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Background: A close anatomic relationship between the incisive canal and the roots of the central maxillary incisors should be kept in mind during dental-implant treatment in the anterior maxilla. The aim of the present study is to analyze incisive canal characteristics on computed tomography (CT) sections and to evaluate its relation to bone anterior to the canal with regard to dental implantation. Methods: A total of 933 partially edentulous and/or edentulous patients scheduled for implant insertion in four dental clinics enrolled in the present study. The following were measured and recorded from CT sections for analysis: 1) diameter and length of the incisive canal; 2) width and length of the bone anterior to the canal; 3) palatal bone width and length; and 4) root width and length of the central incisor. Results: Mean canal length was 10.86 ± 2.67 mm, and mean diameter was 2.59 ± 0.91 mm. Canal length was shortened in edentulous anterior maxilla compared to dentate maxilla. However, canal diameter did not show any difference between dentate and edentulous groups. Males had a longer and wider incisive canal than females. Canal shape was mostly cylindrical in 40.73% of images. No correlation was found with mean canal length and mean canal diameter according to age. Conclusions: Although variations exist in every patient, the findings from this study suggest that sex and dental status are important factors that can affect incisive canal characteristics and amount of bone anterior to the canal. Clinicians should perform careful planning using CT scans before performing dental implant surgeries in premaxillary region. [ABSTRACT FROM AUTHOR]

Background: Vertical bone augmentation (VBA) remains unpredictable and challenging for most clinicians. This study aims to compare hard tissue outcomes of VBA, with and without recombinant human bone morphogenetic protein (rhBMP)-2, under space-making titanium mesh in a canine model., Methods: Eleven male beagle dogs were used in the study. Experimental ridge defects were created to form atrophic ridges. VBA was performed via guided bone regeneration using titanium mesh and allografts. In experimental hemimandibles, rhBMP-2/absorbable collagen sponge was well mixed with allografts prior to procedures, whereas a control buffer was applied within controls. Dogs were euthanized after a 4-month healing period. Clinical and radiographic examinations were performed to assess ridge dimensional changes. In addition, specimens were used for microcomputed tomography (micro-CT) assessment and histologic analysis., Results: Membrane exposure was found on five of 11 (45.5%) rhBMP-2-treated sites, whereas it was found on nine of 11 (81.8%) non-rhBMP-2-treated sites. Within 4 months of healing, rhBMP-2-treated sites showed better radiographic bone density, greater defect fill, and significantly more bone gain in ridge height (P <0.05) than controls. Experimental hemimandibles exhibited lower rates of membrane exposure and a noteworthy, ectopic bone formation above the mesh in 72% of sites. Results from micro-CT also suggested a trend of less vertical bone gain and bone mineral density in controls (P >0.05). Under light microscope, predominant lamellar patterns were found in the specimen obtained from rhBMP-2 sites., Conclusion: With inherent limitations of the canine model and the concern of such a demanding surgical technique, current findings suggest that the presence of rhBMP-2 in a composite graft allows an increase of vertical gain, with formation of ectopic bone over the titanium mesh in comparison with non-rhBMP-2 sites.

Background: The aim of this study is to assess the short-term effects of non-surgical periodontal therapy (NSPT) on the gingival crevicular fluid (GCF) cytokine profile in sites with standardized periodontal bony defects in beagle dogs with and without diabetes., Methods: Four beagle dogs with streptozotocin (STZ)-induced diabetes and four healthy dogs were included. Fasting blood glucose levels were measured using a glucometer. In all animals, a 3-walled bony defect was created on the mesial surface of the second premolar and first molar in all quadrants. After 12 weeks, all animals underwent weekly NSPT for 3 weeks. Baseline and post-NSPT GCF samples were collected, and levels of interleukin (IL)-1, IL-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α were measured using enzyme-linked immunosorbent assay. Statistical analyses were performed using a software program, and P values <0.05 were considered statistically significant., Results: Mean fasting blood glucose levels were significantly higher in dogs with induced diabetes than those without diabetes (P <0.01). At baseline, mean IL-6 (P <0.01) and IL-8 (P <0.05) levels were higher in dogs with diabetes than those without diabetes. A significant reduction in levels of IL-1, IL-1β, IL-6, IL-8, and TNF-α was noted in dogs without diabetes 1 week after NSPT. However, this significant reduction (P <0.05) only appeared 2 weeks after NSPT in dogs with diabetes., Conclusions: NSPT reduces GCF levels of proinflammatory cytokines in dogs with and without STZ-induced diabetes; however, chronic hyperglycemia seems to retard the effect of NSPT on GCF cytokine concentration.

Background: Gingival recession (GR) defects can be treated by various methods, including acellular dermal matrix (ADM) or coronally advanced flaps (CAFs). The aim of this histomorphometric experiment is to compare the efficacy of ADM and CAF for treating GR defects in dogs., Methods: In eight beagle dogs, a critical-size labial GR defect was surgically induced on bilateral maxillary cuspids under general anesthesia. Test sites received ADM and CAF, and control sites underwent CAF treatment alone. Plaque index (PI), bleeding index (BI), and gingival index (GI) were measured at 4 weeks (baseline), 8 weeks, and 16 weeks. Width of keratinized gingiva (KG) was determined at baseline and at 16 weeks. Depth of recession and width of GR below the cemento-enamel junction (CEJ) was also determined. After 4 months, animals were sacrificed, and jaw blocks were histomorphometrically assessed for tissue thickness and distance from the stent to the gingival margin (GM) and to the CEJ., Results: At 4-, 8-, and 16-week intervals, there was no significant difference in the BI, GI, and PI at the test and control sites. At 16 weeks, thickness of KG was significantly higher at the control sites than test sites (P <0.01). There was no difference in the midfacial recession depth and recession width at the test and control sites at baseline and before euthanasia (16 weeks). Histomorphometrically, there was no significant difference in tissue thicknesses and distances from the stent to the GM and CEJ in the test and control sites., Conclusion: ADM might yield similar results to a CAF alone and could decrease the amount of KG.

Background: It is known that gutka chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the association of periodontal inflammatory conditions with gutka chewing and prediabetes., Methods: In this cross-sectional study, the effect of gutka use on periodontal health is investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka-chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]) and fasting blood glucose levels (FBGLs) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α ≤5%)., Results: Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in individuals with prediabetes irrespective of gutka-chewing habit (P <0.05). Odds of periodontal inflammation in individuals with prediabetes were nine times higher than in healthy controls (95% confidence interval [CI] = 3.4 to 23.6). Gutka chewing alone, chewing among individuals with prediabetes, and chewing among healthy controls did not significantly increase the odds of periodontal inflammatory conditions. Individuals with prediabetes were significantly more likely to have periodontal inflammation than individuals without prediabetes even after controlling for sex and gutka chewing (odds ratio = 13.2; 95% CI = 4.3 to 40.7)., Conclusion: In medically healthy individuals, periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers; in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.

Background: Use of collagen membrane (CM) with xenograft and recombinant human platelet-derived growth factor (rhPDGF) in guided bone regeneration (GBR) is debatable. The aim of this microcomputed tomographic experiment was to assess the efficacy of using PDGF and xenograft (with or without CM) for GBR around immediate implants with dehiscence defects., Methods: Ten beagle dogs underwent atraumatic bilateral second and fourth premolar extractions from both arches. A standardized dehiscence defect (6 × 3 mm) was created on the buccal bone and immediate implants were placed in distal sockets in each site. Animals were randomly divided into three groups: 1) group 1, xenograft with rhPDGF was placed and covered with CM; 2) group 2, xenograft with rhPDGF was placed over the defects; and 3) group 3, four immediate implants were associated with dehiscence (controls). After 16 weeks, animals were sacrificed and jaw segments were assessed for buccal bone thickness (BBT), buccal bone volume (BBV), vertical bone height (VBH), and bone-to-implant contact (BIC) using microcomputed tomography., Results: BBT was higher in group 2 (1.533 ± 0.89 mm) than group 1 (0.745 ± 0.322 mm) (P <0.001) and group 3 (0.257 ± 0.232 mm) (P <0.05). BBV was higher in group 2 (67.87 ± 19.83 mm(3)) than group 1 (42.47 ± 6.78 mm(3)) (P <0.05) and group 3 (19.12 ± 4.06 mm(3)) (P <0.001). VBH was higher in group 2 (6.36 ± 1.37 mm) than group 3 (0.00 ± 0.00 mm) (P <0.001). VBH was higher in group 1 (3.91 ± 2.68 mm) than group 3 (0.00 ± 0.00 mm) (P <0.05). BIC was higher in group 2 (67.25% ± 13.42%) than group 1 (36.25% ± 12.78%) (P <0.05) and group 3 (30.25% ± 7.27%) (P <0.01)., Conclusion: GBR around immediate implants with dehiscence defects using PDGF and xenograft alone resulted in higher BBT, BBV, VBH, and BIC than when performed in combination with CM.

Background: Previous studies assessed bone remodeling after a single tooth extraction; however, the effect of multiple contiguous teeth extractions around immediate implant remains unknown. The aim of this microcomputed tomographic investigation is to analyze the alveolar bone remodeling around immediate implants placed in accordance with the extraction socket classification (ESC)., Methods: Under general anesthesia, 10 beagle dogs underwent atraumatic tooth extractions. Animals were randomly divided into three groups, with 16 sites per group: 1) ESC-1, single tooth extraction; 2) ESC-2, two contiguous teeth extraction; and 3) ESC-3, more than two contiguous teeth extractions. Immediate implants were inserted in each socket, and postoperative plaque control measures were undertaken. After euthanasia, the jaw segments were evaluated for bone thickness, marginal bone loss (MBL), and bone-to-implant contact (BIC) using microcomputed tomography., Results: The mean buccal bone thickness (P <0.05) and MBL (P <0.05) was compromised in jaws in ESC-3 compared to those in ESC-1 and ESC-2. The BIC was significantly higher among jaws in ESC-1 compared to those in ESC-2 and ESC-3 (P <0.05). There was no significant difference in the buccal bone thickness, MBL, and BIC among the groups in the maxilla and mandible. Lingual bone remodeling did not reveal any significant differences among the groups in either jaw., Conclusion: Buccal bone remodeling is significantly more extensive around immediate implants placed in multiple contiguous tooth extraction sites compared to immediate implants placed in single tooth extraction sites.

Background: This study tests the effectiveness of hydroxyapatite and collagen bone blocks of equine origin (eHAC), infused with recombinant human platelet-derived growth factor-BB (rhPDGF-BB), to augment localized posterior mandibular defects in non-human primates (Papio hamadryas)., Methods: Bilateral critical-sized defects simulating severe atrophy were created at the time of the posterior teeth extraction. Test and control blocks (without growth factor) were randomly grafted into the respective sites in each non-human primate., Results: All sites exhibited vertical ridge augmentation, with physiologic hard- and soft-tissue integration of the blocks when clinical and histologic examinations were done at 4 months after the vertical ridge augmentation procedure. There was a clear, although non-significant, tendency to increased regeneration in the test sites. As in the first two preclinical studies in this series using canines, experimental eHAC blocks infused with rhPDGF-BB proved to be a predictable and technically viable method to predictably regenerate bone and soft tissue in critical-sized defects., Conclusion: This investigation supplies additional evidence that eHAC blocks infused with rhPDGF-BB growth factor is a predictable and technically feasible option for vertical augmentation of severely resorbed ridges.

Background: Prescribing analgesics after periodontal surgery is a common practice. However, it can become a challenge for patients with systemic diseases or who are on long-term medications. Ketorolac tromethamine (KT), a non-steroidal anti-inflammatory drug, is incorporated into an adhesive film to overcome the limitations associated with oral, intravenous, intramuscular, or sublingual routes of drug administration. This study evaluates the analgesic effect of a KT adhesive film for pain management after periodontal surgery., Methods: Aqueous solvents of two bioadhesive polymers (hydroxypropyl methylcellulose and polyacrylic acid), together with 30 mg of KT, were used to formulate the adhesive film. Sixty-eight patients, who each received a free gingival graft, were randomly divided into treatment and control groups. In the treatment group, the prepared adhesive film was applied over the surgical site, whereas in the control group adhesive film without KT was placed initially. Two hours after surgery, the KT adhesive film was applied on the surgical site in the control group. A visual analog scale was used to assess the degree of pain encountered at 0, 1, 2, 3, 4, 5, 24, and 48 hours post-surgery., Results: The treatment group reported a significant reduction of pain intensity during the first 2 hours after surgery (P <0.05). After the KT adhesive film was applied in the control group, pain intensity was reduced to a non-significant level by the third hour after surgery. No adverse reaction or undesirable gastrointestinal side effect was observed., Conclusion: Adhesive film containing 30 mg of KT was effective in controlling post-surgical pain with no observable gastrointestinal effects.