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

Comparison of Manual Tools, Ultrasonic and Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser on the Debridement Effect of the Surface of the Root of Teeth Suffering from Periodontitis

Introduction: Periodontal diseases are considered as some of the most common reasons of teeth loss, which occur due to the aggregation of microbial plaque and other precipitations on the dental surfaces. In this study, the scaling effect using manual tools, ultrasonic machine and Erbium-Doped Yttrium Aluminum Garnet (Er:YAG)laser on the connection of the human gums connective tissue cells on the root surface of the teeth suffering from severe periodontitis will be compared.  Methods: After removal of the big precipitations with manual tools, Er:YAG laser light emission of Photona machine is used with respect to the following characteristics: wavelength: 2940μm, each pulse: 100mJ, frequency: 10 pulse/sec, optic fiber with cross section 0.5x1.65mm, fiber tip angle with root surface: 15-20 degrees with non-contact mode, 1.5mm farther than the root surface and pulse duration 230 very short. The gingival fibroblast cellular was incubated as a sample of the human gums connective tissue cells under 37C. These cells were departed from the culture medium after the cellular reproduction in the third passage.On the 3rd day after incubation, the gingival fibroblast cells morphology was studied by Scanning Electron Microscopy (SEM). Results: The results of SEM images in the present study indicated the spread fibroblast cells with philopodia were found  in all of 5 groups; untreated healthy group (control), untreated group suffering from periodontitis, the scaling effect using manual tools (Scaled Gracey), ultrasonic machine and Er:YAG laser. There is a meaningful difference among the three treatment groups (P<0.001) in the numbers of the fibroblast cells, while all the four treated groups had a meaningful difference with the positive control group (P < 0.001).Conclusion: The present study indicated that although various dental surfaces cleaning methods may be different in other aspects, but are similar concerning the fibroblasts morphology. Also in addition to power, laser emission time may also be effective in the cells morphology results

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

Is Acoustic modal analysis a reliable substitution for Osstell® device in dental implant stability assessment? An experimental and finite element analysis study

Background: Different methods have been proposed to investigate the fixation stability of dental implants, eachof which has its limitations. Among these methods, resonance frequency analysis (RFA) has been widely utilizedto measure dental implant stability. This study aimed to assess dental implants with two non-destructive RFA andacoustic modal analysis (AMA) validated with a finite element simulation of the fundamental natural frequency(NF) of the bone analog-implant structure.Material and Methods: A total number of 18 implants were inserted into two Polyurethane (PU) bone blocks withdifferent densities (0.16 g/cc and 0.32 g/cc). AMA was used to measure NF; First, the sound originating fromthe axial tapping of the implant was recorded with a simple microphone. Secondly, a fast Fourier transformationalgorithm was conducted to determine the NF of the implant-bone analog structure. In parallel, the ISQ (ImplantStability Quotient) value was measured using the Osstell® device. Finally, using finite element analysis (FEA), theimplant-bone analog structure was modeled for validation.Results: Doubling the bone analog density resulted in an average increase of 82% and 47% in the NF and ISQusing AMA and Osstell®, respectively (P-value<0.05). Furthermore, a strong linear relationship (R2= 0.93) wasobserved between the measured NF and ISQ values in the linear regression analysis. The NF of the dental implantpredicted by FEA was overestimated by about 15.2% and 15.0% than those in the low- and high-density PUs,respectively. Moreover, the FEA predicted an increase of 83% in NF by increasing the bone analog density from0.16 to 0.32 g/cc.Conclusions: Having required the minimum process combined with easily available equipment makes it an idealmethod for fixation strength studies. The good correspondence between the ISQ values and NFs, in addition tothe good accuracy and reliability of the later method, confirms its application for fixation stability assessment

Effects of Root Debridement With Hand Curettes and Er:YAG Laser on Chemical Properties and Ultrastructure of Periodontally-Diseased Root Surfaces Using Spectroscopy and Scanning Electron Microscopy

Introduction: The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser for root debridement in comparison with curettes has been the subject of many recent investigations. Considering the possibility of chemical and ultra-structural changes in root surfaces following laser irradiation, this study sought to assess the effects of scaling and root planing (SRP) with curettes and Er:YAG laser on chemical properties and ultrastructure of root surfaces using spectroscopy and scanning electron microscopy (SEM).Methods: In this in vitro experimental study, extracted sound human single-rooted teeth (n = 50) were randomly scaled using manual curettes alone or in conjunction with Er:YAG laser at 100 and 150 mJ/pulse output energies. The weight percentages of carbon, oxygen, phosphorous and calcium remaining on the root surfaces were calculated using spectroscopy and the surface morphology of specimens was assessed under SEM. Data were analyzed using one-way analysis of variance (ANOVA).Results: No significant differences (P > 0.05) were noted in the mean carbon, oxygen, phosphorous and calcium weight percentages on root surfaces following SRP using manual curettes with and without laser irradiation at both output energies. Laser irradiation after SRP with curettes yielded rougher surfaces compared to the use of curettes alone.Conclusion: Although laser irradiation yielded rougher surfaces, root surfaces were not significantly different in terms of chemical composition following SRP using manual curettes with and without Er:YAG laser irradiation. Er:YAG laser can be safely used as an adjunct to curettes for SRP

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

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