A New Classification for the Relationship between Periodontal, Periapical, and Peri-implant Complications

Introduction: There are numerous studies supporting the high success rate of dental implants used for reconstruction of missing teeth. However, complications like mucositis and peri-implantitis are increasingly reported. Placement of dental implants in partially edentulous patients is associated with the risk of peri-implant diseases, especially when an old or a new inflammatory lesion is present adjacent to the implant site. Although no consensus has been reached on the difference in prevalence of peri-implant mucositis and peri-implantitis between fully and partially edentulous patients, available data clearly show that the combination of periodontal lesion and peri-implantitis is a possible risk factor for further complications. Several classification systems have been suggested for determination of the severity of disease around dental implants. However, no classification has been proposed for combined biological complications around teeth and implants. This study reviews the possible pathologic communication routes between natural dentition and the implants installed adjacent to them. Furthermore, we introduce a new classification system for the peri-implant disease in association with natural teeth called “PIST”. This system was designed based on the origin of the defects in order to clarify the different pathological situations which can be detected around dental implant. Using this classification system can help improve diagnosis, comparison and subsequent selection of the best treatment option

Effect of Hand, Ultrasonic Scaler and Erbium-Doped Yttrium Aluminum Garnet (Er: YAG) Laser on the Morphology of Root Surfaces with Periodontitis: a Comparative in Vitro Scanning Electron Microscopy Study

INTRODUCTION: The main purpose of the present study was to describe the ultra structural changes which happened after treatment of the root surfaces with ultrasonic and hand devices followed by Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) laser irradiation.METHODS: Sixty single-rooted maxillary and mandibular teeth which had been extracted due to periodontal problems were collected. Crown and apical parts of the root were cut off using a diamond bur. The specimens were mounted on an acrylic resin in order to make a plain surface of the root accessible. The samples were assigned as following: group1: samples were root planed using conventional hand curette, group2: were prepared by ultrasonic device, group3: roots after scaling by hand instrumentation were treated by Er:YAG laser with 50 mJ/pulse and frequency of 10 Hz, group4: roots were prepared by ultrasonic scaler and consequently were treated by laser. Furthermore, the teeth were dried, sputter-coated with gold, and monitored with scanning electron microscope (SEM).RESULTS: Photomicrographs from ten samples of root surfaces which were taken at magnifications up to 500X revealed that there were not any severe morphologic changes, such as melting and charring, in any group. However, the samples treated by laser irradiation showed more irregularities and distortions.CONCLUSION: Er:YAG laser setting at 50mj/pulse, as an adjunctive to traditional scaling and root planning, did not induce severe damages to root surfaces, although root surface irregularities were more pronounced in laser treated groups compare to hand instruments

Comparison of the Efficacy of Digital Caliper and a Newly Designed Digital Bone Gauge for Measurement of Edentulous Alveolar Ridge Width

Objectives: An efficient, safe, affordable and easily accessible measuring instrument for quantitative assessment of bone prior to dental implant placement enables more accurate treatment planning. Costly imaging modalities are neither widely available, nor affordable for some patients. This study sought to assess the efficacy of a newly designed digital bone gauge for measurement of bone width with 0.1 mm accuracy in comparison with a digital caliper.Methods: Using CATIA software, three-dimensional (3D) model of the instrument was designed and its experimental version was fabricated in two models and tested on an edentulous alveolar ridge model. The efficacy of the instrument was assessed by comparing the values obtained by the designed bone gauge with direct measurements made by a digital caliper. The buccolingual width of the edentulous ridge was measured at the crestal level and at 1, 2, 3 and 4 mm apical to the bone crest by the designed bone gauge and digital caliper. The intraclass correlation coefficient (ICC) of the values was calculated.Results: Virtual and experimental models of the instrument were designed and patented. The designed instrument was successfully capable of measuring bone width with 0.1 mm accuracy. The ICC values at 1, 2, 3 and 4 mm apical to the bone crest and at all levels were calculated to be 0.973, 0.994, 0.997, 0.998 and 0.998, respectively.Conclusion: The designed digital bone gauge can efficiently measure bone width at different levels with high accuracy. It can provide valuable and reliable information about bone width at initial clinical examination

Designing, fabrication, and efficacy assessment of a new surgical guide for dental implant placement in partial edentulism

Objectives Several tools have been introduced to increase the accuracy of dental implant placement. This study aimed to design and fabricate a new surgical guide for dental implant placement in partial edentulism and assess its efficacy. Methods The designed aluminum surgical guide has eight accessories and one graded rocket. The accessories have 6, 7, 8 and 9 mm diameter, and 6 mm height. Each accessory pair has a hole for passage of 2 mm and 2.8 mm drills. The efficacy of the designed surgical guide was tested by placement of 15 dental implants in jaw models. Cone-beam computed tomography (CBCT) scans were obtained, and analyzed to assess the implant-tooth and inter-implant distances and inter-implant angulation using NNT Viewer software. Data were analyzed using one-sample t-test. P<0.05 was considered significant. Results A significant difference was noted between the planned and actual values in the implant-adjacent tooth mesiodistal distance (P<0.001), and inter-implant distance (P=0.005). However, no significant difference existed in inter-implant angulation (P=0.073). The mean implant-tooth and inter-implant distances, and the mean inter-implant angulation were 0.284±0.199 mm, 0.0350±0.176 mm, and 3.883±4.20°, respectively. Conclusion The designed surgical guide had high accuracy in achieving optimal inter-implant angulation and linear implant-adjacent tooth and inter-implant distances, and the obtained mean values were clinically acceptable

Relationship of Anxiety and Depression in Patients with Chronic Periodontitis

Objectives Many researchers have attempted to link the current concepts of anxiety and depression to periodontal disease. This study aimed to compare the level of anxiety and depression in Iranian patients with chronic periodontitis (CP) and periodontally healthy controls.Methods Fifty CP patients and 50 periodontally healthy controls participated in this study according to our eligibility criteria. Periodontal clinical examination was performed using a Williams probe. The clinical attachment loss (CAL), pocket probing depth (PPD) and bleeding on probing (BOP) were recorded for all teeth except for third molars. In order to psychologically assess the individuals, the Beck’s Depression Inventory (BDI) and the Beck’s Anxiety Inventory (BAI) were used. The mean scores of BAI and BDI were compared between the two groups using the Student t-test.Results The mean age of participants was 44.86±8.07 years. The mean score of BDI was 13.58±8.35 in periodontally healthy controls and 25.62±13.01 in CP patients. The mean score of BAI was 9.9±5.65 in the control and 21.02±13.63 in the test group. The Student t-test revealed a significant difference between the two groups in total score of BDI and BAI (P<0.000). A significant correlation was noted between the BDI and age (P=0.027) but BAI had no significant correlation with age (P=0.245).Conclusion According to the results of this study, the level of anxiety and depression in CP patients was higher than that in periodontally healthy controls in our study populatio

Validity of Panoramic Indices to Evaluate the Association of Bone Mineral Density with Morphology of the Mandible in Osteoporotic Patients

Objective: Osteoporosis is the most common metabolic disease of the bone decreasing bone mineral density (BMD) particularly in postmenopausal women. On the other hand, panoramic radiography has several applications in dentistry. It appears that by calculating some indices on panoramic radiographs, we may be able to predict the risk of osteoporosis in high-risk individuals. The present study was conducted to determine the correlation of skeletal pattern of bone and the morphology of the mandible in osteoporotic patients presenting to the Osteoporosis Clinic of Khatamolanbia Hospital and Imam Khomeini Dental Clinic in Yazd.Methods: This descriptive, analytical, cross-sectional study was conducted on 70 women aged over 45 years, whom were selected from the above-mentioned centers. The gonialangle (GA), gonial index (GI), antegonial angle (AA), mental index (MI), antegonial index (AI) and antegonial depth (AD) were calculated on panoramic radiographs of patients and their BMD was measured in the lumbar area and femoral areas using dual X-ray absorptiometry (DXA). The correlation of panoramic indices with BMD was assessed using Spearman and Pearson’s correlation tests. The difference in BMD values in different morphological patterns of the inferior cortex of the mandible was analyzed by Student t-test and in different thicknesses of the cortex using one-way ANOVA. Results: The morphology of the inferior cortex was C1 in 62.9% and C2 in 37.1%. The cortex was thin in 24.3%, moderately thick in 32.9% and thick in 42.9%. Lumbar BMD was 0.92 (0.14) and0.75 (0.15) g/cm2, in C1 and C2, respectively (p<0.001). Femoral BMD was 0.81 (0.13) and 0.66 (0.09) g/cm2 in C1 and C2, respectively (p<0.001). No significant association was found between GI,AI, GA, AA and AD (based on the estimates made on panoramic radiographs) with the BMD (based on DXA estimates).Conclusion: Use of mandibular cortex indices on panoramic radiographs may be efficient for assessment of osteoporosis. However, further multicenter studies on larger sample sizes are required

Histologic effects of demineralized bone matrix on regeneration of alveolar socket in diabetic rats

INTRODUCTION: The aim of this in vivo study was to determine the effect of demineralized bone matrix (DBM) on alveolar bone repair in type I diabetic rats. MATERIALS AND METHODS: This study was carried out on 40 adult (8 weeks-old) albino rats with an average weight of 200-250 grams. The animals were divided into four groups (n=10) as follows: group 1 nondiabetic rats, group 2, 3 and 4 were diabetic rats; group 4 rats took one unit of insulin daily.  Diabetes was induced by Alloxan Monohydrate through the tail veins of the rats in groups 2-4. Only group 4 received insulin NPH 1 unit daily. After 10 days, the upper right incisors of all samples were extracted and the socket was filled with DBM in groups 3 and 4. The animals were sacrificed at the end of week 1 and 2. The specimens were prepared and stained with H&E. RESULTS: Histological results of group 4 displayed osteoblastic activity and bone formation with collagen fibers at the end of the first week and thick bone trabeculae formation in vicinity of DBM at the end of second week. In group 3, DBM showed some osteoinductivity at the end of the first week, but in some regions DBM particles were degraded by osteoclastic activity. Bone trabeculae formed with a dispersed and separate pattern at the end of second week. In group 2 hematoma and inflammation were dominant histological features at the end of first and second weeks; poor bone formation was detected in these two groups (2 and 3). In group 1, the results were as expected. CONCLUSION: It seems demineralized bone matrix simulate osteoblastic activity

Assessment of Sterility and Residual Solvents Agents in Antler-derived and Bovine Xenograft Bone Substitutes: An In-vitro Study

Objectives This study aimed to assess and compare the results of sterility and residual solvent testing in a newly developed antler-derived xenograft versus a bovine-derived xenograft. Methods First, test and control samples were prepared using thermal and chemical procedures, involving immersion in deionized water for 24 hours, drying, boiling in sterile water, chemical treatment with chloroform and methanol, and heating at 650°C in a furnace. Next, they were sterilized via gamma radiation at 25 kGy. The sterility test was then performed based on the ISO 11737-2:2019 standard, using the direct inoculation method. Finally, residual solvent testing was carried out via gas chromatography-mass spectrometry. Results The sterility test showed no evidence of bacterial or fungal growth in any of the samples during 14 days of incubation. Also, residual solvent testing indicated no sign of residual solvents in the samples. Conclusion Antler-derived xenograft was safe to use in terms of the sterility and removal of residual solvents. Further studies should be carried out regarding other important laboratory tests as well as the animal and clinical studies

The Clinical Evaluation of the Effects of Low-Level Laser Therapy on the Donor and Recipient Sites of the Free Gingival Graft: A Case Series

Introduction: Free gingival grafting is among the most foreseeing procedures for increasing the zone of keratinized attached gingiva and enhancing soft tissue around the teeth and dental implants. Nowadays low-level laser therapy (LLLT) is a promising approach in providing patients with more pleasing results in terms of esthetics and comfort. This study aims to investigate the effects of LLLT on gingival recessions treated with free gingival graft (FGG).Methods: This case series was conducted on 12 individuals requiring a bilateral gingival graft in the mandibular region. There was a 30-day interval between the two operations. The test side was selected randomly and irradiated by a low-level laser (LLL) just before surgery. The patients did not know which side was irradiated. LLLT was applied to the donors’ as well as recipients’ site immediately after the operation and 48 hours later. The patients were instructed to record their post-operative pain in a visual analogue scale (VAS) 3 and 24 hours and 7 days after the surgical procedure. The clinical photographs were taken immediately and 30 days after surgical treatment were graded by three experienced periodontists for color matching to adjacent tissues.Results: Ten individuals could finish the study. The test group presented significantly better shade matching and wound healing at the palatal donor site on days 7, 14 and 21. There was a significant reduction in postoperative pain after 24 hours (P = 0.007). No statistically significant difference was found between both groups in terms of clinical periodontal indices.Conclusion: LLLT could reduce post-operative pain 24 hours after surgical treatment. Furthermore, the application of LLLT could improve the donors’ site healing and the recipients’ site color matching

Using Diode Laser for Soft Tissue Incision of Oral Cavity

INTRODUCTION: The purpose of this case report is to analyze the results of vestibuleplasty around an over-denture based on dental implants to determine the evidence on the effectiveness of laser-assisted surgery and soft tissue management in implant dentistry.CASE REPORT: The patient in this case report was a 57 year- old male who was completely edentulous, with a mandibular over denture based on 4 standard implants suffering from pain on chewing, and a general discomfort, especially in anterior segment. He received a standard gingival augmentation surgery which failed to create sufficient vestibular depth. A laser-assisted vestibuloplasty was done to make the environment suitable for making a new overdenture.CONCLUSIONS: There were clinically significant improvements in vestibular depth and peri implant soft tissue situation by laser. Also, bleeding during surgery was well controlled; the patient’s discomfort and pain were less than the first operation done with gingival graft. Based on our clinical data and review of the literature, an evidence-based approach to the use of lasers for the management of soft tissue in oral surgery is necessary. Simply, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. However, improved hemostasis and patient’s satisfaction can be considered as advantages of adjunctive laser therapy in some clinical situations like vestibuloplasty