Fundamentals and history of implant dentistry

The practice of implant dentistry was not there a few decades ago It has its long historical retrospectives. The quest for rehabilitation of edentulous ridge has intrigued mankind since ancient times. The period from the time of Egyptian and Mayan civilizations to 1930s was unique when clinicians attempted to replace a missing tooth utilizing various materials. The spark of inquiry began from mid-1930s with the advent of an alloy named “vitallium;” attempts have been made to utilize this new material as an implant. Thereafter, in early 1950s, a good deal of fundamental and clinical research started taking place. These research data had given a boost to the tremendous growth of the practice of using dental implants made of vitallium that practically exploded to reach every general practitioner's clinic across the globe. Critical understanding of bone physiology, drilling protocol, implant design and surface texture, initial implant stability, single-stage implant surgery, and immediate loading of implants are the few factors based on which modern implant practice has become a predictable treatment modality for the replacement of missing teeth

Gingival crevicular blood: A noninvasive pathway to determine blood glucose level in periodontal patients

Aim: The aim of this study is to determine the efficacy and reliability of estimation of blood glucose level of patients with diabetes suffering from periodontal disease using gingival crevicular blood through periodontal pockets. Materials and Methods: A total of 70 patients with a known history of diabetes mellitus suffering from chronic periodontal diseases having visible signs of gingival inflammation were selected for the study based on other inclusion criteria. The excess gingival crevicular blood produced during routine periodontal examinations were carefully collected onto the glucometer test strips, and blood glucose levels were estimated with the help of glucose self-monitoring device (Glucometer). The finger-prick blood samples were also collected and glucose levels were also estimated using Glucometer. Patient's venous blood samples were collected at the same time, and blood glucose estimations were done using conventional laboratory measurements. Results: The results of this study revealed a strong correlation between (a) the gingival crevicular blood glucose (GCBG) and finger-prick blood glucose (Pearson's correlation r = 0.982; P < 0.001); and also (b) between GCBG and corrected venous blood glucose (Pearson's correlation r = 0.891; P < 0.001). Conclusion: Oozing blood from the gingival crevice during the routine periodontal examination can be used as a quick, noninvasive, chair-side diagnostic mode to estimate, and/or monitor blood glucose levels in periodontal patient suffering from diabetes mellitus with the help of Glucometer

A study on gingival component of smile

Background: Esthetic enhancement of smile requires prior quantification of gingival component of smile. Hence, a study has been designed on randomly selected volunteers′ and posed frontal smiling photographs were taken and analyzed through computer-aided ImageJ software. Aim: To determine the role of gingival component in designing a smile. Settings and Design: Present observational study includes one frontal photograph from each of 212 subjects who were attending the Department of Periodontics (examined during the study period) and then divided into three age groups (18-30, 31-40, and 41-50 years). Materials and Methods: Standardized frontal photographs with posed smile from 212 volunteers irrespective of age and sex were taken and the images were analyzed in computer by using ImageJ software. Statistical analysis used: Mean and standard deviation of intercommissural width (ICW), interlabial gap (ILG), and smile index (SI) during posed smiling were calculated for different sex. Comparison between male and female group were done by Mann-Whitney U test, and P-values were calculated for ICW, ILG, and SI. Spearman′s rank correlation coefficients (rho) were calculated for SI and different components of central zone of smile. Results: Male group as compared to female group exhibited greater ICW and ILG, and there was existence of fair to good correlation between lip dynamics and different factors of smile. Conclusion: Present study indicates that different factors of central zone of smile havefair to good correlation with lip dynamics assessed by SI

Laser excision of a mucocele: A case report

A mucous cyst (mucocele, mucous retention cyst, ranula, and epulis) is usually a painless, thin sac on the inner surface of the lips. It contains clear fluid. It is painless but can be bothersome. The cyst is thought to be caused due to sucking of the lip membranes between the teeth. A mucous cyst is common and harmless. However, if left untreated, it can organize and form a permanent bump on the inner surface of the lip. A mucous cyst is called ranula when it occurs on the floor of the mouth and epulis when it occurs on the gums. The sac may also be formed around the jewellery (piercings) that has been inserted into the lips or the tongue. This article highlights the use of lasers in the treatment of the excision of mucocele

A micro-anatomical comparison of goat jaw cancellous bone with human mandible: Histomorphometric study for implant dentistry

Aim/Background: To compare human jaw micro-anatomy with goat jaw to find a suitable animal model for various biomechanical experiments with dental implants. Materials and Methods: Fifteen fresh goat jawbones (mandibles) were collected from slaughterhouse and five dried human skull bones (mandibles) were collected from the anatomy department of various medical colleges in Kolkata. All the jawbones were then vertically sectioned, processed, stained, and suitably viewed under an optical microscope to evaluate the minimum trabecular width in coronal, middle, and apical areas of the alveolar bone. A total of 150 such samples were evaluated for goat and human mandible. Results and Observations: The trabecular width of goat alveolar bone was found to be greatest in coronal area (62.99 μm) and the least in apical area (41.13 μm). The width of human mandibular trabeculae was greatest in coronal area (67.65 μm), and the least in apical area (40.17 μm). Conclusion: There is a similarity of micro-anatomical dimensions between goat and human mandibles, and hence, suitable for many implant experiments concerning biomechanical testing

In vivo bone response and interfacial properties of titanium-alloy implant with different designs in rabbit model with time

Background: Using implants for dental applications are well-accepted procedures as one of the solutions for periodontal defect repair. Suitable design and materials, their reaction with the surrounding hard tissues and interfacial biomechanical properties are still considered to be the primary criteria which need to be addressed systematically. In the present study, a thorough and systemic approach was made to identify a suitable implant, considering the above criteria after both in vitro and in vivo animal trials. Materials and Methods: Titanium alloy (Ti-6Al-4V) implants, with thread and without thread models, were implanted to the mid-metaphysial portion of the tibia of the right hind leg of three white Australian Chinchilla rabbit species and their effects and response to the surrounding bone were investigated. Parameters studied included hematological and biochemical features (serum alkaline phosphatase and calcium), both preoperatively and postoperatively, consecutively for 7 days and after 1-3 months. The interfacial integrity and compositional variation along the interface were studied using scanning electron microscope (SEM) with energy dispersive analysis of X-ray (EDAX) and histopathology from 1 to 3 months consecutively. Finally, biomechanical properties were studied with the help of push-out test. Results: Bone remineralization started through the process of electro-physiological ionic exchanges, which helps in formation of osteoblastic cells in the area of bony injury. The SEM-EDAX results confirmed the initial stability for the Ti (with thread) implant, but the regeneration of new bone formation was faster in the case of Ti (Without thread) implant, and hence could be used for faster healing. These have also been substantiated through push-out and histopathlogical tests. Conclusion: From the physico-chemical and biomechanical observations, it was found that that smooth type implants were well accepted in the physiological condition although chances of elemental leaching from the surface were also observed. Increase of the surface roughness can help into the formation of physico-chemical bondage with the surrounding hard tissues

In vivo bone response and interfacial properties of titanium-alloy implant with different designs in rabbit model with time

Background: Using implants for dental applications are well-accepted procedures as one of the solutions for periodontal defect repair. Suitable design and materials, their reaction with the surrounding hard tissues and interfacial biomechanical properties are still considered to be the primary criteria which need to be addressed systematically. In the present study, a thorough and systemic approach was made to identify a suitable implant, considering the above criteria after both in vitro and in vivo animal trials. Materials and Methods: Titanium alloy (Ti-6Al-4V) implants, with thread and without thread models, were implanted to the mid-metaphysial portion of the tibia of the right hind leg of three white Australian Chinchilla rabbit species and their effects and response to the surrounding bone were investigated. Parameters studied included hematological and biochemical features (serum alkaline phosphatase and calcium), both preoperatively and postoperatively, consecutively for 7 days and after 1-3 months. The interfacial integrity and compositional variation along the interface were studied using scanning electron microscope (SEM) with energy dispersive analysis of X-ray (EDAX) and histopathology from 1 to 3 months consecutively. Finally, biomechanical properties were studied with the help of push-out test. Results: Bone remineralization started through the process of electro-physiological ionic exchanges, which helps in formation of osteoblastic cells in the area of bony injury. The SEM-EDAX results confirmed the initial stability for the Ti (with thread) implant, but the regeneration of new bone formation was faster in the case of Ti (Without thread) implant, and hence could be used for faster healing. These have also been substantiated through push-out and histopathlogical tests. Conclusion: From the physico-chemical and biomechanical observations, it was found that that smooth type implants were well accepted in the physiological condition although chances of elemental leaching from the surface were also observed. Increase of the surface roughness can help into the formation of physico-chemical bondage with the surrounding hard tissues