Khalid S. Hassan

Does grafting of third molar extraction sockets enhance periodontal measures in 30- to 35-year-old patients?

PURPOSE This study was designed to evaluate the use of xenograft plus a membrane as grafting material for periodontal osseous defects distal to the mandibular second molar compared with nongrafted extraction sites after removal of impacted mandibular third molars. MATERIALS AND METHODS We performed a single-blind, randomized, controlled clinical trial, and the sample comprised of subjects at high risk for the development of periodontal osseous defects distal to the second molar after third molar extraction (aged 30-35 years), pre-existing osseous defects distal to the second molar, and horizontal third molar impaction. The predictor variable was the treatment status of the second molar osseous defects. The third molar extraction sites were grafted with an anorganic xenograft plus a membrane. The other sites received a full-thickness flap and extraction of the third molar without placement of the grafting materials. The outcome variables were the change in gingival index, pocket probing depth, and clinical attachment level on the distobuccal aspect of the second molar preoperatively and at 3, 6, 9, and 12 months after surgery. Data were statistically analyzed by multivariate analysis of variance, and the statistical significance was set at P < .05. RESULTS The study was composed of 28 sites that were selected by use of a split-mouth design for each patient, and this was randomly determined through a biased coin randomization. Twelve months after third molar removal, there was a statistically significant gain in the clinical attachment level and a reduction in the probing pocket depth in the grafted sites compared with the nongrafted sites (P < .001). Moreover, there was a significant difference in the alveolar bone height during the monitoring periods for the grafted sites compared with the nongrafted sites (P < .001). CONCLUSIONS Grafting of osseous defects distal to mandibular second molars with an anorganic xenograft plus a membrane predictably resulted in a significant reduction in the probing pocket depth, clinical attachment level gain, and bone fill, which suggests that grafting the extraction sites with an anorganic xenograft plus a membrane could prevent periodontal disease in the future.

Composite bone graft for treatment of osseous defects after surgical removal of impacted third and second molars: case report and review of the literature

The aim of this case report was to evaluate the clinical and radiographic measurements of mandibular first molar bone support after mandibular third and second molar extraction and immediate augmentation of the extraction site with a combined autogenous bone graft with Bio-Oss materials. A pyramidal full-thickness mucoperiosteal flap with 1 distal releasing incision was used for removal of impacted third and second molars. During the procedure, autogenous bone graft was collected with a bone trap and then combined with Bio-Oss materials. The osseous defects distal to first molar and extraction site was filled with the composite bone graft and covered with Bio-Gide membrane. After 1 year, there was a successful defect regression and gain of bone and clinical attachment level. Moreover, there was a reduction of probing pocket depth and gingival inflammation. From the results of this study, it can be concluded that grafting of osseous defects and extraction site with autogenous bone graft combined with Bio-Oss materials will predictably result in a decreased risk of developing a periodontal defect on the distal aspect of mandibular first molar.

Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation:

Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate. All cases were followed up clinically and radiographically for 12 months. Differences in bone density, root length, and lesion size were calculated using preoperative and postoperative computed tomography images. The means of the differences in individual parameters in the blood clot and PRP groups were compared using the Mann–Whitney U test. Results After 5 months, sensitivity tests (cold and electric pulp tests) elicited a delayed positive response in 23 sites. At 12 months, cone-beam computed tomography revealed resolution or a decrease in lesion size and an increase in bone density in all 30 (100%) teeth. Additionally, continued root development was observed in 22 (73%) teeth and early root growth was observed in the test group (mineral trioxide aggregate with PRP). Conclusions The results of this study suggest that PRP can serve as a successful scaffold for regenerative endodontic treatment. With the exception of a significant increase in root length, the results of treatment with PRP were not significantly different from those of the conventional protocol using a blood clot as the scaffold.

Platelet-Rich Plasma Gel Combined with Bovine-Derived Xenograft for the Treatment of Dehiscence Around Immediately Placed Conventionally Loaded Dental Implants in Humans: Cone Beam Computed Tomography and Three-Dimensional Image Evaluation.

PURPOSE This study clinically and radiographically investigated the potential of platelet-rich plasma (PRP) gel combined with bovine-derived xenograft to treat dehiscence defects around immediate dental implants. MATERIALS AND METHODS This study was performed on 32 sites from 16 patients who each received an immediate implant for a single tooth replacement at a maxillary anterior or premolar site. Patients were divided into two groups according to the augmented materials used. One group received an immediate implant and filling of defects using a PRP gel plus bovine-derived xenograft. The other group received an immediate implant and filling of defects with a bovine-derived xenograft without PRP gel. Cone beam computed tomography (CBCT) was taken before placement, and at 6 and 12 months postsurgery. RESULTS Both treatment procedures resulted in significant improvements for the primary outcome regarding bone fill, as well as the marginal bone level. In addition, statistically significant differences were found in the bone density for the combined therapy compared with sites treated with bovine-derived xenografts alone (P ≤ .01). CONCLUSION Autogenous PRP gel combined with bovine-derived xenograft demonstrated superiority to the bovine-derived xenograft alone, which suggested that it could be successfully applicable for the treatment of dehiscence around an immediate dental implant. Moreover, CBCT can be used to measure dehiscence and to assess bone thickness along the implant.

A comparative study of bovine bone used alone and in combination with transforming growth factor-beta for the treatment of periodontal osseous defects in humans

Objectives: Transforming growth factor-betas (TGFβs) are multifunctional growth factors with a broad range of biological activities in various cell types in many different tissues. The purpose of this study was to evaluate the treatment of intrabony defects with anorganic bovine bone mineral matrix combined with TGFβ-1 with the use of anorganic bovine bone alone. Materials and Methods: Thirty-two sites from sixteen patients were selected using a split-mouth study design for each patient, determined randomly through a biased coin randomization. One site received a mucoperiosteal flap, and the osseous defect was filled with the combined therapy (Group 1). The other site treated was with anorganic bovine bone alone and served as a control (Group 2). All the treated sites were covered with a bioabsorbable collagen membrane. The clinical parameters and radiographic follow-up examinations were recorded after 3, 6, 9, and 12 months. Results: Clinically, there was a statistically significant gain in the clinical attachment level (+5.03 ΁ 0.14 mm) and a statistically significant reduction of pocket probing depth (−5.16 mm ΁ 0.13) for Group 1 sites compared to sites in Group 2 (P ≤ 0.01). In addition, there were significant differences in bone density and a significant decrease of marginal bone loss after the combined therapy compared with the use of anorganic bovine bone alone (P ≤ 0.01). Conclusion: The use of anorganic bovine bone mineral matrix combined with TGFβ-1 seemed to be effective in the treatment of intrabony defects. This showed an improvement in the clinical outcome of periodontal therapy superior to the use of anorganic bovine bone on its own.

The prevalence of premature loss of primary teeth and its impact on malocclusion in the Eastern Province of Saudi Arabia

Abstract Objectives. The present study was designed to determine the prevalence of premature loss of primary teeth and its effect on malocclusion in Eastern Province, Saudi Arabia. Materials and methods. This is an observational, cross-sectional study that included 307 male children aged 9–11 years old. Clinical examinations were performed using a disposable sharp explorer, a UNC periodontal probe and a dental mirror. The samples were examined clinically to detect the following traits: Angle’s classification of malocclusion, overjet, overbite, anterior open-bite, lateral open-bite, midline shift and cross-bite. Additionally, a dental caries examination was performed using WHO methods. Questionnaires in Arabic were coded and sent to the students’ parents. Results. The mean DMFT was 5.61 (SD = 3.01). The d-component was the highest, with a mean of 4 (SD = 2.83). Of the 307 children, it was found that 204 (66.4%) had a high DMFT score, which is defined as a score above 4. It was found that 156/307 (51%) children had premature loss of deciduous teeth. Conclusion. A high prevalence of premature loss of teeth was found in this study. This finding emphasizes the importance of increasing awareness levels about this issue and focuses attention on the need for more preventive efforts to maintain healthy and normal dentitions that would improve the masticatory function and aesthetics of individuals and the whole population. In addition, the findings emphasize the importance of the early detection of premature loss of primary teeth to prevent future malocclusion.

Complexity of comprehensive care treatments in undergraduate dental programs: The benefits of observing and assisting experienced faculty members

Objective To improve the confidence of the final year dental students in completing occlusal and oral rehabilitation of patients, with complexities beyond their scope, based on full analysis of the biomechanical and esthetic considerations of each case. Material & methods Two comprehensive patient situations presenting with special difficulties including extensive, reduced vertical dimension of occlusion, limited interocclusal space and maxillary alveolar bone for implant insertion necessitating bone augmentation and a sinus lift surgery was managed by two students at our institute. Procedures like surgical crown lengthening, sinus lifting, and bone augmentation were performed by senior faculty with the respective two students’ assisting as well as following up at the healing phase and reporting progress of healing and any possible complications to the supervisor. Students’ reported significant improvement in decision making skills; time management; interpersonal skills, management of cases in an evidence –based interdisciplinary approach as well as increase in their confidence in managing complex cases independently. Follow up with both cases showed optimum outcome and patients’ satisfaction. Results Students’ reported significant improvement in decision making skills; time management; interpersonal skills, management of cases in an evidence –based interdisciplinary approach as well as increase in their confidence in managing complex cases independently. Follow up with both cases showed optimum outcome and patients’ satisfaction. Conclusions Exposing students to manage complex oral rehabilitation including procedures like sinus lifting and bone augmentation, through an evidence-based interdisciplinary approach during the undergraduate comprehensive clinical dentistry course enhances their confidence and clinical acumen as an independent practitioner.

Sensitivity and specificity of subgingival bacteria in predicting preterm birth- a pilot cohort study

OBJECTIVE Preterm birth (PTB) increases the risk of adverse outcomes for new born infants. Subgingival bacteria are implicated in causing PTB. The aim of the present study was to assess the accuracy of some subgingival gram positive and gram negative bacteria detected by routine lab procedures in predicting PTB. METHODOLOGY Pregnant Saudi women (n= 170) visiting King Fahad hospital, Dammam, Saudi Arabia, were included in a pilot cohort study. Plaque was collected in the 2nd trimester and screened for subgingival anaerobes using Vitek2. Pregnancy outcome (preterm/full term birth) was assessed at delivery. Sensitivity, specificity and positive and negative likelihood ratios were calculated for the identified bacteria to predict PTB. RESULTS Data about time of delivery was available for 94 subjects and 22 (23.4%) had PTB. Three gram negative and 4 gram positive subgingival bacteria had sensitivity ≥ 95% with two of each having negative likelihood ratios ≤0.10. Three gram positive bacteria had specificity > 95% with only one having positive likelihood ratio >2. CONCLUSION Subgingival bacteria identified using readily available lab techniques in the plaque of pregnant Saudi women in their 2nd trimester have useful potential to rule out PTB.

Comparative study of the shear bond strength of composite resin bonded to enamel treated with acid etchant and erbium, chromium: Yttrium, scandium, gallium, garnet laser

Aim: The purpose of this investigation is in vitro comparison of the shear bond strength (SBS) of composite resin bonded to enamel pretreated with an acid etchant against enamel etched with erbium, chromium: yttrium, scandium, gallium, garnet (Er, Cr:YSGG) laser. Materials and Methods: Sixty premolars were sectioned mesiodistally and these 120 specimens were separated into two groups of 60 each (Groups A and B). In Group A (buccal surfaces), enamel surface was etched using 37% phosphoric acid for 15 s. In Group B (lingual surfaces), enamel was laser-etched at 2W for 10 s by Er, Cr:YSGG laser operational at 2780 nm with pulse duration of 140 μs and a frequency of 20 Hz. After application of bonding agent on all test samples, a transparent plastic cylinder of 1.5 mm × 3 mm was loaded with composite and bonded by light curing for 20 s. All the samples were subjected to SBS analysis using Instron Universal testing machine. Failure modes were observed under light microscope and grouped as adhesive, cohesive, and mixed. Failure mode distributions were compared using the Chi-square test. Results: SBS values obtained for acid-etched enamel were in the range of 7.12–28.36 megapascals (MPa) and for laser-etched enamel were in the range of 6.23–23.35 MPa. Mean SBS for acid-etched enamel was 15.77 ± 4.38 MPa, which was considerably greater (P < 0.01) than laser-etched enamel 11.24 ± 3.76 MPa. The Chi-square test revealed that the groups showed no statistically significant differences in bond failure modes. Conclusions: We concluded that the mean SBS of composite with acid etching is significantly higher as compared to Er, Cr: YSGG (operated at 2W for 10 s) laser-etched enamel.

Immediate Dental Implants and Bone Graft

Dental implants were initiated in 1922 by Branemark, who and associates described the relationship between titanium implant and bone which termed osteointegration, defined as the direct structural and functional connection between living bone and the surface of an implant (Albrektsson et al., 1981). Immediate implant placement, defined as the placement of dental implant immediately into fresh extraction socket site after tooth extraction , has been considered a predictable and acceptable procedure (Schwartz et al., 2000). In addition, with immediate implant placement there is minimal use of surgical drills because the socket is already found except for slight increase of the socket length in an attempt to improve primary stability (Barzilay et al., 1991). The decreased surgical trauma of immediate placement type will decrease the risk of bone necrosis and permit bone remodeling process to occur, i.e. the healing period is rapid and allows the woven bone to be transformed into lamellar bone (Hansson et al., 1983, Ericsson, 2000). Moreover, the natural socket is rich in periodontal cells and matrix, which makes the healing faster and more predictable. Based on the review article by Penarrocha et al., 2004 and the time elapsed between tooth extraction and implantation, the following classification has been established relating the receptor zone to the required therapeutic approach. (a) Immediate implantation, when the remnant bone sufficient to ensure primary stability of the implant, which is inserted in the course of surgical extraction of the tooth to be, replaced (primary immediate implants). (b) Recent implantation, when approximately 6-8 weeks have elapsed from extraction to implantation – a time during which the soft tissues heal, allowing adequate mucogingival covering of the alveolus (secondary immediate implants). (c) Delayed implantation, when the receptor zone is not optimum for either immediate or recent implantation. Bone promotion first carried out with bone grafts and/or barrier membranes, followed approximately six months later by implant positioning (delayed implants). (d) Mature implantation, when over nine months have elapsed from extraction to implantation. Mature bone is found in such situations.