft-tissue diode laser, which resulted in resolution of the abscess and clinical wound healing within approximately 2 to 3 weeks. Prognosis was excellent due to early diagnosis and immediate treatment.

Should Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on: Peri-Implant Diseases.

BACKGROUND AND AIM: Traditionally patients with metabolic conditions such as diabetes mellitus are considered not suitable candidates for dental implant therapy due to increased risk of infection, impaired bone healing or the potential for vascular complications. Peri-implantitis as the more progressive form of peri-implant disease involves bone loss and estimated to occur in nearly half of all implant cases long-term. Despite extensive research on association of hyperglycemia with dental implants in preclinical and animal models, translational effort to clinical practice is hampered by discrepancies in reported outcome indicators for peri-implantitis in patients with a spectrum of glycemic profiles. This review aims to evaluate clinical evidence for peri-implant disease in metabolically compromised patients and in particular in patients with poorly-controlled diabetes in order to inform clinical management of peri-implant disease. MATERIALS AND METHODS: A comprehensive literature review was performed utilizing PubMed database and using the key word 'diabetes' combined with "dental implant" or "Periimplantitis" or/and "Preimplant disease". RESULTS: Clinical studies with follow up more than 1year, systematic review and meta-analysis that evaluated peri-implant disease in diabetic patients in relation to glycemic control were taken into consideration in this review. CONCLUSION: Studies reported conflicting results regarding the long-term effect of diabetes on peri-implant health regardless of the level glycemic control. Therefore, interpretation of finding and relevance to clinical practise should be considered on individual bases.

Osteonecrosis of Jaws in Prostate Cancer Patients Treated With Antiresorptive Drugs: A Review.

Prostate cancer is the most frequently diagnosed cancer among elderly men in the United States. Skeletal architecture is affected by metastasis and androgen deprivation therapy (ADT), which is considered a gold standard treatment in prostate cancer. Osteoporosis and skeletal effects are reported among most patients on ADT. To counter these effects and to reduce bone turnover, antiresorptive drugs such as bisphosphonates and denosumab are commonly prescribed in prostate cancer. These drugs increase the prevalence of osteonecrosis of the jaw in a subset of patients. The future should hold promise for new drugs that could have a positive impact on bone metabolism without jeopardizing bone integrity.

Evaluation of clinical performance and survival rate of Straumann dental implants in Saudi Population based on cross-sectional study.

Risk indicators of peri-implantitis is still contradictory and somehow unclear in present literature therefore efforts should be done for better understanding of the exact etiology of peri-implant disease progression. The present study aimed to assess risk indicators associated with peri-implantitis by observing the changes in several periodontal parameters after implant placement. This cross-sectional study included 213 female and 271 male patients aged 26-87 years, who received 484 titanium implants (Straumann, Switzerland) at King Saud University's Dental College, Saudi Arabia. Patients were called for dental visits. During these visits; full clinical and radiographic assessment of implants were done. The periodontal pocket depth (PPD) was greater around implants placed at grafted sites than non-grafted sites and around bone-level implants than tissue-level implants. The plaque index (PI) was associated with poor oral hygiene. There was a strong association between graft (yes/no) and bleeding on probing (BOP). Patients with good oral hygiene showed high radiographic bone stability. Keratinized tissue width < 2 mm was associated with a higher PPD, higher PI, higher BOP, more edematous gingiva, and more exposed implant threads on radiography. In patients receiving implants, poor oral hygiene status and inadequate keratinized tissue level can be proposed as risk indicators for developing periimplantitis due to strong association found between them and developments of peri-implantitis.