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Objectives: Vitamin D deficiency is a driving force of common cancers like breast cancer. Vitamin D receptor (VDR) can play a tumor suppressor role by helping the precise function of vitamin D in cells such as modulation TGF-β signaling pathway. This study aimed to investigate the association of VDR gene variants and susceptibility to breast cancer in Iranian women., Methods: Genomic DNAs were isolated from blood samples of 161 women with breast cancer and 150 healthy women. After amplification of five positions of VDR gene, the prepared amplicons were digested with Taq I, Apa I, Bsm I, Cdx2, and Fok I restriction enzymes., Results: Subsequently, the digested products were electrophoresed on the 1.5% agarose gel. Odds ratios (ORs) for breast cancer were calculated for genotypes and estimated haplotypes. Binary logistic regression analysis showed Fok I (rs2228570), Bsm I (rs1544410), and Apa I (rs7975232) polymorphisms had the significant distribution in patients than to the normal group. Analysis of linkage disequilibrium for all pairs of SNPs showed that D'-value between SNP Taq I and SNP Bsm I was significantly (p ≤ 0.05). We observed that four major haplotypes of Apa I, Bsm I, Fok I, Cdx2, and Taq I SNPs significantly were in high frequency than predicted frequency. Among these four haplotypes, CGTAT haplotype was in a higher significant association than others with breast cancer risk (p-value = 0.0001 )., Conclusion: Our results showed that Fok I, Bsm I, and Apa I of VDR polymorphisms associated with the risk of breast cancer in Iranian population., Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study. All the fees provided by research center fund and deployed accordingly., (© 2021 The Authors.)

Background: Schneiderian membrane thickness may influence the final clinical outcome of sinus augmentation and dental implantation. Mucosal thickening has been regarded as a contributing factor for post-treatment complications. This study aimed to systematically review the available literature on the association between mucosal thickening and potential complications related to sinus augmentation and implant placement., Methods: An electronic search was carried out in MEDLINE, Embase, and Web of Science by two independent reviewers. It was complemented by manual search of the reference lists of all relevant studies. The studies reporting on sinus augmentation and dental implantation in cases with preoperative mucosal thickening were considered eligible for this study., Results: The initial search yielded 1032 articles. Five hundred and sixty-four records were screened by title and abstract, and 57 studies succeeded the inclusion criteria for full-text evaluation. Finally, 10 records remained for data extraction. The included studies assessed sinus augmentation and implantation procedures in 765 patients, 324 (42.3%) of them showed mucosal thickening. Increased membrane thickness did not significantly elevate the frequency of sinus augmentation complications. In addition, the overall implant survival rate was 99.03%., Conclusions: Within the limitations of the present study, the presence of mucosal thickening might not be a risk factor for sinus augmentation and implant survival rate., Competing Interests: Conflict of interestThe authors declare no conflicts of interest., (© The Association of Oral and Maxillofacial Surgeons of India 2021.)

Xenograft bone substitutes are obtained from different species and prepared by various procedures including heat treatment, hydrazine, and chemical and hydrothermal methods. These grafts are utilized widely because of similar structure and properties to human bone, proper bone formation, and biocompatibility. The aim of this systematic review was to evaluate different xenografts from structural and chemical aspects. In vitro studies published in English language, which assessed xenografts' features, met the inclusion criteria. Electronic search of four databases including PubMed, Google Scholar, Scopus, and Web of Science and a hand search until September 2020 were performed. The irrelevant studies were the ones which focused on cell adhesion and effect of growth factors. Finally, 25 studies were included in the review. Nineteen studies used bovine xenografts, and 12 studies applied heat treatment as their preparation method. Particles showed various morphologies, and their largest size was observed at 5 mm. From 18 studies, it is found that the smallest pore size was 1.3 µm and the highest pore size was 1000 µm. There is large heterogeneity of porosity, crystallinity, Ca/P ratio, and osteogenesis based on the preparation method. Proper porosity and the connection between pores affect bone regeneration. Therefore, biomaterial selection and outcomes evaluation should be interpreted separately., (© 2020 International Union of Biochemistry and Molecular Biology, Inc.)

Objective: To conduct a systematic review of the inflammatory elements in peri-implantitis (PI) and peri-implant mucositis (PM) in comparison with healthy peri-implant tissues (HI) and periodontal disease., Design: The PubMed, Embase, Web of Science, and Scopus databases were searched up to December 2020. English articles that evaluated human soft tissue biopsies of PI or PM were included. Values reported for the surface area of the infiltrated connective tissue (ICT) were pooled using the random-effect model meta-analysis to estimate the mean (95% CI)., Results: A total of 33 articles were included. Of 30 studies on PI, the majority evidenced significantly increased vascularization and inflammatory cell counts dominated by plasma cells in PI compared with HI. Studies that compared PI with chronic periodontitis primarily reported more severe inflammatory infiltrates in PI. This was confirmed by the meta-analysis results since the surface area of the ICT was significantly larger in PI (p < 0.001). Only seven studies analyzed the PM lesions and reported increased inflammatory infiltrates and vascularization in PM compared with HI. Based on the meta-analysis results, the surface area of the ICT was 3.00 [1.50, 4.51] mm 2 in PI and 0.23 [0.02, 0.44] mm 2 in PM lesions. Based on the available evidence, presence of foreign body particles considerably increased the inflammatory infiltrate; however, smoking did not have a significant effect., Conclusions: There was controversy regarding the prevalence of various inflammatory cell types in peri-implant diseases; however, a considerably high ICT surface area in PI indicates the aggressive nature of the disease., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: Peri-implantitis is a biofilm-induced pathological condition, and different approaches have been proposed to manage this condition. This study introduces a surgical technique in accordance with the concept of guided bone regeneration for implants with extensive peri-implant defects., Methods: This pilot study was conducted on 7 patients with 11 implants (4 females and 3 males; 32 to 61 years). In this technique, we used a titanium mesh, a combination of autogenous bone, allogenic graft material, and acellular dermal matrix to reconstruct the peri-implant defects. All implants were placed submerged, and the second-stage surgery was conducted after 8 months. Soft tissue augmentation and vestibuloplasty were performed in the second-stage surgery, if required., Results: The mean function time of implants was 60.5 ± 29.4 months. The mean baseline probing pocket depth was 5.7 ± 1.4 mm, and soft tissue recession was observed at two sites (18%). The mean recession and keratinized tissue width (KTW) values were 0.4 ± 0.8 mm and 3 ± 1.6 mm, respectively. The mean marginal bone loss and bone gain were 4.4 ± 1.2 mm and 2.9 ± 0.9 mm, respectively, which showed a significant improvement., Conclusion: Our preliminary evaluations showed favorable results in terms of radiographic defect fill and soft tissue condition. It appears that this technique may lead to promising outcomes in cautiously selected patients seeking to retain their failing implants. However, long-term results following functional loading are required before recommending this technique for daily practice., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Peri-implantitis is a common complication of dental implant treatment. A cause-and-effect relationship has been previously documented between microbial plaque and peri-implantitis and implant failure. A difference has been reported in the disinfection efficacy of erbium laser irradiation and air-flow abrasion for contaminated titanium surfaces. Also, the surface changes caused by lasers and air-flow abrasion have not been well studied. Thus, the purpose of this study was to compare the surface changes of contaminated titanium discs following decontamination by erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation and air-flow abrasion. Methods: Twenty-eight intact, sandblasted, and acid-etched (SLA) titanium discs were used. Twenty-four titanium discs were contaminated with Escherichia coli . Then, they were decontaminated by using Er:YAG laser irradiation and air-flow abrasion. Four discs remained intact. The mean and standard deviation of the contact angle and the weight percentage of aluminum, titanium, oxygen, carbon, phosphorus, and calcium were measured. Qualitative changes in surface topography of titanium discs were assessed by scanning electron microscopy (SEM). Results: The mean weight percentage of carbon in the air-flow abrasion group (4.98%) experienced a significant reduction compared with the contaminated (positive control) group ( P =0.035). The contact angles were 46.54° and 38.67° in the laser and air-flow abrasion groups respectively, which were significantly lower than the value in the positive control group (75.15°) ( P ≤0.001). SEM micrographs showed no significant change in the surface area in either technique. Conclusion: Air-flow abrasion was more successful in improving the surface characteristics of titanium discs with no alteration in surface topography or elements, compared with Er:YAG laser irradiation. Further studies regarding the safety of the Er:YAG laser for the decontamination of titanium surfaces are recommended., (Copyright © 2021 J Lasers Med Sci.)

Background: Bone volume plays a pivotal role in the success of dental implant treatment. Autogenous bone grafts should be harvested from reliable sites in the maxillofacial region. This study sought to assess the quantity and quality of bone in the mandibular symphysis for autogenous bone graft harvesting using cone-beam computed tomography (CBCT)., Methods: This cross-sectional study evaluated the CBCT scans of 78 adults presenting to three oral and maxillofacial radiology centers. The vertical (VD) and horizontal (HD) alveolar bone dimensions, cortical thickness (CT), and cancellous to cortical bone ratio (C/C) were measured in the interforaminal region of the mandible at the sites of central incisor to first premolar teeth. The interforaminal distance (ID) and the anterior loop length were also measured. Nonparametric statistical tests were used to analyze the data with respect to sex, age, and tooth position., Results: The median VD, HD, and CT of the symphysis were 20.21 (3.26), 4.13 (0.37), and 2.25 (0.23) mm, respectively. The median C/C was 1.51 (0.11). The median ID was 52.24 (8.24) mm, and the median anterior loop length was 1.82 (1.06) mm. Significant differences were observed in all parameters among different teeth. Most of the measured parameters were greater in males compared with females. There were significant differences in ID, VD, and CT between different age groups., Conclusions: The quantity and quality of the available bone in the mandibular symphysis for bone graft harvesting vary by gender, age, and harvesting site, necessitating careful preoperative evaluation., (© 2021. The Author(s).)

Background: Improvement in implant design has made implant dentistry a challenging treatment modality worldwide., Objectives: This study aimed to investigate the efficacy of a xenogeneic collagen matrix in managing 3-4-millimeter gaps in flapless immediate implant placement., Material and Methods: Twenty-two patients received 39 immediate implants via the flapless approach. Patients with intact bony walls, buccal bone thickness ≥2 mm and a jumping distance of 3-4 mm were included in this study. The gap between the implant and the socket walls was filled with a xenogeneic collagen matrix (Collacone®). The final clinical and radiographic evaluations were performed at least 24 months following functional loading., Results: There was no early or late failure, and the implants showed a 100% survival rate. The mean mesial (0.28 ±0.39 mm) and distal (0.28 ±0.39 mm) marginal bone loss (MBL) at the site of incisors was not significantly different from the values at the site of premolars and molars (0.30 ±0.42 mm and 0.34 ±0.48 mm, respectively). The evaluation of the implant success index (ISI) score revealed no difference between the mandible and the maxilla (p = 0.700), or incisors compared with premolars and molars (p = 0.420). The only significant difference was in terms of distal MBL, which was higher in the maxilla (0.39 ±0.49 mm) than in the mandible (0.12 ±0.23 mm) (p = 0.040)., Conclusions: Within the limitations of this study, it seems that the application of a xenogeneic collagen matrix to manage 3-4-millimeter gaps in carefully selected cases may bring promising outcomes.

Peri-implantitis (PI) is a multifactorial condition caused by the interactions of pathogens and the host immune response. Previous studies have demonstrated a relationship between PI and specific gene polymorphisms, particularly cytokine genes involved in the pathogenesis of PI. This study aimed to evaluate the frequency of single nucleotide polymorphisms (SNPs) of interleukin-10 (IL-10), interleukin 1ß (IL-1ß), and tumor necrosis factor-α (TNF-α) genes in PI patients and healthy controls. A total of 50 patients with PI and 89 periodontally healthy controls were recruited for this study. Venous blood samples (5 cc) were collected, and DNA was extracted. After DNA purification, the relevant gene segments were amplified by polymerase chain reaction (PCR). Restriction fragment length polymorphism (RFLP) and electrophoresis were performed to assess the polymorphisms of the related genes. The analysis revealed that allele and genotype frequencies of IL-10 ─ 819 C/T, IL-10 ─ 592 C/A, and IL-1ß + 3954 C/T significantly differed between PI patients and healthy controls. The analysis revealed no significant association between TNF-α ─ 857 G/A and TNF-α ─ 308 G/A polymorphisms and PI. Our results indicated that specific gene polymorphisms of IL-10 ─ 819 C/T, IL-10 ─ 592 C/A, and IL-1ß + 3954 C/T may play a role in the pathogenesis of PI, and increase its risk of occurrence.

This randomized controlled clinical trial with a 1-year follow-up evaluated gingival thickness changes around teeth after use of dermal allograft and xenograft matrix. A total of 116 teeth (19 patients) were separated into two groups. One group received xenogeneic collagen matrix (n = 48), while the other received allogeneic acellular dermal matrix (n = 68) via a coronally advanced flap (CAF). Gingival thickness (GT), keratinized gingival width (KGW), pocket depth (PD), and clinical attachment loss (CAL) were measured on the day of surgery (baseline) and at 3 weeks, 2 months, 6 months, and 1 year postoperative. The two groups were compared using repeated-measures ANOVA ( P < .05). The mean GT at 1 year was 1.59 ± 0.31 mm in the xenogeneic group and 1.63 ± 0.33 mm in the allogeneic group ( P = .60). The mean change in GT was 1.08 mm in the xenogeneic group and 1.13 mm in the allogeneic group, which was clinically relevant and statistically significant compared to baseline values ( P < .001). However, changes in GT were not significantly different between the two groups at any time point ( P > .05). The GT increased in all cases treated with allogeneic and xenogeneic enriched collagen matrix. Both soft tissue substitutes were equally effective in acheiving optimal GT.

Introduction - Scaffolds and cells are two important components in bone tissue engineering. There is a gap of information about stem cell activity next to bone substitutes. Thus, the aim of this in vitro study was to compare the proliferation and differentiation of bone marrow stem cells (BMSCs) and dental pulp stem cells (DPSCs) in presence of freeze-dried bone allograft (FDBA). Method and Materials - DPSCs and BMSCs were cultured and placed on mineralized bone allograft. Cell proliferation was analyzed by the methyl thiazolyl tetrazolium (MTT) assay after 24, 48, and 72 h. To compare the enzymatic activity and mineralization of cells, the alkaline phosphate (ALP) test and alizarin red staining were performed at 30 days. Data were analyzed by ANOVA. Results - The rate of proliferation of DPSCs was higher at 48 and 72 h. ALP activity was significantly higher in DPSCSs (P < 0.05), while alizarin red staining did not show any significant difference between the groups in formation of calcified nodules. DPSCs showed higher cell proliferation and osteoblastic differentiation than BMSCs. Conclusion - Considering the easier and less invasive isolation of DPSCs, a combination of DPSCs and allograft can be a good choice for bone regeneration, especially in the dentoalveolar area.

This in vitro study aims to assess inward bacterial microleakage at the implant-healing abutment (IHA) interface in two different implant designs, namely platform switching (PS) and platform matching (PM). Five samples were collected from each of the PS and PM implant systems. In the first phase, healing abutments were tightened onto the implants by 10 Ncm torque. Next, IHA assemblies were immersed in an Escherichia coli (E. coli) suspension for 24 hours and 7 and 14 days. The healing abutments were then unscrewed, and samples were collected from the internal part of the implants and streak-cultured on culture media. After 1 day of incubation, the number of grown colonies was counted. In the second phase, the aforementioned steps were repeated for the assemblies that were torqued by 20 Ncm. Data were analyzed by the Kruskal-Wallis and Mann-Whitney tests (α = 0.05). The mean colony count was found to increase over time in the PM group torqued by 10 and 20 Ncm; however, this increase was only significant for 10 Ncm torque (P = 0.02). In the PS group, the colony count did not follow a certain pattern over time, neither in the 10 Ncm nor in the 20 Ncm torque. The mean colony count in the PS group was lower than that in the PM group at all time points in both torques. This difference was not significant at day 1, irrespective of torque value, but it was significant at 7 and 14 days, in both 10 and 20 Ncm torques (P < 0.05). Thus microleakage is lower in PS than PM design. The selection of a PM or PS design is a more important factor than the applied torque (10 or 20 Ncm) for reduction of bacterial microleakage in Tube-in-Tube implant systems with screw-retained connections.

Introduction - This study aimed to compare the amount and pattern of stress and strain distributed around periodontally compromised splinted teeth and the two-implant abutments supported six-unit fixed partial denture (FPD) using finite element analysis (FEA). Methods and Materials - Six mandibular anterior teeth of a dental model were scanned and the scans were transferred to 3D CAD design and finite element software. Jaw bone was also designed and the teeth were splinted by fiber-reinforced composite (FRC) band. In another model, two implants were placed at the site of canine teeth and a six-unit FPD was designed over them. Models were transferred to finite element software and after meshing and fixing, they were subjected to 100- and 200-N loads under 0 and 30° angles. Results - Apical areas and crestal bone showed the highest accumulation of stress and strain in periodontally compromised splinted teeth. Crestal bone and bone between crestal microthread and the first thread of implant body had the highest accumulation of stress and strain in the implant supported six-unit FPD. Conclusion - The results showed significantly higher shear stress, von Mises stress and von Mises strain in peri-implant bone compared with bone around periodontally compromised teeth. Increase in applied load magnified this difference. Also, a greater difference was noted in stress and strain in bone around teeth and implants when oblique load was applied.

Objectives - Aphthous stomatitis is one of the most common ulcerative lesions in the oral cavity. The aim of this study was to report the characteristics of patients with aphthous stomatitis after dental implantation. Patients and Method - The study included 14 patients who were diagnosed with aphthous stomatitis. The subjects were analyzed with the respect to age, sex, patient's general health status, type, number, location, and duration of the ulcers and the number of dental implants. Results - Of the 14 cases, 64.3% were female and 35.7% were male. The mean age of patients was 57.7. In terms of general health status, 64.3% of patients did not have a remarkable disease; however, 14.3%, 14.3%, and 7.1% of cases had diabetes, hypothyroidism, and cardiac disease, respectively. The majority of the lesions have been presented as minor type (85.7%) and the mean number of the ulcers was 2.5. Labial mucosa has been affected more frequently (71.4%), followed by tongue and floor of the mouth. The most lesions (42.8%) were occurred one day after dental implant surgery. The mean number of dental implants was 3.1. Conclusion - Presence of apthous ulcers should be considered by dentists as a potential postoperative complication of dental implantation.

Objective: Low-level laser therapy is a method for osteogenesis since it stimulates cell proliferation, vascularization and osteoblastic activity. Various protocols applying low-level laser with different outcomes exist. The aim of the present study was to review the result of different methods on bone formation in critical-size defects of in vivo studies., Design: According to PRISMA statement, electronic search of PubMed, google scholar, Scopus and Web of Science and a hand search limited to in vivo English language studies until December 2019. Studies used low-level laser therapy in bone regeneration of critical-size defects met the inclusion criteria and which used high power lasers or a defect size smaller than 5 mm, were excluded., Results: Finally, 18 studies were included. Fourteen studies utilized low-level laser with a wavelength ranging from 606 to 980 nm and 53 % of studies applied low-level laser in a single session. Ten studies utilized continuous wave mode of laser. Highest and lowest values of power density were 1.5 W/cm 2 and 0.1 W/cm 2 in order. Eleven studies evaluated low-lever laser therapy on defects of 5 mm in calvaria. Meta-analysis showed the positive effect of low-level laser therapy on osteogenesis after 30 days compared to control group and no significant difference after 60 days., Conclusions: New bone formation can be increased in early stage by applying low-level laser therapy through stimulating osteoblasts and fibroblasts' proliferation. This effect would be more remarkable by combining with bone substitutes. Hence, for each case, protocol selection should be performed according defect's properties, attentively., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Several species of dangerous snakes are found in Iran and, according to the Emergency Response Center of Iran from 2002 to 2011, 53,787 Iranians have suffered from snakebite. Although the mortalities caused by snakebite are very low, snakebite-related amputations are still a major concern. Currently, anti-venom polyclonal antibodies derived from animals, such as horses are used to treat snakebites; however, in some cases they can cause anaphylactic shock and serum sickness. In line with this premise, generation of recombinant anti-venom antibodies can be considered as an alternative strategy. Single-chain fragment variable (scFv) antibodies offer several advantages compared to the whole antibodies, including ease of production, high affinity and specificity. In the present study, scFv antibodies were selected against the venom of the most poisonous snakes in Iran using phage display technology. Phage particles harboring anti-venom specific scFv were separated and scFv antibodies were produced in bacteria. In-vitro assay showed that polyclonal scFvs specifically bind to the venom. Furthermore, in-vivo experiment in mice BALB/c indicated effective toxin neutralization using 20 µg of polyclonal scFv. Our study indicates the neutralizing capacity of anti-venom polyclonal scFvs, although further neutralization assays are needed to confirm their effectiveness.

Background: This study aimed to assess the association of haptoglobin (HP) and natural resistance-associated macrophage protein 1 (NRAMP1) alleles with the presence of heme-consuming periodontal pathogens in a group of Iranian patients with chronic periodontitis and peri-implantitis., Methods: This cross-sectional study evaluated 69 eligible chronic periodontitis and peri-implantitis patients selected from Shahid Beheshti Dental School. The periodontally diseased individuals had at least three teeth with clinical attachment loss of ≥3 mm and a probing pocket depth (PPD) of ≥3 mm in at least two quadrants. Peri-implant PPD of at least one site was ≥5 mm with or without suppuration and bleeding on probing. A plaque index of >20% and a radiographic crestal bone loss was present in at least one site around the implant. The paper point method was used for sampling from the deepest periodontal/peri-implant pocket of each tooth or implant for the DNA checkerboard hybridization technique. Statistical analyses were performed with PASW Statistics 18.0. The variables were presented as absolute and relative frequencies (%)., Results: An Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) score of 1-2 was 5.8 times more frequent in HP 2, rs1723540 G, and rs2276631 G alleles. A Porphyromonas gingivalis (P. gingivalis) score of 1-2 was 4.8 times more common in the subjects carrying HP 2, rs1723540 G, and rs2276631 G alleles compared with HP 1, rs1723540 A, and rs2276631 A alleles., Conclusion: Within the limitations of this study, it seems that there was a relationship between HP and NRAMP1 allele frequencies and the presence of heme-consuming periodontal pathogens in the Iranian patients with chronic periodontitis and peri-implantitis evaluated in the present study., Competing Interests: The authors declare that they have no competing interests., (© 2020 The Author(s).)

Background: The present study aimed to evaluate the osteopromoting ability of human tooth powder and compare it to a bovine xenograft, a synthetic material, and the DFDBA allograft., Methods: In this in vitro study, 30 teeth without caries, inflammation, and infection, which had been extracted for orthodontic reasons, were collected. The crowns were removed, pulpectomy was carried out, and the samples were ground to a powder with particles <500 µm. Osteoblast-like cells of MG-63 were cultured with the tooth powder, Cerabone, DFDBA, and Osteon II. Cell proliferation was assessed by the MTT assay at 24- and 72-hour intervals. The alizarin red test was carried out after three and five days. The alkaline phosphatase level was measured after 24, 48, and 72 hours to assess the osteoblastic activity. The results were analyzed with one-way ANOVA., Results: According to the MTT assay, all the materials exhibited a higher proliferation rate than the control group in 24 hours. In 72 hours, DFDBA had the lowest cell proliferation rate at concentrations of 40 and 80 mg/mL. DFDBA and the positive control group were able to create calcified nodules by the alizarin red test. At the 48- and 72-hour intervals, DFDBA had the lowest alkaline phosphatase activity at a concentration of 40 mg/mL. At the 72-hour interval, bovine xenograft had the highest alkaline phosphatase level, followed by the synthetic material and tooth powder., Conclusion: The tooth powder was able to increase cell proliferation in comparison with the bovine xenograft, the synthetic graft, and the DFDBA. However, its osteopromoting ability was less than that of the osteogenic materials., Competing Interests: The authors declare that there were no competing interests between the authors., (© 2020 The Author(s).)

Background: It is crucial to maintain periodontal health in patients undergoing orthodontic treatment. Biotype is a critical factor to be considered in this regard. This systematic review investigated the scientific evidence on the relationship between gingival biotype and marginal periodontal alterations induced by orthodontic interventions., Methods: An electronic search was conducted for pertinent studies in three databases: PubMed, Scopus, and Cochrane up to August 1, 2019 based on a detailed protocol according to the PRISMA statement. The authors also completed a hand search in six dental journals and the bibliographic lists of the relevant studies., Results: Of 1512 citations retrieved through the electronic search, 602 were duplicate entries. By evaluating titles, abstracts, and full texts, eight articles conformed to the inclusion criteria; however, no relevant studies were found through hand searching. The evidence suggested that recession was inversely related with the thickness of the facial margin. These findings were more evident in proclined teeth and patients using fixed appliances., Conclusion: The existing evidence suggests that orthodontic therapy might result in mild detrimental effects on the periodontium, especially in patients with thin biotype. However, due to the limited investigations and their inconsistent methodology, further well-designed prospective studies are necessary., Competing Interests: The authors declare no conflict(s) of interest related to the publication of this work., (© 2020 The Author(s).)

COVID-19 has imposed tremendous burden on the healthcare systems and healthcare professionals worldwide. As periodontitis and peri-implantitis are chronic diseases, regular recall visits play a critical role in management of these conditions; however, the current situation may stop patients from attending their regular maintenance. Therefore, it may be necessary to reconsider and revise the treatment protocols.

Leukocyte platelet-rich fibrin (L-PRF) has the potential to accelerate wound healing. Here, we assess clinical and radiographic outcomes of socket preservation using L-PRF. For this single-blind, randomized, split-mouth clinical trial, we selected 22 patients (15 males and seven females), who required extraction of single-rooted teeth. Subjects were randomly assigned to two groups. We used L-PRF in the extraction socket on one side and no material on the contralateral side. We obtained cone-beam computed tomographic images and diagnostic casts from tooth extraction sockets before surgery and 3 mo after the procedure. Changes in buccolingual diameter and height of bone at 3 mo after tooth extraction (compared to baseline) were determined and digitized data statistically analyzed using Statistical Package for the Social Sciences software, ver. 25.0 (IBM, Armonk, NY) via the paired t-test. In tooth sockets with/without L-PRF application 3 mo after extraction, bone buccolingual diameter significantly decreased at socket center to 0, 1, and 3 mm from the ridge crest, compared to baseline. A significant reduction occurred in sockets with/without L-PRF application in buccal and lingual bone height at the bony socket midbuccal portion of and mesial and distal septa (p < 0.0001). However, the Mann-Whitney U test showed changes to be significantly greater in controls than the case group (p < 0.0001). Taking into account study limitations, application of L-PRF in tooth extraction sockets significantly decreased reductions in bone height and buccolingual diameter compared to control sockets.

Background: This study aimed to compare the effect of one and two sessions of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) on clinical and microbial parameters in patients with chronic periodontitis., Methods: This study was conducted on 20 patients. The dental quadrants of patients were randomly assigned to SRP at baseline (group 1), SRP at baseline and one month (group 2), SRP plus aPDT at baseline (group 3) and SRP plus aPDT at baseline and one month (group 4). Probing depth (PD), clinical attachment level (CAL) gain, and bleeding on probing (BoP) were measured at baseline, and one and three months later. F. nucleatum counts were determined by PCR. ANOVA was used for the comparison of these variables between the groups., Results: In all the groups, PD reduction and CAL gain increased significantly at 1- and 3-month intervals compared to baseline (P=0.001). At three months, the difference in PD between groups 1 and 3 was statistically significant (P=0.014). CAL gain between groups 2 and 4 at one month (P=0.016) and three months (P=0.001) wasstatistically significant. Reduction in F. nucleatum counts was not significant between the four study groups (P>0.05)., Conclusion: A combination of two sessions of aPDT and SRP could improve CAL gain; however, further long-term studies are necessary in this regard., Competing Interests: The authors declare no conflict(s) of interest related to the publication of this work., (© 2019 The Author(s).)

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 post-operative 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., (Copyright © 2019 J Lasers Med Sci.)

Background: Human colorectal cancer cells overexpress carcinoembryonic antigen (CEA). CEA is a glycoprotein which has shown to be a promising vaccine target for immunotherapy against colorectal cancer., Objectives: To design a DNA vaccine harboring CEA antigen and evaluate its effect on inducing immunity against colorectal cancer cells in tumor bearing mice., Methods: In the first step the coding sequence of the CEA was cloned into the pcDNA3.1 vector. The mice were injected with the vaccine construct and the immune responses were monitored during the experiment period. The specific IgG anti-CEA, IFN-γ, IL-2 and IL-4 were measured by ELISA and levels of IFN-γ was detected by ELISpot assay. The lymphocyte proliferation was assessed using a 5-bromo-2-deoxyuridine (BrdU) cell proliferation assay kit., Results: Immunization of the mice with the CEA plasmid resulted in stimulation of CEA-specific T cell and antibody responses. The serum level of specific IgG antibodies against CEA was increased in immunized mice. Moreover, the injection of CEA plasmid led to the stimulation of T-helper-1 by increase in the secretion of IFN-γ, IL-2 and lymphocyte proliferation response., Conclusion: As the CEA DNA vaccine displayed encouraging antitumor effects, therefore, we suggest that it can be a potential therapeutic modality for colorectal cancer and is worthy of further investigation.

This study was conducted on 87 patients with chronic periodontitis (CP), 50 patients with peri-implantitis and 90 periodontally healthy individuals referring to the Department of Periodontics for evaluating the association between Fc gamma-receptor genes polymorphisms with CP and peri-implantitis. After obtaining consent, venous blood samples (5cc) were obtained from patients and DNA was extracted using Miller's salting-out method. Polymerase chain reaction (PCR)-restriction fragment length polymorphism and tetra-primer amplification refractory mutation system-PCR methods were used to assess the polymorphisms of FcγRs IIa, IIIa, and IIIb genes. Analyzing showed a significant association between specific genotypes with increasing CP and peri-implantitis risks in codominant and dominant models. For FcγR IIIa, analyzing revealed a significant association between specific genotypes with increasing CP and peri-implantitis risks in codominant, dominant, and recessive models. For FcγR IIIb, we also detected a significant association between specific genotypes with increasing CP and peri-implantitis risks in codominant, dominant, and recessive models ( P < 0.05). According to the results of this study, the FCGRIIa (rs1801274), FCGRIIIa (rs396991), and FCGRIIIb (rs1050501) polymorphisms were significantly associated with CP and peri-implantitis and may have a role in the pathogenesis of these diseases., (© 2019 Wiley Periodicals, Inc.)

Purpose: This study was conducted to investigate one-piece narrow-diameter implants installed in maxillary lateral and mandibular incisor sites using immediate nonfunctional loading., Materials and Methods: In this 10-year clinical trial study, 42 narrow-diameter (3.0-mm) one-piece implants for 35 patients were inserted. Clinical and radiographic measurements were recorded in 10 years and analyzed statistically using t test., Results: A total of 26 patients (20 females and 6 males) with 30 implants were available for the 10-year follow-up. The 10-year implant survival rate was 100%. A statistically significant mean marginal bone loss was observed between 12 months and 10 years (0.18 ± 0.29 mm). The mean pocket depth increase was statistically significant (0.68 ± 0.83 mm). No bleeding on probing was observed around 90% of the implants. Full-mouth plaque index was registered at 20% of the implants., Conclusion: The results obtained in this analysis suggest that modest marginal bone loss was observed around the implants. One-piece narrow-diameter implants (Maximus 3.0; BioHorizons) can predictably restore missing maxillary lateral incisors and mandibular incisors in cases of careful patient selection.

This study sought to histologically and histomorphometrically assess and compare application of xenograft bone substitute and synthetic nonceramic hydroxyapatite for tooth-socket preservation in dogs. This split-mouth clinical trial was conducted in five hybrid dogs, using four tooth sockets in each dog, with a total of 20 sockets for evaluation. Group 1 received xenografts, and group 2 received synthetic nonceramic hydroxyapatite in the sockets. In group 3 (positive controls), sockets remained empty. All sockets were covered with collagen resorbable membrane, and the flap was stitched using nonresorbable sutures. In group 4 (negative control), sockets were without membrane, left empty, and sutured. After 12 wk, 8-mm-high bone core biopsies were harvested from inside the sockets, using a trephine bur with an internal diameter of 2 mm. We assessed the tissue in terms of percentage of newly formed viable bone, percentage of remaining particles, degree of inflammation, and type of connective tissue. Data were statistically analyzed. The percentage of newly formed viable bone was 34.98% in group 1 and 41.30% in group 2, and this difference was not statistically significant (p = 0.710). The percentage of remaining particles was 15.95% in group 1 and 14.14% in group 2; this difference was also not statistically significant (p = 0.902). Both synthetic nonceramic hydroxyapatite and xenograft bone substitute showed similar efficacy, histologically and histomorphometrically, when used with resorbable collagen membrane for tooth-socket preservation in dogs.

Objective: Contemporary implantology is moving toward less invasive approaches. To date, several techniques have been proposed for maxillary sinus lift surgery. In this article, we introduce a new technique for maxillary sinus floor elevation that is less invasive than the osteotome technique., Methods and Materials: In the vertical expander screw (VES) technique, which uses a combination of drilling and bone-expander screws; a primary implant hole is created. Bone expander screws are used in lateral and vertical dimensions to elevate the sinus membrane., Results: The results at the two-year follow-up revealed bone formation around the implant body in the bony sinus cavity for three patients. Accordingly, 100% survival and success rates were reported for implants placed with VES technique., Conclusion: The maxillary sinus floor can be elevated to the desired height with a VES technique with minimal invasion. The VES technique can be used as an alternative to elevate the sinus floor with less invasion than the osteotome technique.

Objectives: Chronic periodontitis is a common inflammatory disease of the oral cavity that causes destruction of periodontal tissues and bone around the teeth. Sclerostin is a protein encoded by the SOST gene. In this study, gingival crevicular fluid (GCF) levels of sclerostin in patients with chronic periodontitis were compared with those of healthy subjects., Materials and Methods: In this case-control study, a total of 40 subjects were enrolled and divided into the healthy group (n=23) and chronic periodontitis group (n=17). GCF samples were collected, and the concentration of sclerostin was evaluated using enzyme-linked immunosorbent assay. Comparison of significance between groups was assessed using Mann-Whitney U test., Results: Sclerostin concentration was significantly higher in the chronic periodontitis group compared with the healthy group ( P <0.005)., Conclusion: Despite the limitations of this study, sclerostin can be a possible marker for assessment of periodontal health status., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Background: Splinting of teeth is performed for effective distribution of loads in mobile teeth and to lower the stress applied to compromised teeth. Biomechanics cannot adequately explain load distribution around natural teeth. This study aimed to compare the distribution pattern and magnitude of stress and strain around splinted and non-splinted teeth with compromised periodontium using three-dimensional (3D) finite element analysis (FEA)., Methods: Six mandibular anterior teeth were scanned and data were registered in CATIA® and then SolidWorks® software programs. The jawbone was also designed. In the second model, the teeth were splinted with fiber-reinforced composite (FRC). The models were then transferred to ANSYS® software program and after meshing and fixing, 100- and 200-N loads were applied at zero and 30° angles. The magnitude and distribution of stress and strain in the periodontal ligament (PDL) and the surrounding cortical bone were determined., Results: A significant reduction in stress was noted in cortical bone around central and lateral incisors while an increase in stress was noted around the canine tooth after splinting. All these changes were more significant under 100-N load compared to 200-N load and greater differences were noted in response to the application of oblique loads compared to vertical loads., Conclusion: Splinting decreased the magnitude of stress and strain in teeth close to the center of splint and increased the stress and strain in teeth far from the center of splint. Adequate bone support of canine teeth must be ensured prior to selection of splinting as the treatment plan for the anterior mandible since it increases the longevity of all the teeth., Competing Interests: The authors declare no competing interests with regards to the authorship and/or publication of this article., (© 2018 The Author(s).)

Objectives: This study aimed to optimize the thread depth and pitch of a recently designed dental implant to provide uniform stress distribution by means of a response surface optimization method available in finite element (FE) software. The sensitivity of simulation to different mechanical parameters was also evaluated., Materials and Methods: A three-dimensional model of a tapered dental implant with micro-threads in the upper area and V-shaped threads in the rest of the body was modeled and analyzed using finite element analysis (FEA). An axial load of 100 N was applied to the top of the implants. The model was optimized for thread depth and pitch to determine the optimal stress distribution. In this analysis, micro-threads had 0.25 to 0.3 mm depth and 0.27 to 0.33 mm pitch, and V-shaped threads had 0.405 to 0.495 mm depth and 0.66 to 0.8 mm pitch., Results: The optimized depth and pitch were 0.307 and 0.286 mm for micro-threads and 0.405 and 0.808 mm for V-shaped threads, respectively. In this design, the most effective parameters on stress distribution were the depth and pitch of the micro-threads based on sensitivity analysis results., Conclusion: Based on the results of this study, the optimal implant design has micro-threads with 0.307 and 0.286 mm depth and pitch, respectively, in the upper area and V-shaped threads with 0.405 and 0.808 mm depth and pitch in the rest of the body. These results indicate that micro-thread parameters have a greater effect on stress and strain values., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Background: The finite element method (FEM) has been used to analyze stress and strain distributions around 3 suggested dental implants with newly-designed thread parameters and the optimal shape of the implant was introduced considering the response surface optimization method sensitivity analysis. Experimental tests seemed necessary to confirm the results of the FEM., Objectives: The aim of this study was to use experimental tests to prove the results of a finite element analysis of 3 dental implants with different thread designs under axial loads. Photoelastic stress analysis was chosen due to the similarity of analysis with FEM., Material and Methods: Two-dimensional models of 3 dental implants were built of grade 4 titanium to be tested in the polariscope. Model 1: A tapered implant with V-shaped threads; Model 2: A tapered implant with micro-threads in the upper area and V-shaped threads in the rest of the body; Model 3: A tapered implant with reverse buttress threads in all areas. Axial loading of 100 N was applied to the top of the implants and stress patterns and the maximum stress were evaluated for each implant., Results: The minimum Huber-Mises-Hencky stresses of cortical bone were recorded in model 2, a tapered implant with micro-threads in the upper area and V-shaped threads in the rest of the body. The value for 100 N loading was 15.25 MPa, which was in agreement with the FEM., Conclusions: Considering the stress patterns and values obtained from experimental tests of photoelasticity, the tapered implant with micro-threads in the upper area and V-shaped threads in the rest of the body has the most uniform and desirable stress distribution in the surrounding cortical bone and is preferred to be used in future applications.

The frenum is a mucosal fold that attaches the lips or cheeks to the alveolar mucosa, gingiva, and underlying periosteum. Consequences of an abnormal frenal attachment include gingival recession, decreased vestibular depth, decreased range of lip movement, and involvement of interdental papilla, causing a diastema. Several methods to eliminate ectopic frenal attachments have been suggested, including frenectomy (elimination) and frenotomy (repositioning). This case report describes the use of a modified frenectomy technique in a 15-year-old girl with excess gingiva between the maxillary central incisors, which exhibited a 3-mm diastema. First, a semilunar primary incision was made in the palatal surface at a 5-mm distance from the tip of the papilla. Next, sulcular incisions were made around the tooth, and the papilla was transposed to the buccal via a papilla preservation flap. After complete elimination of frenal attachments in the bone, the flap was repositioned and sutured to the palatal surface. Afterward, the frenum was classically cut and sutured. Through this approach, the position of the frenum was changed apically without invading the papilla. At the 3-month follow-up, it was found that the modified technique (combination of papilla preservation flap and frenotomy) had minimized the surgical scar on the buccal surface, preserved the papilla, and yielded optimal esthetic results.

Application of surgical stents for implant placement via guided flapless surgery is increasing. However, high cost, need for some professional machines, and not taking into account the soft-tissue parameters have limited their application. We sought to design and introduce a technique named in-office guided implant placement (iGIP) to decrease the cost by using available devices in office and enhance the applicability of surgical stents. A customized surgical stent was fabricated based on prosthetic, soft- and hard-tissue parameters by taking into account the amount of available bone (using the computed tomographic [CT] data), soft-tissue thickness and contour (using a composite-covered radiographic stent), and position of the final crown (by diagnostic cast wax up and marking the final crown position with composite). The efficacy of iGIP, in terms of the accuracy of the three-dimensional position of the implant placed in the study cast and in patient's mouth, was confirmed by direct observation and postoperative CT. The iGIP can enhance implant placement in the prosthetically desired position in various types of edentulism. Using this technique minimizes the risk of unwanted consequences, as the soft-tissue thickness and contour are taken into account when fabricating a surgical stent.

Objective: This study sought to assess the relationship between facial gingival and bone dimensions in maxillary anterior teeth region using cone beam computed tomography (CBCT)., Design: This study assessed 621 maxillary anterior teeth in 144 patients. In the sagittal plane, facial bone thickness (BT) and gingival thickness (GT) were measured at the crestal level and at 2, 4 and 6mm apical to the cementoenamel junction (CEJ). The dentogingival complex (DGC) dimensions and the distance from the CEJ to bone crest were also measured on CBCT scans. To determine the gingival biotype, GT at 2mm apical to the gingival margin was measured and GT <1.5mm was categorized as thin while GT ≥1.5mm was categorized as thick. The data were analyzed using SPSS version 21 via repeated measures ANOVA and the Cochrane's Q, chi-square and independent samples t-tests., Results: The BT around the maxillary central and lateral incisors and canine teeth at 4 and 6mm apical to the CEJ was significantly different in thick and thin gingival biotypes (P<0.05). The mean GT at 2 and 4mm apical to the CEJ was significantly different around central and lateral incisors (P<0.05). Thickness of crestal bone was significantly different between the two gingival biotypes around central and lateral incisors (P<0.05)., Conclusion: The two gingival biotypes had significantly different mean BT; different biotypes and their relationship to BT varied around anterior maxillary teeth., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Survival of dental implants depends on several factors; soft tissue (ST) management around dental implants is one of the foremost. Several studies have suggested techniques for ST management around dental implants, but none of them has discussed a suitable timetable for this process. This study aimed to review published articles related to the timing of ST management around dental implants and suggest a customized treatment protocol. A search of the PubMed database was conducted; the search was limited to English-language articles published from January 1995 to July 2015 with available full texts. Only in vivo studies and clinical trials in relation to the terms soft tissue management, management timing, keratinized mucosa, free gingival graft, connective tissue graft, soft tissue, augmentation, and dental implant were included. A total of 492 articles were reviewed, and eventually 42 articles were thoroughly evaluated. Those with treatment protocols in terms of the timing of ST grafting were selected and classified. ST management around dental implants may be done prior to the surgical phase, after the surgical phase, before loading, or even after loading. A thick gingival biotype is more suitable for implant placement, providing more favorable esthetic results. A treatment plan should be based on individual patient needs as well as the knowledge and experience of the clinician. The width and thickness of keratinized tissues, the need for bone management, and local risk factors that influence esthetic results determine the appropriate time for ST augmentation procedures.

Objectives: The purpose of the present study was to compare the cytotoxicity of Reso-Pac and Coe-Pak periodontal dressing., Material and Methods: According to ISO-10993-12:2012, 1-, 3- and 7-day extracts of the two periodontal dressings were prepared in cell culture medium and exposed to the two cultured cell lines. Cell viability and proliferation at 24 h and 72 h following exposure were evaluated using quantitative MTT assay., Results: The results showed a significant (P < 0.05) reduction in the viability of cells exposed to the 3- and 7-day Coe-Pak extracts at 24 h and 72 h compared to the control group (no exposure to the extract). Reso-Pac extracts slightly decreased cell viability compared to the control group. Understudy materials showed greater cytotoxicity against human osteoblast-like compared to the human gingival fibroblast cells. No significant (P > 0.05) difference was found in the viability of cells exposed to undiluted (100%) one-day extract and diluted (50%) extract of both understudy materials at 24 h and 72 h after exposure., Conclusions: Based on the results, Reso-Pac periodontal dressing has less cytotoxicity than Coe-Pak.

The aim of this study was to assess stress and strain patterns in cortical and cancellous bones surrounding newly designed dental implants with different thread patterns. Static loading of dental implants has been well studied, but studies on dynamic loading and fatigue analysis of dental implants are scarce. This study analyzed the static, dynamic, and fatigue behaviors of dental implants using finite element analysis (FEA). Two models of dental implants were analyzed in this study. Model A was a tapered implant with V-shaped threads and model B was a tapered implant with microthreads in the uppermost region and V-shaped threads in the rest of the body. Two types of loading conditions were simulated in an FEA model and stress and strain patterns in the surrounding bone were analyzed. Dynamic loading increased the level of stress by 5-10% compared with static loading. Both implants showed acceptable results under static and dynamic loadings, but the second implant with microthreads caused lower stress and strain in cortical and cancellous bones. Dynamic and fatigue analyses can provide a more realistic understanding of the function of dental implants. Replacing the uppermost threads with microthreads can lead to more desirable stress patterns in bone, as well as a higher safety factor and longevity.

Short implants can be used as alternatives to standard implants to prevent invasive surgical procedures. However, due to concerns about complications caused by less bone-implant contact area, researchers have focused on biomechanical properties of short implants and methods to promote them. Splinting has been suggested to decrease the limitation of short implants. This study compared the pattern of stress and strain distribution in bone supporting splinted standard and short implants positioned at crestal and subcrestal levels. An edentulous posterior mandible was made using computer-aided design. Five models of different combinations of splinted short (4 × 6 mm) and standard (4 × 10 mm) implants placed at the level of crestal bone or subcrestally mesial and distal to the edentulous region with a pontic between them were designed using the CATIA software program. ANSYS software was used for finite element analysis (FEA). In each model, 100 and 300 N loads at zero (parallel to the long axis of implants) and 30° angles were applied to implants. Maximum stress and strain for each of the five models, including equivalent stress, shear stress, and strain in peri-implant cortical and cancellous bone, were calculated and stress distribution pattern in different models were recorded. The highest stress was caused by the 300 N load applied at a 30° angle, followed by the 300 N load applied axially and the 100 N load applied at 30°. This order changed in model 1, where the highest stress was noted under the 300 N load at 30°, followed by the 100 N load at 30°. Maximum stress in peri-implant bone occurred under oblique (30°) load. Maximum stress was noted when two splinted short implants were placed subcrestally. In addition, stress in bone around crestal-level splinted short implants was lower than that around standard implants. Combination of short and standard implants had no biomechanical advantage. Application of load parallel to the long axis can significantly decrease stress in peri-implant bone. Although the combination of short and standard implants has no biomechanical advantage, crestal-level placement of splinted short implants is a suitable treatment plan.

Introduction: Most of the headache cases only require pain management in emergency department (ED). The present study aimed to evaluate the efficacy of intranasal lidocaine in this regard., Method: In this clinical trial, adult patients with primary headache were randomly treated with 7.5 mg intravenous (IV) chlorpromazine and 1 ml intranasal lidocaine 2% (treatment) or normal saline 0.9% (placebo), and were compared 5, 15, and 30 minutes later regarding success rate using SPSS 21., Result: 100 patients were assigned to either treatment or placebo group. Number needed to treat of intranasal lidocaine at 5, 15, and 30 minutes were 4 (95% CI: 2.2 - 6.6), 3 (95% CI: 1.7 - 3.5), and 4 (95% CI: 2.3 - 15.9), respectively. These measures for absolute risk reduction were 30 (95% CI: 15.2 - 44.8), 44 (95% CI: 28.7 - 59.3), and 26 percent (95% CI: 6.3 - 44.3), respectively. Pain relapse occurred in 16% of treatment and 11% of control group within 1 hour of treatment (p = 0.402)., Conclusion: It seems that, intranasal lidocaine along with IV chlorpromazine could result in more successful and faster management of primary headaches in ED.

Aim: The purpose of this study was to investigate the cytotoxicity of nanohybrid mineral trioxide aggregate (MTA) in comparison with calcium-enriched mixture (CEM) cement and MTA-Angelus, using human gingival fibroblasts (HGFs)., Materials and Methods: Nine disc-shaped specimens of each material (in 2 set stat: A, set for 24 h; B, set for 30 min; and C, fresh stat) were prepared. HGFs were exposed to tested materials' extracts or control media. Cytotoxicity testing was performed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide assay in two time intervals., Statistical Analysis: Results were evaluated by one-way ANOVA and t -test. Statistical significance was set at P < 0.05., Results: CEM cement demonstrated favorable cell viability values when completely set (24 h set MTA = 24 h set CEM) at both time intervals. Interestingly, 24 h after incubation, CEM in Groups B and C demonstrated higher cell viability values than MTA ( P < 0.05). However, after 72 h of incubation, these groups of CEM and MTA showed equal cell viability. All samples of nanohybrid MTA had slight cytotoxic effects after 24 h of incubation, and moderate cytotoxic effects after 72 h of incubation., Conclusion: Set CEM and set MTA-Angelus exerted similar, favorable effects on cell viability. However, within the limitations of this in vitro study, the results suggest that nanohybrid MTA could not be recommended as a material of choice for cervical root resorption., Competing Interests: There are no conflicts of interest.

Statement of the Problem: Gingival recession has been considered as the most challenging issue in the field of periodontal plastic surgery., Purpose: The purpose of this study was to evaluate the clinical efficacy of root coverage procedures by using partial thickness double pedicle graft and compare it with full thickness double pedicle graft., Materials and Method: Eight patients, aged 15 to 58 years including 6 females and 2 males with 20 paired (mirror image) defects with class I and II gingival recession were randomly assigned into two groups. Clinical parameters such as recession depth, recession width, clinical attachment level, probing depth, and width of keratinized tissue were measured at the baseline and 6 months post-surgery. A mucosal double papillary flap was elevated and the respective root was thoroughly planed. The connective tissue graft was harvested from the palate, and then adapted over the root. The pedicle flap was secured over the connective tissue graft and sutured. The surgical technique was similar in the control group except for the prepared double pedicle graft which was full thickness., Results: The mean root coverage was 88.14% (2.83 mm) in the test group and 85.7% (2.75 mm) in the control group. No statistical differences were found in the mean reduction of vertical recession, width of recession, or probing depth between the test and control groups. In both procedures, the width of keratinized tissue increased after three months and the difference between the two groups was not statistically significant in this respect., Conclusion: Connective tissue with partial and full thickness double pedicle grafts can be successfully used for treatment of marginal gingival recession.

In inflammatory diseases such as peri-implantitis (PI) and chronic periodontitis (CP) both adaptive and innate immunity play a part. Natural resistance associated macrophage protein 1 (NRAMP1) has considerable effects on macrophage function (phagocytosis) and host innate immune response against infections. The present study was to investigate the relationship of NRAMP1 gene polymorphisms with PI and CP in an Iranian population. In this cross sectional study 79 patients with CP, 38 patients with PI and 84 healthy controls presenting to the Periodontology Department of Shahid Beheshti University of Medical Sciences were enrolled. DNA was extracted from fresh blood samples of arm vein of participants and transferred to KBiosience institute (United Kingdom) for genotyping. X2 and Fisher's exact tests were used by SPSS software v.19 for statistical analyzes. Significant differences were detected in the distribution of genotypes between control and CP groups both for rs17235409 and rs2276631 polymorphisms (P:0.044 and P:0.028 respectively). Distribution of genotypes differed insignificantly in comparison of PI and control groups for rs2276631 (P:0.623) and either rs17235409 (P:1) polymorphisms. Based on our results, we conclude that presence of G allele in both rs2276631 and rs17235409 location may be a protective factor against CP. More studies with a larger sample size in different populations are required for confirming NRAMP1 as a genetic determinant in periodontal disorders.

In this study, we aimed to design an ideal dental implant with respect to stress and strain patterns on the surrounding cortical and cancellous bones. The effects of static loading on dental implants have been previously assessed, but the impact of dynamic loading and fatigue analysis has not been well studied. We evaluated static, dynamic, and fatigue behaviors of dental implants to fully understand the mechanism and acquire a more realistic perspective of the process. In this study, we analyzed three models of a tapered dental implant: model 1 had V-shaped threads; model 2 had microthreads in the upper area and V-shaped threads in the rest of the body; model 3 had reverse buttress threads in all areas. Two types of loading conditions were simulated in a finite element model, and stress and strain patterns in the surrounding bone were evaluated. Minimum von Mises stresses of cortical bone were recorded in model 2. The values for a 100-N load with a 25° angle were 44.5 and 47.4 MPa for static and dynamic analyses, respectively. Considering the obtained stress and strain patterns, we conclude that a tapered implant with microthreads in the upper area and V-shaped threads in the rest of the body is preferred for best uniform stress distribution in both static and dynamic analyses.

Periodontitis is an infectious disease of the tooth-supporting tissues. Specific periodontal pathogens trigger inflammatory responses and result in progressive bone loss, which eventually leads to exfoliation of teeth. Periimplantitis is the destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The periodontal pathogens found around failing implants are very similar to those associated with various forms of periodontal diseases. Genetic susceptibility has been known to be an important risk factor for periodontitis and periimplantitis and there have been numerous studies evaluating this in different populations. Many gene polymorphisms may influence individual susceptibility to periodontitis and peri-implantitis. We conducted a review of the literature for gene polymorphisms associated with periodontitis and peri-implantitis susceptibility in the Iranian population. A comprehensive search of the literature on human studies in English, published from January 2004 to February 2015 in PubMed database and Google scholar was performed using the key words "periodontitis," "peri-implantitis," "gene polymorphisms," and "Iranian population." Sixty-six studies were identified; 33 articles were excluded based on review of titles and abstracts. Thirty articles were eligible and had the full text evaluated. Further studies are needed to get more inclusive perception of the influence of gene polymorphisms in periodontitis and peri-implantitis.

Objectives: Dentin is composed of many minerals and growth factors. Based on this composition, we studied its effect as a possible regenerative material for alveolar healing., Materials and Methods: This study was conducted using four 2.5-year-old mongrel dogs (male; weight, 25 to 30 kg). The third mandibular premolars were carefully mobilized with a dental elevator and then removed using forceps. The crown portions of the extracted teeth were removed with cutters, and the root portions of the remaining teeth were collectively trimmed as closely as possible to 350 to 500 µm. Dentin and cementum (DC) chips harvested from the extracted teeth were soaked in blood and packed into the fresh sockets (autograft). Biopsies were performed at the ends of day 14 and day 56 following implantation. Data were expressed as mean±standard deviation and compared with t-test results., Results: The ratio of SA(bone) to total area of each probe was determined and was 170±16 µm(2) for the control group and 71±14 µm(2) for the DC group, a significant difference (P<0.05)., Conclusion: DC particulate grafts offered no improvement in bone regeneration in alveolar extraction sockets.

This article proposes a combined technique including bone grafting, connective tissue graft, and coronally advanced flap to create some space for simultaneous bone regrowth and root coverage. A 23 year-old female was referred to our private clinic with a severe class II Miller recession and lack of attached gingiva. The suggested treatment plan comprised of root coverage combined with xenograft bone particles. The grafted area healed well and full coverage was achieved at 12-month follow-up visit. Bone-added periodontal plastic surgery can be considered as a practical procedure for management of deep gingival recession without buccal bone plate.

Purpose: This study aimed to assess the interdental bone level in premolar bitewing radiographs while retracting the cheeks., Methods: Seventy-two horizontal bone defects were created on dried mandibles and maxillae. The distance from the bone level to the cement-enamel junction of premolars was detected by a modified digital caliper (considered the gold standard). The reliability of all radiographs was assessed by intraclass correlation coefficient (ICC), and the validity was compared to the gold standard using the analysis of variance test. P-values less than 0.05 were considered statistically significant., Results: This study showed that the reliability of radiographs without a cheek simulator and with 0.16 second exposure time was significantly higher than that of the two other groups (ICC=0.96 compared to 0.93 and 0.88, respectively). The results from the radiographs without a cheek simulator and with 0.16 second exposure time were more similar to the gold standard measures than those of the two other groups, although the difference was not statistically significant., Conclusions: Retracting the buccal soft tissue plays an important role in increasing the accuracy of radiographs in detecting the interdental alveolar bone level and produces more accurate results than increasing the exposure time, although it does not have a significant role in reliability of results.

Objectives: This study aimed to assess and compare the levels of interleukin-1beta (IL-1β) and interleukin-6 (IL-6) in the crevicular fluid around healthy implants, implants with peri-implantitis, and healthy teeth., Materials and Methods: This study evaluated 16 dental implants in 8 patients (4 males and 4 females). These patients had at least one healthy implant and one implant with peri-implantitis next to healthy teeth. The crevicular fluid was collected using absorbent cones and transferred to the laboratory. Specimens were evaluated by ELISA for interleukin levels. Data were analyzed using repeated measures ANOVA and Bonferroni tests (P<0.05)., Results: Levels of IL-1β in the crevicular fluid around implants with peri-implantitis were significantly higher than around healthy implants (P=0.002); the latter was significantly higher than around healthy teeth (P=0.015). A significant difference was found in the level of IL-6 in the crevicular fluid around implants with peri-implantitis and healthy implants (P=0.049) and also between implants with peri-implantitis and healthy teeth (P<0.001)., Conclusion: Within the limitations of this study, significant differences exist in the levels of IL-1β and IL-6 in the crevicular fluid of implants with peri-implantitis, healthy implants, and healthy teeth. More studies with larger sample sizes in different populations are necessary.

Introduction: Low level laser therapy (LLLT) also known as photobiomodulation, is a treatment that uses low-level lasers or light-emitting diodes (LEDs) to change cellular function and is a clinically well accepted tool in regenerative medicine and dentistry. Considering the variety of laser, exposure, cells and study types, the exact effects of low level laser therapy seems to be unclear. The aim of this study was to review the data published in the field of the effects of low level laser therapy on proliferation and differentiation of the cells contributing in bone regeneration., Methods: To access relevant articles, an electronic search in PubMed was conducted from 2001 to April 2014. English language published papers on low level laser therapy were found using the selected keywords .The full texts of potentially suitable articles were obtained for final assessment according to the exclusion and inclusion criteria., Results: 240 articles were found from 2001 to April 2014. Following the initial screening of titles and abstracts as well as the final screening of full texts, 22 articles completely fulfilled the inclusion criteria of this study. Wavelength used in LLLT irradiation varied between 600 to 1000 nm with an energy density of 0.04-60J/cm(2) . Although almost all studies agreed on getting positive effects from LLLT, some had opposing results., Conclusion: Low level laser with low-energy density range appears to exert a biostimulatory effect on bone tissue, enhance osteoblastic proliferation and differentiation on cell lines used in in vitro studies. Despite the fact that many researches have been recently done on the effects of LLLT on different cell lines, without knowing the precise mechanism and effects, we are not able to offer a clinical treatment protocol. This paper is a beginning to help further progress and extend practical use of LLLT in future.