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Purposes: 1. to measure Gingival Thickness (GT) both directly and with CBCT using various exposure times, and compare them. 2. to compare hard tissue measurements between different exposure times within each CBCT system. The study hypothesis was that accuracy of CBCT GT measurement is impaired when reducing exposure time. Methods: 8 fresh pig maxillae were utilized for each of two CBCT scan systems (SysA and SysB). Eight disposable dental needles were inserted into the gingival tissue of each jaw until reaching resistance from the underlying bone. A mark on each needle at its entrance point into the soft tissue was created using a permanent marker. Jaws were scanned twice, using low (RadL) and high (RadH) exposure times. The needles were extruded, and an electronic caliper was used to measure the length of the penetrated portion of the needle in mm (Cli). Radiographic GT was measured on cross sectional images, produced in the axial direcion of the 3D location of the needles (Rad) in two software systems (R and I). Descriptive statistics, t-test and ANOVA were performed. Significance was set at 5%. Results: Software I mean Cli was 2.22mm ± 0.54mm, RadL and RadH were 2.34mm ± 0.47mm and 2.34mm ± 0.52mm. Software R RadL and RadH were 2.16mm ± 0.50mm and 2.23mm ± 0.49mm, respectively. Using pairwise comparisons, both soft and hard tissue RadL and RadH were not statistically different. There was a good correlation between clinical and radiographic measurements of gingival thickness and essentially no significant difference between higher and lower radiation doses. Conclusions: Reducing CBCT radiation may be possible without affecting accuracy of radiographic gingival thickness measurements , thus opening the way to a wider utilization of CBCT in dentistry. Clinical relevance: Reducing radiation dose may enable a wider utilization of CBCT in dentistry.

Aims: To compare baseline residual ridge height using CBCT and panoramic radiographs. A secondary aim was to examine the magnitude of vertical bone gain 6-months following trans-crestal sinus augmentation and compare it between operators. Methods: Thirty patients, who underwent trans-crestal sinus augmentation simultaneously with dental implant placement were included in this retrospective analysis. Surgeries were done by two experienced surgeons (EM and EG) using the same surgical protocol and materials. Pre-operative residual ridge height was measured on panoramic and CBCT images. The final bone height and the magnitude of the vertical augmentation were measured on panoramic x-ray taken 6 months following surgery. Results: Mean residual ridge height measured pre-operatively using CBCT was 6.07±1.38 mm, while these same measurements on the panoramic radiographs yielded similar results (6.08±1.43 mm), which were statistically insignificant (p=0.535). Postoperative healing was uneventful in all cases. All 30 implants were successfully osseo-integrated at 6 months. The mean overall final bone height was 12.87±1.39 mm (12.61±1.21 and 13.39±1.63 mm, for operators EM & EG respectively (p=0.19). Likewise, mean post-operative bone height gain was 6.78±1.57 mm. which was 6.68±1.32 mm and 6.99±2.06 mm for operators EM and EG respectively, p=0.66. A moderate positive correlation was found between residual bone height and final bone height (r=0.43, P= 0.002). A moderate negative correlation was found between residual bone height and augmented bone height (r=-0.53, p= 0.002). Conclusion: Sinus augmentation performed trans-crestally produce consistent results with minimal inter-operator differences between experienced clinicians. Both CBCT and panoramic radiographs produced similar assessment of the pre-operative residual bone height.

Previous studies focused on the influence of buccal mucosa thickness on peri-implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri-implantitis sites. Therefore, we hypothesize that thick palatal peri-implant mucosa may be associated with deeper pockets and disease severity.To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease.Adult, non-smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri-implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t-test; as well as between peri-implantitis and non-peri-implantitis sites (among patients).Sixty patients were included. Thirty-four implants were diagnosed with peri-implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p = 0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p = 0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p = 0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri-implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p = 0.001). Palatal thickness at peri-implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p = 0.000. Implant sites with palatal mucosa4 mm (n = 32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n = 28) (4.48 ± 1.18, p = 0.018).Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri-implantitis.

BACKGROUND Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent commonly used in medicine. Application of (CHX) during abutment connection reduced the bacterial load at the implant-abutment interface. We hypothesize this treatment may consequently reduce peri-implant soft tissue inflammation and marginal bone loss. PURPOSE To evaluate the effect of a single application of CHX gel inside the dental implant internal hexagon on peri-implant tissue. METHODS Forty patients were recruited to this randomized, double-blinded, clinical trial. At the time of implant installation, a 4-mm healing abutment was connected to the implant. In the test group, chlorhexidine gel 1% was applied inside the implant hex, whereas control implants did not receive any gel. Clinical and radiographic measurements included soft tissue recession (REC), plaque index (PI), gingival index (GI), plaque index (PI), keratinized mucosa width (KM), probing depth (PD), and a peri-apical parallel x-ray. Peri-implant crevicular fluid (PICF) was collected for cytokine analysis. t-Test was used to compare changes from baseline to 3 months. Mann-Whitney U test and t test were used to compare test and control groups. RESULTS Twenty patients in the test group and 17 in the control group completed the study. One implant in the control group failed to osteointegrate. There were no significant differences between the control and test groups for REC changes, bone loss, and PD. GI was significantly lower in the test group after 1 week (1.79 ± 0.24 vs 0.75 ± 0.18, respectively) and 3 months (1.18 ± 0.21 vs 0.25 ± 0.12, respectively) although PI was equal. At 3 months, interleukin 1-β (IL1-β) was higher in the control group (p

BACKGROUND The aim of this study was to examine osseous changes following lateral bone augmentation using a novel Ossix Volumax (OV) scaffold alone and compare it to combination therapy using freeze-dried bone allograft (FDBA) and resorbable collagen membrane (FDBA/CM). METHODS Thirty patients completed this 9-months prospective two-center cohort clinical trial. Before surgery and 9-months re-entry, linear measurements were performed, and impressions taken. Cone-beam computed tomography (CBCT) were done at baseline and 9 months. DICOM slice data were converted into volumetric images using 3D Slicer. Following 3D volumetric image construction, pre- and post-op Standard Triangle Language files were superimposed and volumetric data were extracted for a 10-mm region of interest. Linear measurements were compared similarly. RESULTS Baseline clinical parameters were similar in both groups (4.22 and 4.53 mm for OV and FDBA/CM at -2 mm, respectively). Following treatment, vertical distance from the stent had changed minimally (-0.36 and -0.12 mm, respectively). Similarly, lateral bone gain ranged from 0 to 0.4 mm, for both groups. To the contrary, the CBCT measurements showed a significantly greater increase in horizontal width in the control at -2 mm (0.95 ± 0.2 mm) compared with -0.62 mm for the OV (P = 0.000). Similar changes were observed at -5 mm (0.63 and -0.41 mm, respectively, P = 0.01). Sites volume had increased from 266 ± 149 mm3 to 360 ± 138 mm3 (P = 0.001) for FDBA/CM with negligible changes for OV (from 334 to 335 mm3 , P = 0.952). these between-group changes being statistically significant (P = 0.023). CONCLUSION FDBA/CM yielded better albeit moderate increase in the volume of the edentulous ridge, while OV scaffolds failed to produce similar results.

The color is a major factor in determining inflammation status in most gingival indices. Current indices have limitations mainly due to subjective nature. Digital color analysis can provide objective and accurate measurements. Thus, the present study aimed to assess by digital tool the gingival color in the different stages of an active periodontal treatment.Forty patients (19 males and 21 females) diagnosed with periodontitis (stage III/ IV, grade C) and treated surgically were included in the study. Clinical data (probing depth, bleeding on probing, clinical attachment level, gingival index, and gingival recession) and photographs by digital single-lens-reflex (DSLR) camera were recorded before initial periodontal treatment, which included scaling and root surface debridement (T0); the same parameters were then re-evaluated 6-8 weeks (T1) and 3 months after periodontal surgery (regenerative/resective) (T2). Differences between clinical parameters were calculated. The color space defined by the International Commission on Illumination (CIELab) was used to analyze gingival color.In 56 periodontal surgical sites, 168 photographs were taken. The a*-value of the CIELab color system (higher a*- value translate to a stronger red color) was significantly reduced between T0 to T1 and further decreased at T2 (32.01, 29.28, and 27.45 respectively). Significant improvement in clinical parameters were found between T0 to T1 and T1 to T2. Sub-analysis of two distinct surgical interventions revealed that only regenerative procedure improved the a*-value, which was significantly correlated with pocket depth reduction.Photometric analysis can be used to assess gingival color change during periodontal treatment of patients with periodontitis.Gingival inflammation is a major factor in periodontal assessment; nevertheless, all current gingival inflammation indices are partially subjective and only semi-quantitative. The digital photometric analysis may allow for accurate and objective gingival color assessment during periodontal treatment.

In this narrated review, we shall study the commonality and discord in the anatomy, bacterial flora, immune response, rate of progression, and response to therapy. Finally, we shall explore the unique, periimplantitis-related risk factors. The absence of PDL around implants, combined with poor periimplant vascularization and weaker attachment apparatus, might account for the poor cellular response to bacterial implant in periimplantitis. Using 16S ribosomal gene sequencing, it has been recently shown that although certain known periodontal pathogens may also be found around dental implants with periimplantitis, apparently, the multiplicity of bacterial flora in this condition is great with some distinct microorganisms associated with periimplantitis. The inflammatory cell infiltrate is more pronounced than in periodontitis and extended more apically. Mean bone loss in periimplantitis is generally much greater than around natural teeth with periodontitis. Risk factors that are uniquely associated with dental implants include bone type, prosthetic and surgical variables, and implant surface characteristics. The role of titanium particles found in the periimplantitis lesion is yet unclear. Lastly, the possibility of foreign body reaction being the trigger for periimplantitis is plausible but as of yet requires further substantiation. The search to improve our treatment strategies in periimplantitis should first focus on establishing or declining the primary mode of breakdown. The results of such studies will help guide us to either improve our current anti-infective therapies targeting the unique characteristics of periimplantitis or else put us on a new road to understanding how to modify or restrict the natural immunological response as might be the case for a foreign body response.

To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction.Patients that required extraction in non-molars areas were included. Test group-15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM-C), covered by a procaine collagen membrane (CMXs). Control group-15 sockets left for spontaneous healing. We used a custom-made acrylic stent as a reference for alveolar ridge measurements. Six-month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft.Six months later, horizontal ridge width at -3 mm showed a significant (p 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At -5 mm sub-crestally, statistically non-significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group.Alveolar ridge preservation using DBBM-C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter-group differences might account for this phenomenon.

PURPOSE To describe the postoperative complications following lateral wall sinus augmentation using (poly L-lactideco-e-caprolactone; PLCL) and natural polysaccharides polymers-coated bovine bone (PBB). The secondary aims were to examine histologic findings and to propose complication management alternatives. MATERIALS AND METHODS This retrospective study included 61 subjects who underwent 67 lateral wall sinus augmentation procedures using PBB in the standard protocol. In cases that presented complications, treatment included additional antibiotic therapy, implant removal, or sinus reentry and total removal of the grafting material. In three cases, biopsy specimens were taken from the sinuses, and histologic analyses were performed. RESULTS The prevalence of postoperative complications was 32.8% (22 of 67 cases) in 18 of the patients (29.5%). The most prevalent symptoms were persistent pain (68.2%), swelling (63.6%), and oroantral fistula (54.5%). Radiographic signs appeared in 45.5% of the complications. A total of 24 implants failed; thus, an overall 80.3% survival rate was established at 19 months. The vast majority of complications (86.4%) were treated eventually with reentry surgery and revealed that the sinus was full with granulation tissue surrounding pieces of a nonossified rubber-like material. In cases where implants were placed, nonosseointegrated implants were surrounded by soft tissue. The sinus was cleaned thoroughly; the graft material remnants were removed together with inflamed parts of the sinus membrane, followed by chlorhexidine and saline lavages. In the biopsy specimens taken from the sinus cavity, there were no histologic features of new bone formation around the grafted material. CONCLUSION Lateral wall maxillary sinus augmentation using PBB was associated with an acute sinus infection histologic appearance and with a 7-times-higher failure rate compared with previous reports. This serious adverse event suggests that PBB cannot be recommended for maxillary sinus augmentations.

To examine whether a surgeons' position affects the axial angulation of dental implants placed freehand.Implants' axial angulation was assessed on digital panoramic radiographs. An occlusal line was plotted based on the neighboring teeth/crowns. The mesial angle between the long axis of the implant and the occlusal line was measured. In addition, post-hoc ideal implant-positioning planning was done on the panoramic digital image, and the angle of the intersection between the long axis of the actual and post-hoc ideal implant was measured. Student t test for unpaired observations and the Kolmogorov-Smirnov nonparametric tests were utilized to compare the ipsi- and contralateral sides and between clinicians.Seventy-seven patients (149 implants) were eligible for the study. Implants had slight mesial inclination (mean 97.7 ± 8.7 degrees) which was similar for both the ipsi- (98.2 ± 8.4 degrees) and contralateral sides (97.2 ± 9.1 degrees), P = .491. For the post-hoc planning versus actual placement comparison, the overall median (interquartile range) of implant angular deviation was minimal (-0.25 degrees [-2.98, +3.47 ]). This was true for both the ipsilateral (-0.5 degrees [-2.9, +2.9 ]) and contralateral (-0.2 [-4.2, +5.4 ]) sides, P = .55. For the actual versus post-hoc planning, most observations clustered around the midline (zero to minimal deviation ), while for the implant to occlusal plane angle, a tendency towards slight mesial angulation was observed.Dental implants placed freehand by experienced clinicians have only slight axial deviation as measured from post-hoc optimal position. Implants placed in ipsilateral and contralateral sides and by left- and right-dominant -hand clinicians had similar angulations.