Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes.

OBJECTIVES: To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction. MATERIALS AND METHODS: A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90 mg, dexamethasone 4 mg, or no premedication (control group) 1 h before surgery. Paracetamol 500 mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24 h, 48 h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale. RESULTS: In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05). CONCLUSIONS: Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability. CLINICAL RELEVANCE: Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).

Immediate Vs Early Loading of Bone Level Tapered Dental Implants With Hydrophilic Surface in Rehabilitation of Fully Edentulous Maxilla: Clinical and Patient Centered Outcomes.

The aim was to: (1) compare changes among primary and secondary implant stability between immediate and early loaded implants in edentulous maxilla, (2) evaluate oral health-related quality of life (OHRQoL), and (3) determine patient satisfaction with 6 implant supported fixed full-arch dentures. A prospective, randomized controlled clinical trial was conducted on 24 edentulous maxilla patients. The BLT SLActive implants in 12 patients were immediately loaded with temporary restorations while 12 patients did not receive temporary restorations. Definitive (final) dentures were delivered to all patients after 6 weeks. Stability of the implants were assessed by insertion torque (IT) and resonance frequency analysis (RFA). Oral Health Impact Profile-19 (OHIP-19) questionnaire was used to evaluate OHRQoL and a visual analogue scale (VAS) was used for patient satisfaction. The IT value of implants assigned for immediate and early loading group was 27.17 ± 9.55 Ncm and 25.01 ± 11.06 Ncm, respectively. Changes in implant stability from baseline to week 6 were similar in both groups when measured by Penguin (P = .881) and Ostell (P = .828). Patients in the immediate loading group reported significantly lower OHIP physical pain scores (P = .016) and OHIP psychological disability score (P = .046), and the patients reported significantly higher VAS function score (P = .009) and VAS esthetics score (P = .009). Implant loading protocols do not have a significant effect on the change in implant stability 6 weeks after implantation; however, immediate loading significantly improves OHRQoL as well as satisfaction of patients with maxillary edentulism treated by fixed full-arch dentures. Future trials will determine the role of immediate loading protocol in clinical scenarios with various amounts of available jaw bone using different numbers of implants to retain a fixed prosthetic restoration in the edentulous maxilla.

Bone microRNA-21 as surgical stress parameter is associated with third molar postoperative discomfort.

OBJECTIVE: To evaluate an association between bone levels of inflammation/oxidative stress mediators and postoperative discomfort after third molar conventional or piezosurgery. MATERIAL AND METHODS: Twenty-six subjects with bilaterally impacted mandibular third molars, who underwent either piezo or conventional surgery, were included in a split-mouth design study. MicroRNA-21 (miR-21) expression, interleukin-1 beta (IL-1ß), and vascular endothelial growth factor (VEGF) proteins, as well as superoxide dismutase (SOD) activity in alveolar bone, were evaluated. Pain intensity, the first pain appearance, analgesic first use and total dose taken, trismus, and swelling were clinically recorded. RESULTS: MiR-21 expression was higher while VEGF protein was lower in piezosurgery vs. conventional groups. The differences in IL-1ß protein and SOD activity were not significant between groups. The pain intensity on the first day was significantly decreased in piezosurgery group. The first pain appearance and the first analgesic taken were reported sooner in conventional vs. piezosurgical group. Significantly pronounced trismus on the third day following conventional surgery was found. In conventional group, significantly increased trismus was observed on the third compared to the first postoperative day. MiR-21 showed significant correlation with the first pain appearance. CONCLUSION: Delayed onset of less pronounced postoperative pain after piezosurgical vs. conventional extraction of impacted lower third molar was significantly associated with expression of bone miR-21. CLINICAL RELEVANCE: Alveolar bone miR-21 may reflect surgical stress and is associated with third molar postoperative pain onset.

Reconstruction of Interimplant Papilla by Demineralized Freeze-dried Bone Allograft Block Fixed by Titanium Screw in Maxillary Esthetic Zone.

AIM: To evaluate effectiveness of demineralized freeze-dried bone allograft (DFDBA) block fixed by titanium screw for reconstructing interimplant papilla in maxillary esthetic zone during one-stage early loading multiple implant procedure. MATERIALS AND METHODS: A total of 20 implants were placed in 10 systemically healthy patients (2 implants per patient) for replacement of multiple teeth by early loading one-stage implants along with interimplant papilla reconstruction using DFDBA block fixed by titanium screw. At the baseline, 6 months, and at 1 year, clinical measurements (interimplant papillary height measurement, papilla contour) and radiographic measurements were recorded. RESULTS: At 1 year, mean gain in interimplant vertical crestal bone was 1.7 mm, and complete reconstruction of the papilla was observed in 90% cases. CONCLUSION: Demineralized freeze-dried bone allograft block fixed by titanium screw for reconstruction of interimplant papilla in maxillary esthetic zone during one-stage early loading multiple implant procedure is effective. CLINICAL SIGNIFICANCE: Presence of interimplant papilla is of utmost importance for esthetically successful implant-supported restoration in the anterior region. This technique leads to reconstruction of interimplant papilla, thus providing esthetic appearance.

Histopathological comparative analysis of periimplant bone inflammatory response after dental implant insertion using flap and flapless surgical technique. An experimental study in pigs.

AIM: To evaluate by histopathological analysis the peri-implant bone inflammation degree, in certain time intervals (7, 14, 21 and 28 days), following mini-incision flapless and flap implant placement. MATERIAL AND METHODS: The experiment was conducted on four domestic pigs. Nine weeks prior to implant insertion, second and third mandibular premolars were extracted. Each animal received six implants in lower jaw. On one randomly chosen side of jaw flapless technique using mini-incision was performed, while on the other side implants were inserted after flap raising. After 7, 14, 21, and 28 days, the experimental animals were sacrificed. Following mandibular resection and decalcification, the samples for histopathological analysis of the peri-implant bone were obtained in the empty implant bed area, from the buccal side of the mandible, adjacent to implant neck region and parallel to crestal edge of implant bed. The degree of inflammatory response of the peri-implant bone was estimated through ordinal scores from 0 to 2. RESULTS: Seven days after the surgery all samples in the flap group had score 2 indicating high inflammation degree, in contrast to lower inflammatory reaction in flapless group. On the 14th and 21st postoperative day decreasing of inflammation degree was noted in all samples of the flapless group (score 1), while in flap group samples presented scores 1 and 2. Twenty-eight days after the implant placement, further reduction of inflammation in the flapless group (33% of samples had score 0) was observed. CONCLUSION: Flapless technique in comparison to conventional flap procedure minimizes postoperative bone inflammatory reactions.

Randomized clinical study of the peri-implant healing to hydrophilic and hydrophobic implant surfaces in patients receiving anticoagulants.

OBJECTIVES: To compare the peri-implant bone healing between TiZr implants with hydrophilic SLActive and hydrophobic SLA implant surface in patients receiving anticoagulants, to assess the implant survival and success rate, as well as to evaluate whether small-diameter TiZr implants could be used in patients on OAT in order to avoid augmentation procedures. MATERIAL AND METHODS: A total of 80 small-diameter tissue-level TiZr implants with SLActive and SLA surfaces were placed in 20 anticoagulated patients, following the "split-mouth" study design. Implant stability was measured up to the third postoperative month by resonance frequency measurements (RFA). One-year implant survival and success rate were evaluated. RESULTS: After one year, 100% implant survival and success rate were observed. A significant decrease in ISQ comparing to baseline values was noted in the SLActive group from the first postoperative week, and in the SLA group, from the 3rd week after the surgery. In both groups, a statistically significant decline in ISQ was observed between second and third postoperative week. No significant differences in ISQ values between SLActive and SLA implants were noted, at any time point. CONCLUSIONS: Titanium-zirconium small-diameter implants with SLActive and SLA surface predictably achieve and maintain adequate bone tissue integration in patients receiving anticoagulants. OAT appears to influence the bone healing events resulting in lower ISQ in the end of 3-month period in comparison with baseline values, although without compromising implant stability.

The influence of three different apical implant designs at stability and osseointegration process: experimental study in rabbits.

OBJECTIVES: The aim of this study was to perform a histomorphometric and biomechanical comparison of three implants with different designs of the apical area to promote a better bone initial stability and its correlation with the osseointegration. MATERIAL AND METHODS: Fifty-four tapered implants with same length, diameter and surface properties but with three different apical configurations (Group I: MK4: Group II: C1 and Group III: MK7) were inserted in the tibia of rabbits. Implant stability and bone formation were evaluated by resonance frequency analysis measured at 0, 6, 8 and 12 weeks and by histomorphometric analysis performed at 6, 8 and 12 weeks. RESULTS: Statistical test to compare the stability through the implant stability quotient in the four times showed few differences between the groups and time periods proposed, with significance set at P < 0.05. In the bone-implant contact, by comparing the groups in the three times proposed, it was possible concluded that there is a similar behavior among the three implant design (P < 0.05). CONCLUSION: With the limitations of this animal study, it can be concluded that the design of the apical area influences the implant stability and the bone-to-implant contact.

Human fetal osteoblast behavior on zirconia dental implants and zirconia disks with microstructured surfaces. An experimental in vitro study.

OBJECTIVES: To measure the lateral surface area of microgrooved zirconia implants, to evaluate the cell geometry and cell density of human fetal osteoblasts seeded on zirconia microgrooved implants, to describe the surface roughness and chemistry, and to evaluate the activity of human fetal osteoblasts seeded on zirconia microgrooved disks. MATERIALS AND METHODS: This experimental in vitro study used 62 zirconia implants and 130 zirconia disks. Two experimental groups were created for the implants: 31 non-microgrooved implants (Control) and 31 microgrooved implants (Test); two experimental groups were created for the disks: 65 non-microgrooved disks (Control) and 65 microgrooved disks (Test). The following evaluations of the implants were made: lateral surface area (LSA), cell morphology, and density of human fetal osteoblasts seeded on implant surfaces. On the disks, surface parameters (roughness and chemistry) and cell activity (alkaline phosphatase - ALP and alizarin red - ALZ) were evaluated at 7 and 15 days. RESULTS: LSA was lower for control implants (62.8 mm) compared with test implants (128.74 mm) (P < 0.05). Cell bodies on control surfaces were flattened and disorganized, while in the test group, they were aligned inside the microgrooves. Control group cells showed few lamellipodia, which were attached mainly inside topographical accidents (surface cracks, valleys, and pits). Test group implants presented cells rich in lamellipodia prolongations, attached to the inner walls or to the borders of the microgrooves and in the flat areas between the microgrooves. Cell density was higher in the test group compared with controls (P < 0.05) Surface roughness and oxygen content increased in test disks samples compared with controls (P < 0.05). Carbon and aluminum were reduced in disks test samples compared with controls (P < 0.05), and ALP and ALZ levels were significantly increased on test surfaces (P < 0.05) at both study times. CONCLUSIONS: Within the limitations of this experimental study, it may be concluded that (i) Roughness is increased and chemical composition enhanced on the surface of zirconia implants with microgrooves. (ii) The LSA of microgrooved zirconia implants is greater and provides more available surface compared with implants of the same dimensions without microgrooves. (iii) Microgrooves on zirconia implants modify the morphology and guide the size and alignment of human fetal osteoblasts. (iv) Zirconia surfaces with microgrooves of 30 µm width and 70 µm separation between grooves enhance ALP and ALZ expression by human fetal osteoblasts.

Dental implant surgery in patients in treatment with the anticoagulant oral rivaroxaban.

OBJECTIVES: The aim of this study was to evaluate the incidence of bleeding complications after dental implant placement in patients in treatment by the anticoagulant oral rivaroxaban without interrupting its administration or modifying dosage. MATERIALS AND METHODS: About 57 patients were divided into two groups: 18 had been in treatment by rivaroxaban for over 6 month before implant surgery and a control group consisted of 39 healthy subjects. All subjects received dental implants in different positions, without interrupting or modifying rivaroxaban dosage. Patients were treated in an outpatient setting. Non-absorbable sutures were used, and all patients were given gauze impregnated with tranexamic acid 5%, to bite on for 30-60 min. RESULTS: One rivaroxaban patient presented moderate bleeding the day after surgery, and two control patients presented moderate bleeding the day after and on the second day. Bleeding was managed with gauzes impregnated with tranexamic acid. No statistically significant differences (P = 0.688) were found in relation to bleeding episodes between the groups, with a relative risk = 0.919 based on the pooled groups and 95% confidence interval of 0.078-10.844. CONCLUSIONS: Dental implant surgery in patients taking the anticoagulant oral rivaroxaban can be performed safely in outpatients departments applying local hemostatic measures without the need to modify or interrupt anticoagulant medication.

Histopathological comparative analysis of peri-implant soft tissue response after dental implant placement with flap and flapless surgical technique. Experimental study in pigs.

AIM: The aim of this study was comparing the effect of flapless vs. flap technique of implant placement on inflammation degree of peri-implant soft tissue, through histopathological analysis. METHOD: The experiment was conducted on five domestic pigs. Nine weeks after tooth extraction, implants were installed. Each animal received six implants in mandible. According to split-mouth design, randomly one side was used for flapless technique using mini-incision, while on the other side, flap was raised. After 7, 14, 21, 28, and 90 days, the experimental animals were sacrificed. Samples for histopathological analyzes were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The degree of inflammatory response in the peri-implant soft tissue was estimated through ordinal scores from 0 to 3. RESULTS: In the flap group Score 3 indicating high degree of inflammation was present from day 7 to day 21, in contrast to flapless group where Score 3 was not recorded during the entire follow-up. Three months after implantation, there were no signs of inflammation neither around flap nor around flapless implants. CONCLUSION: Flapless surgical implantation technique using mini-incision decreases peri-implant soft tissue inflammatory reaction compared with flap surgery.

Immunohistochemical analysis of blood vessels in peri-implant mucosa: a comparison between mini-incision flapless and flap surgeries in domestic pigs.

AIM: The aim of this experimental study is to compare the effect of mini-incision flapless versus flap technique of implant placement on the amount of vascular structures and blood vessel elements in peri-implant soft tissue, using immunohistochemical analysis. METHOD: The experiment was conducted on five domestic pigs. Each animal received six implants in mandible according to the split-mouth design. On one randomly chosen jaw side, mini-incision flapless surgery was performed, whereas on the opposite jaw side, flap was raised. After 3 months of implant healing through submerged approach, the experimental animals were sacrificed and samples for immunohistochemical analyses were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The study outcome was the presence of vascular structures and elements of the blood vessels in the peri-implant mucosa per microscopic field, estimated through ordinal scores from 0 to 2. Effects of surgical approach, site of implantation, and their interaction on vascular scores of peri-implant mucosa were assessed by Brunner and Langer nonparametric analysis of longitudinal data. RESULTS: Statistically significant effect of surgical approach on vascularity of peri-implant mucosa has been revealed in the second mucosal layer, where flapless approach provided higher vascularity compared with flap approach (P = 0.002). In the remaining two layers, surgical approach did not affect mucosal vascularity significantly (layer 1: P = 0.071; layer 3: P = 0.433). CONCLUSION: The flapless surgical implant placement approach using mini-incision provides better vascularization of peri-implant mucosa after 3 months of healing compared with flap surgery.

Real-time thermographic analysis of low-density bone during implant placement: a randomized parallel-group clinical study comparing lateral condensation with bone drilling surgical technique.

OBJECTIVES: To compare the effect of two surgical techniques, lateral condensation and bone drilling, on changes in temperature of the adjacent low-density bone during implant placement into posterior maxilla and to investigate the influence of the host factors - age, gender, region of implantation, bone density, and thickness of the cortical bone at the recipient sites. MATERIAL AND METHODS: Local bone temperature was measured thermographically during implant placement into posterior maxilla following lateral bone condensing (test group) or bone drilling (controls). The main study outcomes were baseline bone temperature prior to implantation and maximum bone temperature recorded during implantation. Early implant success was evaluated after 6 months of healing. RESULTS: A total of 40 implants were randomly allocated to test and control groups and placed into maxillary premolar and/or molar region of 18 participants of both genders and average age of 51.74 years. All recorded bone temperatures were below the threshold for thermal necrosis. Although both groups showed significant increase in bone temperature during implant placement procedure (P ≤ 0.0005), it was significantly higher for bone condensing compared with drilling (P ≤ 0.0005; 3.79 ± 1.54°C; 1.91 ± 0.70°C respectively). No host factor was singled out as a significant predictor of bone temperature changes, although trend of higher increase was observed in young patients, regardless of gender, during implant placement procedure into maxillary first premolar region with bone density type 3 and cortical layer thicker than 1 mm. Early implant success rate after 6 months follow-up was 100%. CONCLUSION: Although both surgical techniques, bone condensing and bone drilling, can be considered safe regarding their thermal effect on the bone of posterior maxilla, bone drilling is associated with fewer local bone heating during implantation. Host factors do not affect the bone thermal changes significantly.

Evaluation of photodynamic therapy efficacy vs. conventional antifungal therapy in patients with poor-fitting dentures suffering from denture stomatitis. A prospective clinical study.

BACKGROUND: The long-term use of antifungal therapy in denture stomatitis (DS) treatment could be accompanied by antifungal-resistant strain onset, leading to compromised therapeutic procedure and disease reappearance. Photodynamic therapy (PDT) has shown the ability to eradicate oral infections and resistance strains. This prospective clinical study aimed to assess the PDT's effectiveness compared to the conventional treatment on clinical and microbiological parameters in patients with DS without denture wear during the treatment and follow-ups. METHODS: Forty-two patients diagnosed with DS were randomly assigned to one-session single PDT application (test group) or conventional antifungal therapy (control group). Clinical and microbiological parameters were assessed and analyzed before and at 3rd, 15th, and 30th day following the treatments. Microbiological samples were analyzed by a Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The data was statistically analyzed. RESULTS: Prior to the treatment, Candida species, including C. albicans (100%), C. glabrata (33%), C. tropicalis (31%), C. krusei (31%) were isolated in all patients. Both treatment procedures demonstrated a statistically significant reduction in C. albicans at all follow-up time intervals (p < 0.05). However, PDT displayed a statistically significant reduction in C. krusei compared to the conventional treatment at all follow-up periods (p < 0.05). Clinical parameters improved considerably in the test group compared to the control group at the 3rd and 15th day of follow-up. CONCLUSION: One-session single PDT application demonstrated significant improvement in both clinical and microbiological outcomes in a short-term period, resulting in complete Candida spp. eradication compared to conventional antifungal therapy.

Immediate versus early loading of immediately placed bone-level tapered dental implants with hydrophilic surface in full arch maxillary rehabilitation: A pilot randomized clinical trial with 2-year follow-up.

This study aimed to compare implant stabilities between the immediate and early loaded, immediately placed bone-level tapered dental implants in the maxilla and to evaluate marginal bone loss (MBL), oral health-related quality of life (OHRQoL), and patient satisfaction at a 2-year follow-up. A pilot, prospective, randomized, controlled clinical trial was conducted on 24 maxillary failing dentition patients. The bone-level tapered implants of 12 patients were immediately loaded with temporary restorations, while the other 12 patients did not receive any kind of temporization. Implant-supported screw-retained complete porcelain-fused-to-metal prostheses were delivered to all patients in the seventh postoperative week. The insertion torque values of implants assigned to the immediate and early loading groups were 33.0 ± 4.87 and 29.26 ± 8.31 Ncm, respectively. The dynamics of implant stability changes from implant placement up to a 2-year follow-up were similar for both groups (Penguin®, p = 0.268; Ostell®, p = 0.552), while the MBL was at submillimeter level. The cumulative implant survival rate was 91.80% for immediately loaded implants and 97.22% for early loaded implants, without significant difference (p = 0.162). The total score on the Oral Health Impact Profile questionnaire significantly decreased over time in both groups, indicating improvement in OHRQoL (p < 0.001), and the high level of patient satisfaction remained after 2 years of function regardless of a loading protocol. Both loading protocols, immediate and early, of six immediately placed bone-level tapered dental implants are an adequate treatment choice for fixed rehabilitation of the maxillary failing dentition.

Heat generation during implant placement in low-density bone: effect of surgical technique, insertion torque and implant macro design.

OBJECTIVES: The study aimed to investigate the effect of surgical technique, implant macrodesign and insertion torque on bone temperature changes during implant placement. MATERIAL AND METHODS: In the in vitro study, 144 self-tapping (blueSKY(®) 4 × 10 mm; Bredent) and 144 non-self-tapping (Standard implant(®) 4.1 × 10 mm; Straumann) were placed in osteotomies prepared in pig ribs by lateral bone condensing or bone drilling techniques. The maximum insertion torque values of 30, 35 and 40 Ncm were used. Real-time bone temperature measurement during implant placement was performed by three thermocouples positioned vertically, in tripod configuration around every osteotomy, at a distance of 5 mm from it and at depths of 1, 5 and 10 mm. Data were analysed using Kruskal-Wallis, Mann-Whitney U-tests and Regression analysis. RESULTS: Significant predictor of bone temperature at the osteotomy depth of 1 mm was insertion torque (P = 0.003) and at the depth of 10-mm implant macrodesign (P = 0.029), while no significant predictor at depth of 5 mm was identified (P > 0.05). Higher insertion torque values as well as non-self-tapping implant macrodesign were related to higher temperatures. Implant placement in sites prepared by bone drilling induced significantly higher temperature increase (P = 0.021) compared with bone condensing sites at the depth of 5 mm, while no significant difference was recorded at other depths. Compared with 30 Ncm, insertion torque values of 35 and 40 Ncm produced significantly higher temperature increase (P = 0.005; P = 0.003, respectively) at the depth of 1 mm. There was no significant difference in temperature change induced by 35 and 40 Ncm, neither by implant macrodesign at all investigated depths (P > 0.05). CONCLUSIONS: Placement of self-tapping implants with low insertion torque into sites prepared by lateral bone condensing technique might be advantageous in terms of thermal effect on bone.

Reconstructive Peri-Implantitis Therapy by Using Bovine Bone Substitute with or without Hyaluronic Acid: A Randomized Clinical Controlled Pilot Study.

BACKGROUND: The present pilot study aimed to assess clinical and radiographic efficiencies of bovine bone substitute (BBS) merged with hyaluronic acid (HA) in peri-implantits reconstructive surgery. METHODS: Peri-implantitis (diagnosed 6.03 ± 1.61 years of implant loading) bone defects were randomly treated either with BBS plus HA (test group) or BBS alone (control group). Clinical parameters including peri-implant probing depth (PPD), bleeding on probing (BOP), implant stability (ISQ), and radiographic changes in vertical and horizontal marginal bone (MB) levels were assessed at six months postoperatively. New temporary and permanent screw-retained crowns were made at two weeks and three months postoperatively. Data were analyzed using parametric and non-parametric tests. RESULTS: In both groups, 75% of patients and 83% of implants achieved treatment success after six months (no BOP, PPD <5 mm, and no further MB loss). Clinical outcomes improved over time within groups; however, without significant difference between them. ISQ value obtained significant increases in the test compared to the control group at six months postoperatively (p < 0.05). The vertical MB gain was significantly greater in the test group compared to the control (p < 0.05). CONCLUSIONS: Short-term outcomes suggested that BBS merged with HA could improve clinical and radiographic outcomes in peri-implantitis reconstructive therapy.

Influence of Dental Restorations on Oxidative Stress in Gingival Crevicular Fluid.

Biocompatibility of dental materials (DM) can be evaluated by gingival crevicular fluid (GCF) oxidative stress (OS) status. The goal of the study was to ascertain influence of dental caries degree, teeth position, and type and amount of applied DM on GCF OS profile. For this purpose, we tested six DMs that were sealed in one session: amalgam (Amg), composites: Tetric EvoCeram and Beautifil (BF), phosphate cement-zinc phosphate and polycarboxylate cements-zinc polycarboxylate cements, and glass ionomer cement (GIC). The study included 88 dental outpatients. Follow-up was scheduled at 7th and 30th day. Oxidative stress parameters (malondialdehyde (MDA) and glutathione (GSH) levels and total superoxide dismutase (tSOD) activity) were measured before (0th day) and after the treatment (7th and 30th day) in GCF. Control teeth were mirror-positioned healthy teeth. The DM accomplished the following effects (listed in descending order): increase of GSH in GCF was realized by ZPoC > BF > GIC > Amg; tSOD activity increase by ZPoC > BF > Amg; and MDA decrease by ZPoC > ZPhC > Amg > TEC. Dental caries provokes insignificant rise of OS in GCF. ZPoC and ZPhC showed the highest antioxidant effect, contrary to GIC. Restorations with antioxidant properties may reduce gum diseases initiated by caries lesion, what is of great clinical relevance in dentistry.

Retrospective study of spontaneous bone regeneration after decompression of large odontogenic cystic lesions in children.

BACKGROUND/AIM: Surgical treatment of odontogenic cysts in childhood could be accompanied by injury of important anatomical structures. Even though enucleation is considered to be preferable treatment of odontogenic cysts, the specificities of pediatric age favor more conservative surgical approach. The aim of this study was to assess the effectiveness of decompression as the uttermost treatment of odontogenic cysts in the pediatric age. METHODS: This retrospective study included 22 patients, 7-16 years old, with a single jaw cystic lesion. The majority of these lesions were dentigerous cyst (14), and the rest belonged to keratocystic odontogenic tumor (KCOT) (8). All lesions were primarily treated with decompression; it was a final treatment (one-stage procedure) in 13 dentigerous cysts, and it was followed by enucleation (two-stage procedure) in one dentigerous cyst and all the KCOT. RESULTS: A total of 13 (59.1%) dentigerous cysts were treated successfully only with decompression as one stage procedure, while the other 9 (40.9%) cysts required enucleation (1 dentigerous and 8 KCOT), after decompression (p ≤ 0.001). CONCLUSION: Related to non-aggressive lesions, more conservative treatment approach, such as decompression as one-stage procedure, should be considered. On the other hand, KCOTs in children require a two-stage procedure for a successful treatment outcome.

Analysis of load distribution in tooth-implant supported fixed partial dentures by the use of resilient abutment.

INTRODUCTION: Differences between the tooth and implant response to load can lead to many biological and technical implications in the conditions of occlusal forces. OBJECTIVE: The objective of this study was to analyze load distribution in tooth/implant-supported fixed partial dentures with the use of resilient TSA (Titan Shock Absorber, BoneCare GmbH, Augsburg, Germany) abutment and conventional non-resilient abutment using finite element method. METHODS: This study presents two basic 3D models. For one model a standard non-resilient abutment is used, and on the implant of the second model a resilient TSA abutment is applied. The virtual model contains drawn contours of tooth, mucous membranes, implant, cortical bones and spongiosa, abutment and suprastructure. The experiment used 500 N of vertical force, applied in three different cases of axial load. Calculations of von Mises equivalent stresses of the tooth root and periodontium, implants and peri-implant tissue were made. RESULTS: For the model to which a non-resilient abutment is applied, maximum stress values in all three cases are observed in the cortical part of the bone (maximum stress value of 49.7 MPa). Measurements of stress and deformation in the bone tissue in the model with application of the resilientTSA abutment demonstrated similar distribution; however, these values are many times lower than in the model with non-resilient TSA abutment (maximum stress value of 28.9 MPa). CONCLUSION: Application of the resilient TSA abutment results in more equal distribution of stress and deformations in the bone tissue under vertical forces. These values are many times lower than in the model with the non-resilient abutment.

Two-Center Prospective, Randomized, Clinical, and Radiographic Study Comparing Osteotome Sinus Floor Elevation with or without Bone Graft and Simultaneous Implant Placement.

PURPOSE: To evaluate stability and success rate of hydrophilic nanostructured implants placed via osteotome sinus floor elevation (OSFE) without grafting material or using ß-tricalcium phosphate (ß-TCP), deproteinized bovine bone (DBB), or their combination, and also to assess three-dimensional volumetric stability of endo-sinus bone gained in the aforementioned conditions. MATERIALS AND METHODS: OSFE with simultaneous implant placement (10-mm long SLActive-BL® , Straumann, Basel, Switzerland) was performed. Grafting materials were randomly allocated to implant sites, whereas one site was left without graft. Implant stability was measured by resonance frequency analysis over 6 months. Implant success was evaluated after 2 years of loading. Volume of new endo-sinus bone was calculated from CBCT images using 3D Slicer® software. RESULTS: A total of 180 implants were inserted into posterior maxilla of 45 patients with 6.59 ± 0.45 mm of residual bone height, and all remained successful after 2 years. Implant stability steadily increased during healing, without significant difference between groups (p = .658). After 2 years, endo-sinus bone significantly shrank (p < .001) in all groups (DBB:66.34%; ß-TCP:61.44%; new bone formed from coagulum: 53.02%; ß-TCP + DBB:33.47%). CONCLUSIONS: Endo-sinus bone gained after OSFE inevitably and significantly shrinks regardless of whether grafting material is applied or not. Grafting material offers no significant advantage to stability nor clinical success of hydrophilic and nanostructured implants placed simultaneously with OSFE.