Split Mouth Prospective Study Research Articles

Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study

The aim of the present split-mouth prospective study was to evaluate clinically and histologically the bone regeneration obtained following preprosthetic vertical bone augmentation performed with titanium-reinforced dense polytetrafluoroethylene membrane (d-PM) compared to titanium mesh (TM). Healthy adult patients presenting with bilateral partial edentulism in the posterior mandible requiring vertical ridge augmentation for implant placement purposes were consecutively included. One side of the mandible was randomly assigned to the use of d-PM, the other to TM. The graft consisted in a mixture of autogenous bone harvested nearby the surgical site and deproteinized bovine bone mineral particles in a 1:1 ratio. On each side during bone augmentation surgery, a 2-mm diameter mini-implant was inserted for clinical and histological analyses. After a healing period of 8 months, the second surgical phase was carried out to remove the nonresorbable barriers, to evaluate clinically the vertical bone gain, and to collect a bone biopsy that included the mini-implant. During the same surgical session, dental implants were inserted in a prosthetically guided position. A total of five patients were enrolled. Eight out of 10 sites healed uneventfully. In the remaining two sites, premature exposure of the TM was observed. Mean vertical bone gain of 4.2 and 1.5 mm was achieved in d-PM and TM groups, respectively (p = 0.06). A mean mineralized tissue of 48.28 and 35.54% was observed in d-PM and TM groups, respectively (p = 0.51). The vertical bone gain, although not significantly, was higher in the d-PM group. Similar histological outcomes were noticed if exposure did not occur. In case of wound dehiscence, major resorption was observed. Both d-PM and TM can be used to augment atrophic localized ridges vertically. The outcome of bone regeneration seems to be impaired by exposure of the device. How to cite this article: Maiorana C, Fontana F, Rasia dal Polo M, et al. Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study. J Contemp Dent Pract 2021;22(5):465-472.

COMPREHENSIVE EVALUATION OF FACTORS LEADING TO CLASS III SUBDIVISION MALOCCLUSION USING 3-D CBCT

Introduction:Several studies have been conducted to assess skeletal and dental asymmetry on Class II subdivision cases but no studies have yet been published to assess such asymmetries for patients with Class III subdivision malocclusion. The purpose of the study was to assess the maxilla-mandibular dimensional and positional asymmetry along with asymmetry at glenoid fossa level and to find out true dental asymmetry at molar and canine level in class III subdivision malocclusion. Materials and Methods: A split mouth prospective study was conducted on Angles Class III subdivision malocclusions (n=15) and CBCT scans were analyzed with 3-D Dolphin software. 3-D and 2-D measurements were recorded to assess asymmetry between class I and class III sides. 2-D measurements were recorded to assess the position of glenoid fossa, joint spaces and condyle dimension, position and their angulation. Results: Statistically significant differences were found in glenoid fossa depth, position of the maxilla, mandible, as well as in gonial angle. Statistically significant dental differences were also found for the position of the mandibular first molars and canines along with total asymmetry (combined skeletal and dental) in maxilla and mandible. Conclusions: The components contributing to Class III subdivision malocclusion were multifactorial involving glenoid fossa asymmetry, positional asymmetry in maxilla and mandible. Mandibular dimensions were more on class III side but it was not statistically significant. True dental asymmetry was also foundin mandible along with total asymmetry in maxilla and mandible.

METRONIDAZOLE (1%) AND CHLORHEXIDINE (0.25%) GEL AS AN ADJUNCT TO SCALING AND ROOT PLANING IN THE TREATMENT OF MODERATE TO SEVERE CHRONIC PERIODONTITIS—A CLINICAL STUDY.

Metronidazole and Chlorhexidine are commonly employed antimicrobial agents in the antinfective stage of periodontal therapy, used with the aim to achieve complete eradication of the pathogenic flora from the subgingival niches, in conjunction with professional debridement. This study was aimed to determine the adjunctive effect of a novel combination of metronidazole (1%) and chlorhexidine (0.25%) in a gel form for management of moderate to severe chronic periodontitis. Twenty subjects were included for a split mouth prospective study. Gingival index, Plaque Index, Bleeding scores and Probing depth were noted at baseline, 2 weeks and 1 month after scaling and root planing with or without an additional subgingival delivery of the antimicrobial gel. An improvement of periodontal health was seen after therapy, and the difference between the test and control sites was significant for sites with an initial probing depth of 6-8mm. However, for deeper pockets (>8mm) the difference was statistically non-significant. The reduction in bleeding score was sustained at the test sites throughout the study period. It was concluded that the adjunctive use of metronidazole (1%) and chlorhexidine (0.25%) gel could provide clinical benefit for the management of deep pockets uptil 8mm of initial probing depth.

Comparison of peri-implant soft tissues in submerged versus transmucosal healing: A split mouth prospective immunohistochemical study

ObjectiveThe present split-mouth prospective study involves an immunohistochemical evaluation of peri-implant soft tissue healing after the osseointegration period, comparing submerged and transmucosal approaches using two-piece implant systems. The null hypothesis was that both surgical procedures elicit a similar immune response of the peri-implant soft tissues. DesignThirty-one healthy patients were included in this study, in which two implants were placed in the right and left maxillary pre-molar regions. A total of 62 dental implants were analyzed, establishing a control side with 31 submerged implants, and a study side with 31 exposed implants bearing healing abutments. After a three-month healing period, a soft tissue biopsy was collected and prepared for immunohistochemical analysis of the proportions of different lymphocyte subpopulations. ResultsThe comparative analysis between the submerged and transmucosal approaches failed to identify statistically significant differences in CD19+ B cells, CD4+ T cells, CD8+ T cells, CD25+ T cells or γd T cells. However, significant differences in NK lymphocytes (p = 0.012) were recorded with the submerged surgical procedure. ConclusionsPeri-implant soft tissue immune response with submerged or transmucosal healing protocols demonstrated comparable outcomes after the osseointegration period. There is sufficient evidence that the null hypothesis of no difference cannot be rejected. To the best of our knowledge, this is the first study of its kind. Further research is therefore needed to further clarify the role of these lymphocyte subpopulations in peri-implant soft tissues.

Healing of extraction socket following local application of simvastatin: A split mouth prospective study

BackgroundThe role of simvastatin in lowering serum cholesterol level is well described. However, recent findings suggest they have a role in bone formation as well. Aim and objectivesThe present prospective study was conducted to evaluate the efficacy of simvastatin on bone formation in extraction sockets. Materials and methods15 patients undergoing all four first premolar extraction were selected based on inclusion and exclusion criteria. Extraction sockets of left premolars (24 and 34) were considered as cases and right premolars (14 and 44) as controls. Overall 30 extraction sites were assigned to each group. Atraumatic extraction was done in all cases following which simvastatin mixed with gelatin sponge was placed in extraction socket of 24 and 34 while only gelatin sponge was placed in 14 and 44. All sockets were then closed with 3-0 vicryl. The patients were kept on follow-up and complications such as dry socket, pain, and swelling were recorded. Intra oral peri apical radiographs were taken immediately after extraction and at 2nd month and 4th month to record changes in the density of alveolar bone. The radiographic measurements were compared and the differences were statistically analyzed. ResultPercent increase in bone density at the end of 8th week and 16th week was significantly high in case as compared to the control group. ConclusionLocal application of simvastatin induces bone formation in extraction sockets. Application is very simple and provides a very cost effective way of faster bone regeneration following tooth extraction.

Comparative Evaluation of the Intranasal Spray Formulation of Midazolam and Dexmedetomidine in Patients Undergoing Surgical Removal of Impacted Mandibular Third Molars: A Split Mouth Prospective Study.

The purpose of this prospective randomized single blinded split mouth study was to conduct a comparative evaluation of the efficacy of intranasal atomised spray formulation of Dexmedetomidine with Midazolam in patients undergoing surgical removal of bilaterally impacted mandibular third molars. This prospective study was conducted in twenty volunteers. Each volunteer underwent the surgical removal of an impacted mandibular third molar at two separate appointments at an interval of two weeks. The first third molar surgery was conducted using either intranasal Midazolam (Group M) or intranasal Dexmedetomidine (Group D). At the second appointment the surgical procedure was performed using the sedative agent not used at the first appointment. The primary testing outcome variables were Plasma oxygen saturation (SpO2), pulse and blood pressure and Modified Observer's Assessment of Alertness/Sedation (OAA/S) scale. These were recorded at predetermined intervals starting 10min before the administration of local anaesthesia and continued up to 10min after completion of the procedure. In addition surgeon's opinion regarding the patient cooperation, event amnesia, post operative nausea & vomiting were obtained. The sample composed of twenty patients (M=9 and F=11). There was statistically no significant difference between Group M and Group D with respect to mean SpO2. Minor differences were however noted at 20 and 30min after sedation. There was no significant difference between the groups with respect to mean pulse rate, blood pressure, OAA/S, event amnesia, post operative nausea and vomiting and patient cooperation. We conclude that Midazolam and Dexmedetomidine are equivalent and can be used in minor oral surgery with minimal complications. These drugs can be used intranasally using nasal atomization device in routine outpatient basis in otherwise normal healthy but anxious patients. All procedures must however be performed in the presence of an anaesthesiologist and with ready availability of emergency drugs and equipment.

Gingival crevicular fluid alkaline phosphate activity during the retention phase of maxillary expansion in prepubertal subjects: A split-mouth longitudinal study.

The aim of this study was to monitor the alveolar bone formation at the tension sites of teeth supporting the appliances for rapid maxillary expansion (RME) during the retention phase according to the local gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity. This split-mouth prospective study included 23 prepubertal subjects (15 girls, 8 boys; mean age, 9.0 ± 1.4 years) who had a constricted maxillary arch and were undergoing RME. Periodontal parameters, including probing depth, were recorded at 3 and 6 months after RME. Furthermore, the GCF ALP activity was measured at the tension sites of the supporting test teeth (TT) and at the antagonist control teeth (CT) sites. Periodontal parameters were generally similar between the TT and CT sites during the study, with the exception that probing depth underwent a slight increase at the TT sites. At baseline, the GCF ALP activity was similar between the TT and CT sites; however, at both 3 and 6 months, significantly greater enzymatic activity was seen at the TT sites. The overall probing depth changes were not significantly correlated with the corresponding GCF ALP activity changes for either the TT or the CT sites. Alveolar bone formation at the tension sites would last up to 6 months of retention after RME. These results warrant more comprehensive studies to assess whether the GCF ALP activity has potential as a diagnostic tool for bone formation during the retention phase of RME.

Comparative evaluation of healing after gingivectomy with electrocautery and laser

Purpose of the studyTo evaluate whether laser has got any advantage over electrocautery in performing gingivectomy procedure. MethodThis was randomized split mouth prospective study where 17 patients having symmetrical gingival hyperplasia were treated with electrocautery and laser on each side. Intra- and postoperative parameters assessed were duration of surgery, bleeding, tissue sticking, postoperative pain and healing. The results were statistically analyzed and compared. ResultThere were 7 Females and 10 Males with a mean age of 28.2 ± 11.6 years. The mean time taken on the laser and electrocautery was 16 (±8.05) and 16.7 min (±9.86) respectively and the difference was not significant. On laser side, there was no bleeding in 3 (17.6%) and self limiting in 14 patients (82.4%) whereas electrocautery side, there was no bleeding in 2 (11.8%) and self limiting in 15 patients (88.2%). Both electrocautery and laser were comparable regarding ease of use during gingivectomy procedure. Charring was observed on both sides although there was more charring on the laser side. Fibrinous slough was present on both sides at 24 h. Difference in healing was not significant at various time intervals. There were no significant difference in postoperative pain experienced by the patients among the laser and cautery group at different time intervals. ConclusionBoth techniques with proper adhesion to safeguards, can be used to remove gingival overgrowth with equal efficiency and wound healing capacity. There is no advantage of diode laser over electrocautery in performing gingivectomy.