Vladimir Kokovic

Guided bone regeneration with a synthetic biodegradable membrane: a comparative study in dogs

OBJECTIVES The aim of the present study was to compare a newly developed biodegradable polylactide/polyglycolide/N-methyl-2-pyrrolidone (PLGA/NMP) membrane with a standard resorbable collagen membrane (RCM) in combination with and without the use of a bone substitute material (deproteinized bovine bone mineral [DBBM]) looking at the proposed tenting effect and bone regeneration. MATERIALS AND METHODS In five adult German sheepdogs, the mandibular premolars P2, P3, P4, and the molar M1 were bilaterally extracted creating two bony defects on each site. A total of 20 dental implants were inserted and allocated to four different treatment modalities within each dog: PLGA/NMP membrane only (Test 1), PLGA/NMP membrane with DBBM (Test 2), RCM only (negative control), and RCM with DBBM (positive control). A histomorphometric analysis was performed 12 weeks after implantation. For statistical analysis, a Friedman test and subsequently a Wilcoxon signed ranks test were applied. RESULTS In four out of five PLGA/NMP membrane-treated defects, the membranes had broken into pieces without the support of DBBM. This led to a worse outcome than in the RCM group. In combination with DBBM, both membranes revealed similar amounts of area of bone regeneration and bone-to-implant contact without significant differences. On the level of the third implant thread, the PLGA/NMP membrane induced more horizontal bone formation beyond the graft than the RCM. CONCLUSION The newly developed PLGA/NMP membrane performs equally well as the RCM when applied in combination with DBBM. Without bone substitute material, the PLGA/NMP membrane performed worse than the RCM in challenging defects, and therefore, a combination with a bone substitute material is recommended.

Immediate vs. early loading of SLA implants in the posterior mandible: 5‐year results of randomized controlled clinical trial

OBJECTIVES The aim of this study was to compare clinical results of immediate and early loading (EL) self-tapping implants placed in posterior mandibles. MATERIAL AND METHODS Twelve patients with bilateral edentulous posterior mandibular were randomly assigned to treatment either with immediate (test) or early loaded implants (control). Seventy-two self-tapping implants with SLA surface (Ø 4, 1/4, 8 mm; length 8 and 10 mm) were analyzed in this study. Test implants (36) were loaded on the day of surgery and control implants 6 weeks later. The measuring of implant stability quotient (ISQ) was performed on 0, 6th, 12th, and 52nd week after implant insertion. The bone resorption, modified plaque, and bleeding index were notified at 1 and 5 years later. RESULTS After 5 years, survival in the both groups was 100%. The mean value of primary implant stability was 76.92 ± 0.79 ISQ. In the first 6 weeks, ISQ values significantly increased in the test group (77.92 ± 1.16 vs. 79.61 ± 0.90) as well as in the control group (7.92 ± 1.05 vs. 77.55 ± 0.99). A significant longitudinal increase in ISQ value was recorded in test and control group. The differences between immediate and early loaded implants were statistically insignificant (P > 0.05). At the 5 years, no statistically significant differences were found between immediate and early loaded implants with respect to mean crestal bone loss measurements (0.4 ± 0.24 vs. 0.8 ± 0.15 mm), mean bleeding index (0.22 ± 0.11 vs. 0.25 ± 0.11), and mean plaque index (0.17 ± 0.15 vs. 0.19 ± 0.20). CONCLUSION Based on these results, the self-tapping implants inserted in posterior mandible can provide adequate primary stability value as the main factor for immediate and EL protocol.

The closure of oroantral communications with resorbable PLGA-coated β-TCP root analogs, hemostatic gauze, or buccal flaps: A prospective study

OBJECTIVE The aim of this study was to compare the treatment of oroantral communications (OACs) with bioresorbable root analogs made of poly(lactide-co-glycolide) (PLGA)-coated beta-tricalcium phosphate (beta-TCP), hemostatic gauze or a buccal flap technique. STUDY DESIGN In this prospective clinical study, 30 patients with oroantral communications were randomly assigned to a treatment. Clinical success, vestibular depth at the defect site, pain, and swelling were monitored. RESULTS The OAC closure was successful in all cases. The vestibular depth stayed constant in the groups treated with the PLGA-beta-TCP composite or hemostatic gauze. In contrast, a vestibular depth reduction of 1.2 +/- 0.2 mm was observed in the buccal flap group, indicating atrophy of the alveolar ridge in these patients. Furthermore, pain and swelling were more pronounced in this group. CONCLUSION Closures of OACs with PLGA-beta-TCP composite or hemostatic gauze are reliable minimally invasive methods that minimize atrophy of the alveolar ridge, swelling, and pain compared with a buccal flap technique.

The Effectiveness of Orally Administered Probiotic on Peri-Implant Tissue Condition: A Prospective Study

Purpose: This study investigated the effects of a probiotic lozenges in peri-implantitis patients. Method: 40 patients with mild to moderate peri-implantitis were involved in this study. Following a baseline clinical examination, a probiotic supplementation along with routine oral hygiene was recommended. The clinical examination was repeated at 30 and 90 days after beginning of probiotics supplementation. The clinical examination included probing pocket depth (PPD), bleeding on probing (BOP), the implant plaque index (IPI), implant stability (IS) and radiographic assessment. Results: Significant difference was observed in bleeding on probing (BOP), the implant plaque index (IPI) while probing pocket depth (PPD), implant stability (IS) and radiographic assessment didn’t show any statistical difference from baseline. Conclusion: This study suggests that probiotic supplementation prevents inflammation (bleeding on probing) by potentially interfering with microbial biofilm formation and affecting host responses in peri-implantitis patients.

Stability Development of Immediately Loaded Hybrid Self-Tapping Implants Inserted in the Posterior Maxilla: 1-Year Results of a Randomized Controlled Trial

&NA; The objective of the present study was to elucidate stability development of immediately loaded hybrid self‐tapping implants inserted in the posterior maxilla. Forty‐eight hybrid self‐tapping implants with a chemically modified surface (Ø4.1; length: 8 mm) were inserted bilaterally in the maxillary first and second premolar and first molar sites of 8 patients. In each patient, both sides of the maxilla were assigned randomly to either immediate (IL) or early (EL) loading group. Implant stability was evaluated by means of resonance frequency analysis immediately after implant placement and after 1, 2, 3, 4, 5, 6, 12, 26, and 52 weeks. High values of primary stability were found in both groups (71.91 ± 6.52 implant stability quotient [ISQ] in IL group; 73.87 ± 6.5 ISQ in EL group), with significant differences between the groups at the different time points. Initial decrease in stability was observed between the first and fifth weeks in the IL group and between the first and third weeks for the EL group. In the IL group 1 implant was removed after 3 weeks due to lack of stability. Early results of this study showed the ability of hybrid self‐tapping dental implants with a chemically modified surface to achieve sufficient primary stability and to maintain high values of secondary implant stability in bone type 3 and 4, even when loaded immediately. Minimal alterations in stability were observed for both investigated groups, but the EL group showed faster recovery after an initial drop in stability.

Efficacy of fentanyl transdermal patch in pain control after lower third molar surgery: A preliminary study.

Background Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. The aim of this study was to evaluate the efficacy of transdermal system with fentanyl in relieving pain following impacted lower third molar surgery. Material and Methods Seventeen patients with bilateral impacted lower third molars were included in this preliminary study. For postoperative pain control, patients randomly received a fentanyl patch plus placebo tablet after the first operation and regular (placebo) patch and an analgesic, after the second operation. Analgesia was evaluated during first 24 hours postoperatively according to patients’ reports about time of first pain appearance and additional analgesic consumption. Pain severity was rated using a 10 cm long visual analogue scale (VAS). Results Intensity of postoperative pain and postoperative analgesic consumption were significantly lower after the Fentanyl Transdermal System (FTS) was applied (p<0.05). Duration of postoperative analgesia was significantly higher with FTS when compared to control treatment (p<0.05). Conclusions Based on the results of this preliminary study, transdermal system with fentanyl significantly reduced postoperative pain after third molar surgery. Key words:Analgesia, fentanyl, transdermal administration, third molar surgery, acute pain, postoperative care.