Effects of Ultraviolet Photoactivation on Osseointegration of Commercial Pure Titanium Dental Implant After 8 Weeks in a Rabbit Model.

This study investigated whether a 6-Watt ultraviolet C-lamp was capable of producing photofunctionalization on commercial implants during a medium observation term of 8 weeks. A total of 20 implants were inserted in 5 New Zealand rabbits, with each animal receiving 2 implants per tibia (one photofunctionalized and one untreated), according to a previously established randomization sequence. All implants were inserted by a single surgeon following the manufacturer's instructions. Histological analysis was performed by an evaluator who was blinded to the treatment condition. After 8 weeks of healing, the 2 groups showed no statistically significant differences in terms of bone-to-implant contact. Compared to control implants, the photofunctionalized implants showed improved wettability and more homogenous results. Within the limits of the present study, the use of this 6-W ultraviolet C-lamp, for an irradiation time of 15 minutes at a distance of 15 cm, did not improve the percentages of bone-to-implant contact in rabbits at an osseointegration time of 8 weeks.

Effect of Rotary Instrument Mineral Oil Lubricant on Osseointegration: A Randomized, Blinded Study in Rabbits.

The mechanisms of early failures in dental implant osseointegration are unclear. A possible cause of low levels of bone formation is lubricant contamination on implants during insertion. To explore the impact of lubricant contamination on dental implants, we used 5 New Zealand rabbits and inserted 2 implants per tibia in each animal for a total of 4 implants per animal (20 implants in total). In general, bicorticalization was achieved. The first implant was placed as suggested by the manufacturer with no lubricant used (control). The second implant was placed using a freshly lubricated contra-angle handpiece, which was used only for the test implants. Implant allocation was randomized, and the examining histologist was blinded to the results. All implants were placed by the same surgeon. The animals were maintained in accordance with animal experimentation guidelines. None of the implants failed to osseointegrate. Moreover, no significant difference was observed between the test and control groups. Based on the results of this study, the use of rotary instrument mineral oil lubricant did not jeopardize the osseointegration of dental implants in New Zealand rabbits.

Cone-Beam CT Assessment of the Position of the Medial Lingual Foramen for Dental Implant Placement in the Anterior Symphysis.

OBJECTIVES: To determine the position of the mandibular medial lingual foramen with cone-beam CT (CBCT) 3D imaging modalities when implants are to be placed in the anterior symphysis of the mandible. MATERIALS AND METHODS: A total of 111 CBCTs were considered acceptable and analyzed. The variables measured were as follows: (1) length of the outlet duct; (2) distance from the canal to the buccal cortex; (3) distance from the canal to the inferior cortex; (4) distance from the canal to the lingual cortex; (5) distance from the canal to the alveoli of the nearest tooth in dentate patients and distance from the canal to the marginal crest in edentulous patients; (6) angle of the duct to the horizontal Frankfurt plane; (7) diameter of the exit orifice; and (8) output level of the socket in relation to the teeth and the presence of bifurcations. RESULTS: A single canal was observed in 64% of patients; 2 canals were observed in 33% of patients; and a triple foramen was observed in 3% of patients. Women showed slightly lower values than men for each of the analyzed variables, with statistically significant differences in the length of the canal in edentulous (P = 0.029) and dentate patients (P = 0.027). CONCLUSION: The medial lingual foramen should be considered while performing presurgical planning. Careful attention is needed while setting the placement position of the dental implant to decrease the risk of complications.

Characterization of the Maxillary Sinus Using Cone Beam Computed Tomography. A Retrospective Radiographic Study.

PURPOSE: To analyze the anatomical findings and alterations of the maxillary sinus in asymptomatic patients observed by cone beam computed tomography. MATERIALS AND METHODS: A cross-sectional retrospective study of the anatomical variations and alterations of the maxillary sinus was made in 160 patients-71 males (44.3%) and 89 females (55.6%), with an age range of 18 to 74 years-measuring the thickness of the Schneiderian membrane and the cortical thickness of the lower margin of the maxillary sinus (in its most caudal portion), and correlations among the different study variables were assessed. RESULTS: Sinus pneumatization was the most frequent anatomical finding (81.3%). A negative correlation was observed between the thickness of the Schneiderian membrane and the presence of Underwood septa (P < 0.005). Mucosal thickening of more than 2 mm was directly correlated with the presence of maxillary sinus lesions (opacification, discontinuity of the floor of the sinus, polypoid lesions, or air-liquid levels). CONCLUSION: The presence or absence of septa seems to be related to the thickness of the Schneiderian membrane.

Periodontal Disease and Nonsurgical Periodontal Therapy on the OHRQoL of the Patient: A Pilot Study of Case Series.

The objective of this prospective study was to assess oral health-related quality of life (OHR-QoL) in patients with periodontitis and nonsurgical periodontal treatment. A prospective, longitudinal case series study was carried out at the University Dental Clinic of the Morales Meseguer Hospital in Murcia. Eighty periodontal patients with periodontitis, aged 22 to 72 years, were included in this study. The Spanish version of the Oral Health Impact Profile 14 (OHIP-14sp) questionnaire was used on two occasions: at the first visit and one month after completing the nonsurgical periodontal treatment. Clinical measurements of probing depth, plaque index and bleeding on probing were performed at baseline and after periodontal therapy. Data were analyzed using Student's t-test and analysis of variance. We found statistically significant differences (p < 0.05) between the pre- and post-treatment in all the dimensions studied except disability. Similarly, statistically significant differences were also found according to the degree or stage of the disease. However, these differences were not observed with respect to the extent of periodontal disease. Periodontal disease has a negative impact on the OHRQoL of periodontal patients, especially in severe stages (III-IV). Basic periodontal treatment can improve the OHRQoL of periodontal patients one month after treatment.

Presence of aspartate aminotransferase in peri-implant crevicular fluid with and without mucositis.

The aim of this study was to assess the presence of aspartate aminotransferase (AST) in peri-implant crevicular fluid, with or without clinical signs of mucositis, to determine its predictive diagnostic value, sensitivity, and specificity. The AST levels were determined (at a threshold of 1200 µIU/mL) for 60 clinically successful implants in 25 patients with or without peri-implant mucositis. Samples were taken prior (AST1) to peri-implant probing with a manual constant-pressure probe (0.2 N) and 15 minutes after probing (AST2). Clinical assessments included radiographic determination of preexisting bone loss, probing, and the evaluation of mucositis, plaque, and bleeding upon probing. Analysis was performed at both the level of the implant and the patient as a unit. We detected a significant difference between AST1 and AST2 at both levels. A significant difference was observed at AST1 between implants that bled upon probing and those that did not. However, when we considered the patient as a unit, there were no significant differences. The plaque index was not significant at either level. AST1 had high specificity and positive predictive diagnostic value (80%) for bleeding upon probing. Probing induces a greater release of AST from inflamed tissues compared with healthy tissues in situ but not at the systemic level. At the implant level, the implant position could be responsible for this difference. Aspartate aminotransferase was a reliable predictor of patients with mucositis.

Ozone in Patients with Periodontitis: A Clinical and Microbiological Study.

The purpose of this article was to assess the effectiveness of ozone therapy as an adjunct to mechanical therapy in periodontitis patients. Thirty-two patients diagnosed with generalized periodontitis were selected, with a total of 655 teeth examined. Each patient's mouth was divided into four quadrants (the split-mouth model) to be randomly treated with four sessions of gaseous ozone or air. The following clinical variables were recorded: the gingival index, the periodontal clinical attachment loss, the Miller's mobility index and the clinical improvements, as assessed through the visual analog scale (VAS). In addition, the microorganisms were qualitatively compared. After four weeks of treatment, the teeth of the ozone-treated quadrants showed statistically significant reductions in the gingival index and an improvement in the clinical attachment (p < 0.0001). The same treatment also significantly improved mobility by between 70% and 86% compared to the control group (p < 0.0001). Statistically significant differences were also recorded for the VAS (p < 0.0001). In the qualitative study of the subgingival flora, significant differences were observed (p < 0.0001). The overall results of this trial support the view that ozone treatment is effective and well tolerated in cases of generalized chronic periodontitis.

Electrical Potentiometry with Intraoral Applications.

Dental implants currently in use are mainly made of titanium or titanium alloys. As these metallic elements are immersed in an electrolytic medium, galvanic currents are produced between them or with other metals present in the mouth. These bimetallic currents have three potentially harmful effects on the patient: micro-discharges, corrosion, and finally, the dispersion of metal ions or their oxides, all of which have been extensively demonstrated in vitro. In this original work, a system for measuring the potentials generated in vivo is developed. Specifically, it is an electrogalvanic measurements system coupled with a periodontal probe that allows measurement of the potentials in the peri-implant sulcus. This device was tested and verified in vitro to guarantee its applicability in vivo. As a conclusion, this system is able to detect galvanic currents in vitro and it can be considered capable of being employed in vivo, so to assess the effects they may cause on dental implants.

Temperature of periimplant tissues in clinically successful implants: an observational clinical study in humans.

OBJECTIVE: The aim of this study was to evaluate periimplant tissue temperature in a successful implant. It has been shown that periimplant disease and mucositis are inflammatory diseases. As such, one of the main clinical signs is the change in temperature. We try to establish normal values of temperature with an easy to use appliance. DESIGN: Fifty-one individuals were enrolled in this study. Only 1 implant per patient was included. The implants were clinically and radiographically examined and diagnosed as clinical successful implants. An infrared ear thermometer was used to measure periimplant temperature (PIT) and the difference with the sublingual temperature (ΔT). These data were analyzed using the Student t test, analysis of variance, and cluster analysis. RESULTS: Statistically significant differences in PIT were observed between the second sextant and the fourth and fifth sextants. These differences were not significant on considering ΔT. In addition, for the clinically and radiographically successful implants, ΔT for all sextants showed a mean of 0.81 (CI, 0.57-1.04). CONCLUSIONS: We have found a difference in outcome between periimplant temperature and the temperature differential. PIT depends on the anatomical location, though ΔT is an independent measurement with a value of 0.81°C.

Primary stability and PES/WES evaluation for immediate implants in the aesthetic zone: a pilot clinical double-blind randomized study.

The use of immediate implants in the aesthetic area is a technique widely used in modern implantology. The characteristics of the patient, the implant, and the surgical procedure used may influence the final results. The aim was to assess whether the implant design affects primary (P.S.) and secondary stability (S.S.), bone level (B.L.), and PES/WES evaluation. Twenty implants with two different designs (n = 10) were immediately placed and randomly located in the upper anterior maxilla with no grafting material. Implant-Stability-Quotient (ISQ), B.L., and Pink-Esthetic-Score/White-Esthetic-Score (PES/WES) were evaluated. Shapiro-Wilk normality test was performed to determine the sample normality, as the data did not follow a normal distribution, the Wilcoxon-Mann-Whitney test was applied (p < 0.05). ISQ was determined at placement (PS): control 59.1 (C.I.54.8-63.3); experimental 62.2(C.I.60.1-64.2) and three months after placement (SS): control 62.2.1 (C.I.53.3-71.0); experimental 67.2(C.I.65.8-68.5). The BL was measured at three months after placement: control 0.38 mm (C.I.- 0.06 to + 0.83); experimental 0.76 mm (C.I.0.33-1.19) and at 12 months post-loading: control 0.07 mm (C.I.- 0.50-0.65); experimental 0.90 mm (C.I.0.38-1.42). PES/WES values were evaluated for the control group: 15 (C.I.12.68-17.32), and for the experimental group 15.20 (C.I.11.99-18.41). No significant differences were shown between both implant designs. A good grade of osseointegration and primary/secondary stability was achieved, as well as proper maintenance of crestal bone and adequate PES/WES scores. The criteria for selection for the ideal patient for immediate implant placement is essential.ClinicalTrials Protocol ID: NCT04343833.

Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps.

Microsurgical scalp reconstruction is indicated in patients with large scalp defects. The aim of this study was to compare the outcomes of scalp reconstruction in oncologic patients reconstructed with latissimus dorsi (LD), anterolateral thigh (ALT), and omental (OM) free flaps. Thirty oncologic patients underwent scalp reconstruction with LD (10), ALT (11), and OM (9) flaps. The length of the vascular pedicle, the operation time, the possibility of a two-team approach, the length of hospital stays, the complications, and the aesthetic results were evaluated. The OM flap was the flap with the shortest vascular pedicle length with a mean of 6.26 ± 0.16 cm, compared to the LD flap, which was 12.34 ± 0.55 cm and the ALT flap with 13.20 ± 0.26 cm (p < 0.05). The average time of surgery was 6.6 ± 0.14 h in patients reconstructed with OM, compared to the LD flap, which was 8.91 ± 0.32 h and the ALT flap with 7.53 ± 0.22 h (p < 0.05). A two-team approach was performed in all patients for OM flaps and ALT flaps, but only in two patients reconstructed with the LD flap (p < 0.001). In patients reconstructed with the OM flap, a very satisfactory or satisfactory result was reported in seven patients (77.8%). Eight patients reported a very unsatisfactory or unsatisfactory result with LD flap (80%) and 10 patients with ALT flap (90.9%) (p = 0.002). The mean hospital stay after surgery was not statistically significant (p > 0.05). As for complications, two patients reconstructed with OM flap, five LT flaps, and two ALT flaps developed complications, not statistically significant (p = 0.235). Omental flap, latissimus dorsi flap, and anterolateral thigh flap fulfill most of the characteristics for complex scalp reconstruction. The decision on which flap to use should be based on clinical aspects of the patients taking into account that the three flaps show similar rates of complications and length of hospital stay. Regarding the aesthetic outcome, OM flap or LD flap should be considered for reconstruction of extensive scalp defects.

Etiology, risk factors and management of implant fractures.

Implant fracture is an infrequent and late biomechanical complication with a serious clinical outcome. In effect, such fractures pose important problems for both the patient and the dental surgeon. According to most literature sources, the prevalence of dental implant fractures is very low (approximately 2 fractures per 1000 implants in the mouth). Considering that implant placement is becoming increasingly popular, an increase in the number of failures due to late fractures is to be expected. Clearly, careful treatment can contribute to reduce the incidence of fracture. An early diagnosis of the signs alerting to implant fatigue, such as loosening, torsion or fracture of the post screws and prosthetic ceramic fracture, can help prevent an undesirable outcome. The present literature review describes the management options and discusses the possible causal mechanisms underlying such failures, as well as the factors believed to contribute to implant fracture.

Control of Peri-Implant Mucous Inflammation by Using Chlorhexidine or Ultraviolet C Radiation for Cleaning Healing Abutments. Double-Blind Randomized Clinical Trial.

Two-phase implants must be exposed to the external environment after the period of osteointegration has elapsed. For this purpose, a healing abutment is placed passing through the mucosa while forming the emergence profile. The continuous connection and disconnection can lead to an alteration in the tissue maturation, both because of the contact of bacterial plaque and because of the mechanical trauma that involves its manipulation, manifesting with different degrees of erythema or bleeding. To assess whether this epithelium disruption can be counteracted, a blinded study design was developed on 150 unitary implant patients divided into three groups (n = 50), applying chlorhexidine (group 1), ultraviolet C (UV-C) at a wavelength of 254 nm (group 2)and no treatment as a control group (group 3), during each of the disconnections and connections during the prosthodontic treatment (1 time per week for four weeks). All groups showed a better epithelium aspect at the end of the evaluation. Although there were no statistically significant differences in the degree of inflammation, the UV-C treated group had the lowest plaque accumulation, and the highest was for the chlorhexidine-treated group.

Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft.

Double-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction, double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, (p < 0.001). The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm (p < 0.001), respectively. There were significant differences in vertical bone reconstruction and bone resorption between double-barrel flap and vertical distraction and between iliac crest and vertical distraction (p < 0.001). The study did not show significant differences in implant failure (p = 0.346). Radiotherapy did not affect vertical bone reconstruction (p = 0.125) or bone resorption (p = 0.237) but it showed higher implant failure in radiated patients (p = 0.015). The double-barrel flap and iliac crest graft showed better stability in the height of bone and less bone resorption and higher implant success rates compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction but resulted in a higher implant failure.

Periodontal disease affecting tooth furcations. A review of the treatments available.

The molars are the teeth that suffer the greatest periodontal destruction in untreated patients. When periodontal disease affects the furcation of a tooth, the chance that it will be lost increases considerably. An increase in the exposed root surface, anatomical peculiarities and irregularities of the furcation surface all favor the growth of bacteria. These problems make it harder for the patient to maintain hygiene, and impede adequate treatment. The treatment of furcations affected by periodontal disease is one of the most difficult problems for the general dentist and periodontist. The motivation of both the attending professional and of the patient are therefore of great importance. No ideal procedure for treating such lesions exists. The present paper reviews those options that are currently available. Long-term research will be needed, along with the development of new techniques, to solve the problem of furcations affected by periodontal disease, possibly including substitution of the affected tooth by an implant.

Effects of the Preoperative Administration of Dexketoprofen Trometamol on Pain and Swelling After Implant Surgery: A Randomized, Double-Blind Controlled Trial.

The fear of postoperative pain is often mentioned by patients as one of the factors that is most frequently associated with dental implants. To reduce this factor, a single oral dose of 25 mg dexketoprofen trometamol (DKT) or placebo was administered 15 minutes before implant surgery. One hundred patients who required single-implant treatments were randomly assigned to 1 of 2 blinded groups. The patients in the test group were given 25 mg DKT (DKT group), and those in the control group were given 500 mg vitamin C as a placebo (PLACEBO group). A subjective visual analogue scale of 100 mm in length was used to evaluate pain. Inflammation and complications were assessed using a 5-point Likert scale. An analysis of variance, t-tests, and a Mann-Whitney U test were performed. Among the 100 patients, 83 completed the study (there were 8 dropouts in the PLACEBO group and 9 in the DKT group). The patients who received DKT reported a lower pain intensity during the immediate postoperative period. The inflammatory response was weaker in the DKT group than the control group at 48 hours, but bleeding was greater. There were no other complications in either of the groups. In conclusion, the preemptive use of 25 mg soluble DKT administered orally 15 minutes before implant surgery can reduce the severity of immediate postoperative pain.

Tobacco as a risk factor for survival of dental implants.

BACKGROUND: It has been shown that smoking habits represent an increased risk for impaired bone healing and implant failure. This study aimed to evaluate the implant survival rates among non-smokers (NS) and different kinds of smokers (S). METHODS: A retrospective analysis was made over a 5-year period of the clinical and radiographic findings corresponding to 66 consecutive patients who had received a total of 165 dental implants. Patients were divided into two groups: S, 40 patients (95 implants; 58% of the sample); and NS, 26 patients (70 implants; 42% of the sample). Also, S and NS were classified into four different categories according to daily tobacco use: NS, 26 patients and 70 implants; light smokers (LS), 23 patients and 44 implants; moderate smokers (MS), 11 patients and 25 implants; and heavy smokers (HS), six patients and 26 implants. RESULTS: Sixteen implants (9.7%) failed and had to be removed. Group S showed 15 failures and a success rate of 84.2%. Group NS had only one failure, giving a success rate of 98.6%. The risk of implant failure was approximately 31% in those who smoked more than 20 cigarettes per day. HS showed statistical differences from NS or LS. However, they did not show any differences from MS. CONCLUSIONS: Within the limits of the present study, the use of tobacco involves a 15.8% risk of implant failure, with a 13.1 odds ratio. LS or MS tobacco use involves a 10.1% relative risk of implant loss, whereas the consumption of >20 cigarettes per day increases this risk to 30.8%.

Zirconia implants and peek restorations for the replacement of upper molars.

BACKGROUND: One of the disadvantages of the zirconia implants is the lack of elasticity, which is increased with the use of ceramic or zirconia crowns. The consequences that could result from this lack of elasticity have led to the search for new materials with improved mechanical properties. CASE PRESENTATION: A patient who is a 45-year-old woman, non-smoker and has no medical record of interest with a longitudinal fracture in the palatal root of molar tooth 1.7 and absence of tooth 1.6 was selected in order to receive a zirconia implant with a PEEK-based restoration and a composite coating. The following case report describes and analyses treatment with zirconia implants in molars following a flapless surgical technique. Zirconia implants are an alternative to titanium implants in patients with allergies or who are sensitive to metal alloys. However, one of the disadvantages that they have is their lack of elasticity, which increases with the use of ceramic or zirconia crowns. The consequences that can arise from this lack of elasticity have led to the search for new materials with better mechanical properties to cushion occlusal loads. PEEK-based restoration in implant prosthetics can compensate these occlusal forces, facilitating cushioning while chewing. CONCLUSION: This procedure provides excellent elasticity and resembles natural tooth structure. This clinical case suggests that PEEK restorations can be used in zirconia implants in dentistry.

Medication-related osteonecrosis of the jaw: Is autologous platelet concentrate application effective for prevention and treatment? A systematic review.

PURPOSE: To date, no ideal strategy has been established for treating or preventing medication-related osteonecrosis of the jaw (MRONJ). The aim of the present work was to perform a systematic literature review to determine the efficacy of autologous platelet concentrate (APC) application, for prevention or treatment of MRONJ, together with surgical debridement. MATERIAL AND METHODS: An electronic search was performed using MEDLINE (PubMed), EMBASE, and Cochrane databases until January 2015 using the following search terms: osteonecrosis, bisphosphonates, antiresorptive, antiangiogenic therapy, BRONJ, platelet concentrate, PRP, PRF, and PRGF. Two reviewers assessed the eligibility of articles independently and extracted key data. The methodology used met PRISMA criteria. The Newcastle-Ottawa scale was used to assess the quality of the articles. RESULTS: Preventive applications of platelet-rich plasma (PLP) were reported in 697 dental extractions in patients taking bisphosphonates intravenously, of whom seven patients developed osteonecrosis (five mandibular and two maxillary). In cases of established osteonecrosis, eight studies reported treatment by surgery combined with APC (seven with PRP and one with leukocyte-rich and platelet-rich fibrin) in 123 patients (34 men and 89 women) with ONJ, who received 157 treatments, of which 135 achieved complete resolution (85.98%). CONCLUSION: There are no published scientific data to sufficiently support any specific treatment protocol, including the use of APC together with surgical debridement, for the management of MRONJ. Randomized controlled clinical trials of the use of APC are needed.

Morphological Characterization of the Anterior Palatine Region Using Cone Beam Computed Tomography.

BACKGROUND: Surgery of the anterior maxillary zone has a strong impact upon dental and facial aesthetics and function. PURPOSE: To determine the anatomical characteristics and dimensions of the nasopalatine canal and alveolar bone using cone beam computed tomography (CBCT). MATERIALS AND METHODS: A retrospective, cross-sectional study was made of the nasopalatine canal in 122 randomly selected CBCT scans corresponding to 66 males (44.3%) and 56 females (55.6%). The following measurements were made: maximum length and diameters of the nasal and oral openings of the nasopalatine canal; distance from the crestal margin to the buccal wall (at apical, middle, and coronal level); and angulation of the nasopalatine canal. The anatomical variants were morphologically classified as follows: A (single canal), B (double canal), or C (Y-shaped canal). RESULTS: The anatomy of the nasopalatine canal showed important variability in terms of morphology and dimensions. Type A was observed in 48 patients (39.34%), type B in 10 (8.19%), and type C in 64 (52.45%). The mean diameter of the nasal opening or orifice was 3.02 ± 1.0 mm versus 3.29 ± 1.0 mm in the case of the oral opening. The mean length of the canal was 11.02 ± 2.4 mm. Significant differences were found between males and females, with greater canal dimensions and alveolar bone thickness values anterior to the nasal canal zone among males (p < .05). CONCLUSIONS: Our study shows gender to exert a significant influence upon the anatomical dimensions of the anterior maxilla and incisor canal. Given the anatomical variability characterizing the nasopalatine canal, we recommend CBCT evaluation prior to any type of surgery of the anterior maxillary zone.