Evaluation of the Effect of Maxıllary Sinus Augmentatıon on the Maxillary Sınus Volume and Sinus Physiology: A Cone-Beam Computed Tomography Follow-Up

Sinus lifting procedure is a form of preprosthetic surgery for increasing the quantity of bone in the posterior maxilla. Although not many patients develop maxillary sinus pathology-related complaints after sinus floor elevation surgery, this procedure carries the inherent risk of compromising sinus physiology. There is the risk of miscalculating the amount of available bone in the posterior maxilla for implant placement by using two-dimensional panoramic views. CBCT provides much more accurate measurements of the available bone volume. The overall aim of the present thesis were to evaluate three-dimensionally the augmented bone volume and total volume of the maxillary sinus, correlation between the thickness of the Schneiderian membrane and crestal gingival thickness, following sinus lift procedures. In this study all included 22 patients were successful two stage sinus elevation surgeries and without complications. All patients were preoperatively and postoperatively analyzed by CBCT. The average percentage of the grafted part was 14.87 % through manual measurements and 14.66 % through automatically measurements. Safe volume after sinus grafting means not to interfere with the osteomeatal unit that hazardous to sinus physiology. No correlation weref found between the thickness of the Schneiderian membrane and crestal gingival thickness.ONAY SAYFASI iii YAYIMLAMA VE FİKRİ MÜLKİYET HAKLARI BEYANI iv ETİK BEYAN SAYFASI v TEŞEKKÜR vi ÖZET vii ABSTRACT viii CONTENTS ix ABBREVATIONS xi FİGURES xii TABLES xiii INTRODUCTION 1 1. LITERATURE REVIEW 4 1.1. Implants 4 1.2. Bone 5 1.2.1. Bone Regeneration After Sinus Lift Surgery 7 1.3. Anatomy of Maxillary Sinus 8 1.3.1. Septa 12 1.3.2. Ostium 14 1.3.3. Schneiderian Membrane 15 1.3.4. Vascularization 17 1.3.5. Innervation 20 1.4. Sinus Lifting 21 1.4.1. Pre-surgical Evaluation 22 1.4.2. Grafts 25 1.4.3. Sinus Lift Techniques 26 1.4.4. Surgical Technique 28 1.4.5. Complications 32 1.4.6. Implant Survival in the Augmented Sinus 35 2. MATERIALS AND METHODS 38 2.1. Objectives 38 2.2. Study Design and Study Groups 38 x 3. RESULTS 43 4. DISCUSSION 46 5. CONCLUSION 51 6. REFERENCES 52Sinüs lift ameliyatı posterior maksilladakı rezidüel kemik miktarının arttırılması için yapılan işlemdir. Sinüs elevasyon ameliyatından sonra hastaların çoğunda ameliyata bağlı patoloji gelişmese de bu ameliyat sinüs fizyolojisi için risk taşımaktadır. İlgili bölgenin kemik kalınlığının ölçülmesinde KIBT daha net sonuçlar vermektedir. Bu çalışmanın amacı sinüs cerrahisi sonrasında augmente edilmiş kemik hacmi ve total sinüs hacmini, krestal dişeti kalınlığı ve Schneiderian membran kalınlığı arasındaki ilişkini üçboyutlu olarak değerlendirmektir. Çalışmaya dahil edilmiş 22 hastaya iki aşamalı sinüs yükseltme ameliyatı uygulanmış, ameliyat sonrasında da herhangi bir komplikasyon gelişmemiştir. Tüm hastaların ameliyattan önceki ve sonraki KIBT görüntüleri detaylı incelenmiştir. Sinüs kvitesinin ortalama greftlenmiş kısmı %14,87 olarak tespit edilmiştir. Sinüs kavitesinin osteomeatal üniteye ve dolayısıyla sinüs fizyolojisine zarar vermeden greftlenmesi, sinüsün greftlenebilir güvenli hacminin aşılmadığı anlamına gelmektedir. Schneiderian membran kalınlığı ve krestal dişeti kalınlığı arasında korrelasyon tespit edilmemiştir

Assessment of Radiodensity at Mandibular Periapical Bone Sites using Three-Dimensional Cone-Beam Computed Tomography

Objectives: The aims of this retrospective study were to objectively assess bone density values obtained by cone-beam computed tomography and to map the periapical and inter-radicular regions of the mandibular bone. Material and Methods: In total, periapical bone regions of 6898 roots scanned by cone-beam computed tomography were evaluated retrospectively, and the results were recorded using Hounsfield units (HU). Results: The correlation between periapical HU values of adjacent mandibular teeth were strongly positive (P ˂ 0.01). The anterior region of the mandible yielded highest mean HU value (633.55). The mean periapical HU value of the premolar region (470.58) was higher than that was measured for molar region (374.58). The difference between furcation HU values of the first and second molars was unnoticeable. Conclusions: The results of this study have tried to evaluate the periapical regions of all mandibular teeth, which could ease to predict the bone radiodensity before implant surgery. Even though the Hounsfield units provide the average radio-bone density, a site-specific bone tissue evaluation of each case is essential for appropriate cone-beam computed tomography preoperative planning

Morphological Classification of Extraction Sockets and Clinical Decision Tree for Socket Preservation/Augmentation after Tooth Extraction

Objectives The aim of present study was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. Material and Methods The search protocol used the electronic MEDLINE (PubMed) and EMBASE databases for articles published between January 1 2009 and May 1 2019. The search included only human studies published in English. Outcomes were the indications and reasons for socket preservation/augmentation and classification of extraction sockets. Results Ten studies fulfilled the inclusion criteria and were selected for the study. Although there are various types of extraction socket classifications none of them could completely evaluate all morphological parameters of alveolar ridge. Furthermore, present study revealed that indications for extraction socket preservation/augmentation have wider spectrum than socket morphology and are related to surrounding tissue anatomy or dental implantation operation indications and timing. Based on currently proposed extraction socket classifications and rationales, a novel decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic area was suggested. Conclusions The need of extraction socket preservation/augmentation immediately after tooth extraction should be determined by the aesthetic, functional and risk-related viewpoint. A novel clinical decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic zones can be useful tool in socket preservation/augmentation procedures.PubMe

Effects of Crest Morphology on Lingual Concavity in Mandibular Molar Region: an Observational Study

Objectives: The aim of this radiological study is to evaluate the lingual concavity dimensions and possible implant length in each posterior tooth region according to posterior crest type classification by using cone-beam computed tomography. Material and Methods: According to inclusion criteria, 836 molar teeth regions from 209 cone-beam computed tomography images were evaluated. Posterior crest type (concave, parallel, or convex), possible implant length, lingual concavity angle, width, and depth were recorded. Results: In each posterior tooth region, concave (U-type) crest was detected most frequently while convex (C-type) was the lowest. Possible implant length values were higher in second molar regions than first molars. Lingual concavity width and depth were decreasing from second molars to first molars for both sides. Additionally, lingual concavity angle showed higher values in second molar sites than first molars. In all molar teeth regions, lingual concavity width values were the highest in concave (U-type) crest type while they were the lowest in convex (C-type) crest type (P < 0.05). Lingual concavity angle values were recorded as the highest in concave (U-type) and the lowest in convex (C-type) crest type at the left first molar and right molars (P < 0.05). Conclusions: The lingual concavity dimensions and possible implant length may vary according to crest type and edentulous tooth region. Due to this effect, the surgeons should examine crest type clinically and radiologically. All parameters in the present study are decreasing while moving from anterior to posterior as well as from concave (U-type) to convex (C-type) morphologies

Elevated Interleukin‐17A expression in amlodipine‐induced gingival overgrowth

WOS:000563549300001PubMed: 32173874Background and objectives Amlodipine, a calcium channel blocker derivative, is frequently used by patients with high blood pressure. Studies reported that it can induce gingival overgrowth. However, the underlying mechanism is not fully described yet. Interleukin-17A (IL-17A) is known as a proinflammatory cytokine, but current studies indicate that it has a role in fibrotic disorders and epithelial-mesenchymal transition (EMT). The aim of this study was to figure out the possible role of IL-17A in amlodipine-induced gingival overgrowth. Materials and methods Twenty-nine (29) individuals participated in the study, and they were assigned into 3 groups based on medical status and clinical periodontal examination; 9 patients with amlodipine-induced gingival overgrowth, 11 patients with inflammatory gingival overgrowth, and 9 healthy individuals as a control group. Clinical periodontal parameters including plaque index (PI), gingival index (GI), and gingival overgrowth index (GOI) were recorded. Blood and gingival crevicular fluid (GCF) samples were obtained. Gingival tissues were taken by appropriate periodontal surgery following initial periodontal therapy. To detect IL-17A on tissue samples, immunohistochemistry (IHC) was performed. Quantitative analysis was done, and the expression level of IL-17A was given as the percent positively stained cells. Enzyme-linked immunosorbent assay (ELISA) kits were used to analyze IL-17A in serum and GCF samples. Results All recorded clinical parameters were significantly higher in gingival overgrowth groups compared with control. Evaluation of inflammation on tissue sections did not show any significant change within the groups. Immunohistochemistry findings showed that IL-17A expression was increased in amlodipine samples (81.90%) compared with control samples (42.35%) (P < .001). There was an increase in the inflammatory group (66.08%) which is significantly less than the amlodipine group (P < .05). IL-17A levels in serum and GCF samples were not different within the study groups. Conclusion In this study, elevated IL-17A expression regardless of inflammation shows that amlodipine might cause an increase of IL-17A in gingival tissues. This increase might induce fibrotic changes and EMT in gingival overgrowth tissues. The association of IL-17A with fibrosis and EMT in gingival tissues requires further investigation.Scientific and Technological Research Council of Turkey (TUBITAK), Ankara, TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK)The Scientific and Technological Research Council of Turkey (TUBITAK), Ankara, Turkey

The 2nd Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2019. Summary and Consensus Statements

Introduction The task of Group I was to review and update the existing data concerning the physiologic process of socket healing, in the absence or presence of grafting materials or platelet concentrates, addressing the associated molecular and cellular events that culminate in the restoration of the lost tissue architecture and functionality. The second task was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. Material and Methods The main areas indicated by this group were as follows: socket healing process, including haemostasis and coagulation, inflammatory phase, proliferative phase, bone tissue modelling and remodelling; socket healing with graft materials and autologous platelet concentrates; extraction socket classifications; indications and reasons for extraction socket preservation/augmentation. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was screened and reported following the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in Preface chapter. Results The results and conclusions of the review process are presented in the respective papers. One theoretical review-analysis and one systematic review were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.PubMe