Publications by authors named "Georgios E Romanos"

201 Publications

Connective Tissue Graft vs Platelet-rich Fibrin in the Treatment of Gingival Recessions: A Randomized Split-mouth Case Series.

J Contemp Dent Pract 2021 Apr 1;22(4):327-334. Epub 2021 Apr 1.

Department of Periodontology, Stony Brook University, New York, New York, United States.

Aim And Objective: Coronally advanced flap (CAF) with connective tissue graft (CTG) has been considered the gold standard for obtaining complete root coverage. However, some limitations have been reported with the use of CTG, especially because it increases morbidity and leads to postoperative pain and bleeding. Recently, platelet-rich fibrin (PRF) has been used in periodontal plastic surgery for the treatment of gingival recessions (GRs). The aim of this study was to evaluate the outcome of PRF combined with a CAF (test) compared to de-epithelialized connective tissue graft (DeCTG) + CAF (control) for GR coverage.

Materials And Methods: Ten healthy patients exhibiting mandibular or maxillary Miller class I and II were treated with PRF + CAF or DeCTG + CAF. GR, probing depth (PD), and gingival thickness (GT) were evaluated at baseline, 6 weeks, and 28 weeks postoperatively.

Results: GR, PD, and GT differences between the test and control groups at 28 weeks were not statistically significant. GR was 3.30 ± 1.25 mm and 3.00 ± 1.63 mm (control vs test) group (baseline) and -0.10 ± 0.32 vs -0.20 ± 0.42 mm (7 months), respectively.

Conclusion: Within the limitations of the present study, it can be concluded that localized gingival recessions could be successfully treated with CAF + PRF or CAF + DeCTG.

Clinical Significance: This study suggests that PRF membrane may be an alternative and valid graft material for treating localized gingival recessions Miller class I and II.
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April 2021

Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet Laser for Root Conditioning and Reduction of Postoperative Morbidity in the Treatment of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

Photobiomodul Photomed Laser Surg 2021 Jun 11. Epub 2021 Jun 11.

Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA.

This clinical trial evaluates the effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) root surface biomodification and laser harvesting of de-epithelialized gingival graft (DGG) on root coverage clinical outcomes and postoperative morbidity, and compares this to the conventional blade-harvested DGG method without Er,Cr:YSGG root surface biomodification in treatment of Miller's class I, II gingival recessions (GR). The application of laser technology to enhance tooth root coverage clinical outcomes as well as the impact of laser on postoperative morbidity after harvesting autogenous soft tissue grafts requires further research. This study is a randomized, single-blinded controlled trial, including 24 volunteers with isolated GR defects. They were allocated into three treatment groups to receive one of the following three interventions: blade-harvested DGG (control group: B-DGG); Er,Cr:YSGG-harvested DGG and root surface biomodified [test 1 group: L-laser-harvested DGG (L-DGG)/laser root biomodification (LRB)]; and B-DGG and Er,Cr:YSGG root surface biomodification (test 2 group: B-DGG/LRB). Clinical and radiographic parameters were recorded at baseline (1 week before surgery) and 3, 6, and 9 months postoperatively. Root coverage did not show a statistically significant difference between control and test groups. Statistically significant differences were found for Visual Analog Scale on the day of surgery and day 3 and 4 postoperatively, as well as pain medication on the day of surgery favoring the L-DGG group. The use of Er,Cr:YSGG laser in root surface biomodification improved root coverage outcomes at 9 months. Even these changes were not statistically significant from the control group; the L-DGG technique was associated with decreased postoperative morbidity in the palatal donor site.
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http://dx.doi.org/10.1089/photob.2020.4918DOI Listing
June 2021

Thermal Transfer on Splinted Implants During Diode Laser Irradiation .

Photobiomodul Photomed Laser Surg 2021 Jul 18;39(7):471-479. Epub 2021 May 18.

Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA.

Laser irradiation is being used for treatment of peri-implantitis. Therefore, this study aimed to assess the heat transfer from laser irradiation on an implant-supported, metal-ceramic fixed prosthesis . Two titanium implants were placed in artificial type I bone, and after abutment connection, a bridge was fabricated and cemented. A peri-implant 3-wall defect was created around one of the implants. Thermocouples were placed at coronal (T1/T2) and apical (T3/T4) positions of both implants, and the T5 thermocouple was placed in the pontic. An identical setup was created in the type IV artificial bone. Diode laser irradiation (2 W, noninitiated tips, 320-μm fiber, and noncontact) was performed for 60 sec on each experimental model. This experiment was performed separately with 810- and 980-nm lasers for pulsed and continuous modes. ΔT based on the baseline was recorded during irradiation. Statistical analysis was performed with repeated analysis of variance. Across all experimental models, the recorded ΔT (°) values in T2, T4, and T5 at 10, 30, and 60 sec were significantly less than 10°C ( < 0.001) for both types of bones. For both types of bones, there was a statistically significant ΔT greater than 10°C ( < 0.001) for continuous and pulsed 980-nm irradiation and continuous 810-nm diode laser irradiation after 60 sec. For both 810- and 980-nm lasers, there was a statistically significant ΔT greater than 10°C ( < 0.001) for type I and IV bones under irradiation and only for the type I bone model under pulsed irradiation after 60 sec. Within the limitations of this study, 810- and 980-nm lasers on splinted implants placed may increase the temperature on adjacent splinted implants due to material conductivity and splinting. Clinicians are advised to keep the temperature lower than the critical threshold following recommended power settings to avoid excessive heat and control complications due to overheating.
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http://dx.doi.org/10.1089/photob.2020.4944DOI Listing
July 2021

Titanium Wear of Dental Implants from Placement, under Loading and Maintenance Protocols.

Int J Mol Sci 2021 Jan 21;22(3). Epub 2021 Jan 21.

Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794-8700, USA.

The objective of this review was to analyze the process of wear of implants leading to the shedding of titanium particles into the peri-implant hard and soft tissues. Titanium is considered highly biocompatible with low corrosion and toxicity, but recent studies indicate that this understanding may be misleading as the properties of the material change drastically when titanium nanoparticles (NPs) are shed from implant surfaces. These NPs are immunogenic and are associated with a macrophage-mediated inflammatory response by the host. The literature discussed in this review indicates that titanium NPs may be shed from implant surfaces at the time of implant placement, under loading conditions, and during implant maintenance procedures. We also discuss the significance of the micro-gap at the implant-abutment interface and the effect of size of the titanium particles on their toxicology. These findings are significant as the titanium particles can have adverse effects on local soft and hard tissues surrounding implants, implant health and prognosis, and even the health of systemic tissues and organs.
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http://dx.doi.org/10.3390/ijms22031067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865642PMC
January 2021

Temperature Change from Diode Lasers in Oral Mucosa: An Study.

Photobiomodul Photomed Laser Surg 2021 May 25;39(5):334-338. Epub 2021 Jan 25.

Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA.

The aim of this study was to assess the mean temperature change deep in tissue during diode laser (980 vs. 810 nm) irradiation using continuous and pulsed laser and initiated versus noninitiated tips. Previous studies have determined thermal effects of diode lasers on tissue damage but have yet to compare the incision qualities of 980 versus 810 nm diode lasers. Further studies need to be done to determine the efficiency of diode lasers to create a safer protocol for clinicians. Ninety-six incisions of 20 mm length were made in three bovine tongues using diode lasers (980 and 810 nm). Both continuous and pulsed modes were tested with initiated (using blue articulating paper) and noninitiated glass fibers ( = 12 per group). Thermocouples attached to LabChart software were used to measure mean temperature changes. Mean, standard deviations, and values were conducted for each group to test the statistical significance ( < 0.05). Quality of incisions were better using the initiated tips for both laser wavelengths. Pulsed mode with 810 nm diode laser produced the least mean temperature change in tissue. Overall, both pulsed and continuous mode showed similar thermal effects on tissue. Within the limitations of this study, noninitiated tips are responsible for diffuse irradiation in tissue and are associated with tissue temperature increase during surgery. Low incision quality was observed using noninitiated tips. The temperature changes seem to be dependent on the laser wavelength and are higher for 980 nm compared with 810 nm pulsed diode laser.
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http://dx.doi.org/10.1089/photob.2020.4862DOI Listing
May 2021

Efficacy of photobiomodulation therapy on neurosensory recovery in patients with inferior alveolar nerve injury following oral surgical procedures: a systematic review.

Quintessence Int 2021 ;52(2):140-153

Objective: The present systematic review aimed to assess the efficacy of photobiomodulation (PBM) therapy on neurosensory recovery of patients with inferior alveolar nerve injury following third molar surgery or dental implant placement.

Method And Materials: An electronic search was carried out in Scopus, Embase, Medline, PubMed, Web of Science, Cochrane Library, and Google Scholar databases. Among 1,122 identified papers, seven articles (three RCTs, one observational study, and three case series) met the inclusion criteria.
Results: Time lapse from nerve injury to the onset of PBM therapy varied widely from 2 days to 4 years. The number of patients in each study ranged between 4 and 74. In the majority of the studies, PBM was done using a diode laser at wavelengths ?in the range of 808 to 830 nm with power of 5 to 500 mW and radiation dose of 3 to 244 J/cm2. Two out of three RCTs found significant neurosensory recovery in the patients who received PBM therapy compared to the controls. The observational study and all case series reported significant improvement in the neurosensory status following PBM therapy. The degree of neurosensory recovery was found to be greater in younger patients and those who received the treatment within 6 months following the injury.
Conclusions: Due to the limited number of well-designed RCTs and small number of patients in each study, it is not possible to make a clear conclusion about the efficacy of PBM therapy on neurosensory recovery in patients with inferior alveolar nerve injury following third molar or implant procedures. Considering the possibility of spontaneous inferior alveolar nerve recovery during this period, the conclusion based on the studies with no control group should be interpreted with caution. (Quintessence Int 2021;52:140-153; doi: 10.3290/j.qi.a45430).
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http://dx.doi.org/10.3290/j.qi.a45430DOI Listing
January 2021

Is medication-related osteonecrosis of the jaw associated with tumor necrosis factor-α inhibition?

Oral Surg Oral Med Oral Pathol Oral Radiol 2021 Apr 16;131(4):422-427. Epub 2020 Dec 16.

Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA. Electronic address:

Objective: This article reviews the literature and evidence of the association of medication-related osteonecrosis of the jaw with tumor necrosis factor-α inhibition.

Methods: A systematic review was performed using electronic databases (PubMed, MEDLINE, and Embase) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key terms were used in the search. No restrictions were placed on publication status. Selection criteria comprised all levels of available evidence. Articles in the English language were selected up to and including July 2020. Reference lists of relevant studies were searched for additional articles. Articles were selected on the basis of inclusion and exclusion criteria. Findings from eligible studies were extracted by one reviewer and confirmed by a second. Disagreements were settled through discussion.

Results: The initial search of the key terms yielded 2107 articles. There were 1192 articles remaining after removal of duplicates and addition of 6 articles that were hand-selected from among reference lists of relevant studies. There were 12 eligible articles after screening. The full texts were read, and 5 articles were included on the basis of inclusion and exclusion criteria.

Conclusions: Further research is required to determine an association of medication-related osteonecrosis of the jaw and tumor necrosis factor-α inhibition.
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http://dx.doi.org/10.1016/j.oooo.2020.12.001DOI Listing
April 2021

Anti-inflammatory effect of salt water and chlorhexidine 0.12% mouthrinse after periodontal surgery: a randomized prospective clinical study.

Clin Oral Investig 2021 Jul 3;25(7):4349-4357. Epub 2021 Jan 3.

Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.

Objectives: The purpose of this study was to compare the anti-inflammatory efficacy of sodium chloride- and a 0.12% chlorhexidine mouth rinses in patients undergoing minimal invasive periodontal surgery.

Materials And Methods: Forty-seven patients with a diagnosis of periodontitis and indication for access flap procedure were randomly selected. Group A: a sodium chloride (salt)water-based mouth rinse (test group) or group B: a 0.12% chlorhexidine mouth rinse (control group) administered after surgery. Gingival Index (GI) were evaluated in the whole mouth and in the surgical site at baseline (T1), a week later (T2), and 12 weeks (T3) after the treatment. Total MMP activity was measured in GCF using a commercial kit and plate reader. Medians of total MMP activity and GI were compared for time intervals T1 vs. T2, T1 vs. T3, and T2 vs T3 using Friedman tests and Wilcoxon signed rank tests, and were also compared between test and control using Mann-WhitneyU tests at each timepoint.

Results: The average GI values showed significant differences between baseline and T2 (p = 0.0005) and baseline and T3 (p = 0.003) in the test group.

Conclusion: The sodium chloride-mouth rinse use after periodontal surgery seems to have similar anti-inflammatory properties as CHX mouth rinse and can be used regularly postoperatively after periodontal surgical procedures.

Clinical Relevance: The use of salt water mouthwash showed an anti-inflammatory effect similar to CHX 0.12% after minimal invasive periodontal surgery. Salt water mouthwash is accessible to the world population and can contribute on the healing process after periodontal surgery.
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http://dx.doi.org/10.1007/s00784-020-03748-wDOI Listing
July 2021

3D construct of hydroxyapatite/zinc oxide/palladium nanocomposite scaffold for bone tissue engineering.

J Mater Sci Mater Med 2020 Sep 30;31(10):85. Epub 2020 Sep 30.

Marquette University School of Dentistry, Milwaukee, WI, 53233, USA.

The purpose of this study was to produce and characterize Hydroxyapatite/Zinc Oxide/Palladium (HA/0.05 wt% ZnO/0.1 wt% Pd) nanocomposite scaffolds and study their mechanical and antibacterial properties, biocompatibility and bioactivity. The initial materials were developed using sol-gel and precipitation methods. Scaffolds were characterized using atomic absorption analysis (AA), scanning electron microcopy (SEM), energy dispersive spectroscopy (EDS) and transmission electron microscopy (TEM), atomic force microscopy (AFM) and Brunauer-EmmeS-Teller (BET) method. Furthermore, the bioactivity of scaffolds in simulated body fluid (SBF) and the interaction of dental pulp stem cells (DPSCs) with the nanocomposite scaffolds were assessed. Our results showed that the HA/ZnO/Pd (H1), HA/ZnO/Pd coated by 0.125 g chitosan (H2) and HA/ZnO/Pd coated by 0.25 g chitosan (H3) scaffolds possess higher compressive strength and toughness and lower microhardness and density compared to the pure HA (H0) scaffolds. Immersion of samples in SBF showed the deposition of apatite on the surface of the scaffolds. The biocompatibility assay indicated lower cell proliferation on the H1, H2 and H3 in comparison to the H0. The antibacterial results obtained show a significant impact by loading Pd/ZnO on HA in the deactivation of microorganisms in vitro.
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http://dx.doi.org/10.1007/s10856-020-06409-2DOI Listing
September 2020

Association between age-related macular degeneration and periodontal and peri-implant diseases: a systematic review.

Acta Ophthalmol 2021 Jun 30;99(4):351-356. Epub 2020 Sep 30.

Department of Periodontology, Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.

The aim of the present systematic review was to assess the association between age-related macular degeneration (AMD) and periodontal and peri-implant diseases. The focused question was 'Is there a relationship between AMD and periodontal and peri-implant diseases?' Indexed databases were searched up to and including May 2020 to identify pertinent original studies. The Cochrane Collaboration's tool was used to assess the risk of bias. Five observational cohort studies were included that assessed the association between AMD and periodontitis. The number of patients with and without AMD ranged between 54 and 90 and 1697 and 12,171 individuals, respectively. Examiner blinding to the study groups was performed in 1 of the 5 studies. None of the studies were power adjusted. Scrutiny of studies showed that all 5 studies included in the present systematic review had a high risk of bias. Results from all studies reported a direct association between AMD and periodontitis. No studies assessed the association between AMD and peri-implant diseases. The association between AMD and periodontal and peri-implant diseases remains debatable. Further well-designed and power-adjusted studies are needed to determine whether or not a 'true' association exists between AMD and periodontal and peri-implant diseases.
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http://dx.doi.org/10.1111/aos.14629DOI Listing
June 2021

Qualitative and Semi-Quantitative Assessment of Processing-Related Surface Contamination of One- and Two-Piece CAD/CAM Abutments before and after Ultrasonic Cleaning.

Materials (Basel) 2020 Jul 20;13(14). Epub 2020 Jul 20.

Department of Prosthodontics and Head of Department of Postgraduate Education, Master of Oral Implantology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.

Manufacturing processes of custom implant abutments may contaminate their surfaces with micro wear deposits and generic pollutants. Such particulate debris, if not removed, might be detrimental and provoke inflammatory reactions in peri-implant tissues. Although regulatory guidelines for adequate cleaning, disinfection, or sterilization exist, there does not appear to be a consistent application and data on the amount and extent of such contaminants is lacking. The aim of the present in vitro study was to evaluate the quality and quantity of processing-related surface contamination of computer-aided design/computer-aided manufacturing (CAD/CAM) abutments in the state of delivery and after ultrasonic cleaning. A total of 28 CAD/CAM monotype and hybrid abutments were cleaned and disinfected applying a three-stage ultrasonic protocol (Finevo protocol). Before and after cleaning, the chemical composition and the contamination of the abutments were assessed using scanning electron microscopy (SEM), dispersive X-ray spectroscopy (EDX), and computer-aided planimetric measurement (CAPM). In the delivery condition, monotype abutments showed a significantly higher amount of debris compared to hybrid abutments (4.86 ± 6.10% vs. 0.03 ± 0.03%, < 0.001). The polishing process applied in the laboratory after bonding the hybrid abutment components reduces the surface roughness and thus contributes substantially to their purity. The extent of contamination caused by computer-aided manufacturing of custom abutments can be substantially minimized using a three-stage ultrasonic protocol.
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http://dx.doi.org/10.3390/ma13143225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412481PMC
July 2020

Volumetric Changes in Morse Taper Connections After Implant Placement in Dense Bone. In-Vitro Study.

Materials (Basel) 2020 May 16;13(10). Epub 2020 May 16.

Restorative Dentistry, School of Dentistry, Murcia University, 30008 Murcia, Spain.

The stability of the implant-abutment interface is crucial for the maintenance of the implant index integrity. Several factors are capable of inducing deformation in implant-abutment connection, such as the actual insertion of the implant into the bone. This study aimed to evaluate the deformations produced in the connection after the insertion of the implant. Ten implants with two different implant carriers (Type A: carrier attached to platform and Type B: carrier attached inside the index-connection) were placed in artificial Type II bone, and volumetric changes were evaluated for different connection features with a 3D digital microscope. ANOVA (analysis of variance), Wilcoxon, and Tukey HSD post-test were used for statistical comparisons. Type A implants presented deformation at the platform level (inner slot angles and slot width), but no volumetric changes were observed inside the connection. Type B implants presented deformation in three parameters inside the connection (outer channel length, coronal step width, and coronal step length). Within the limitations of this study, we can conclude that more deformation is expected at the internal connection when the implant carrier engages this area. The engagement area should be as far away as possible from the index connection.
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http://dx.doi.org/10.3390/ma13102306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287620PMC
May 2020

Metal Ion Accumulation on Denture Teeth Following Exposure to Chlorhexidine and Different Drinks: A Spectrometric Analysis.

Materials (Basel) 2020 Apr 26;13(9). Epub 2020 Apr 26.

Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Department of Periodontology, Stony Brook University, Stony Brook, NY 11794, USA.

Denture teeth are used for removable prostheses and implant-supportive restorations. The purpose of this study was to analyze the surface of artificial teeth following exposure to different liquids. Mechanical wear and the cleaning of artificial teeth were also investigated. Two groups of resin teeth were used; original surface (Group A) and surface abrasion/wear (Group B). The teeth were exposed for 24 h to water (control), cola (Group 1), coffee (Group 2), tea (Group 3), chlorhexidine (Group 4), and red wine (Group 5). Baseline measurements of liquids were taken. An x-ray fluorescence spectrometric analysis was performed. Data were evaluated using semi-quantitative descriptive analysis. The data showed approximate increases of peak intensity for Group A1-2-fold Fe, 2-fold Ni, 2.2-fold Zn; for Groups A2 and A3- less than 1.5-fold Fe, Ni, and Zn. Group B yielded similar results; however, the increases in Fe, Ni, and Zn were significantly higher in Groups 1 and 2 (ranged 2-4-fold increases in intensity). Group B3 showed little increase in Fe, Ni, and Zn. Groups A4 and A5 showed intensity increases for Zn. Groups A1-A5 showed reductions in intensity following 30 s of cleaning. A pronounced accumulation of iron, nickel, and zinc was found after exposure to liquids, especially when artificial teeth were worn down. Peak intensities were reduced following 30 s of brushing.
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http://dx.doi.org/10.3390/ma13092021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254267PMC
April 2020

Primary stability of narrow-diameter dental implants with a multiple condensing thread design placed in bone with and without osteotomes: An in vitro study.

Clin Implant Dent Relat Res 2020 Jun 13;22(3):409-414. Epub 2020 Apr 13.

Department of Periodontology, Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA.

Background: The authors hypothesized that there is no difference in the primary stability (PS) of multiple condensing thread design (MCTD) implants placed in simulated type-IV bone with and without using osteotomes.

Purpose: This in vitro study assessed the PS of narrow-diameter dental implants with MCTD placed in simulated soft (type-IV) bone with and without using osteotomes.

Materials And Methods: Sixty MCT-designed implants (diameter: 3.0 mm; length: 11.5 mm) were placed using 800 rpm drilling speed in cellular rigid polyurethane foam bone-blocks that simulated type-IV bone. Prior to placement, the implants were divided into three groups (20 implants per group) depending upon the protocol used for osteotomy preparation-Group-1: Conventional drilling (CD); Group-2: CD followed by osseous condensation using a chisel-shaped tapered osteotome with maximum diameter of 3 mm; and Group-3: CD followed by osseous condensation using a cylindrical osteotome with maximum diameter of 3 mm. Abutments were connected to all implants and PS was recorded using resonance frequency analysis (RFA) and the periotest (PTV). Group comparisons were performed using analysis and Bonferroni post-hoc adjustment tests. Level of significance was set at P < .05.

Results: There was no statistically significant difference in the RFA values for the MCT-designed implants placed in groups 1, 2, and 3 (59.85 ± 0.72, 59.67 ± 0.76 and 59.42 ± 0.92, respectively). There was no statistically significant difference in the PTV values for MCT-designed implants in groups 1, 2, and 3 (1.655 ± 0.82, 1.405 ± 0.57, and 1.078 ± 0.63, respectively).

Conclusion: The MCTD implants with narrow diameters have a high PS in artificial soft bone in vitro. Due to the condensation effect of the thread design, there is no need for additional condensation of the peri-osteotomy bone in order to improve implant stability.
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http://dx.doi.org/10.1111/cid.12908DOI Listing
June 2020

Assessment of routine diet (garlic consumption) as a pre- and postoperative protocol in oral and maxillofacial surgical interventions: An evidence-based literature review.

Nutr Health 2020 Jun 3;26(2):135-139. Epub 2020 Apr 3.

Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.

Background: It was hypothesized that pathological bleeding (PB) during and/or after oral surgical procedures is higher in systemically healthy patients who have a history of garlic intake compared to controls (patients without a history of garlic consumption).

Aim: The aim of the present review article was to identify studies in which garlic consumption was included as a patient management protocol before and after oral and maxillofacial surgery (OMFS).

Methods: A review of pertinent indexed literature was performed. The focused question that was addressed was "Has diet (garlic consumption) been considered as a patient management protocol before and after OMFS?" The inclusion criteria were: (a) studies published in indexed databases, (b) original studies, (c) studies on OMFS, and (d) studies that considered diet (garlic consumption) as a patient management protocol before and after OMFS. Literature review, commentaries, letters to the editor, and studies published in non-indexed resources were excluded. The pattern of the present review was customized to summarize the pertinent information.

Results: The initial search using the terms "oral," maxillofacial," "protocol," and "surgery" yielded 1478 studies. The addition of the term "diet" to this search strategy reduced the number of studies to five. Further filtration of these studies using the terms "garlic" and/or "" showed no studies.

Conclusions: Garlic intake predisposes patients to PB. However, there are no studies in the indexed literature that have considered the inclusion of garlic consumption in patient management protocols before and after OMFS.
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http://dx.doi.org/10.1177/0260106020912940DOI Listing
June 2020

Control of Peri-Implant Mucous Inflammation by Using Chlorhexidine or Ultraviolet C Radiation for Cleaning Healing Abutments. Double-Blind Randomized Clinical Trial.

Materials (Basel) 2020 Mar 3;13(5). Epub 2020 Mar 3.

D.D.S., Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794-8712, USA.

Two-phase implants must be exposed to the external environment after the period of osteointegration has elapsed. For this purpose, a healing abutment is placed passing through the mucosa while forming the emergence profile. The continuous connection and disconnection can lead to an alteration in the tissue maturation, both because of the contact of bacterial plaque and because of the mechanical trauma that involves its manipulation, manifesting with different degrees of erythema or bleeding. To assess whether this epithelium disruption can be counteracted, a blinded study design was developed on 150 unitary implant patients divided into three groups (n = 50), applying chlorhexidine (group 1), ultraviolet C (UV-C) at a wavelength of 254 nm (group 2)and no treatment as a control group (group 3), during each of the disconnections and connections during the prosthodontic treatment (1 time per week for four weeks). All groups showed a better epithelium aspect at the end of the evaluation. Although there were no statistically significant differences in the degree of inflammation, the UV-C treated group had the lowest plaque accumulation, and the highest was for the chlorhexidine-treated group.
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http://dx.doi.org/10.3390/ma13051124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084961PMC
March 2020

Cytotoxicity of Self-Etch Versus Etch-and-Rinse Dentin Adhesives: A Screening Study.

Materials (Basel) 2020 Jan 17;13(2). Epub 2020 Jan 17.

Department of Operative Dentistry, Dental School (Carolinum), Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.

Six dentin adhesives were tested in vitro regarding their cytotoxicity on human fibroblasts. The adhesives Hybrid Bond, One-up Bond F Plus, AdheSE, Clearfil SE Bond, Optibond Solo Plus and Syntac were eluted with culture medium as single or sequentially applied adhesive part for 24 h. 75 Petri dishes were produced per group. They were evaluated triangulated, comprising the quantitative evaluation (105 ones) to determine "viable", "dead" and "debris" cells with the use of a cell-counter and the reactivity index was also identified based on the qualitative assessment (420 ones). One-up Bond F Plus, AdheSE and Clearfil SE Bond showed a statistical difference of viable cells to the cell control. For One-up Bond F Plus, statistically, differences compared to hybrid bond and Syntac were also found. All the adhesives except One-up Bond F Plus showed significant differences between single and sequentially applied adhesive part regarding the quantitative evaluation. The test material showed a moderate grade of cytotoxicity. As a result, a statistically significant difference of the cytotoxicity between the self-etch and etch-and-rinse adhesives cannot be demonstrated regarding the qualitative evaluation and the reactivity index, but the differences between sequentially applied and single applied components can be proved.
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http://dx.doi.org/10.3390/ma13020452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013582PMC
January 2020

The 'All-on-four' protocol in HIV-positive patients: A prospective, longitudinal 7-year clinical study.

Int J Oral Implantol (Berl) 2019 ;12(4):501-510

Purpose: This prospective study aims to evaluate the clinical outcomes of 'All-on-four' rehabilitations in controlled human immunodeficiency virus (HIV)-positive patients.

Materials And Methods: Edentulous patients requiring an implant prosthetic restoration of one or both jaws were enrolled in the present study. Each patient received at least one fixed full-arch prosthesis. Four implants, immediately loaded, were placed in each jaw using the 'All-on-four' protocol. Marginal bone loss, implant and prosthetic failure, biological and mechanical complications, and serological levels (CD4 cell count, CD4/CD8 ratio, and HIV viral load) were recorded up to 7-year follow-up.

Results: A total of 116 implants were placed in 24 patients, and 29 rehabilitations based on the 'All-on-four' concept were achieved. Implant failures were registered in four patients (10 of 116 implants), and the implant survival rate was 91.37%. At the 7-year radiographic evaluation, peri-implant crestal bone loss averaged 1.91 ± 1.3 mm for upright maxillary implants (n = 30 implants) and 1.79 ± 1.28 mm for tilted maxillary implants (n = 30 implants). In the mandible, mean peri-implant crestal bone loss was 1.54 ± 1.27 mm for upright implants (n = 28) and 1.5 ± 1.3 mm for tilted implants (n = 28). No statistically significant correlation was found between serological parameters and marginal bone levels at 6 months, or through 7 years of annual follow-up (P > 0.05). A statistically significant linear correlation (P < 0.001) was found between early implant failure and HIV viral load. The CD4/CD8 ratio was significantly correlated with late implant failure (P = 0.009).

Conclusions: Within the limitations of this prospective 7-year longitudinal study, HIV-positive patients with a stable immune system can be candidates for the 'All-on-four' treatment concept.
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December 2019

Photobiomodulation in Periodontology and Implant Dentistry: Part 2.

Photobiomodul Photomed Laser Surg 2019 Dec 25;37(12):766-783. Epub 2019 Nov 25.

Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.

(Part 1 of this article can be located at www.liebertpub.com/doi/10.1089/photob.2019.4710.) Finding evidence-based treatment strategies for low-level light therapy and the correct incorporation of these treatment methods in the clinical practice of periodontics. Photobiomodulation has been shown to have biostimulatory, anti-inflammatory, and analgesic effects that can be beneficial in periodontal and dental implant treatment procedures. In this review, we have addressed some clinical questions regarding the potential clinical application of low-level light irradiation and its photobobiomodulatory effects in periodontology and implantology. The literature was searched for (animal or clinical) articles written in English in four electronic databases of PubMed, Scopus, Google Scholar, and Cochrane Library until April 2019. Only studies with low irradiation doses without any thermal effects used only for their photobiomodulatory purposes were included. We were able to find relevant studies for all of our questions, and positive effects for the application of light therapy were reported in most of the studies. However, there is still a great deal of heterogeneity in terms of study designs and most importantly in light irradiation devices and the parameters used. Due to this issue, it was not possible to reach specific evidence-based irradiation protocols for the questions addressed in this review. Based on our search results, an obvious positive effect of low-level light therapy on stimulation of healing of periodontal soft and hard tissues and reduction of inflammation can be seen. Future well-designed randomized control studies with the same irradiation settings and systematic reviews evaluating the studies found on the questions mentioned are necessary to reach evidence-based recommendations.
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http://dx.doi.org/10.1089/photob.2019.4731DOI Listing
December 2019

Photobiomodulation in Periodontology and Implant Dentistry: Part 1.

Photobiomodul Photomed Laser Surg 2019 Dec 21;37(12):739-765. Epub 2019 Nov 21.

Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.

(Part 2 of this article can be located at www.liebertpub.com/doi/10.1089/photob.2019.4731.) Finding evidence-based treatment strategies for low-level light therapy (LLLT) and the correct incorporation of these treatment methods in the clinical practice of periodontics. Photobiomodulation has been shown to have biostimulatory, anti-inflammatory and analgesic effects that can be beneficial in periodontal and dental implant treatment procedures. In this review we have addressed some clinical questions regarding the potential clinical application of low-level light irradiation and its photobiomodulatory effects in periodontology and implantology. The literature was searched for (animal or clinical) articles written in English in four electronic databases of PubMed, Scopus, Google Scholar, and Cochrane Library until April 2019. Only studies with low irradiation doses without any thermal effects used only for their photobiomodulatory purposes were included. We were able to find relevant studies for all of our questions, and positive effects for the application of light therapy were reported in most of the studies. However, there is still great deal of heterogeneity in terms of study designs and most importantly in light irradiation devices and the parameters used. Owing to this issue it was not possible to reach specific evidence-based irradiation protocols for the questions addressed in this review. Based on our search results, an obvious positive effect of LLLT on stimulation of healing of periodontal soft and hard tissues and reduction of inflammation can be seen. Future well-designed randomized control studies with the same irradiation settings and systematic reviews evaluating the studies found on the questions mentioned are necessary to reach evidence-based recommendations.
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http://dx.doi.org/10.1089/photob.2019.4710DOI Listing
December 2019

In vitro comparison of resonance frequency analysis devices to evaluate implant stability of narrow diameter implants at varying drilling speeds in dense artificial bone blocks.

Clin Implant Dent Relat Res 2019 Oct 29;21(5):1023-1027. Epub 2019 Aug 29.

Department of Periodontology, Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, New York.

Background: There are no studies that have assessed the implant stability quotient (ISQ) values of narrow diameter implants placed in artificial dense bone blocks at varying drilling speeds (DSs).

Purpose: The aim of the present in vitro experiment was to compare the performance of OSSTELL and Penguin devices to evaluate implant stability at DSs of 800 and 2000 rpm.

Materials And Methods: A total of 360 osteotomies were created in dense artificial bone blocks at DSs of 800 and 2000 rpm. Dental implants from three manufacturers (group-1: NobelActive implants, Nobel Biocare, Yorba Linda, California; group-2: Zimmer, Eztetic-Zimmer implants, Zimmer Biomet Dental, Palm Beach Gardens, Florida; and group-3: Astra Tech implant system, Dentsply Sirona, York, Pennsylvania) were randomly placed in these osteotomies using an insertion torque of 15 Ncm (60 implants/group). Implant stability in all bone blocks immediately following implant placement was evaluated using the OSSTELL and Penguin devices. ISQ values were presented as means ± SD. Statistical significance was set at P < .05.

Results: There was no significant difference in the ISQ values obtained from the OSSTELL and Penguin devices for implants in groups 1, 2, and 3. There was no significant difference when ISQ values obtained from the OSSTELL device were compared with the Penguin device for narrow diameter dental implants placed in dense bone blocks with osteotomies performed at 800 and 2000 rpm. ISQ values showed statistically significant higher values for OSSTELL compared to Penguin device.

Conclusion: The OSSTELL and Penguin devices are reliable for the assessment of implant stability in dense artificial bone. Implant design and site-DS does not seem to have a significant impact of implant stability in artificial dense bone blocks.
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http://dx.doi.org/10.1111/cid.12842DOI Listing
October 2019

Soft tissue-related complications and management around dental implants.

Periodontol 2000 2019 10;81(1):124-138

Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Implant installation for replacing missing teeth is a frequent treatment procedure with high long-term survival and success rates. However, the success of implant therapy may be jeopardized by several complications related to mistakes in treatment planning, surgical procedure, management of hard and soft tissues, and infections. Increasing evidence suggests that the stability of the soft tissues surrounding osseointegrated dental implants may substantially influence long-term clinical stability and esthetics. Therefore, when implant therapy is planned, the clinician must not only be able to perform the appropriate steps to maintain/create a stable soft tissue, but also needs to be aware of the potential sources for complications and possess the adequate knowledge for their appropriate management. The present paper provides an overview of the most important aspects related to the prevention and management of soft tissue-related complications in conjunction with implant therapy. The current literature indicates that the presence of an adequate width of keratinized attached mucosa around dental implants may lead to better soft and hard tissue stability, less plaque accumulation, limited soft tissue recession, and lower incidence of peri-implant mucositis. Proper implant positioning by carefully considering appropriate mesio-distal and bucco-lingual dimensions and implant angulation may prevent the loss of interdental soft tissues and development of soft tissue recessions. To optimize the width of keratinized attached mucosa, the appropriate soft tissue augmentation protocol should be selected for each particular indication. When the use of autogenous soft tissue grafts is planned, a thorough knowledge of the anatomical structures is mandatory in order to harvest soft tissue grafts of an appropriate quality and quantity and to avoid/minimize postoperative complications. Finally, the clinician needs to master the necessary steps in order to manage complications related to extensive bleeding and tissue necrosis that may occur in conjunction with soft tissue augmentation procedures.
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http://dx.doi.org/10.1111/prd.12287DOI Listing
October 2019

Chronic hyperglycemia as a risk factor in implant therapy.

Periodontol 2000 2019 10;81(1):57-63

Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York.

It has been estimated that by 2030, the number of patients with diabetes aged > 64 years will be > 82 million in underdeveloped countries, and > 48 million in developed countries. Chronic hyperglycemia delays wound healing by reducing the expression of growth factors in the wound fluid and re-epithelialization. Impaired wound healing in patients with diabetes has also been associated with inhibition of the production of stromal cell-derived factor-1alpha by several tissues including bone marrow, brain, heart, spleen, and gingivae. Chronic hyperglycemia interferes with the osseointegration of implants by deferring the expression of fibronectin and integrins. Results from experimental studies have shown a significantly higher bone-to-implant contact around implants placed in healthy animals compared with animals with streptozotocin-induced diabetes. Moreover, persistent hyperglycemia plays a role in abnormal differentiation of osteoclasts, thereby making bone tissue more susceptible to resorption. Furthermore, persistent hyperglycemia has also been associated with increased peri-implant soft tissue inflammation (increased peri-implant bleeding on probing and probing depth) and crestal bone loss. Clinical studies have shown that under optimal glycemic control dental implants can show success and survival rates of up to 100% in patients diagnosed with diabetes. Although patients with diabetes can undergo dental implant therapy and can exhibit implant survival similar to those in systemically healthy individuals, the contribution of glycemic control and regular oral hygiene maintenance cannot be disregarded.
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http://dx.doi.org/10.1111/prd.12283DOI Listing
October 2019

Effects of occlusal forces on the peri-implant-bone interface stability.

Periodontol 2000 2019 10;81(1):179-193

Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA.

The occlusal forces and their influence on the initiation of peri-implant bone loss or their relationship with peri-implantitis have created discussion during the past 30 years given the discrepancies observed in clinical, animal, and finite element analysis studies. Beyond these contradictions, in the case of an osseointegrated implant, the occlusal forces can influence the implant-bone interface and the cells responsible for the bone remodeling in different ways that may result in the maintenance or loss of the osseointegration. This comprehensive review focuses on the information available about the forces transmitted through the implant-crown system to the implant-bone interface and the mechano-transduction phenomena responsible for the bone cells' behavior and their interactions. Knowledge of the basic molecular biology of the peri-implant bone would help clinicians to understand the complex phenomenon of occlusal forces and their effects on the implant-bone interface, and would allow better control of the negative effects of mechanical stresses, leading to therapy with fewer risks and complications.
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http://dx.doi.org/10.1111/prd.12291DOI Listing
October 2019

Concepts for prevention of complications in implant therapy.

Periodontol 2000 2019 10;81(1):7-17

Department of Periodontology, University of Bern, Bern, Switzerland.

The use of dental implants is nowadays a well-accepted and highly predictable treatment modality for restoring the dentition and reestablishing the masticatory function of edentulous and partially edentulous patients. Despite the high predictability and excellent long-term survival rates reported for implant therapy, complications may still occur and can jeopardize both short- and long-term success. The present paper provides an overview on the most important aspects related to the etiology, prevention, and management of complications associated with implant therapy. Data from the literature indicate that a number of factors, such as surgical trauma, implant diameter, type of implant-abutment connection, abutment disconnection and reconnection, presence of microgap, and implant malpositioning, can substantially influence the biologic processes of bone remodeling and biofilm formation, thus increasing the rate of short- and long-term hard- and soft-tissue complications. Other factors, such as excess cement at cement-retained prosthetic restorations, abutment mobility, and infections (e.g. peri-implant mucositis and peri-implantitis) caused by bacterial biofilm, are further causes for complications and failures. More recent evidence also indicates that besides the need for sufficient bone volume surrounding the implant, the presence of an adequate width and thickness of attached mucosa may improve biofilm control and limit crestal bone resorption. Furthermore, emerging evidence points also to the pivotal role of human factors as one of the most important causes of complications in implant dentistry. It can be concluded that clinicians need to consider all biologic and biomechanical factors affecting implant placement and survival, as well as undergo adequate training to improve their surgical skills to control and prevent implant complications. Careful patient selection and control of environmental and systemic factors, such as smoking, diabetes etc., coupled with an accurate surgical and prosthetic planning, enable a better prevention and control of infections.
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http://dx.doi.org/10.1111/prd.12278DOI Listing
October 2019

Molecular tools for preventing and improving diagnosis of peri-implant diseases.

Periodontol 2000 2019 10;81(1):41-47

Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.

Peri-implantitis is an inflammatory disease of tissues surrounding osseointegrated dental implants. Inflammation affecting soft and hard peri-implant tissues can cause alveolar bone resorption and subsequent implant loss. Clinical surveillance and early diagnosis are of paramount importance to reduce clinical failures and improve implant survival. Current diagnosis of implants is based on clinical and radiological signs. Molecular tests are an emerging diagnostic methodology, which potentially can help to detect and prevent early peri-implantitis and monitor the efficacy of therapy as well. A plethora of potential biomarkers are potentially available to support the clinical diagnosis of peri-implantitis. However, conflicting diagnostic conclusions have been reached, probably related to weak statistical results due to limited sample size or disease heterogeneity. The present paper reviews candidate diagnostic biomarkers for peri-implantitis, including infective agents, genetic susceptibility factors, and key proteins related to inflammation and tissue remodeling.
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http://dx.doi.org/10.1111/prd.12281DOI Listing
October 2019

Tobacco-product usage as a risk factor for dental implants.

Periodontol 2000 2019 10;81(1):48-56

Eastman Institute of Oral Health, University of Rochester, Rochester, NY, USA.

The oral cavities of tobacco smokers and users of smokeless tobacco products are exposed to high concentrations of nicotine. A limited number of animal studies have assessed the effect of nicotine on osseointegration. Results from experimental studies have reported a statistically significant decrease, at 4 weeks of follow-up, in bone-to-implant contact among rats exposed to nicotine compared with unexposed rats. Nicotine increases the production of inflammatory cytokines (such as interleukin-6 and tumor necrosis factor-alpha) by osteoblasts. Waterpipe, pipe, and cigarette smokers are at increased risk of developing oral cancer, periodontal disease, and alveolar bone loss. One explanation for this is that smokers (regardless of the type of tobacco product) are exposed to similar chemicals, such as nicotine, tar, oxidants, polyaromatic hydrocarbons, and carbon monoxide. Moreover, raised levels of proinflammatory cytokines have been identified in the gingival crevicular fluid of cigarette smokers with peri-implant diseases. Therefore, it is hypothesized that nicotine and chemicals in tobacco smoke induce a state of oxidative stress in peri-implant tissues (gingiva and alveolar bone), thereby increasing the likelihood of peri-implant disease development via an inflammatory response, which if left uncontrolled, will result in implant failure/loss. In this regard, tobacco smoking (including cigarettes, waterpipe, and pipe) is a significant risk factor for peri-implant diseases. The impact of vaping electronic cigarettes using nicotine-containing e-juices remains unknown. Habitual use of smokeless tobacco products is associated with oral inflammatory conditions, such as oral precancer, cancer, and periodontal disease. However, the effect of habitual use of smokeless tobacco products on the success and survival of dental implants remains undocumented.
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http://dx.doi.org/10.1111/prd.12282DOI Listing
October 2019

Photothermal Effects of Defocused Initiated Versus Noninitiated Diode Implant Irradiation.

Photobiomodul Photomed Laser Surg 2019 Jun 13;37(6):356-361. Epub 2019 Feb 13.

3 Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, New York.

Diode lasers have been used for implant decontamination. However, the use of initiated or noninitiated tips remains unevaluated to verify potential photothermal risks. To assess the photothermal effects of defocused-initiated versus noninitiated irradiation. A dental implant (3.5 × 11 mm) was placed into an artificial bone, an infrabony defect was created to simulate a four-wall peri-implant defect. Irradiation was performed using pulsed diode lasers of 940, 975, and 980 nm. The laser tips were positioned parallel to the implant (maximum 2W pulsed mode). The implant was irradiated for 30 sec using noninitiated, cork-, and blue paper-initiated tips. Temperature differences were observed at the apical and coronal regions of the implant. The data were statistically evaluated and compared using one-way analysis of variance and Tukey tests. The average temperature increase and the amount of time that it took to yield the critical temperature were comparable at the coronal level for the 940 and 975 nm diode lasers ( > 0.05). For the 980 nm laser, blue-initiated tip had the highest temperature increase (22.4°C), followed by cork (18.8°C) and noninitiated tip (17.3°C). The critical threshold at the coronal portion for the 980 nm laser was reached in 11.5, 8.79, and 6.46 sec for the blue paper-, cork-, and noninitiated tips, respectively. The 975 and 980 nm lasers had average temperature increases, comparable among the blue paper-, cork-, and noninitiated tips at the apical level ( > 0.05). Apically, for the 940 nm, the noninitiated tip had the highest temperature increase (5.57°C), followed by the cork- (4.96°C) and blue paper-initiated tip (4.54°C). The initiator does not affect the temperatures produced during implant decontamination although noninitiated diode lasers may overheat (within 30 sec) than initiated tips. There is minimal risk of overheating at the apical portion. It seems that the 940 nm diode is the safest of the evaluated laser systems.
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http://dx.doi.org/10.1089/photob.2018.4545DOI Listing
June 2019

Apical stability of implants with progressive thread design in vitro, based on clinicians with different levels of experience.

J Periodontol 2019 11 1;90(11):1320-1324. Epub 2019 Jul 1.

Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.

Background: The implant design and the surgical technique are important parameters that can be modified to improve the implant primary stability. The aim of this study was to evaluate the role of the apical part of an implant on the implant stability of implants placed in Type II dense bone by novice and experienced clinicians.

Methods: Implants with a progressive thread design (3.5 mm diameter, 11 mm length) were used. A total of 80 osteotomies were prepared in dense bone samples (quality Type II) by two clinicians with different levels of experience (novice and experienced) under the same surgical protocol. Two experimental groups were prepared. In the test group (apical stability), 40 implants were inserted with only 3 mm of the apical portion of the implant within the bone and without lateral contact between the residual implant length and the osteotomy walls. In the control group (full implant stability), 40 implants were inserted with full contact between the osteotomy walls and the implant surface. The stability of both groups (test and control) was evaluated using a resonance frequency analysis (RFA) (implant stability quotient [ISQ] values). Statistical comparisons between the groups were performed using the Kruskal-Wallis test with Dunn post-test for multiple comparisons.

Results: The results did not show statistically significant differences (P > 0.05) in terms of primary stability between implants placed by novice or experienced clinicians in dense bone. The control group showed significantly higher ISQ values compared with the test group (P < 0.001). The apical implant stability contributed to ≈ 30% and 43% of the entire implant stability for novice and experienced clinicians, respectively.

Conclusions: The apical portion of an implant plays a fundamental role in the entire implant stability and is independent on the clinician's experience. However, precise implant site preparation to guarantee apical implant anchorage is recommended.
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http://dx.doi.org/10.1002/JPER.18-0680DOI Listing
November 2019

"Religious Belief": An Undervalued Ethical Inclusion Criterion for Clinical Trials on Bone Grafting Procedures.

J Relig Health 2020 Dec;59(6):2928-2934

Department of Periodontology, Stony Brook University, Stony Brook, NY, USA.

The aim of the present review was to assess randomized controlled trials (RCTs) on bone grafting procedures that included religious belief as an eligibility criterion. Indexed databases were searched up to and including February 2019 using different search strategies. In strategy 1, the following terms were used: (a) belief; (b) bone graft; (c) faith; (d) inclusion; (e) exclusion; (f) eligibility; (g) criteria; (h) randomized clinical trial; (i) religion; and (j) xenograft. In strategy 2, the following terms were used in addition to those used in strategy 1: Xenografts AND oral surgery OR xenografts AND maxillofacial OR xenografts AND dental implants. These searches were filtered using the terms "Randomized clinical trial" and "human studies". The initial search yielded 3932 studies. Filtration of results using the terms "Randomized clinical trial" and "human studies" showed 0 studies. Evaluation of patients' religious beliefs seems to be undervalued in RCTs related to the placement of xenografts. This is an essential and ethical criterion that should be taken into consideration prior to inclusion of participants and signing the informed consent form for RCTs related to the placement of bone grafts.
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http://dx.doi.org/10.1007/s10943-019-00851-5DOI Listing
December 2020
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