Güliz N. Güncü

Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study

OBJECTIVES Knowledge and evaluation of the maxillary sinus anatomy before sinus augmentation are essential for avoiding surgical complications. Posterior superior alveolar artery (PSAA) is the branch of maxillary artery that supplies lateral sinus wall and overlying membrane. The aims of this study were to examine the prevalence, diameter, and location of the PSAA and its relationship to the alveolar ridge and to study the prevalence of the sinus pathology and septum using computerized tomography (CT) scans. MATERIALS AND METHODS One hundred and twenty-one CT scans (242 sinuses) from patients undergoing sinus augmentation procedure and/or implant therapy were included. Lower border of the artery to the alveolar crest, bone height below the sinus floor to the ridge crest, distance of the artery to the medial sinus wall, diameter of the artery, and position of the artery were measured; presence of septa and pathology were recorded from CT sections. RESULTS Prevalence of sinus septa and sinus pathology was 16.1% and 24.8%, respectively. Artery was seen in 64.5% of all sinuses and was mostly intraosseous (68.2%). Mean diameter of PSAA was found 1.3 ± 0.5 mm. No significant correlation between the diameter of the artery and age was observed. CONCLUSIONS The results from this study suggested that CT scan is a valuable tool in evaluating presence of sinus pathology, septa, and arteries before maxillary sinus surgery. Although variations exist in every patient, the findings from this study suggest limiting the superior border of the lateral window up to 18 mm from the ridge to avoid any potential vascular damage.

In-patient comparison of immediate and conventional loaded implants in mandibular molar sites within 12 months.

OBJECTIVES The aim of this prospective clinical study was to evaluate the clinical outcomes of dental implants placed in the mandibular molar sites and immediately functionally restored compared with conventionally loaded controls in an in-patient study. MATERIAL AND METHODS Twenty-four dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient was determined as immediately loaded (IL) and the other side was conventionally loaded (CL). Resonance frequency analyses for implant stability measurements, radiographic examinations for marginal bone levels and peri-implant evaluations were performed during the clinical follow-up appointments within 12 months. RESULTS During the 12-month follow-up period, only one implant was lost in the IL group. The mean implant stability quotient values were 74.18+/-5.72 and 75.18+/-3.51 for Groups IL and CL at surgery, respectively, and the corresponding values were 75.36+/-5.88 and 75.64+/-4.84 at 1-year recall, respectively. The difference was not statistically significant between the two groups during the 12-month study period (P>0.05). When peri-implant parameters were evaluated, excellent peri-implant health was demonstrated during the 1-year observation period and all implants showed less than 1 mm of marginal bone resorption during the first year. CONCLUSIONS In the present study, immediate functionally loading did not negatively affect implant stability, marginal bone levels and peri-implant health when compared with conventional loading of single-tooth implants.

Evaluation of Maxillary Incisive Canal Characteristics Related to Dental Implant Treatment With Computerized Tomography: A Clinical Multicenter Study

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

Effect of inflammation on cytokine levels and bone remodelling markers in peri-implant sulcus fluid: a preliminary report.

OBJECTIVES Since ingredients of peri-implant sulcus fluid (PISF) may be related to the bony structure surrounding dental implants, analyze of specific markers related to bone resorption in PISF seems to be suitable for long term monitoring of peri-implant health. It is suggested that analysis of PISF may serve for detection of inflammation. The aim of this study is to analyze PISF interleukin-1 beta (IL-1β), IL-10, osteoprotegerin (OPG), receptor activator of nuclear factor-kappa B ligand (RANKL) levels to determine whether the diagnostic value of PISF can be used to evaluate early changes around implants. MATERIALS AND METHODS A total of 47 dental implants either healthy/non-inflamed (n=20) (Group I), or gingivitis/inflamed (n=27) (Group II), were classified. Peri-implant status has been evaluated by clinical evaluation (plaque index, gingival index, probing depth and gingival bleeding time index) were recorded and PISF samples were also obtained. PISF IL-1β, IL-10, RANKL, and OPG levels were measured by enzyme-linked immunosorbent assay. Potential volumetric changes in PISF were also evaluated. RESULTS All clinical parameters and volume of PISF were higher in Group II and these differences were statistically significant except volume values. IL-1β, IL-10 and OPG levels in PISF were significantly higher in Group II. Although the PISF RANKL level in Group II was higher than the level of Group I, the difference between groups did not reach the statistically significant level. CONCLUSIONS These data suggest that a balance of inflammatory- and osteoclastogenesis related molecules locally produced may play an important role in the development of inflammatory peri-implant lesions.

Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series

The shrinkage of free gingival grafts (FGGs) is a well-known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGGs. The aim of the study is to examine the shrinkage of FGG in both horizontal and vertical dimensions and calculate the changes in the surface area of the graft at early and delayed periods of healing. The FGG procedure was applied to 15 consecutive patients in their mandibular anterior area. The graft sizes and areas were measured and the shrinkage of the graft was calculated at baseline and days 10, 21 and 180. Hemorrhage, sense alteration and pain symptoms were also examined. Change in the horizontal direction was not statistically significant during the whole study period (p > 0.05). However, there was a statistically significant reduction in the vertical direction in all visits, except day 10 (p < 0.05). Calculated graft area was also significantly reduced during the study period at all time-points compared to the baseline (p < 0.001). At day 10, 4 (26.7%) recipient sites and 5 (33%) donor sites demonstrated paresthesia. Only one (0.07%) recipient site demonstrated paresthesia at day 21 where the donor site resulted with an uneventful healing. At day 10, 5 (33%) patients demonstrated bleeding at their donor regions and resulted with a complete cessation of bleeding at day 21. Pain symptom was found in 8 (53.3%) recipient sites where 3 (20%) donor regions presented pain symptom at day 10. Graft shrinkage in the vertical dimension seems to affect the clinical outcomes of the FGG procedure. However, the influence of horizontal graft shrinkage was minimal.

Relationships between implant stability, image‐based measures and nitric oxide levels

For monitoring of dental implants, practitioners seem to use simultaneously a variety of image-based and laboratory measurements. This longitudinal study was conducted to analyse the possible relationships between nitric oxide (NO) content of peri-implant sulcus fluid (PISF), marginal bone levels and implant stability in terms of resonance frequency analysis (RFA) at immediately (IL) and conventionally (CL) loaded mandibular molar dental implants from the same individuals. Dental implants were placed in 10 patients who had first molar loss bilaterally in the mandibular area. One site of the patient was determined as IL and the other site was CL. PISF samples, marginal bone level and RFA were taken for all dental implants during a 12-month follow-up period. For both types of loading, there were no significant changes at implant stability (ISQ) and PISF volume during the whole study period. The lowest total nitrite levels were observed at the end of 12 months. Marginal bone gain of 0.22 and 0.09 mm was noticed between 6 and 12 months in IL and CL groups, respectively. During the study period, negative correlation was noted between radiographic bone level and ISQ at both IL and CL sites; however, this correlation reached a significant level only at 6 months in CL implant group (P = 0.015). Although not significant, marginal bone loss seems to have a negative relationship with the implant stability values regardless of the mode of loading. NO metabolism around IL and CL dental implants may not demonstrate a significantly different pattern.

Periodontal disease in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) and periodontal disease (inflammatory diseases of the tissues around teeth) are common disorders associated with diabetes and cardiometabolic risk. Comprehensively examining the periodontal status in PCOS, this study suggests that the susceptibility for periodontal disease may significantly increase in patients with PCOS compared with healthy young women, and that local/periodontal oxidant status appears to be affected in PCOS.

Evaluation of mandibular lingual foramina related to dental implant treatment with computerized tomography: a multicenter clinical study.

Background:Bleeding can be one of the severe complications during implant placement or other surgeries. Presurgical assessment of the area should be performed precisely. Thus, we examined lingual vascular canals of the mandible using dental computerized tomography (CT); define the anatomical characteristics of canals and the relationship with mandibular bone. Methods:One thousand sixty-one foramina in 639 patients, in 5 dental clinics, were included in this multicenter study. Distance between crest and lingual foramen, tooth apex and lingual foramen, distance from mandibular border, diameter of lingual foramen, canal type, anastomosis, and location of foramen were examined. Results:Foramen was 18.33 ± 5.45 mm below the bony crest and 17.40 ± 7.52 mm from the mandibular border, with men showing larger measurements. The mean diameter of lingual foramina was 0.89 ± 0.40 mm; 76.8% canal type was mono; 51.8% patients presented with median lingual canal-foramen (MLC) and 21.1% with lateral lingual foramen. Diameter of MLC was statistically larger. Conclusions:With a large sample group, results represented that lingual foramina could be visualized with dental CT, providing useful data for mandibular implant surgeries. Findings suggest that vascular canals and several anastomoses exist in the anterior mandible extending through premolar and molar regions as well. It is imperative to consider these vessels with the dental CT before and during the mandibular surgery to prevent threatening hemorrhage.

Overexpressions of hBD-2, hBD-3, and hCAP18/LL-37 in Gingiva of Diabetics with Periodontitis

Antimicrobial peptides of the epithelium play a significant role in the innate immune response in the oral cavity, which is constantly exposed to microbes. Type 2 diabetes mellitus (T2DM) is a highly prevalent metabolic disease which is related to periodontal disease. To date, little is known about expressions of antimicrobial peptides in gingival epithelia of diabetics. Our aim was to examine the expression and localization of human beta-defensins (hBD)-2 and -3 and cathelicidin (hCAP18/LL-37) in diabetic subjects suffering from generalized periodontitis (GP). Gingival tissue sections were collected from three subject groups: 14 T2DM subjects with GP (T2DM+GP), 11 systemically healthy GP patients (GP), and 13 systemically and periodontally healthy subjects (control). Surgical incisions targeted the sulcular epithelium and/or the bottom of the selected periodontal pocket. Tissue specimens were fixed in paraformaldehyde and embedded in paraffin blocks. Immunohistochemistry stainings were performed for cytokeratin19, hBD-2, hBD-3 and hCAP18/LL-37. Stainings were examined under light microscope with 40× magnification. Results were statistically evaluated by the t-test. In controls, hBD-2 was localized at the superficial layers of the gingival epithelium, hBD-3 and hCAP18/LL-37 were at the basal layers, whereas in subjects with periodontitis both defensins were visible at all epithelial layers. hBD-2 was detected in the nucleus and cytoplasm, while hBD-3 and hCAP18/LL-37 were detected only in the cytoplasm of the cells. Expressions of hBD-2 (p=0.005), hBD-3 (p=0.007), and hCAP18/LL-37 (p=0.002) were elevated in subjects with T2DM+GP in comparison to controls. No statistically significant difference was found in the expression of hBD-2, -3, and hCAP18/LL-37 between the GP group and the control or T2DM+GP groups. Gingival antimicrobial peptides are overexpressed in T2DM. This outcome can be part of impaired immune response in diabetics, and underlying factors and mechanisms need to be elucidated.

Possible impact of inflammatory status on C‐telopeptide pyridinoline cross‐links of Type I collagen and osteocalcin levels around oral implants with peri‐implantitis: a controlled clinical trial

Detection of progression level of peri-implantitis may help in the prevention of oral implant failure. C-telopeptide pyridinoline crosslinks of Type I collagen (ICTP) and osteocalcin (OC) are specific markers of bone turnover and bone degradation. Determination of the ICTP and OC levels in the peri-implant sulcus fluid (PISF) may predict the metabolic and/or inflammatory changes in the peri-implant bone. The aim of this clinical study was to evaluate ICTP and OC levels in the PISF for oral implants with and without peri-implant bone destruction and correlate these levels with the traditional clinical peri-implant parameters (probing depth, plaque index, gingival index and gingival bleeding time index) and radiographic bone level measurements. Fifteen patients with 30 peri-implant sites with bone destruction (radiographic bone loss) and health were included. Clinical parameters were measured and PISF was collected from the sites. Peri-implant sulcus fluid ICTP and OC levels were detected by radioimmunoassay technique from PISF samples. All clinical parameters demonstrated a significant increase in peri-implantitis sites compared with healthy sites. The PISF volume of the peri-implantitis sites was also significantly higher than of the healthy peri-implant sites. Although not statistically significant, a trend of increase was demonstrated in ICTP PISF samples sampled from peri-implantitis sites compared with healthy sites. A significant increase was noticed for OC PISF level in peri-implantitis sites compared with healthy ones. As well as peri-implant clinical measurements, volumetric changes at PISF may be counted as an important clinical parameter to distinguish the bone destruction sites from healthy sites around oral implants.