Evaluation of change in trabecular bone structure surrounding dental implants by fractal dimension analysis and comparison with radiomorphometric indicators: a retrospective study

Background

The trabecular bone surrounding dental implant show some structural changes during healing period. The purpose of this study is to observe the change in trabecular bone with fractal dimensional analysis from baseline to 3rd month of implant placement. It was also aimed to determine the correlation of fractal dimension (FD) change with morphometric indices, mandibular cortical index (MCI) and mandibular cortical width (MCW).

Methods

Digital panoramic radiographs taken from 14 patients were evaluated in this study. A total of 30 implants which were placed on mandibular premolar or molar region were included. MCI and MCW assessments were made on baseline radiograph and FD were analyzed on baseline and 3rd month radiograph. FD change by time was recorded separately for every ROI. A paired sample t-test was used to evaluate the change between FD-baseline and FD-3rdmonth values. One-way ANOVA was used to determine the relationship between FD change and MCI. FD change and MCW measurements correlation was calculated by Pearson correlation analysis.

Results

FD value increased in 75 of 90 implant-adjacent regions evaluated in the 3rd month and it was observed that the FD values were statistically significantly increased in the mesial, distal and apical regions at the 3rd month measurements. There was no statistically significant relationship between mean FD change and MCI, and there was no correlation between mean FD change and MCW value.

Discussion

There are many studies evaluating the resorptive changes in bone. However, there are few studies investigating whether there is a correlation between pre- and post-operative trabecular pattern with MCI and MCW. The results of this study indicate that the implants have an improving effect on bone trabeculation in the region where they are placed.

Palatal mucosa thickness and palatal neurovascular bundle position evaluation by cone-beam computed tomography-retrospective study on relationships with palatal vault anatomy

Background

Measuring the thickness of the palatal mucosa at the planning of the surgical procedure is an important step in order to obtain the maximum width and thickness of the graft from the appropriate area. The aim of this study is to determine whether there is a relationship between palatal angle (PA) or palatal depth (PD) and palatal mucosa thickness (PMT) or palatal neurovascular bundle distance (PNBD).

Methods

PMT, PNBD, PD and PA were measured on cone-beam computed tomography (CBCT) images of maxillary posterior region of 200 male and 200 female patients. The mean of all parameters according to gender was compared and the significance of the difference detected between groups was evaluated. Potential relationship between PMT or PNBD and PA or PD was also evaluated.

Results

In females, the palatal mucosa was significantly thinner at all tooth regions (p < 0.005), and PNBD was lower only at the level of the second molar (p < 0.001). In addition, it was found that there was a significant inverse correlation between the palatal depth value and the palatal mucosal thickness, and palatal depth was correlated with the palatal neurovascular bundle distance (p ≤ 0.001).

Discussion

Consistent with previous studies, it was observed that the thickest mucosa in the palatal region was located in the region of the premolar teeth, and women had thinner palatal mucosa. In addition, in patients with a deeper palate vault, the palatal mucosa was thinner, but the palatal neurovascular bundle was more distant from the cemento-enamel junction.

Comparative evaluation of low-level laser therapy on proliferation of long-term cryopreserved human dental pulp cells isolated from deciduous and permanent teeth

The aim of the current study was to evaluate the proliferative effect of low-level laser therapy on long-term cryopreserved dental pulp stem cells (DPSC_S) and stem cells from human exfoliated deciduous teeth (SHED_S). The DPSC_S and SHED_S were divided into 2 main groups according to gallium aluminum arsenide (GaAIAs) diode laser irradiation densities as 5 J/cm² and 7 J/cm². Each main group was further divided into 4 groups according to laser irradiation periods as 0, 24, 48, 72 h groups. During the incubation periods, cells received laser irradiation in every 24 h according to their groups and were put into incubator after irradiation. Cell groups that were not subjected to laser irradiation were served as control groups. Viabilities of cells were determined via MTT assay at the end of all incubation periods, and data were statistically analyzed. Laser irradiation demonstrated significant effects on proliferation rate of DPSCs and SHEDs in comparison with control. Intragroup comparison data of DPSC_S revealed that repetitive laser irradiation for long term (72 h) increased the cellular viability significantly in comparison with all other treatment groups; however, no significant differences were found when energy densities were compared within each time interval, except for 48 h group at which irradiation with 7 J/cm² provided significantly higher cell viability rates of SHED_S. DPSCs showed significantly higher cellular viability than SHEDs only for the 7 J/cm² energy density in 72 h. Longer term (72 h) repetitive laser irradiation with energy densities of 5 and 7 J/cm² (wavelength of 980 nm) may be recommended to induce the proliferative effect on long-term cryopreserved DPSC_S and SHED_S.

Evaluation of low-level diode laser irradiation and various irrigant solutions on the biological response of stem cells from exfoliated deciduous teeth

This study aimed to evaluate cytotoxic effects and the apoptosis of Gallium-Aluminum-Arsenide (GaAlAs) diode laser irradiation, sodium hypochlorite (NaOCl), ozonated water and ethylene diamine tetraacetic acid (EDTA) on stem cells from human exfoliated deciduous teeth (SHEDs). Cells were exposed to EDTA (5%, 8.5%, 17%), NaOCl (1%, 2.5%, 5%) ozonated water (5, 10, 20 μg/ml) and GaAlAs diode laser irradiation (energy densities of 0.5, 1, 1.5 j/cm²). Culture medium included D-MEM, supplemented with 15% foetal bovine serum, 1% l-glutamine, 1% penicillin-streptomycin, 1% gentamycin, amphotericin-B and served as control group. The prepared irrigants were added to the relevant wells and incubated with the cells at 37 °C for 5, 10 and 15 min. The cells in the laser group were also incubated at 37 °C for 5, 10 and 15 min after the laser application. Cell viability and proliferation were analysed with the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. The percentage of cell viability showed a significant reduction in all concentrations of the EDTA and NaOCl groups when compared to the control group, diode laser irradiation and ozonated water groups at 5th, 10th and 15th minutes respectively but high cytotoxic effects of all EDTA and NaOCl groups with decreased over 50% of cell viability were observed at the 15th minute. Also EDTA group with 17% concentration (17%E) presented the lowest survival rate on SHEDs with mean of 21.67% ± 6.101 at this time interval. The lowest toxic effects were observed at the 5th minutes compared to other time periods at experimental groups. For detection of apoptotic cells, the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling (TUNEL) method was performed. According to the MTT results, doses showed the highest toxicity (cell survival decreased over 50%) in each group were selected for TUNEL assay (17% EDTA; 1% NaOCl; 10 μg/ml Ozonated water; 1.5 j/cm² diode laser irradiation). The significantly lowest percentages of TUNEL-positive cells were detected in ozonated water (10.67% ± 2.93) and diode laser irradiation (13.24% ± 7.61) compared to EDTA (39.89% ± 11.54) and NaOCl (31.15% ± 10.64) respectively. Also the difference between percentage of TUNEL-positive cells in EDTA and NaOCl groups was not significant. Synergistic combination of ozonated water and diode laser irradiation may be used in the disinfection step of necrotic root canals.

Efficacy of glycine powder air-polishing combined with scaling and root planing in the treatment of periodontitis and halitosis: A randomised clinical study

Introduction

This study was performed to evaluate the clinical efficacy of using the Perio-Flow device (Electro Medical Systems, Nyon, Switzerland) adjunctively with mechanical instrumentation on periodontal parameters and halitosis.

Materials and Methods

Sixty patients who presented with a 4- to 6-mm probing pocket depth were recruited for the study. Patients were randomly assigned to scaling and root planing (SRP) or SRP + glycine powder air-polishing (GPAP). For both groups, the plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level scores were recorded at baseline and 1 month. Volatile sulphur compounds (VSCs) were measured by a Halimeter (Interscan Corp., Chatsworth, CA, USA) at baseline, immediately after treatment, and at 7, 14, and 30 days.

Results

Both groups showed significantly lower plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level gain scores at 1 month than at baseline. No significant differences were found between the groups at any time point. The VSCs were significantly different at 1 month compared with baseline in both groups. However, the intergroup comparisons of VSCs were not statistically significant at any time point.

Conclusion

Within the limits of this study, SRP is effective for treatment of periodontitis and halitosis. However, using GPAP adjunctively with mechanical instrumentation has no beneficial effects on halitosis or periodontal parameters.

Treatment of recurrent aphthous stomatitis with Er,Cr:YSGG laser irradiation: A randomized controlled split mouth clinical study

The present randomized controlled split mouth clinical study aimed to investigate the efficacy of Er,Cr:YSGG laser irradiation on pain reduction and healing rate of recurrent aphthous stomatitis. 40 patients with RAS were recruited for this study and RAS ulcerations of each patient were randomly assigned to the control or test group. In the test group, Er,Cr:YSGG laser with non-contact mode was used to irradiate RAS lesions. In the placebo group, RAS lesions were irradiated with the same device without laser emission. Pain was evaluated with visual analog scale (VAS) while a clinician graded healing of RAS (HRAS). In the placebo group at immediate; scores of VAS presented no statistically significance; in the test group, laser application showed significant pain reducing, at 1st day control. In the test group, a significantly healing effect at 1st day control was observed and this effect was maintained throughout the study. In the placebo group, scores of HRAS were statistically significant at controls on 3, 7, 10days. Statistically significant difference between the scores of VAS and HRAS was found for all control days except day 10 according to the intergroup comparisons. Based on these findings, Er,Cr:YSGG laser application at 0.25W without water may be appropriate to reduce pain and also accelerate the healing of RAS.

Evaluation of the neurovascular bundle position at the palate with cone beam computed tomography: an observational study

BACKGROUND

The aim of this study was to investigate the neurovascular bundle (NVB) position with cone-beam computerized tomography (CBCT).

METHODS

CBCT images of 345 patients were evaluated. The distance from the neurovascular bundle to the cemento-enamel junction (CEJ) was measured (DNB). The distance from mid-palatal suture to the alveolar crest was used to determine the palatal depth. Palatal junction angle (PA) was measured using the junction angle between the hard palate and alveolar crest. The relationships between the DNB and the palatal depth and between these two parameters and the PA were evaluated. Student's t-test was used to analyze the differences in DNB related to gender, and the correlation between the DNB while Pearson correlation analysis was used to determine the correlation between the DNB and age (p = 0.05). The relationship between the DNB and the palatal depth, and the relationship between these two parameters and the PA were also evaluated using Pearson correlation analysis.

RESULTS

Except at the canine and first premolar areas the DNB was positively correlated with the palatal depth. No significant relationship between the PA and DNB or with PVD was observed. The highest DNB was 14 mm at the first molar, and the lowest was 10.8 mm at the canine.

CONCLUSIONS

Care is needed while rotating flap and harvesting the subepithelial connective tissue graft at the canine area because the neurovascular bundle passes approximately 11 mm apically to CEJ at the canine region.

Efficacy of Erbium, Chromium-doped:Yttrium, Scandium, Gallium, and Garnet Laser Irradiation Combined with Resin-based Tricalcium Silicate and Calcium Hydroxide on Direct Pulp Capping: A Randomized Clinical Trial

INTRODUCTION

The purpose of this randomized clinical study was to evaluate the efficiency of erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser irradiation combined with a resin-based tricalcium silicate material and calcium hydroxide in direct pulp capping for a 6-month follow-up period.

METHODS

A total of 60 teeth of 60 patients between the ages of 18 and 41 years were recruited for this study. Sixty permanent vital teeth without symptoms and radiographic changes were randomly assigned to the following 4 groups (n = 15): Gr CH, the exposed area was sealed with calcium hydroxide (CH) paste; Gr laser CH, the treated area was sealed with CH paste after Er,Cr:YSGG laser irradiation at an energy level of 0.5 W without water and with 45% air; Gr TheraCal, TheraCal LC (Bisco, Schaumburg, IL) was applied directly to the exposed pulp; and Gr Laser TheraCal, TheraCal LC was applied after irradiation with an Er,Cr:YSGG laser. At the 1-week and 1-, 3-, and 6-month recall examinations, the loss of vitality, spontaneous pain, reactions to thermal stimuli and percussion, and radiographic changes were considered as failure.

RESULTS

The success rates in the CH and TheraCal groups were 73.3% and 66.6%, respectively. These rates did not reveal any significant difference. In both laser groups, success rates were 100%. The Er,Cr:YSGG laser-irradiated TheraCal and Er,Cr:YSGG laser-irradiated CH groups showed statistically higher success rates than the TheraCal and CH groups, respectively.

CONCLUSIONS

Er,Cr:YSGG laser irradiation at 0.5 W without water combined with pulp capping agents can be recommended for direct pulp therapy.

Cone-beam computed tomography evaluation of the soft tissue thickness and greater palatine foramen location in the palate

AIM

The aim of this study was to evaluate the palatal mucosa thickness and greater palatine foramen location using cone-beam computerized tomography (CBCT).

MATERIALS AND METHODS

Cone-beam computerized tomography images of 345 patients were measured. The relationship between palate vault depth and angle between the alveolar bone and palatal plane (PA) was evaluated. Differences in the palatal mucosal thickness according to age, gender and tooth site were evaluated.

RESULTS

The mean palatal mucosal thickness from the second molar to the canine teeth were 3.7, 3.3, 3.7, 3 and 3 mm, respectively. The palatal mucosal thickness at the second molar and second premolar was statistically different from those at other zones. There was no correlation between the palatal junction angle and the palatal depth. Greater palatine foramen was observed at the level of third molar tooth, between third and second molar, second molar 63%, 31% and 6% in men and 56%, 36% and 8% in women respectively.

CONCLUSIONS

The second premolar to second molar zone was considered a suitable graft site based on the mean palatal mucosal thickness.

Interdisciplinary approach to oral rehabilitation of patient with amelogenesis imperfecta

Amelogenesis imperfecta is a hereditary condition that affects the development of enamel, causing quantity, structural and compositional anomalies that involve all dentitions. Consequently, the effects can extend to both the primary and secondary dentitions. Patients with amelogenesis imperfecta may present with clinical difficulties, such as insufficient crown length, tooth sensitivity and orthodontic discrepancies, all of which can be resolved successfully with an interdisciplinary approach. This case report describes the interdisciplinary approach to the treatment of a 22-year-old patient with amelogenesis imperfecta. The proper alignment of anterior teeth and gingivo-cervical line was provided with orthodontic and periodontal treatments. All-ceramic crowns were placed on anterior, and metal-ceramic restorations were placed on posterior teeth to reduce sensitivity and improve esthetics with function. Improved esthetic appearance, reduced tooth sensitivity and the resolution of a potentially harmful psychosocial condition were achieved. Patient remained satisfied in the 12-month follow-up examination.

Are gingival phenotype, residual ridge height, and membrane thickness critical for the perforation of maxillary sinus?

BACKGROUND

Sinus membrane perforation is the most common complication of the sinus-augmentation procedure. Anatomic factors have been implicated in the risk of sinus membrane perforation (SMP) during sinus-lift surgery. However, there are no reports on the relationships among gingival phenotype (GP), residual ridge height (RRH), membrane thickness (MT), and perforation rate of the maxillary sinus. Therefore, the aim of this clinical study is to determine the associations among GP, RRH, MT, and SMP rate.

METHODS

Forty-four patients (64 sinus-lift procedures) were included in the study. Preoperative computed tomography scanning was performed to radiographically evaluate GP, RRH, and MT. The smallest RRH, highest MT, and gingival thickness values were recorded. These values were classified as follows: RRH, < or >3.5 mm; MT, < or >1 mm; and GP, <1.5 or >2 mm. Sinus-lift surgery was performed with a lateral window approach, and SMPs were detected at 11 sinus sites. Perforation size and locations were recorded, and the perforations were repaired with collagen membrane. One hundred seventy-six implants were placed immediately after augmentation procedure.

RESULTS

Strong correlations of GP with RRH (r = 0.722, P = 0.001) and MT (r = 0.702, P = 0.001) were noted. Moderate correlations were found between RRH and MT (r = 0.596, P = 0.001) and between MT and SMP (r = 0.417, P = 0.001). Furthermore, mild correlations of SMP with RRH (r = 0.290, P = 0.020) and GP (r = 0.248, P = 0.04) were established. Four implants were lost, but no significant difference was found between implant failure and SMP.

CONCLUSION

Within the limits of the study, it may be suggested that GP, RRH, and MT may be important factors for sinus perforation.

Low-level laser therapy in the treatment of mucous membrane pemphigoid: a promising procedure

BACKGROUND

Mucous membrane pemphigoid is a heterogeneous group of autoimmune, subepithelial, blistering diseases. A combination of topical and systemic steroid treatment is often used when managing patients with mucous membrane pemphigoid. The use of systemic steroids presents an increased risk of adverse side effects. Consequently, effective alternative modalities of therapy should be considered, such as the application of low-level laser therapy (LLLT).

METHODS

A patient presented with mucous membrane pemphigoid and was successfully treated with the application of local corticosteroids and LLLT using an 810-nm diode laser. The lesions were treated by LLLT over a period of 7 days using a continuous waveform for 40 seconds and an energy density of 5 J/cm(2).

RESULTS

After treatment, a significant improvement in tissue color and consistency was observed. The patient was followed every month for a period of 12 months, and the lesions healed uneventfully.

CONCLUSION

The results reported in this case show that the healing of mucous membrane pemphigoid was achieved when LLLT was used as an adjunct to the application of a local corticosteroid.

[Effectiveness of fibrin tissue adhesive for colocolic anastomosis reliability]

Leakage from a colonic anastomosis remains a major complication of surgery for colon emergencies and is associated with a significant increase in postoperative hospital stay and mortality rate. The purpose of our study was to investigate whether fibrin sealant, a well known tissue adhesive, will augment healing of bowel anastomosis in an experimental peritonitis model. Forty-eight male Sprague-Dawley rats were randomized into four groups. All rats underwent conventional sutured colo-colic anastomosis. The rats in group 3 and 4 had been exposed peritonitis before that procedure. In groups 2 and 4 fibrin sealant was added to the suture line. The measurements of bursting pressure and histopathological evaluations of suture lines revealed that peritonitis was deleterious to healing of colonic anastomosis. It was also seen that fibrin sealant augments healing of colonic anastomosis both in normal and peritonitis models.