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This study presents a biomechanical comparison of bone response to commercially pure titanium screws with four different types of surface topographies placed in the tibial metaphysis of 30 rabbits.One hundred twenty implants were tested double-blinded: (a) blasted, acid-etched, and discrete crystal deposition (DCD), (b) blasted, (c) acid-etched, and (d) blasted and acid-etch. Resonance frequency analysis (RFA/ISQ), reverse torque values (RTV), and bone-to-implant contact (BIC) were measured at the time of implant insertion (day 0), 15, 28, and 56 days of healing.All groups tested demonstrated increased RFA/ISQ and RTV results over the time course. At 15 days, the blasted, acid-etched, and DCD group demonstrated a non-significant trend toward higher values when compared to the blasted and etched group (33.0 ± 16 vs. 26.3 ± 12 Ncm, p = .16). At 56 days, the groups utilizing blasting to create additional surface roughness (Sa 1 micron) showed a statistical significant difference in RTQ versus the non-blasted group (38.5 ± 14 vs. 29.5 ± 9 Ncm, p = .03).Within the limitations of this study, only the increase in surface roughness (Ra 1) at 56 days demonstrated statistically significant effects on RTQ. Other additional surface features, such as sub-micron scale DCD, demonstrated improved healing trends but without significance for clinical applications.

It is hypothesized that active treatment of peri-implantitis (PI) leads to re-stabilization of dental implants. The aim was to assess whether or not dental implants can re-stabilize following treatment of PI. To address the focused question, MEDLINE/PubMed and Google-Scholar databases were explored from 1977 up to and including August 2013. Any disagreements between the authors were resolved via discussion. Articles published only in English were included. Hand searching was also performed. Thirteen experimental studies were included. The treatment regimes adopted in these studies comprised of antibiotic therapy, guided bone regeneration (GBR), laser therapy, use of bone matrix proteins with membrane, conventional flap surgery and mechanical debridement. In four studies, GBR promoted new bone formation; whereas two studies showed photosensitization therapy (in combination with either mechanical debridement or GBR) to regenerate bone around peri-implant defects. Six studies reported that mechanical debridement in conjunction with antibiotic therapy promoted re-stability of dental implants. In one study, recombinant human bone matrix protein-2 with a collagen membrane helped promote re-stabilization of dental implants. New bone formation may occur to some extent around dental implants following treatment for PI; however, a “complete” re-stability may be difficult to achieve without GBR.

Purpose Prevention of peri-implant bone loss is essential for achieving long-term implant success, but few studies have evaluated the impact of placement depth on long-term bone loss. The aim of this retrospective study was to evaluate outcomes for platform-shifted implants placed at different depths relative to the bone crest. Materials and Methods The mesial and distal shoulders of 228 delayed-loaded Ankylos® (Dentsply Implants Manufacturing GmbH, Mannheim, Germany) implants placed in 85 patients were divided retrospectively into two groups based on the implant shoulder position on the day of placement surgery as follows: subcrestal group A (n = 197; 0.5 mm or more below the crestal bone level) or crestal group B (n = 65; within 0.5 mm or less of the crestal bone level). The remaining sites (n = 194; more than 0.5 mm above the crestal bone level) were supracrestal and were excluded from this analysis. Mesial and distal bone loss was evaluated under 5× magnification and analyzed, along with Periotest values. Results Mean Periotest values were −1.77 (±3.57) for Group A and −1.77 (±3.26) for Group B. For Group A, mean mesial (m) bone loss was 1.84 (±1.49 mm) and mean distal (d) bone loss was 1.73 (±1.31 mm). For Group B, the bone loss values were m: 1.41 (±1.65 mm) and d: 1.34 (±1.60 mm). No statistically significant differences were found for the Periotest values (p = .521) or bone level values for the two groups (m: p = .130; d: p = .153). Conclusion Within the limitations of this study, subcrestal or crestal implant placement in combination with delayed loading was associated with similar initial implant stability and subsequent crestal bone loss.

Background Platform-switched implants have been demonstrated to maintain marginal bone-level stability after immediate loading. The present study evaluated crestal bone loss and soft tissue stability around ANKYLOS plus® implants (A-implants) and Certain® PREVAILTM (B-implants). Materials and Methods Patients were identified to receive three A- or three B-implants on each side of their mandibles, with randomization. All implants were loaded immediately after their insertion and splinted with a cemented provisional prosthesis. Final prostheses were delivered 3 months after implantation. Peri-implant crestal bone loss, gingival recession, and other soft tissue changes were evaluated throughout a 2-year follow-up. Results A total of one hundred seven implants were placed in 18 patients. Two of the group A-implants and one group B-implant failed. At the final 24-month assessment, bone loss of at least 2 mm (mesially or distally) was recorded at 5 of the 44 surviving A-implants (11%) and 33 of the 47 B-implants (70%), a success rate of 88.63% for the A- and 29.78% for the B-implants. Conclusions Significant changes in the level of the crestal bone loss around immediately loaded platform-switched dental implants seem to be related to the platform shape and size, as well as the implant-abutment connection, when abutments are not removed.

Introduction: Lack of adequate alveolar bone width or height for proper implant placement is a common clinical situation that clinicians have to overcome in implant dentistry. A new sonic surgical handpiece (SSH) has been developed that uses high-oscillation amplitude to produce precise bony incisions. In combination with the surgical tips, this device can be used in many clinical situations.Case Series: In this case series, we present various clinical applications of the SSH in implant dentistry. The handpiece and the tips were evaluated in various procedures. These included: 1) ridge augmentation; 2) maxillary sinus augmentation; 3) atraumatic tooth extraction; and 4) autogenous bone harvesting. The SSH was able to make very precise incisions through bone and atraumatically separate teeth from their periodontal ligaments. All of these cases healed uneventfully and successfully. Advantages and disadvantages of this new innovative device are illustrated with the clinical cases, including postoperative cli...

Background The immediate loading concept has been extensively documented in the anterior part of the mandible when six primary stable implants are placed, splinted with a fixed prosthesis. Purpose The aim of this study was to evaluate the long-term success of immediately occlusal loaded implants with a progressive thread design and platform shifting in the edentulous mandible. Materials and Methods Seventy-eight implants placed in 13 patients and were connected with their abutments immediately after surgery. The implants were splinted using a fixed temporary restoration having occlusal contacts in the centric and group function in the lateral movements of the mandible (immediate occlusal loading). The patients were advised to use soft/liquid diet for the first 6 to 8 weeks of healing in order to reduce excessive loading in the bone-to-implant interface. Abutment level impressions were taken without removing the abutments in order to fabricate the final prostheses. The final restorations were delivered 4 to 8 weeks after surgery and cemented temporarily in order to evaluate the peri-implant soft tissue condition at the different time intervals after removal of the restoration. Clinical stability and radiological indices were evaluated at the start of loading, at 3-month interval after loading, and then annually. Results After a mean loading period of 75.29 (± 38.18) months, no implant was lost (100% success rate). All clinical indices had values in normal levels. The Periotest values demonstrated a continuous reduction, representing high stability. The crestal bone level was relatively stable and only minimal crestal bone loss was observed in some implants. Conclusions Long-term success and stability of the peri-implant tissues around immediately loaded mandibular implants are expected when implants with platform shifting are restored with bridges without abutment removal.

Purpose Few studies have compared the effects of immediate loading on implant prognoses in smokers and nonsmokers. The aim of this prospective study was to evaluate the long-term success of immediately loaded platform-switched implants placed in smokers and nonsmokers with edentulous jaws. Materials and methods Platform-switched implants were placed using the same treatment protocol in the healed edentulous jaws of two groups of patients: group A patients had smoked at least 20 cigarettes a day for more than 10 years, and group B consisted of nonsmokers. All implants were loaded immediately with provisional fixed prostheses, and definitive cement-retained restorations were delivered 4 to 6 weeks later without removing the abutments. In a standardized follow-up protocol, the implants were evaluated clinically and radiographically at the start of loading, 4 to 6 weeks later, and annually thereafter. Results Sixty-six implants (36 in the maxilla and 30 in the mandible) were placed in eight smokers. Twelve nonsmokers received 97 implants (55 in the maxilla and 42 in the mandible). During an average loading period of 62.53 (± 44.13) months for the smokers and 98.20 (± 19.53) months for the nonsmokers, three implants failed. Two failed in group A (one because of overloading and one because of peri-implanitis) and one failed in group B (overloading), resulting in implant survival rates of 97% and 99%, respectively. No significant differences were found between groups regarding plaque, bleeding, probing pocket depths, or crestal bone loss, either mesially or distally, resulting in success rates of 92.42% for group A and 98.00% for group B. Conclusions Long-term clinical outcomes for immediately loaded platform-shifted implants placed in heavy smokers appear to be comparable to those for nonsmokers if the abutments are placed on the day of surgery and never removed.

Aim: The objective of the present study was to detect the presence of specific periodontopathogenic bacteria in the coronary plaque of patients with coronary artery disease and to find out the significant association between the periodontal status and the presence of pathogenic bacteria in the coronary plaque. Materials and Methods: The study population consisted of 51 patients with chronic generalized periodontitis undergoing coronary artery bypass grafting. Periodontal parameters were recorded and deoxyribonucleic acid was extracted from the subgingival plaque and coronary atherosclerotic plaque samples of the same patients. Polymerase chain reaction was used to amplify the part of 16S ribosomal ribonucleic acid (rRNA) gene to detect the presence of Aggregatibacter actinomycetemcomitans (Aa), Tannerella forsythia (Tf), Porphyromonas gingivali (Pg), Porphyromonas gingivalis (fimA) gene and Treponema denticola (Td). Results: Aa, Tf, Pg, Pg (fimA) gene and Td were detected in 0%, 31.4%, 45.1% 39.2% and 51% of atherosclerotic plaque samples, respectively. Tf was detected in 19.6%, Pg in 39.2%, Pg (fimA) gene in 33.3% and Td in 35.3% of both, subgingival plaque and atherosclerotic plaque samples. Periodontal parameters correlated with the presence of bacteria in coronary plaque. Aa could not be detected in coronary plaque samples. Conclusions: The study confirmed the detection of Red complex bacteria in coronary plaque samples and these bacteria correlated with the severity of periodontal destruction.

The periodontal status of patients with laryngo-onycho-cutaneous syndrome is unknown. This study describes a case of severe aggressive peri- odontitis in a 19-year-old American-Pakistani female with laryngo-onycho-cutaneous syndrome. The patient showed abundant dental plaque and calculus accumulations, suppuration and hemorrhage from virtually all gingivae and interdental papillae, and extensive radiographic alveolar bone loss and vertical mobility of several teeth. Subgingival plaque samples revealed a variety of major periodontal pathogens. The patient was scheduled for full-mouth tooth extraction. (J Oral Sci 55, 359-362, 2013)

There is a debate over the association between low testosterone levels in body fluids and the occurrence of chronic periodontitis (CP). The aim of the present systematic review was to assess whether low testosterone levels in body fluids reflect CP. In order to identify studies relevant to the focus question: “Is there a relationship between low testosterone levels in body fluids and CP?” an electronic search without time or language restrictions was conducted up to June 2016 in indexed databases using different keywords: periodontitis, chronic periodontitis, periodontal diseases, testosterone, and gonadal steroid hormones. A total of eight studies were included in the present systematic review. The number of study participants ranged from 24 to 1,838 male individuals with ages ranging from 15 to 95 years. Seven studies measured testosterone levels in serum, two studies in saliva, and one study in gingiva. Four studies reported a negative association between serum testosterone levels and CP. Two studies reported a positive association between decreased testosterone levels in serum and CP. Increased levels of salivary testosterone among patients with CP were reported in one study; whereas one study reported no significant difference in the concentration of salivary testosterone between patients with and without CP. One study identified significant increase in the metabolism of testosterone in the gingiva of patients with CP. Within the limits of the evidence available, the relationship between low testosterone levels and CP remains debatable and further longitudinal studies and control trials are needed.

Deficient bony ridges often complicate the implant treatment plan. Several treatment modalities are used to regenerate bone, including guided bone regeneration (GBR). The purpose of this study was to summarize the knowledge on different types of membranes available and currently used in GBR procedures in a staged approach or with simultaneous implant placement. The primary role of the membranes is to exclude epithelial and connective tissue cells from the wound area to be regenerated, and to create and maintain the space into which pluripotential and osteogenic cells are free to migrate.A literature search was performed for articles that were published in English on the topic. A selected number of studies were chosen in order to provide a review of the main characteristics, applications, and outcomes of the different types of membranes. Resorbable membranes are made of natural or synthetic polymers like collagen and aliphatic polyesters. Collagens are the most common type used. They have similar collagen composition to the periodontal connective tissue. Other materials available include human, porcine, and bovine pericardium membranes, human amnion and chorion tissue, and human acellular freeze-dried dermal matrix. Nonresorbable membranes used in GBR include dense-polytetrafluoroethylene (d-PTFE), expanded-polytetrafluoroethylene (e-PTFE), titanium mesh, and titanium-reinforced polytetrafluoroethylene.The most common complication of nonresorbable membranes is exposure, which has detrimental effect on the final outcome with both types of membranes. For vertical bone augmentation procedures, the most appropriate membranes are the nonresorbable. For combination defects, both types result in a successful outcome.

There are no studies that have (a) compared self-perceived oral symptoms and clinical and radiographic periodontal parameters (plaque index [PI], bleeding on probing [BoP], clinical attachment loss [CAL], and marginal bone loss [MBL]) among shamma-chewers (SC) and gutka-chewers (GC); and (b) assessed periodontal parameters among SC. The aim of the present study was to compare the self-perceived oral symptoms and periodontal parameters among SC, GC, and controls.Information regarding demographic characteristics and self-perceived oral symptoms was gathered using a structured questionnaire. Odds ratios were computed for self-perceived oral symptoms and periodontal parameters and compared between the groups. For multiple comparisons, the Bonferroni post-hoc test was used. Level of significance was set at P .05.Forty-seven SC, 45 GC, and 41 control individuals were included. Group comparisons for pain in teeth, pain on chewing, bleeding gums, and burning sensation in the mouth showed no statistically significant difference among SC and GC. These symptoms were significantly higher in SC (P .01) and GC (P .01) than controls. PI, BoP, PD (4-6 mm and 6 mm), and CAL were significantly higher in SC (P .05) and GC (P .05) than controls. There was no statistically significant difference in PI, BoP, PD (4-6 mm and 6 mm), and CAL among SC and GC. There was no statistically significant influence of daily frequency of smokeless tobacco consumption and duration of placement in the mouth on the severity of periodontal parameters.Self-perceived oral symptoms and periodontal parameters were worse among SC and GC than controls, with no statistically significant difference when comparing these findings between SC and GC.

Aim The aim of the present study was to assess the periodontal status of individuals and the presence of red complex microorganisms (RCM), such as Treponema denticola (Td), Porphyromonas gingivalis, and Tannerella forsythia in the subgingival tissues of periodontitis patients before and after the application of 4% mangostana gel (Garcinia mangostana [MGA]) as an adjunct to scaling and root planing (SRP). Methods Twenty-five patients (MGA group) were treated with SRP, and the subgingival application of mangostana gel was used as local drug delivery. Twenty-five patients (placebo group) were treated with SRP and placebo gel. Clinical parameters were recorded, and the presence of RCM was assessed at baseline and at the third month. Results Clinical parameters, such as probing pocket depth, clinical attachment level, bleeding index, plaque index, and Td, were significantly reduced in the MGA group compared to the placebo group from baseline to the third month. Conclusion There was a significant improvement in the periodontal status with a reduction in Td with the application of mangostana gel in periodontal pockets. In the near future, 4% mangostana gel can be used as an adjunct to SRP to provide a new dimension to periodontal therapy.

// Isaac K. Sundar 1 , Fawad Javed 2 , Georgios E. Romanos 3 , Irfan Rahman 1 1 Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 2 Department of General Dentistry, Eastman Institute for Oral Health University of Rochester, Rochester, NY 3 Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY Correspondence to: Irfan Rahman, email: irfan_rahman@urmc.rochester.edu Keywords: e-cigarettes, e-juices, RAGE, COX 2 , PGE 2 Received: August 02, 2016 Accepted: October 14, 2016 Published: October 24, 2016 ABSTRACT Electronic-cigarettes (e-cigs) represent a significant and increasing proportion of tobacco product consumption, which may pose an oral health concern. Oxidative/carbonyl stress via protein carbonylation is an important factor in causing inflammation and DNA damage. This results in stress-induced premature senescence (a state of irreversible growth arrest which re-enforces chronic inflammation) in gingival epithelium, which may contribute to the pathogenesis of oral diseases. We show that e-cigs with flavorings cause increased oxidative/carbonyl stress and inflammatory cytokine release in human periodontal ligament fibroblasts, Human Gingival Epithelium Progenitors pooled (HGEPp), and epigingival 3D epithelium. We further show increased levels of prostaglandin-E2 and cycloxygenase-2 are associated with upregulation of the receptor for advanced glycation end products (RAGE) by e-cig exposure-mediated carbonyl stress in gingival epithelium/tissue. Further, e-cigs cause increased oxidative/carbonyl and inflammatory responses, and DNA damage along with histone deacetylase 2 (HDAC2) reduction via RAGE-dependent mechanisms in gingival epithelium. A greater response is elicited by flavored e-cigs. Increased oxidative stress, pro-inflammatory and pro-senescence responses (DNA damage and HDAC2 reduction) can result in dysregulated repair due to proinflammatory and pro-senescence responses in periodontal cells. These data highlight the pathologic role of e-cig aerosol and its flavoring to cells and tissues of the oral cavity in compromised oral health.

Purpose: Bone tissue adapts its structure and mass to the stresses of mechanical loading. The purpose of this review article was to summarize recent advances on cell signaling relating to the phenomenon of bone remodeling, focused on bone ossification and healing at the interface of dental implants and bone under loading conditions. Materials and Methods: When a dental implant is placed within an osteotomy, osteocytes, osteoblasts, and osteoclasts are all present. As functional loads are imposed, the remodeling processes adapt the peri-implant bony tissues to mechanical stimuli over time and reestablish a steady state. Based on the current literature, this article demonstrates fundamental information to these remodeling processes, such as the conversion of mechanical cues to electrical or biochemical signals. Results: Multiple intracellular signals are involved in cellular mechanotransduction; the two Wnt signaling pathways (the canonical, β-catenin-dependent and the noncanonical, β-catenin-independent Wnt pathway) are particularly significant. Knowledge of how these molecular signaling pathways are translated into intracellular signals that regulate cell behavior may provide new therapeutic approaches to enhancing osteogenesis, especially around implants with immediate function or placed in areas of poor bone quality. New knowledge about the primary cilia as an organelle and bone cellular mechanosensor is critical for endochondral ossification and proper signal transduction. Other mechanisms, such as the expression of sclerostin as a negative regulator of bone formation (due to deactivation of the Wnt receptor) and downregulation of sclerostin under loading conditions, also present new understanding of the cellular and pericellular mechanics of bone. Conclusion: The complexity of the cell signaling pathways and the mechanisms involved in the mechanoregulation of the bone formation provide new technologies and perspectives for mechanically induced cellular response. Future novel therapeutic approaches based on the cell signaling pathways may improve and stimulate osseointegration of dental implants and accelerate the healing mechanisms.

The version posted must include the following notice on the first page: "This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions." The details on self-archiving are available on https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html Abstract Objectives: To compare different compressive forces exerted on a particulate graft material during socket preservation and their effects on bone regeneration. Material and methods: Six male dogs were used. The second, third, and fourth premolars, and the first molar were extracted bilaterally at the lower jaws. A particulate synthetic biphasic grafting material (60% HA and 40% b-tricalcium phosphate) was used. Three different standardized compressive forces were applied randomly during the socket preservation. The sample was divided into four experimental groups Test A (10 g), Test B (50 g), Test C (200 g), and Control (empty sockets). Collagen membranes were placed, and primary closure was obtained. Two months after the surgery the animals were sacrificed, and histomorphometric analysis of non-decalcified samples was performed at the coronal, middle, and apical thirds. Results: Grafted sockets resulted in higher bony contour (3 0.43 mm2; P < 0.05). The particles penetrated up to the apical third in the group C but not in the other test groups and controls (P < 0.05). The percentage of new bone were higher at the coronal and apical thirds for Controls and group C compared to A and B groups (P < 0.05). The residual graft was higher for group C (53 1.4%), followed by group B (45 3.1%) and group A (35 1.9%; P < 0.05). The percentages of connective tissue were higher at the middle third without differences between groups (P > 0.05). Conclusions: Within the limitations of this experimental animal study, it might be concluded that grafted sockets compressed with 200 g force will have higher bony contours; higher compressive forces facilitate the penetration of the particulate graft material into the apical area of the socket and results in more bone formation at the coronal, middle, and apical thirds Odontología

Purpose: To identify and critically appraise scientific publications evaluating the possible effect of implant design on treatment outcomes in the rehabilitation of patients with a fully edentulous maxilla. Materials and Methods: Scientific reports were sought in three electronic bibliographic databases, combined with searches for meeting abstracts, and in the grey literature. English, German, or Scandinavian scientific publications on prospective or retrospective longitudinal studies with effects of an implant design or feature on the treatment outcomes were eligible. Minimum requirement for inclusion was at least 10 study participants who were followed up for at least 2 years after implant loading. The PRISMA guidelines were followed for selecting data to extract from the individual studies. These were characteristics of the individual studies, risk of bias within individual studies, and the results of individual studies. Three editorial teams independently identified and extracted the data. Results: The search resulted in 998 primary studies, of which 525 met the inclusion criteria and were read in full text. Of these, 105 studies were included in qualitative syntheses. Seventeen studies were designed with an objective to assess effects of implant design or feature on outcomes, 23 studies described tilted implants to enable placement of longer implants, 30 studies reported effects of implants placed in zygomatic bone with or without additional alveolar implants, and 9 studies reported effects of implants placed in pterygoid bone or other bony buttresses with or without additional alveolar implants. Sixteen articles reported bone augmentation with simultaneous or delayed implant placement in patients with a predominantly Cawood-Howell bone class V and VI maxilla. Ten papers reported effects of implant design on outcomes, despite the lack of an a priori stated objective to assess a particular implant design or feature. There is a lack of compelling data to state that one particular implant system or design feature stands out amidst others, when applied to restoring the fully edentulous maxilla with implant-retained prostheses. Conclusion: This systematic review failed to identify compelling evidence to conclude that any particular implant or feature affects the treatment outcome in patients with a fully edentulous maxilla.

Interaction of gold nanoparticles (AuNPs) in the vicinity of cells' membrane with a pulsed laser (λ = 532 nm, τ = 1 ns) leads to perforation of the cell membrane, thereby allowing extracellular molecules to diffuse into the cell. The objective of this study was to develop an experimental setting to deliver molecules into primary human gingival fibroblasts (pHFIB-G) by using ns-laser pulses interacting with AuNPs (study group). To compare the parameters required for manipulation of pHFIB-G with those needed for cell lines, a canine pleomorphic adenoma cell line (ZMTH3) was used (control group). Non-laser-treated cells incubated with AuNPs and the delivery molecules served as negative control. Laser irradiation (up to 35 mJ/cm2) resulted in a significant proportion of manipulated fibroblasts (up to 85%, compared to non-irradiated cells: p < 0.05), while cell viability (97%) was not reduced significantly. pHFIB-G were perforated as efficiently as ZMTH3. No significant decrease of metabolic cell activity was observed up to 72 h after laser treatment. The fibroblasts took up dextrans with molecular weights up to 500 kDa. Interaction of AuNPs and a pulsed laser beam yields a spatially selective technique for manipulation of even primary cells such as pHFIB-G in high throughput. © 2016 by the authors.

A variety of materials are available to treat exposed dental pulp by direct pulp capping. The healing response of the pulp is crucial to form a dentin bridge and seal off the exposed pulp. Studies have used lasers to stimulate the exposed pulp to form tertiary dentin. The aim of the present systematic review and meta-analysis was to evaluate the evidence on the effects of laser irradiation as an adjunctive therapy to stimulate healing after pulp exposure. A systematic literature search was conducted up to April 2016. A structured search using the keywords “Direct pulp capping,” “Lasers,” “Calcium hydroxide pulp capping,” and “Resin pulp capping” was performed. Initially, 34 potentially relevant articles were identified. After removal of duplicates and screening by title, abstract, and full text when necessary, nine studies were included. Studies were assessed for bias and data were synthetized using a random-effects meta-analysis model. Six studies were clinical, and three were preclinical animal trials; the follow-up period ranged from 2 weeks to 54 months. More than two thirds of the included studies showed that laser therapy used as an adjunct for direct pulp capping was more effective in maintaining pulp vitality than conventional therapy alone. Meta-analysis showed that the success rate in the laser treatment group was significantly higher than the control group (log odds ratio = 1.737; 95 % confidence interval, 1.304–2.171). Lasers treatment of exposed pulps can improve the outcome of direct pulp capping procedures; a number of confounding factors may have influenced the outcomes of the included studies.

There are no studies that have assessed the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of periimplant inflammation in patients with type 2 diabetes mellitus (T2DM). The aim of the present 12-month follow-up study was to assess the efficacy of MD with and without adjunct aPDT in the treatment of periimplant inflammation in patients with T2DM.Sixty-seven patients with diagnosed periimplant inflammation and T2DM were included. Treatment-wise, the patients were divided into 2 groups: (a) test-group (n=34): patients receivedMD+aPDT; and (b) control group (n=33): patients received MD only. Periimplant bleeding on probing (BOP), probing depth (PD) ≥4mm and mesial and distal marginal bone loss (MBL) were measured at baseline and after 6 and 12 months of therapy in both groups. The Kruskal-Wallis test was used to compare the periimplant BOP, PD, MBL and HbA1c levels in both groups. P-values less than 0.05 were considered statistically significant.Mean preoperative hemoglobin A1c (HbA1c) for patients in the control group and test group were 8.5% and 8.8%, respectively. In the control group, there was no significant difference in HbA1c levels at all follow-up durations. Among patients in test group, there was a significant decrease (P0.05) in HbA1c levels at 6 and 12 months of follow-up. Both PD and BOP were significantly lower in the test group compared to the control group at all follow-up durations. At 6 and 12 months of follow-up, there was no significant difference in MBL in both groups.In patients with T2DM, MD with adjunct aPDT is more effective in the treatment of periimplant inflammation compared with MD alone.

The aim was to systematically review the efficacy of vitamin D3 (VD3) supplementation on the osseointegration of implants.The addressed focused question was "does VD3 supplementation affect osseointegration around implants?" Indexed databases were searched from 1969 up to and including March 2015 using various key words including: "Bone to implant contact"; "implant"; "vitamin D"; and "osseointegration." Letters to the editor, case reports/case series, reviews, and articles published in languages other than English were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data.Six experimental studies (4 in rodents and 2 in rabbits) were included. Number of titanium implants placed ranged between 28 and 100 implants. Results from 5 studies showed that VD3 supplementation enhanced new bone formation and/or bone to implant contact (BIC) around implants. One study showed no significant difference in BIC and new bone formation around VD3 coated and noncoated implants. One study reported that insulin therapy with adjunct VD3 supplementation enhances new bone formation around implants in diabetic rats than when insulin replacement therapy is used alone.Efficacy of VD3 supplementation on osseointegration of implants remains controversial and requires further investigations.

Implantable cardiac pacemakers and cardiac defibrillators (ICDs) have been introduced in the care of patients with cardiac dysrhythmias. Most dental practitioners demonstrate extreme caution when treating patients with ICDs. This paper presents a review of the available literature on these devices and how they interact with dental electrosurgery and ultrasonic device use.Based on the analysis of the literature, this view is not corroborated by the current clinical data, and appears to be misguided. While further in-vivo studies are needed to truly determine the true level of risk, the evidence suggests that there is no contraindication for electrosurgery or ultrasonics use in patients with ICDs.Using the precautions stated in this analysis, the risk of any deleterious effect on ICD function is minimal.

This is the peer reviewed version of the following article: Romanos GE, Delgado-Ruiz RA, Calvo-Guirado JL. Influence of the implant diameter and bone quality on the primary stability of porous tantalum trabecular metal dental implants: an in vitro biomechanical study. Clin. Oral Impl. Res. 00, 2016, 1–7], which has been published in final form at 10.1111/clr.12792. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Objectives: The aim of this study was to evaluate the primary, initial stability of Porous Tantalum Trabecular MetalTM implants (TM) compared with Tapered Screw Vent" implants (TSV) with different diameters, inserted in two bone densities. Methods: A total of 160 implants (80 TM and 80 TSV) with narrow (3.7 mm) and conventional (4.1 mm) diameters and the same length (10 mm) were placed in artificial bone blocks representing bone qualities II and IV. The implant stability was evaluated by insertion torque (IT) and Resonance Frequency Analysis. Statistical analysis was performed with non-parametric Kruskal– Wallis test with Dunn post-test for the differences between groups. Results: TheresultsshowedhigherISQvaluesindensebonecomparedwithsoftboneforallthe groups (P < 0.05). Conventional-diameter implants (TSV and TM) showed higher ISQ and IT values compared with narrow implants (TSV and TM) in dense and soft bone (P < 0.05). Tapered TSV implants showed higher stability in soft bone compared with TM implants (P < 0.05). In dense bone, differences were not observed between narrow TSV 3.7 mm and TM 3.7 mm implants (P > 0.05). Conclusions: Within the limitations of this study, it can be concluded: • In dense bone blocks, the wider diameter implants are more stable than narrow implants. • In soft bone blocks, the tapered TSV implants are more stable than TM implants. Odontología

We hypothesized that nonsurgical-periodontal-therapy (NSPT) with adjunct Nd:YAG laser therapy is more effective in reducing periodontal inflammatory parameters (plaque index [PI], bleeding-on-probing [BOP], and probing-pocket-depth [PPD]) and serum interleukin-1beta (IL-1β) and matrix metalloproteinase-9 (MMP-9) levels in patients with and without coronary artery disease (CAD) than NSPT alone. The aim of this short-term pilot study was to assess the effect of NSPT + Nd:YAG laser therapy on periodontal parameters and serum IL-1β and MMP-9 levels in patients with and without CAD.A prospective randomized clinical study was conducted on 87 patients who were divided into two groups: Group-1: 44 patients with CAD and periodontal disease (PD) and Group-2: 43 patients with PD alone. Treatment-wise, these individuals were randomly divided into two subgroups: (i) NSPT alone and (ii) NSPT + Nd:YAG laser therapy. Demographic information was collected using a self-completed questionnaire. Periodontal parameters (PI, BOP, and PPD) and serum IL-1β and MMP-9 levels were measured at baseline and after 3 months of treatment. P-values0.05 were considered statistically significant.At 3 months follow-up, PI (P 0.01), BOP (P 0.01), PPD ≥ 4 mm (P 0.01), and serum IL-1β (P 0.01) and MMP-9 (P 0.01) levels were significantly higher in patients treated with NSPT alone than those treated with NSPT + Nd:YAG laser therapy. Among patients that underwent NSPT + laser therapy in both groups, periodontal parameters and serum IL-1β, and MMP-9 levels were comparable at 3-months follow-up.NSPT + Nd:YAG laser therapy may be more effective in reducing periodontal inflammation and serum IL-1β and MMP-9 levels in patients with and without CAD than NSPT alone. Lasers Surg. Med. 48:929-935, 2016. © 2016 Wiley Periodicals, Inc.

To our knowledge from indexed literature, the role of laminins in the expression of osteogenic biomarkers and osseointegration enhancement has not been systematically reviewed. The aim of the present systematic review was to assess the role of laminin coatings on implant surfaces in promoting osseointegration. To address the focused question, "Do laminin coatings on implant surfaces influence osseointegration?", indexed databases were searched from 1965 up to and including November 2015 using various combination of the following keywords: "Bone to implant contact"; "implant"; "laminins"; and "osseointegration". Letters to the Editor, case-reports/case-series, historic reviews, and commentaries were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data. Nine studies were included. Six studies were prospective and were performed in animals and 5 studies were in vitro. Results from 8 studies showed that laminin coatings enhanced new bone formation around implants and/or bone-to-implant contact. One study showed that laminin coated implants surfaces did not improve osseointegration. On experimental grounds, laminin coatings seem to enhance osteogenic biomarkers expression and/or osseointegration; however, from a clinical perspective, further randomized control trials are needed to assess the role of laminin coatings in promoting osseointegration around dental implants.

Lasers have been proposed for various applications involving dental implants, including uncovering implants and treating peri-implantitis. However, the effect of laser irradiation on the implant surface temperature is only partially known. The aim of this pilot study was to determine the effect of irradiation with diode, carbon dioxide, and Er:YAG lasers on the surface temperature of dental implants placed in bone, in vitro. For this study, one dental implant was placed in a bovine rib. A trephine bur was used to create a circumferential defect to simulate peri-implantitis, and thermocouples were placed at the coronal and apical aspect of the implant. The implant was irradiated for 60 s using four different lasers independently and change in temperature as well as time to reach a 10 °C increase in temperature were recorded. There was wide variability in results among the lasers and settings. Time for a 10 °C increase ranged from 0.9 to over 60 s for the coronal thermocouple and from 18 to over 60 s for the apical thermocouple. Maximum temperature ranged from 5.9 to 70.9 °C coronally and from 1.4 to 23.4 °C apically. During laser irradiation of dental implants, a surface temperature increase beyond the "critical threshold" of 10 °C can be reached after only 18 s.

Immediate loading (IL) in the maxilla is a successful concept when implants are splinted together using a fixed restoration. This concept is associated with high number of implants or difficulties in the plaque control underneath the restoration, which may reduce the patient comfort and satisfaction and compromise the implant prognosis. Objective The aim of this study was to evaluate the long-term clinical outcome of implants placed in the maxilla using telescopic-retained removable prostheses under immediate functional loading protocol. Material and Methods The present retrospective study included 117 implants with a progressive thread design placed in 26 patients (age 57.04 ± 8.87 years old) with clinical and radiographic evaluation for a period of at least 2 years. A total of 29 implants (24.79%) were placed in fresh extraction sockets. All implants were placed 1–3 mm subcrestally from the mid-facial crest of bone level. The implants were connected immediately after placement with conical prefabricated abutments (4- to 6-degree angle) using a final torque of 15 Ncm immediately after surgery. Secondary prefabricated copings with precise fit for the abutments were placed and the partial dentures were relined chair-side. The restorations were palate-free and were to remain in place without removal for 10 days to splint the implants together. Results After a loading period of 54.42 ± 15.68 months (min. 26 months/max. 87 months), the study showed 7 failures (5.98% failure rate), and 10 implants presented a crestal bone loss of more than 2 mm (8.55%). This represented a cumulative survival rate of 94.02% and a success rate for the evaluated implants of 85.47%. All patients were satisfied with the stability of their prostheses and no complications were reported. Conclusions Telescopic implant-supported maxillary prostheses in conjunction with IL present an alternative prosthetic solution for the edentulous maxilla, providing long-term predictability and improving the patient comfort and clinical outcome.

Peri-implant diseases are a common problem in dentistry today and no definitive treatment protocol exists for their treatment. The purpose of this review was to examine the evidence concerning the management of these diseases. The evidence provided suggests that peri-mucositis can be managed with use of mechanical nonsurgical therapy. Peri-implantitis does not respond to nonsurgical therapy. Various surgical methods have been proposed for management of peri-implantitis with some success; however, no single method can be promoted based on the current evidence.

Objectives: Clinical experience in implant placement is important in order to prevent implant failures. However, the implant design affects the primary implant stability (PS) especially in poor quality bones. Therefore, the aim of this study was to compare the effect of clinician surgical experience on PS, when placing different type of implant designs. Methods: A total of 180 implants (90 parallel walled-P and 90 tapered-T) were placed in freshly slaughtered cow ribs. Bone quality was evaluated by two examiners during surgery and considered as ‘type IV’ bone. Implants (o 5 mm, length: 15 mm, Osseotite, BIOMET 3i, Palm Beach Gardens, FL, USA) were placed by three different clinicians (master/I, good/II, non-experienced/III, under direct supervision of a manufacturer representative; 30 implants/group). An independent observer assessed the accuracy of placement by resonance frequency analysis (RFA) with implant stability quotient (ISQ) values. Two-way analysis of variance (ANOVA) and Tukey's post hoc test were used to detect the surgical experience of the clinicians and their interaction and effects of implant design on the PS. Results: All implants were mechanically stable. The mean ISQ values were: 49.57(± 18.49) for the P-implants and 67.07(± 8.79) for the T-implants. The two-way ANOVA showed significant effects of implant design (p

Background: Primary implant stability (PS) is one of the main factors influencing implant survival rate. Several methods to determine the PS have been used, such as Periotest values (PVs) and resonance frequency analysis (RFA) with implant stability quotient (ISQ) values. Purpose: The aim of this study was to compare different implant designs in regard to PS assessed by Periotest and RFA in vitro. Materials and Methods: A total of 90 implants were placed in freshly slaughtered cow ribs. The implants (Straumann®, Institute Straumann AG, Basel, Switzerland; length 10 mm, o3.3 mm) had the following three designs: Bone Level (BL, 30 implants), Standard Plus (SP, 30 implants), and Tapered Effect (TE, 30 implants). Before implant placement, the investigator was calibrated for every design according to the manufacturer's instructions. An independent observer, blinded to the study, assessed the accuracy of placement. RFA based on the Osstell device and PVs were performed after abutment connection. One-way analysis of variance and Tukey's post hoc test were used for statistical evaluation. Results: All implants were mechanically stable. The mean PV for BL was −4.67(± 1.18), for SP, −6.07(± 0.94), and for TE, −6.57(± 0.57). The mean ISQ values were 75.02(± 3.65), 75.98(± 3.00), and 79.83(± 1.85), respectively. The one-way ANOVA showed significant difference among three implant designs in PV (p

The mandibular incisive canal (MIC) is the anterior extension of the mandibular canal and its presence is of interest in surgical procedures in the chin region. The aim of this study was to investigate the presence of a MIC in panoramic radiographs (OPGs).One thousand forty-five OPGs were randomly chosen from patient population. The data collected included patient characteristics and MIC presence/absence according to the type of the dentition. Measurements (in mm) were performed evaluating the following: (A) minimum and (B) maximum distance from the alveolar ridge; (C) thickness and (D) length of the canal; and (E) distance (in bilateral cases) between the canals.The MIC was found in 2.7% of the patients.This study demonstrates the frequency of the MIC in OPGs and suggests that this anatomical structure should be considered to prevent injury during surgery.

A variety of suture materials are available for primary wound closure following oral surgical procedures. The aim was to review the tissue reactions to the various suture materials used in oral surgical interventions. Databases were searched using the following keywords: cotton, nylon, polyglecaprone 25, polytetrafluoroethylene (ePTFE), Polyglactin 910, polyglycolic acid (PGA), polylactic acid, silk, surgery, suture, and tissue reaction. Articles published only in English language were included. Seventeen studies were included. Two studies reported that polyglecaprone 25 had positive effects on wound-healing as compared to silk. Six studies reported that silk elicits more intense tissue inflammatory response and delayed wound healing as compared to other suture materials (including ePTFE, polyglecaprone-25, PGA, and nylon). Polyglactin 910 sutures were associated with the development of stitch abscess in one clinical study. Eight studies reported that tissue reactions are minimal with nylon sutures. Tissue reactions to suture materials used for oral surgical interventions may vary depending on the surface properties and bacterial adherence properties of the material.

Introduction: Essential oil (EO)–formulated dentifrices have significant effectiveness in reducing periodontal inflammation. This study aimed to review the role of dentifrices with EO formulations in periodontal healing. Methods Databases were explored from 1968 until March 2010. The focused question was what is the impact of dentifrices with EO formulations on periodontal wound healing? Databases were searched using the following terms in various combinations: “essential oil,” “periodontal healing,” “mouthrinse,” “mouth-wash” and “periodontitis.” Results Twenty studies were included. The numbers of participants ranged from 20 to 316 individuals (aged 18–70 years) and were rinsing with the EO-formulated dentifrices at least twice daily for 1 week to 48 weeks. Fourteen clinical studies showed reduced periodontal inflammatory conditions in the test group (individuals using EO dentifrices) compared with the placebo group. Three studies showed a reduction in periodontal pathogens in the test group compared with the placebo group. In 1 study, the microbiological findings remained inconclusive between the 2 groups. Conclusion EO-formulated dentifrices have beneficial effects on the clinical and microbiological parameters of periodontal inflammation.

OBJECTIVE We hypothesized that peri-implant soft tissue inflammation is worse and peri-implant marginal bone loss (MBL) is higher around dental implants placed in patients with prediabetes compared to healthy subjects. The aim of the present 12-month follow-up study was to compare the clinical and radiographic status around dental implants placed in patients with and without prediabetes. MATERIAL AND METHODS Twelve patients with medically diagnosed prediabetes (Group-1) and 12 controls (Group-2) were included. All patients were indicated for single tooth maxillary or mandibular premolar replacement with the adjacent teeth intact. Success of the restored implants was assessed by comparing clinical (peri-implant bleeding on probing [BOP], and probing pocket depth [PPD]) and radiographic (peri-implant MBL) parameters at baseline and at 12-months follow-up. Statistical analysis was performed using one-way analysis of variance, and P-values

Purpose The purpose of this study was to evaluate the temperature gradient (ΔT) generated by laser irradiation of an implant surface using a carbon dioxide (CO(2)) and an Erbium:yttrium aluminium garnet (Er:YAG) laser. Materials and methods A dental implant was irradiated with a CO(2) and an Er:YAG lasers, with variable power settings. Temperature increase was measured in 2 locations of the implant surface: in the cervical area (ΔT(c)) and in the apical area (ΔT(a)). Results The CO(2) laser showed the following results: after 60 seconds of irradiation with continuous mode, ΔT(c) was 13.9°C and ΔTa was 12.5°C. The Er:YAG laser showed the following results: after 60 seconds of irradiation with continuous mode, the temperature rise ΔT(c) was 50.6°C and ΔT(a) was 38.6°C. The CO(2) laser with continuous mode generated a temperature increase of 10°C after only 36 seconds. The Er:YAG laser with continuous mode produced a more rapid temperature increase and took only 10 seconds to reach the critical threshold. Conclusions The irradiation of implant surfaces with CO(2) and Er:YAG lasers may produce a temperature increase above the critical threshold (10°C) after 10 seconds of continuous irradiation.

Implant failures due to apical pathology are conditions that have not been extensively studied nor reported in the literature. The implant periapical lesion (IPAL) has different symptoms, and several etiologies have been proposed in the literature. This article reviews cases of IPAL reported in peer-reviewed journals and presents possible treatment options. Analysis of the data collected was performed based on diagnosis, cause of extraction of the natural tooth, location, period of implant placement, implant surface, and treatment approach. Even the data presented in this review are based on few reported cases the etiology of these lesions seems to be multifactorial or with an unknown origin. Contamination of the implant surface, bone overheating during surgery, excessive torquing of the implant, poor bone quality, perforation or thinning of the cortical bone, premature or excessive load over the fixture, fracture of the bone inside the hollow portion of the hollow implant, and an implant placement in an infected maxillary sinus have been discussed. In general, areas around endodontically compromised teeth should be carefully analyzed prior to implant placement to prevent implant failures.

Although hollow nanostructures, such as nanotubes, represent a major portion of nanoscaled materials with a tremendously large application range, a detailed evaluation of their internal characteristics still remains elusive. Transmission electron microscopy is the most common analytical technique to examine the internal configuration of these structures, yet it can only provide evidence of a minimal portion of the overall material, thus, it cannot be accurately generalized. In the present paper, in addition to electron microscopy and other spot-size analysis methods (X-ray diffraction, Raman spectroscopy, etc.), a combination of techniques including adsorption, permeability, and relative permeability are employed in order to provide important insights into various crucial details of the overall internal surface and hollow-space characteristics of carbon nanotube (CNT) arrays and membranes. The CNT arrays are fabricated using anodized alumina as a template in a flow-through chemical vapor deposition (CVD) reactor. This is the first systematic approach for investigating the internal configuration of template-based CNT arrays in detail. Key findings are made for the customized optimization of the resulting nanotube membranes for a variety of applications, including separations, nanofluidics and nanoreactors, biological capturing and purification, and controlled drug delivery and release.

Although platelet-rich plasma (PRP) has been extensively studied for over a decade, there are no definitive reports, which prove the benefit of using PRP in sinus augmentation procedures. In addition, no systematic literature review has been done to report the benefit of treatment outcome in patients who received PRP in conjunction with bone/bone substitutes in maxillary sinus augmentation procedures. Therefore, it can be rightly stated that evidence for an adjunctive benefit of using PRP with bone grafts in sinus augmentation procedures is equivocal and inconclusive.: The objective of this systematic literature review was to examine this literature in determining whether PRP with bone and bone substitutes leads to more rapid and effective bone regeneration clinically, radiographically, and histologically with sinus augmentation procedures and was there any clinical data parallel to animal experiments providing clinical evidence in sinus augmentation procedures?A systematic review of randomized clinical trials of at least 6 months duration was conducted comparing PRP and bone/bone substitutes (test group) to bone/bone substitutes (control group) alone. Electronic databases such as MEDLINE and CENTRAL (Cochrane central register of controlled clinical trials) were searched for relevant articles. The reference list of all included articles was searched along with unpublished clinical trials whose abstracts were available.Although, there is a lack of human studies, which show benefit of using PRP in conjunction with bone grafting materials, it can be stated that use of PRP does lead to early regeneration and reduction in healing time of soft and hard tissues. However, no significant statistical or clinical benefit was reported from studies that would satisfy the inclusion criteria. This study answers the question very clearly that at this point of time, there is no human study that strongly supports the benefit of using PRP in sinus augmentation procedures.There is a paucity of clinically controlled trials regarding benefits of PRP in sinus augmentation procedures. Theoretically, it seems to have significant beneficial effects on the soft and hard tissue healing; however, the disparity in study design, surgical techniques, and different outcome assessment variables used, makes it difficult to assess the practical benefit of its clinical use. Although no obvious positive effects of PRP on healing of bone graft material in maxillary sinus augmentation procedures were noted, the handling of the particulate bone grafts was improved.

Aim: Chlorhexidine (CHX) mouthrinses are known to have a beneficial effect in the management of periodontal disease. The present study was designed to investigate the antibacterial, anti-inflammatory, and matrix metalloproteinases-8 (MMP-8) inhibition efficacy of eight commercially available CHX mouthrinses from the Dominican Republic. Methods: The study samples are categorized into two categories, eight commercially available CHX mouthrinses were case sample group, and positive and negative controls used in the study are categorized as control sample group. Antibacterial activity of the samples was evaluated on bacterial strains obtained from American Type Culture Collection (ATCC, Rockville, MD USA) which were Porphyromonas gingivalis, Fusobacterium nucleatum, Eikenella corrodens, and Aggregatibacter actinomycetemcomitans. Results: The study samples 1, 2, 3, 5, 6, and 8 showed significant higher antibacterial efficacy and sample 4 and 7 were less effective. Samples 1, 2, 3, 5, and 6 showed higher antibacterial efficacy with no bacterial colonies formation in dilution assay method, whereas sample 8 showed smaller colonies of bacterial growth. The halo diameter found to be average in sample 8 with 13 mm, whereas sample 9 showed 12.5 + 3.48 mm, sample 1 was with a mean of 11.79 + 3.51 mm. The smaller halo diameter and minimal antibacterial activity were observed in samples 4 (mean of 3.5 + 5.95 mm) and 7 (3.5 + 7.70 mm). All eight samples showed statistically significant higher MMP-8 inhibition activity with P < 0.0001. Conclusion: Commercially available CHX digluconate mouthrinses showed the difference in plaque inhibition with 0.12 and 0.15% concentration.

Immediate loading of oral implants has been extensively described in the international literature and the requirements for long-term success are evaluated. The author presents here the critical aspects of the criteria for success as well as describes the characteristics of an implant macro- and microdesign for immediate loading to control the periimplant crestal bone loss and secure the long-term stability. Information from the literature and the clinical experience will be presented.

Objective Aberrant matrix metalloproteinase (MMP) and human β-defensin (HBD) functions have been found in inflammatory diseases. The objectives of this study were to investigate the immunolocalisation, mRNA expression and molecular forms of MMP-25, MMP-26, HBD-1 and HBD-2 in chronic and aggressive periodontitis and in peri-implantitis. The expression of MMP-25 by cultured human plasmacytoma cells and macrophages, and the effects of MMP-26 and Porphyromonas gingivalis trypsin-like proteinase on HBD-1 and -2 were also studied. Design Immunohistochemistry, immunofluorescent analysis, reverse transcriptase polymerase chain reaction and immunoblotting were used to assess localisation, mRNA expression and molecular forms of MMP-25, MMP-26, HBD-1 and HBD-2. HBD degradation by MMP-26 and P. gingivalis proteinase was studied by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Results MMP-25 was present in plasma cells and polymorphonuclear leucocytes, and MMP-26 was present in oral and sulcular basement membrane zones. HBD-1 was distributed perivasculary in gingival connective tissue and in oral and sulcular epithelium, and HBD-2 was found to a lesser extent in the perivascular space. Low MMP-25, MMP-26, HBD-1 and HBD-2 mRNA expression was found. Immunoblot revealed 29–57-kDa MMP-25 in myeloma cell lysates, but not in macrophages, and partly activated MMP-25 and -26 in diseased gingival crevicular fluid and peri-implant sulcular fluid. P. gingivalis trypsin-like proteinase degraded HBD-1 and -2. Conclusions Both MMP-25 and -26 were expressed more strongly in extensively inflamed gingiva compared with healthy gingiva. The expression of HBD-1 was stronger than that of HBD-2 in periodontitis and peri-implantitis. De-novo expression of MMP-25 and -26 is associated with periodontal and peri-implant inflammation. Furthermore, P. gingivalis trypsin-like proteinase, but not MMP-26, can degrade HBD-1 and -2, which could lead to a weakened innate immune response.

The healing process in extraction ridges is characterized by internal changes that lead to bone formation within the ridge and external changes that result in loss of the alveolar ridge width and height. This loss of alveolar bone volume after tooth extraction often complicates prosthetic reconstruction after implant placement. To preserve the ridge contours, various techniques and grafting materials have been reported in the literature, with promising results. Several terms have been used to describe such attempts at conserving the integrity of the ridge walls after tooth extraction, including ridge preservation (RP) and site preservation. The authors consider the term ridge preservation to be the most precise and hence have used it in this review. Although many animal studies and clinical case series have demonstrated a role for alveolar ridge-preservation techniques, published reports have covered a wide gamut of techniques, includingsuchvariablesastheextraction site location (anterior/posterior; maxillary/mandibular); whether a flap was elevated; whether grafting materials were used, and if so, what kind; whether a membrane was used; and whether primary closure of the ridge was obtained. The aim of this article was to focus on the anterior maxilla, asking whether using ridge-preservation techniques in the esthetic zone reliably preserves the alveolar ridge in preparation for dental implant placement?

Background: Both osteoporosis (OP) and periodontitis are chronic inflammatory diseases associated with bone loss mediated by local and systemic factors. The two diseases share common risk factors. Previous studies have suggested that OP in itself is a predisposing factor for periodontal tissue destruction in postmenopausal women. However, only a moderate correlation has been shown between the two conditions. In this study, we compared the severity of periodontal disease in postmenopausal osteoporotic women and postmenopausal women without OP. Materials and Methods: The study group consisted of 100 postmenopausal women in the age group of 50-65 years: Group 1 (50 osteoporotic) and Group 2 (50 non-osteoporotic women). Periodontal parameters included sulcus bleeding index, oral hygiene index simplified, probing pocket depth (PPD), and clinical attachment loss (CAL), interproximal alveolar bone loss (ABL), and number of missing teeth. The correlation of periodontal disease status with systemic bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry. Results: The results indicated that osteoporotic (Group 1) women had a significantly greater PPD, CAL, and ABL when compared with the non-osteoporotic Group 2 (P < 0.0001). There was no significant correlation between BMD and various parameters between the groups. Conclusions: Within the limitations of the present study it was noted that postmenopausal OP is associated with an increased incidence and severity of periodontal disease. Educating postmenopausal osteoporotic women regarding the importance of good oral care should be part of their management regime. Hence, it could be inferred a possibility of a probable relationship between OP and periodontal disease, but long-term prospective studies are warranted in the future in order to provide definitive evidence.

There is a dearth of studies that have compared clinical and radiologic markers of periodontal inflammation between water-pipe smokers (WPs) and cigarette smokers (CSs). The aim of the present study is to compare the clinical and radiographic periodontal status between habitual WPs and CSs.In total, 200 males (50 WPs, 50 CSs, and 100 controls) with comparable mean age and education were included. Demographic information was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) and numbers of missing teeth (MT) were recorded.The duration of each smoking session for WPs and CSs was 50.2 ± 6.7 and 15.3 ± 0.4 minutes, respectively. Number of MT [P0.0001], PI [P0.0001], AL [P0.0001], PD ≥4 mm [P0.0001], and MBL [P0.0001]) was significantly higher among WPs and CSs than controls. BOP was significantly higher among controls than WPs (P0.0001) and CSs (P0.0001). There was no statistically significant difference in the aforementioned parameters between WPs and CSs.Males in a Saudi Arabian community who were CSs or WPs had more MT and poorer periodontal condition than never smokers. The periodontal condition of WPs was equally as poor as CSs. Additional clinical observational studies with emphasis on sex and sociodemographic characteristics are needed.

The aim of this study was to review the cytokine profiles in the synovial fluid (SF) of patients with temporomandibular joint disorders (TMJD). Databases were searched from 1965 till September 2015 using different combinations of the following key words: "Temporomandibular joint"; "Cytokine"; "disorder"; and "synovial fluid" and "inflammation". Titles and abstracts of studies identified using the above-described protocol were screened and checked for agreement. Full-texts of articles judged by title and abstract to be relevant were read and independently evaluated. Hand-searching of the reference lists of potentially relevant original and review articles was also performed. The pattern of the present systematic review was customized to mainly summarize the relevant data. Fifteen studies were included. In 12 studies, cytokine profile of patients with TMJD was assessed using enzyme linked immunosorbent assay; and in 2 studies, histological analysis was performed to assess the cytokine profile of patients with TMJD. Patients with TMJD presented raised levels of interleukin (IL)-6 in 8 studies, IL-1beta (1β) in 5 studies and tumor necrosis factor-alpha (TNF-α) in 5 studies. Two studies showed no significant difference in TNF-α levels in patients with and without TMJD; and IL-1β levels were comparable in patients with and without TMJD in 2 studies. Raised levels of IL-6, TNF-α, IL-1β, IL-8, and IFN-γ in the SF have been associated with inflammation in patients with TMJD. Cytokines IL-10, osteoclastogenesis inhibitory factor/osteoprotegerin (OCIF/OPG), and VEGF found in the SF of TMJs could have an anti-inflammatory effect.

The version posted must include the following notice on the first page: "This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions." The details on self-archiving are available on https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html Abstract Aim: The aim of this experimental in vitro study was to evaluate the effects of the piezoelectric device in temperature and time variations in standardized osteotomies performed with similar tip inserts in bovine bone blocks. Methods: Two different piezosurgical devices were used the OE-F15" (Osada Inc., Los Angeles, California, USA) and the Surgybone" (Silfradent Inc., Sofia, Forli Cesena, Italy). Serrated inserts with similar geometry were coupled with each device (ST94 insert/test A and P0700 insert/test B). Osteotomies 10 mm long and 3 mm deep were performed in bone blocks resembling type II (dense) and type IV (soft) bone densities with and without irrigation. Thermal changes and time variations were recorded. The effects of bone density, irrigation, and device on temperature changes and time necessary to accomplish the osteotomies were analyzed. Results: Thermal analysis showed significant higher temperatures during piezosurgery osteotomies in hard bone without irrigation (P < 0.05). The type of piezosurgical device did not influence thermal variations (P > 0.05). Time analysis showed that the mean time values necessary to perform osteotomies were shorter in soft bone than in dense bone (P < 0.05). Conclusions: Within the limitations of this in vitro study, it may be concluded that the temperature increases more in piezosurgery osteotomies in dense bone without irrigation; the time to perform the osteotomy with piezosurgery is shorter in soft bone compared to hard bone; and the piezosurgical device have a minimal influence in the temperature and time variations when a similar tip design is used during piezosurgery osteotomies. Odontología

Esthetic outcomes have become key elements that are critical to defining success in implant restorations. Long-term studies have demonstrated that single or multiple implants are highly predictable with high survival rates. However, in the anterior maxillary zone, the aesthetic success of implant therapy is, for many, as important as the implant survival rates. Several factors contribute to this “success” and can be objectively evaluated. These include the patient's healing capabilities, the level and condition of the existing soft and hard tissues, and the provisional and final restorations. In addition to these objective factors, esthetic perception also plays a significant role in achieving this “success.” This special issue contributes to the growing body of existing literature by examining several important issues related to the aesthetic aspects of maxillary implants and their increasingly important role in implant dentistry. These include esthetic perception, surgical techniques for tissue augmentation, and the esthetics of final implant-supported restorations. One of the esthetic determinants occurring after implant placement is the lack of papilla between implants or between teeth and implants. Whether or not the lack of the interdental papilla leads to significant cosmetic deformities depends on whether shorter papillae may be esthetically tolerated under certain circumstances. Y. C. P. Yu et al. investigated the difference in the perception of aesthetics according to dental specialty. To this goal, the authors used computer assisted asymmetric alteration of the papilla length in the esthetic zone. The results of this study showed that asymmetric deficiencies in papilla length of 2 mm or more are more likely to be perceived as “unattractive.” It should be underlined that many dental professionals perceive even minor asymmetric shortening of the papilla as unattractive. The stability and health of the peri-implant soft tissues are necessary for success and long-term maintenance of dental implants. A two-millimeter wide band of keratinized tissue has long been considered clinically desirable to provide a soft tissue seal around natural teeth. The absence of periodontal ligament and supracrestal fiber attachment around dental implants may increase peri-implant tissue susceptibility to the inflammatory process caused by biofilm accumulation. Therefore, creation of a band of keratinized gingiva around implants is desirable. A. Elkhaweldi et al. in a case series presented a novel surgical technique that can be utilized to augment keratinized soft tissue around implant-supported overdentures. The authors concluded that an apically repositioned flap, a relatively simple procedure, provided good esthetic outcomes, with newly formed tissue indistinguishable from the surrounding mucosa. The disadvantages of this technique are also discussed. Full arch implant-supported prostheses have high success rates. A variety of materials have been used for this type of restoration including metal alloy-acrylic, metal alloy-composite, and metal alloy-ceramic. However, with these materials a number of complications may occur. To minimize these, using zirconia for the framework has been proposed. Several studies have shown that zirconia possesses excellent physical, mechanical, biological, and chemical properties. J. Carames et al. discuss this option and provide examples of monolithic zirconia restorations for full arch implant-supported restorations. A. E. Borgonovo et al. investigated the survival and success rates, as well as the marginal bone loss (MBL) and esthetic indices of zirconia implants positioned in the esthetic jaw areas. The results of this study emphasized that one-piece zirconia dental implants show high biocompatibility, low plaque adhesion, and an absence of a microgap that may contribute to their clinical success in the esthetic areas. Finally, A. L. Ioannou et al. provide a review of several surgical techniques aimed at optimizing anterior implant esthetics. Clinicians who practice implant dentistry need to strive for more than just osseointegration. They must also achieve excellent esthetic outcomes. Therefore, with careful treatment planning and use of a variety of esthetically focused techniques, clinicians will be able to meet patients' ever-increasing demands for ideal esthetic outcomes.

Purpose: Peri-implantitis is a challenging situation that leads to tissue destruction and eventual implant failure. The purpose of this study was to evaluate and compare, clinically and histologically, the influence of ligature-induced peri-implantitis on two implant designs in a canine extraction socket model. Materials and Methods: Sixty-four implants (4.1 × 13 mm) were placed bilaterally in eight dogs immediately after extraction of the mandibular premolars (P3, P4) and molars (M1, M2). Thirty-two conventional threaded implants (group A) and 32 tantalum-based porous implants (group B) were placed. After 12 weeks of normal healing, experimental peri-implantitis was induced in four dogs via the placement of ligatures subgingivally around the implant necks in the treatment group; the control group remained ligature-free. Two dogs in each group were euthanized after 12 or 26 weeks of plaque accumulation (control group dogs received regular cleanings). Clinical evaluations were conducted during the observation period and histologic sections were obtained for histologic and histomorphometric assessments. Results: All the implants exhibited clinical and histologic osseointegration. The treatment group showed significant loss of peri-implant tissue from the induced peri-implantitis. Pocket probing depths for the treatment groups were significantly greater than those of the control groups. Mean bone-to-implant-contact values were not statistically different for control vs treatment groups or for group A vs group B. In the treatment group, group B implants exhibited mean bone ingrowth of 28.4% to 36.3% and achieved more bone formation along the length of the implant than group A implants in the treatment group. Conclusion: Implant design did not influence the tissue response or histomorphometric findings under induced peri-implantitis in the canine extraction socket.