Mohammad D. Al Amri

Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in patients with type 2 diabetes mellitus

OBJECTIVE 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. METHODS 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. RESULTS 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 (P<0.05) 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. CONCLUSION In patients with T2DM, MD with adjunct aPDT is more effective in the treatment of periimplant inflammation compared with MD alone.

Periodontal Status and Whole Salivary Cytokine Profile Among Smokers and Never-Smokers With and Without Prediabetes

BACKGROUND Whole salivary interleukin (IL)-1β and IL-6 in smokers and never-smokers with prediabetes remains uninvestigated. The aim of this study is to assess the periodontal status and whole salivary IL-1β and IL-6 levels among smokers and never-smokers with and without prediabetes (controls). METHODS Ninety-five males (45 with prediabetes and 50 systemically healthy controls) were included. Twenty-seven controls and 29 patients with prediabetes were smokers. Periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment loss, and marginal bone loss) were measured, and the number of missing teeth were recorded. Fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels were recorded. Unstimulated whole saliva samples were collected, unstimulated whole salivary flow rate (UWSFR) was determined, and IL-1β and IL-6 levels were measured. P values <0.05 were considered statistically significant. RESULTS FBG (P <0.05) and HbA1c (P <0.05) levels were higher among patients with prediabetes than controls. All patients with prediabetes were hyperglycemic. UWSFR was significantly higher among controls than among patients with prediabetes (P <0.05). Periodontal parameters and whole salivary IL-1β and IL-6 levels were comparable among smokers and never-smokers with prediabetes. Among controls, periodontal parameters and whole salivary IL-1β and IL-6 levels were higher among smokers than never-smokers (P <0.05). CONCLUSIONS Among controls, periodontal inflammation was worse, and whole salivary IL-1β and IL-6 levels are higher in smokers than never-smokers. Among patients with prediabetes, periodontal inflammation and whole salivary IL-1β and IL-6 levels were comparable between smokers and never-smokers.

Efficacy of non-surgical periodontal therapy with adjunct Nd:YAG laser therapy in the treatment of periodontal inflammation among patients with and without type 2 diabetes mellitus: A short-term pilot study.

BACKGROUND AND AIM Effect of non-surgical periodontal therapy (NSPT) with and without adjunctneodymium-doped:yttrium, aluminum and garnet (Nd:YAG) lasertherapy in the treatment of periodontal inflammation in patients with type 2 diabetes mellitus (T2DM) remains uninvestigated. The aim of the present short-term pilot study was to assess efficacy of NSPT with adjunct Nd:YAG laser therapy in the treatment of periodontal inflammation in patients with and without T2DM. METHODS Twenty-two patients with T2DM (Group-1) and 22 controls (Group-2) were included. Teeth on test- and control-sites underwent NSPT with and without Nd:YAG laser therapy, respectively. Periodontal parameters (plaque index [PI], bleeding on probing [BOP] and probing pocket depth⩾4mm [PPD]) were measured at baseline and after 1 and 3months. Hemoglobin A1c (HbA1c) levels were measured at baseline and after 3months. RESULTS In Group-1, PI, BOP and PPD⩾4mm were higher at the control-sites (6.4% [P<0.05], 5.5% [P<0.05] and 3.5% [P<0.05], respectively) than test-sites (1.5%, 2.1% and 1.1%, respectively) at 1-month follow-up. In Group-2, PI, BOP and PPD⩾4mm were higher at the control-sites (4.2% [P<0.05], 2.2% [P<0.05] and 2.2% [P<0.05], respectively) than test-sites (1.2%, 1.3% and 1.1%, respectively). At 3-months follow-up, there was no difference in PI, BOP and PPD⩾4mm among test- and control-sites in both groups. At 3-month follow-up, mean HbA1c levels were comparable among patients in groups 1 and 2 (5±0.2% and 4.6±0.1%, respectively). CONCLUSION These short-term pilot results support our hypothesis that NSPT+Nd:YAG laser therapy is more effective in reducing periodontal inflammation in patients with and without T2DM than when NSPT is used alone. Further long-term randomized controlled clinical trials are needed in this regard.

Periodontal Parameters and Whole Salivary Cytokine Profiles Among Habitual Gutka Chewers and Non-Chewers

BACKGROUND Whole salivary interleukin (IL)-1β, IL-6, matrix metalloproteinase (MMP)-8, and MMP-9 levels among habitual gutka chewers and non-chewers (controls) have not been investigated. The aim of the present study is to assess clinical periodontal parameters and whole salivary IL-1β, IL-6, MMP-8, and MMP-9 levels among habitual gutka chewers and controls. METHODS Forty-five gutka chewers and 45 controls were included. Demographic information regarding age, sex, duration and daily frequency of gutka chewing, duration of gutka placement in the mouth, and daily toothbrushing habits were collected using a questionnaire. Periodontal parameters, including plaque index (PI), bleeding on probing (BOP), probing depth (PD) >3 mm, clinical attachment loss (AL), marginal bone loss (MBL), and number of missing teeth, were recorded. Unstimulated whole saliva samples were collected, and unstimulated whole salivary flow rate (UWSFR) was determined. Levels of IL-6, IL-1β, MMP-8, and MMP-9 were measured in UWS using an enzyme-linked immunosorbent assay. RESULTS PI (P <0.01), BOP (P <0.01), PD >3 mm (P <0.01), and clinical AL (P <0.01) were significantly higher in gutka chewers than controls, as were whole salivary IL-6 (P <0.01), IL-1β (P <0.01), MMP-8 (P <0.01), and MMP-9 (P <0.01) concentrations. There was no significant difference in UWSFR, number of missing teeth, or MBL among habitual gutka chewers and controls. CONCLUSION Periodontal inflammatory conditions were worse, and whole salivary IL-6, IL-1β, MMP-8, and MMP-9 levels were higher among gutka chewers than non-chewers.

Efficacy of parathyroid hormone supplementation on the osseointegration of implants: a systematic review

ObjectiveThe aim of the present systematic review was to assess the efficacy of parathyroid hormone supplementation on the osseointegration of implants.MethodsThe addressed focused question was Does parathyroid hormone supplementation affect osseointegration around implants? Indexed databases were searched from 1965 up to and including April 2015 using various key words including: Bone to implant contact; implant; parathyroid hormone; and osseointegration. Letters to the Editor, case-reports/case-series, historic reviews, commentaries 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.ResultsEighteen studies fulfilled the eligibility criteria. Evidence was limited to preclinical animal studies only (11 studies in rodents, 4 in dogs and 3 in rabbits). Number of titanium implants placed ranged between 20 and 80 implants. Results from 16 studies showed that PTH supplementation enhanced new bone formation and/or BIC around implants. One study suggests that PTH-coated implants improve BIC and BA. One study showed no significant difference in BIC and new bone formation around implants with PTH hydrogel placement.ConclusionEfficacy of PTH supplementation on osseointegration of implants shows promising results in animal models, however further investigation is necessary to assess the effectiveness in humans.

Comparison of Peri-Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non-Smokers: 5-Year Follow-Up Results

BACKGROUND The aim of this study is to compare peri-implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non-smokers. METHODS Thirty-one patients with IL implants (16 smokers and 15 non-smokers) and 30 patients with DL implants (17 smokers and 13 non-smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri-implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05). RESULTS All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non-smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non-smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non-smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants. CONCLUSIONS Tobacco smoking enhances peri-implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri-implant hard and soft tissue status in healthy smokers and non-smokers.

The effect of two fit-indicating materials and various subsequent cleaning methods on the retention of simulated crowns

STATEMENT OF PROBLEM Different cleaning methods are recommended to remove residual fit-indicating materials before definitive cementation. There is little information in the dental literature regarding the effect of these cleaning methods on the eventual retention of crowns. PURPOSE The purpose of this investigation was to evaluate the effect of various cleaning methods on the retention of simulated crowns after using disclosing wax and silicone as fit-indicating materials. MATERIAL AND METHODS One hundred and ten specimens were divided into 11 groups (n=10) according to the fit indicators used (silicone and disclosing wax) and the methods of cleaning as follows: Group C, no fit indicator with airborne-particle abrasion and steam cleaning (control); Group S+0, silicone with no cleaning; Group S+CH, silicone with chemical cleaning; Group S+ST, silicone with steam cleaning; Group S+US, silicone with ultrasonic cleaning in distilled water; Group S+AA+ST, silicone with airborne-particle abrasion and steam cleaning; Group W+0, disclosing wax with no cleaning; Group W+CH, disclosing wax with chemical cleaning; Group W+ST, disclosing wax with steam cleaning; Group W+US, disclosing wax with ultrasonic cleaning in distilled water; Group W+AA+ST, disclosing wax with airborne-particle abrasion and steam cleaning. Solid acrylic resin blocks were machined to form the specimens. Each specimen consisted of a cylinder and a rod. The specimens were invested and cast using a nickel chromium alloy. The rod and the internal surface of the cylindrical part of each specimen were airborne-particle abraded using 100-mum aluminum oxide powder. After application of fit indicators and subsequent cleaning, all the rods were cemented into their perspective cylinders using zinc phosphate cement at a constant load of 5 kg for 10 minutes. Specimens were randomly assigned to all groups before cementation procedures. The sequence of cementation of all specimens was also performed randomly regardless of the groups to which they were assigned. The specimens were then stored in water at 37 degrees C for 1 month. All specimens were mounted in a universal testing machine and the rods were then pulled out of their respective cylinders at a crosshead speed of 0.05 mm/min. The ultimate load required for separation was recorded and expressed as MPa. The resultant data were statistically analyzed using 2-way ANOVA for fit-indicating materials/cleaning methods, and Tukey honestly significant difference (HSD) tests (alpha =.05). RESULTS Two-way ANOVA showed significant interaction between the effects of fit-indicating materials tested and the method of cleaning on retention (P<.001). The Tukey HSD test indicated that wax and silicone fit indicators significantly reduced retention if not properly cleaned (P<.001). Retention was significantly improved when wax was used compared to silicone, regardless of the cleaning method (P<.001). Airborne-particle abrasion coupled with steam cleaning produced the highest retention values with both fit indicators tested (P<.001). However, when wax was used there was no significant difference between steam cleaning and airborne-particle abrasion along with steam cleaning. CONCLUSIONS Wax and silicone fit indicators significantly reduced retention of simulated crowns if not properly cleaned. Airborne-particle abrasion, in addition to steam cleaning, was necessary to clean silicone. However, steam cleaning alone was sufficient for cleaning wax.

Effect of the Unfilled Space Size of the Abutment Screw Access Hole on the Extruded Excess Cement and Retention of Single Implant Zirconia Crowns

PURPOSE To evaluate in vitro the effect of the size of the unfilled space of the abutment screw access hole on the amount of extruded excess cement and the retention of zirconia copings. MATERIALS AND METHODS Twelve dental implant replicas were attached to the corresponding abutments and embedded in acrylic resin blocks. A total of 36 CAD/CAM zirconia copings were fabricated by one technician using the standard technique. Abutments were divided into group I: the entire screw access channel was completely filled (nonspaced); group II: 1-mm-spaced; and group III: 2-mm-spaced. The copings were air-abraded and temporarily cemented under constant load of 60 N for 10 minutes. The excess cement was calculated as the difference between the post-cementation and post-excess-removal weights using a digital scale. Retention test was performed by a universal testing machine at a 0.5 mm/min crosshead speed. The ultimate force and tensile strength required for separation were recorded. One-way ANOVA and Tukeys test were used for statistical analysis at p ˂ 0.05. RESULTS The average amount of extruded cement in groups 1, 2, and 3 was 33.48 ± 1.55, 23.05 ± 5.48, and 15.58 ± 5.98 mg, respectively. Multiple comparisons showed significant differences in the amount of extruded excess cement between the three groups (p ˂ 0.001). The maximum load at decementation in groups 1, 2, and 3 was 98.8, 87.5, and 88.6 N, respectively. Groups 1, 2, and 3 separated at 6.90 ± 1.2, 6.12 ± 0.7, and 6.21 ± 0.9 MPa, respectively, with no significant differences between them. CONCLUSIONS The amount of extruded excess cement was reduced by more than half when a 2-mm space of the screw access hole was left unfilled in comparison to the nonspaced counterpart. The retention of zirconia copings was not affected by the reported technique.

Comparison of Clinical, Radiographic, and Immunologic Inflammatory Parameters around Crestally and Subcrestally Placed Dental Implants: 5‐Year Retrospective Results

PURPOSE To compare changes in clinical (bleeding on probing [BOP] and probing pocket depth [PPD]), radiographic (crestal bone loss [CBL]), and immunologic inflammatory (interleukin-1beta [IL-1β] and matrix metalloproteinase-9 [MMP-9]) parameters around crestally and subcrestally placed dental implants 5 years after implant placement. MATERIALS AND METHODS Fifty-two patients were divided into 2 groups: group 1 (n = 27): patients with single implants placed approximately 2 mm below the alveolar crest; group 2 (n = 25): patients with single implants placed at bone level. In both groups, peri-implant BOP, PPD, and CBL were measured, and levels of IL-1β and MMP-9 were determined in duplicates using enzyme-linked immunosorbent assay. Full-mouth debridement was performed biannually in both groups. Statistical analysis was performed using the Mann-Whitney U test (significance set at p < 0.05). RESULTS All measurements in groups 1 and 2 were performed 5.3 ± 0.2 and 5.2 ± 0.1 years after implant placement, respectively. The mean CBL was 1.2 ± 0.2 mm and 1.4 ± 0.2 mm in groups 1 and 2, respectively. There was no significant difference in mean BOP, PPD, CBL and in levels of IL-1β, and MMP-9 among implants in both groups. CONCLUSION Clinical, radiographic, and immunologic inflammatory parameters are comparable around crestally and subcrestally placed single dental implants up to 5 years after placement. The depth of implant placement appears to have no effect on clinical status and performance of single dental implants.

Influence of space size of abutment screw access channel on the amount of extruded excess cement and marginal accuracy of cement-retained single implant restorations

Statement of problem. The detrimental effect of extruded excess cement on peri‐implant tissue has been well documented. Although several techniques have been proposed to reduce this effect by decreasing the amount of extruded cement, how the space size of the abutment screw access channel (SAC) affects the amount of extruded cement and marginal accuracy is unclear. Purpose. The purpose of this in vitro study was to evaluate the effect of the size of the unfilled space of the abutment SAC on the amount of extruded excess cement and the marginal accuracy of zirconia copings. Material and methods. Twelve implant replicas and corresponding standard abutments were attached and embedded in acrylic resin blocks. Computer‐aided design and computer‐aided manufacturing (CAD‐CAM) zirconia copings with a uniform 30‐&mgr;m cement space were fabricated by 1 dental technician using the standard method. The copings were temporarily cemented 3 times at different sizes of the left space of the SAC as follows: the nonspaced group (NS), in which the entire SAC was completely filled, the 1‐mm‐spaced group (1MMS), and the 2‐mm‐spaced group (2MMS). Abutments and crowns were ultrasonically cleaned, steam cleaned, and air‐dried. The excess cement was collected and weighed. To measure the marginal accuracy, 20 measurements were made every 18 degrees along the coping margin at ×300 magnification and compared with the pre‐cementation readings. One‐way ANOVA was calculated to determine whether the amount of extruded excess cement differed among the 3 groups, and the Tukey test was applied for multiple comparisons (&agr;=.05). Results. The mean weights (mg) of extruded excess cement were NS (33.53 ±1.5), 1MMS (22.97 ±5.4), and 2MMS (15.17 ±5.9). Multiple comparisons showed significant differences in the amount of extruded excess cement among the 3 test groups (P<.001). The mean marginal discrepancy (&mgr;m) of the pre‐cemented group (29.5 ±8.2) was significantly different (P<.01) from that of the NS (72.3 ±13.7), the 1MMS (70.1 ±19), and the 2MMS group (70.1 ±18.8). No significant differences were found in marginal accuracy among the 3 test groups (P=.942). Conclusions. Within the limitations of this in vitro study, leaving a 2‐mm space in the SAC reduced the amount of extruded excess cement by 55% in comparison with the nonspaced abutments. However, no effect was found on the marginal accuracy of zirconia copings.