Haydar Albayrak

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo-Controlled Clinical Trial

BACKGROUND This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non-root coverage gingival augmentation by laser Doppler flowmetry (LDF). METHODS Thirty-three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post-surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile-14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. RESULTS Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post-surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post-surgery for both donor and recipient sites (P <0.05). The ozone-treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). CONCLUSIONS OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.

Effect of fluid contamination on reverse torque values in bone-level implants.

Introduction: Screw loosening is one of the most common mechanical complications within the prosthetic components of dental implants. Clinicians must know if reverse torque values (RTVs) are affected by contamination of the implant abutment screw hole with either blood, saliva or chlorhexidine. Methods: Forty implants were divided into 4 groups (n = 10). Implants were embedded in epoxy resin and placed in a digital torque meter. Screw holes of 30 implants were contaminated with either chlorhexidine (CG), fresh human saliva (SG), or blood (BG), and the remaining noncontaminated screws served as a control group (NC). Abutment screws were tightened using a hand-held torque meter (25 N·cm). Thermocycling (1500 cycles) was performed, and abutment detorque values were calculated using the digital torque meter. Results: RTVs were lower than insertion torque values for all groups. According to Tukey HSD Test, blood contamination of abutment screws resulted in significantly lower RTVs (18.950 ± 2.641 N·cm) when compared with controls. Conclusions: Blood contamination of abutment screw holes was shown to significantly decrease RTVs. Blood contamination may result in greater loosening of implant screws in clinical practice.

In Vitro Comparison of the Bond Strength between Ceramic Repair Systems and Ceramic Materials and Evaluation of the Wettability

PURPOSE When fracture of an all-ceramic restoration occurs, it can be necessary to repair without removing the restoration. Although there are many studies about the repair of metal-ceramic restorations, there are few about all-ceramic restorations. The aim of this study was to evaluate the shear bond strength between ceramic repair systems and esthetic core materials and to evaluate the wettability of all-ceramic core materials. MATERIALS AND METHODS Disk-like specimens (N = 90) made of three dental ceramic infrastructure materials (zirconia ceramic, alumina ceramic, glass ceramic) were polished with silicon carbide paper, prepared for bonding (abrasion with 30 μm diamond rotary cutting instrument). Thirty specimens of each infrastructure were obtained. Each infrastructure group was divided into three subgroups; they were bonded using 3 repair systems: Bisco Intraoral Repair Kit, Cimara & Cimara Zircon Repair System, and Clearfil Repair System. After 1200 thermocycles, shear bond strength was measured in a universal testing machine at a 0.5 mm/min crosshead speed. In addition, the contact angle values of the infrastructures after surface treatments were examined for wettability. Data were analyzed by using ANOVA and Tukey post hoc tests. RESULTS Although there were no significant differences among the repair systems (p > 0.05) in the glass ceramic and zirconia groups, a significant difference was found among the repair systems in alumina infrastructure (p < 0.001). There were no statistically significant differences among the infrastructures (p > 0.05); however, a statistically significant difference was found among the repair systems (p < 0.05). No difference was found among the infrastructures and repair systems in terms of contact angle values. CONCLUSIONS Cimara & Cimara Zircon Repair System had higher bond strength values than the other repair systems. Although no difference was found among the infrastructures and repair systems, contact wettability angle was decreased by surface treatments compared with polished surfaces.

Effect of repeated ceramic firings on the marginal and internal adaptation of metal-ceramic restorations fabricated with different CAD-CAM technologies

Statement of problem The use of computer‐aided design and computer‐aided manufacturing (CAD‐CAM) for metal‐ceramic restorations has increased with advances in the technology. However, little is known about the marginal and internal adaptation of restorations fabricated using laser sintering (LS) and soft milling (SM). Moreover, the effects of repeated ceramic firings on the marginal and internal adaptation of metal‐ceramic restorations fabricated with LS and SM is also unknown. Purpose The purpose of this in vitro study was to investigate the effects of repeated ceramic firings on the marginal and internal adaptation of metal‐ceramic copings fabricated using the lost wax (LW), LS, and SM techniques. Material and methods Ten LW, 10 LS, and 10 SM cobalt‐chromium (Co‐Cr) copings were fabricated for an artificial tooth (Frasaco GmbH). After the application of veneering ceramic (VITA VMK Master; VITA Zahnfabrik), the marginal and internal discrepancies of these copings were measured with a silicone indicator paste and a stereomicroscope at ×100 magnification after the first, second, and third clinical simulated ceramic firing cycles. Repeated measures 2‐way ANOVA and the Fisher LSD post hoc test were used to evaluate differences in marginal and internal discrepancies (&agr;=.05). Results Neither fabrication protocol nor repeated ceramic firings had any statistically significant effect on internal discrepancy values (P>.05). Marginal discrepancy values were also statistically unaffected by repeated ceramic firings (P>.05); however, the fabrication protocol had a significant effect on marginal discrepancy values (P<.001), with LW resulting in higher marginal discrepancy values than LS or SM (P<.05). Marginal discrepancy values did not vary between LS and SM (P>.05). Conclusions All groups demonstrated clinically acceptable marginal adaptation after repeated ceramic firing cycles; however, the LS and SM groups demonstrated better marginal adaptation than that of LW group and may be appropriate clinical alternatives to LW.

Effect of digital impressions and production protocols on the adaptation of zirconia copings.

Statement of problem. Proper marginal, axial, and occlusal adaptation of dental restorations is essential for their long‐term success. Production protocols including digital impression systems have been developed, but little information is available on the adaptation of zirconia restorations produced via them. Purpose. The purpose of this in vitro study was to compare the effects of digital impression protocols on the marginal, axial, and occlusal adaptation of zirconia copings. Material and methods. Thirty extracted human maxillary premolar teeth without caries or defects were used. The teeth were prepared for zirconia crowns and randomly divided into 3 groups. Zirconia copings were designed at a thickness of 0.5 mm with 30 &mgr;m of simulated die spacer starting 1 mm from the margin of preparations. They were produced using computer‐aided design‐computer‐aided manufacture (CAD‐CAM) protocol with a conventional impression (group Cn) and 2 different production protocols with digital impressions (group C) and group Tr. The marginal, axial, and occlusal discrepancies of these copings were measured using the silicone replica technique with stereomicroscopy at ×50 magnification, and the data were analyzed with 1‐way ANOVAs (&agr;=.05). Results. The mean marginal discrepancy values were 85.6 &mgr;m for group Cn, 58.7 &mgr;m for group C, and 47.7 &mgr;m for the Tr group. Significant differences were found among the production protocols in marginal, axial, and occlusal discrepancies (P<.05). Copings fabricated with the aid of digital impressions had significantly fewer marginal discrepancies than those of group Cn (P<.05). Group Tr exhibited the lowest marginal discrepancy, whereas groups Cn and C demonstrated similar axial adaptations (P>.05), and group Tr revealed the lowest axial discrepancy (P<.05). With regard to the occlusal discrepancy evaluation, group Tr had the lowest discrepancy. However, no significant differences was found between groups C and Cn (P>.05). Conclusions. The copings produced with the aid of digital impression systems exhibited better marginal and occlusal adaptation than those of the copings produced with the aid of conventional impression.

Clinical Outcomes After Immediate and Late Implant Loading for a Single Missing Tooth in the Anterior Maxilla.

Purpose:This study compared the clinical outcomes of 1-year follow-up of immediate and late implant loading after implant restoration of a single tooth in the anterior maxilla. Materials and Methods:Thirty-three patients with missing teeth in the anterior maxilla were included in this study (18 immediate loading and 15 late loading). Standard periapical radiographs were obtained to evaluate the vertical bone loss around the implant. For both implant groups, periimplant parameters (probing depth, gingival bleeding index, gingival index (GI), modified plaque index, width of keratinized gingiva) were evaluated. Results:There were no significant differences in bone loss, the widths of keratinized gingiva, the GI, and modified plaque index between the immediate implant loading and late implant loading groups (P > 0.05). A significant difference in the probing depth was observed between these groups at the initial and 1-month evaluations (P < 0.05). Significant differences in bleeding indices between these groups were observed at months 3 and 6 (P < 0.05). Conclusions:When selecting appropriate patients (adequate primary stability, patient compliance with the surgeons recommendations), immediate implant loading may be an alternative method to late loading protocol for replacement of a missing tooth in anterior maxilla.

Esthetic outcomes after immediate and late implant loading for a single missing tooth in the anterior maxilla

Objective: This study compared the esthetic outcomes of 1-year follow-up of immediate and late implant loading after implant restoration of a single tooth in the anterior maxilla. Materials and Methods: A total of 33 patients with missing teeth in the anterior maxilla (Central = 8/lateral = 22/canine = 3) were enrolled in this study (18 immediate loading and 15 late loading). At after cementation, 1, 3, 6, and 12 months photographs were taken of anterior maxilla. The photographs were assessed using pink esthetic score (PES) which consists of seven variables. All PES data were analyzed with independent sample t-tests and repeated measures ANOVAs. Results: PES values increased significantly in both groups at the 1-year follow-up (P > 0.05). There was no statistically significant difference between the immediate and late loading groups at any time point (P > 0.05). Conclusions: Within the limitation of this study, immediate loading did not have a negative effect on esthetics.

Prosthetic rehabilitation of a patient with a resected right temporomandibular joint

This case report presents the prosthodontic rehabilitation of a patient with a resected right mandible, caused by an accident. Right condyle, ramus, and the posterior part of ramus were affected by the accident. These structures were resected, and the mandible was positioned toward the surgical area and a facial asymmetry was occurred. The patient was treated with a bar-retained maxillar denture with a guide ramp and an implant-supported fixed mandibular prosthesis.

Efficacy of polishing kits on the surface roughness and color stability of different composite resins

Objective: Different polishing kits may have different effects on the composite resin surfaces. The aim of this study was to evaluate the surface roughness and color stability of four different composites which was applied different polishing technique. Materials and Methods: Thirty specimens were made for each composite resin group (nanohybrid, GrandioSo-GS; nanohybrid, Clearfil Majesty Esthetic-CME; hybrid, Valux Plus-VP; micro-hybrid, Ruby Comp-RC; [15 mm in diameter and 2 mm height]), with the different monomer composition and particle size from a total of 120 specimens. Each composite group was divided into three subgroups (n = 10). The first subgroup of the each composite subgroups served as control (C) and had no surface treatment. The second subgroup of the each composite resin groups was polished with finishing discs (Bisco Finishing Discs; Bisco Inc., Schaumburg, IL, USA). The third subgroup of the each composite resin was polished with polishing wheel (Enhance and PoGo, Dentsply, Konstanz, Germany). The surface roughness and the color differences measurement of the specimens were made and recorded. The data were compared using Kruskal–Wallis test, and regression analysis was used in order to examine the correlation between surface roughness and color differences of the specimens (α = 0.05). Results: The Kruskal–Wallis test indicated significant difference among the composite resins in terms of ΔE (P < 0.05), and there was no statistically significant difference among composite resins in terms of surface roughness (P > 0.05). Result of the regression analysis indicated statistically significant correlation between Ra and ΔE values (P < 0.05, r2 = 0.74). Conclusion: The findings of the present study have clinical relevance in the choice of polishing kits used.

Accuracy of torque-limiting devices: A comparative evaluation

Statement of problem. To prevent the loosening of implant screws, clinicians should be aware of the output torque values needed to achieve the desired preload. Accurate torque‐control devices are crucial in this regard; however, little information is currently available comparing the accuracy of mechanical with that of electronic torque‐control devices. Purpose. The purpose of this in vitro study was to identify and compare the accuracy of different types of torque‐control devices. Material and methods. Devices from 5 different dental implant manufacturers were evaluated, including 2 spring‐type (Straumann, Implance) mechanical devices (MTLD), 2 friction‐type (Biohorizons, Dyna) MTLDs, and 1 (Megagen) electronic torque‐control device (ETLD). For each manufacturer, 5 devices were tested 5 times with a digital torque tester, and the average for each device was calculated and recorded. The percentage of absolute deviations from the target torque values (PERDEV) were calculated and compared by using 1‐way ANOVA. A 1‐sample t test was used to evaluate the ability of each device to achieve its target torque value within a 95% confidence interval for the true population mean of measured values (&agr;=.05 for all statistical analyses). Results. One‐way ANOVAs revealed statistically significant differences among torque‐control devices (P<.001). ETLD showed higher PERDEVs (28.33 ±9.53) than MTLDs (P<.05), whereas PERDEVS of friction‐type (7.56 ±3.64) and spring‐type (10.85 ±4.11) MTLDs did not differ significantly. In addition, devices produced by Megagen had a significantly higher (P<.05) PERDEV (28.33 ±9.53) other devices, whereas no differences were found in devices manufactured by Biohorizons (7.31 ±5.34), Dyna (7.82 ±1.08), Implance (8.43 ±4.77), and Straumann (13.26 ±0.79). However, 1‐sample t tests showed none of the torque‐control devices evaluated in this study were capable of achieving their target torque values (P<.05). Conclusions. Within the limitations of this in vitro study, MTLDs were shown to be significantly more accurate than ETLDs. However, none of the torque‐control devices evaluated were able to meet their target torque values successfully.