Vitamin D Supplementation for Prevention of Dental Implant Failure: A Systematic Review

Background. Many factors play a significant role in osseointegration and healing after dental implant insertion and restoration. Some factors are related to dental biomaterials, such as the dental implant, prosthesis, and grafting materials. Other factors can be connected to operator skills and accumulated experience. Local and systemic patient-related factors are crucial in determining the success of the dental implant. Thorough examination and analysis of local factors using available examination tools are vital to prepare the implant candidate for such treatment. The patient’s systemic condition directly affects the healing of the dental implant. One of the most overlooked systemic factors is the patients’ vitamin D level, which influences bone formation around the implant and subsequent osseointegration. The current review examined the available literature regarding the association between vitamin D supplementation and dental implant osseointegration. Methods. Data of this review were derived from recent research available on PubMed, Google Scholar, and Scopus. Inclusion criteria were the relation between the vitamin D serum and dental implant osseointegration or failure. The Systematic Reviews and Meta-Analyses (PRISMA) checklist was followed to perform the review. The study’s outcome was the need for vitamin D supplementation to prevent implant failure. Results. Five human studies (including case reports, case series, and retrospective studies) and six animal studies. All included studies discussed the relationship between vitamin D, early dental implant failure, and bone implant contact. Three retrospective studies found no significant relationship between vitamin D supplementation and EDIFs in humans. On the other hand, one retrospective study showed a significant relationship in humans. A case report and case series claimed that the implant was successfully placed after vitamin D supplementation. A total of four animal studies showed a significant relationship between vitamin D supplementation and osseointegration of the dental implant. Two animal studies showed no significant association. Conclusion. To ensure optimal treatment outcomes, it is recommended to supplement the patient with vitamin D if the serum level is not within the normal range. Further clinical studies and case reports are needed to confirm the association between serum vitamin D levels and osseointegration.

Management of Medically Compromised Prosthodontic Patients

The medical evaluation of patients considering prosthodontic treatment is a vital step in the treatment planning. The prosthodontist should be able to assess the inherent risks associated with the treatment of patients with systemic conditions. Many factors are associated with evaluating the patient’s health status and risk including the patient’s current and past medical and dental history, current and past use of medications, type of treatment, length of treatment, invasiveness of treatment, and degree of urgency of treatment. In this article, some of the systemic diseases like arthritis, cardiovascular diseases, endocrine disorders, hematologic and oncologic disease, neurologic disorders, bone disorders, pulmonary diseases, liver diseases, and chronic kidney disease that commonly affect aged individuals are reviewed. The prosthodontic considerations that should be taken care of while managing patients with these systemic conditions will also be discussed.

Osteotome-Induced Blood Clot and Subsequent Bone Formation with the Use of Collagen Sponge for Integration of Single Dental Implants into the Atrophied Posterior Maxilla: A Retrospective Follow-Up of 36 Implants after 5 to 13 years

Background. Atrophy of the posterior maxilla as a consequence of tooth loss and sinus pneumatization is a frequent condition encountered in the clinical practice. Prosthetic rehabilitation with implants in these patients often requires some kind of bone regeneration procedure to increase the bone volume. Aim. The aim of the present retrospective study is to analyze the survival and success rates of a series of implants placed in the atrophic posterior maxilla with a transcrestal osteotome procedure, without placing a bone grafting material. Materials and Methods. From 2006 to 2014, 36 dental implants (Neoss Ltd., Harrogate, UK) were inserted in 36 patients with at least 4 mm of bone below the maxillary sinus using transcrestal osteotome sinus floor elevation and placement of collagen sponge below the sinus membrane. ISQ measurements were made after implant placement and at abutment surgery after 4 to 6 months. The vertical bone height (VBH) was evaluated in intraoral radiographs taken prior to surgery and in radiographs from annual check-up appointments 5 to 13 years after implant placement. In addition, marginal bone loss (MBL) was evaluated. Results. One implant was lost after four years of prosthetic loading. The remaining 35 implants showed no complications and were loaded with single crowns after 4–6 months of healing. All 35 implants showed clinical success after 8.5 ± 2.8 years of prosthetic loading (from 5 to 13 years). The vertical bone height was 5.9 ± 1.4 mm at surgery, 9.7 ± 1.1 mm at second surgery after 4–6 months, and 8.3 ± 1.8 at the follow-up at 8.5 ± 2.8 years (from 5 to 13 years). The implant stability registered was 73.2 ± 6.2 ISQ at the surgery and 75.8 ± 3.9 at the second surgery after 4–6 months. Conclusions. The present long-term follow-up study showed that the crestal approach for sinus floor bone augmentation without additional bone grafting results in predicable bone formation and high implant survival. The osteotome technique is a valid alternative to the more invasive lateral window technique in single cases with a minimum of 4 mm of VBH below the maxillary sinus.

Does Bleaching Affect the Microleakage of Class II Restoration with Bulk-Fill Composite?

Introduction. The use of technology in bulk-fill composites (BCs) has reduced the stresses caused by polymerization shrinkage, debonding, microleakage, or posttreatment sensitivity in them. This study was conducted to determine whether bleaching affects the microleakage of class II restoration with bulk-fill material. Materials and Methods. This laboratory study was performed on 40 normal human premolars in 4 groups (n = 20). Class II cavities were prepared in mesial and distal surfaces of the teeth with dimensions of 2 × 2 × 4 mm. Then, based on the bleaching process by 20% carbamide peroxide gel and using two types of composites, the restored cavities were randomly divided into 4 groups: (1) CC without bleaching (CC group), (2) BC without bleaching (BC group), (3) CC with bleaching (CCB group), and (4) BC with bleaching (BCB group). Then, the samples were thermocycled for 1000 cycles at a temperature range of 5–55°C, and they were immersed in 0.6% alkaline fuchsine in order to penetrate into the pigment for 24 h. After cutting, the samples were placed under a stereomicroscope (40%) to determine microleakage. The data were analyzed using one-way analysis of variance (ANOVA), and a p value <0.05 was considered as statistically significant. Results. Microleakage was determined in the CC group 0.97 ± 0.42 , BC group 1.08 ± 0.54 , CCB group 1.19 ± 0.37 , and BCB group 0.30 ± 0.47 . There were also no significant differences in the mean microleakage between the groups. No cases with zero microleakage (no microleakage) and grade 3 of microleakage (pigment penetration into the axial wall) were observed in the samples. Also, a two-by-two comparison of significant differences between CC and BC groups p = 0.89 , CC and CCB groups p = 0.45 , CC and BCB groups p = 0.11 , BC and CCB groups p = 0.87 , BC and BCB groups p = 0.41 , and CCB and BCB groups p = 0.86 showed that the difference was not statistically significant. Conclusion. Results showed no difference between microleakage of BC and CC with and without bleaching, and bleaching had the same effect on microleakage of these two types of composites.

Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient’s Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study

Mandibular third molar surgical extraction, either partially erupted or fully impacted, is the most common surgical procedure in oral and maxillofacial surgery (OMFS). However, this procedure can be associated with many postoperative complications including persistent pain, swelling, trismus, and paresthesia due to nerve injury. This study aimed to identify the correlation of postoperative complications with patient’s age, sex, and surgical difficulty level. This study was a cross-sectional retrospective and single-center research conducted on patients with a history of mandibular third molar surgical extraction in the period between 2017 and 2019 at Dental and Oral Hospital Universitas Airlangga, Surabaya, Indonesia. The researchers assessed the factors of age, sex, and surgical difficulty level regarding postoperative complications on the first day of the surgery and after one week on the 7th day of it. Among 916 respondents, the majority of the sample was females (59%) and the dominant age group (60.9%) was the age group of 21–30 years while the dominant surgical difficulty level was shown by the advanced cases group (77%). The statistical analysis showed that there was a significant correlation between surgical difficulty level and postoperative complications including pain, trismus, and paresthesia on the first-day assessment. On the other hand, age was significantly related to complications like pain, swelling, and trismus on the first-week assessment. Age and surgical difficulty level were the most common risk factors of the mandibular third molar extraction postoperative complications. Dentists should take into consideration that older patients (≥51 years) and patients with complex surgical level are more vulnerable to severe postoperative complications.

Reframing Perceptions in Restorative Dentistry: Evidence-Based Dentistry and Clinical Decision-Making

Objectives. The worldwide interest of both dentists and patients in esthetic dentistry has affected decision-making in dental practice. The aim of this study was to investigate contemporary dental practice in restorative dentistry and the relationship between evidence-based dentistry in caries research and decision-making in clinical practice in restorative dentistry. Methods. The study was conducted through a structured questionnaire distributed randomly at the Jordanian Dental Association registered dentists in Jordan. The questionnaire aimed to clarify the degree of knowledge and practice of evidence-based dentistry in caries research the dentists hold regarding clinical decision-making in restorative dentistry. Results. The majority of the surveyed dentists (77%) treat teeth with irreversible pulpitis with root canal treatment rather than vital pulp therapy. 13.8% routinely insert a post and 23% routinely crown the tooth after root canal treatment regardless of the remaining tooth structure. Badly damaged teeth are treated with full crowns in 72% of the cases. Regarding Hollywood smile or smile makeover, the majority of dentists choose conservative approaches, and implants were the first choice to replace missing teeth for 93.8% of the surveyed dentists. Conclusion. A higher degree of implementation of evidence-based dentistry in clinical decision-making was found in Prosthetic Dentistry than in Endodontics. Yet, the gap between evidence-based data and clinical practice needs bridging. More emphasis on communicating these data to educators to integrate them into the dental curriculum is a must.

Clinical, Histological, and Scintigraphic Comparative Study of the Use of Mandibular Bone Marrow and Peripheral Blood in Bone Neoformation

Background and Purpose. To evaluate the capacity of mandibular bone marrow blood aspirate associated with biomaterials to stimulate bone tissue neoformation compared to the use of peripheral blood aspirate in patients with bone loss in the premaxillary region. Materials and Methods. The study included 16 patients with maxillary atresia. The region was grafted with xenograft blocks associated with the following treatments: G1, the patient’s peripheral blood during surgery, and G2, dripping of mandibular bone marrow blood until the xenograft was completely wet. After 7 and 14 days, scintigraphic images of the regions of interest (ROI) were taken to quantify pixels, which indicate osteogenic activity. Additionally, trephined samples obtained at the time of implant placement were stained in H&E, and newly formed bone tissue was quantified. The data were tabulated and statistically analyzed at a significance level of 5%. Results. Scintigraphic data showed greater osteogenic activity with mandibular bone marrow blood (G2) at all times evaluated p < 0.05 . As for the histomorphometric analysis, a greater amount of bone tissue was observed in samples treated with mandibular bone marrow blood (G2) compared to peripheral blood (G1) p < 0.05 . Conclusions. The appositional bone reconstruction technique in the block associated with mandibular bone marrow blood increased bone neoformation and osteogenic activity compared to conventional graft treatment with peripheral blood.

A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up

Purpose. The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes, of zirconia implants with 10-year follow-up. Materials and Methods. 10 patients were selected and 26 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge. After 10 years, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss. Results. The survival and success rates were 100%. The average marginal bone loss from baseline to 120 months after surgery was 0.92 ± 0.97 mm. Conclusion. One-piece zirconia dental implants are characterised by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants.

Infection Risk Prediction Model for COVID-19 Based on an Analysis of the Settlement of Particles Generated during Dental Procedures in Dental Clinics

Background. The health emergency declaration owing to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has drawn attention toward nosocomial transmission. The transmission of the disease varies depending on the environmental conditions. Saliva is a recognized SARS-CoV-2 reservoir in infected individuals. Therefore, exposure to fluids during dental procedures leads to a high risk of contagion. Objective. This study aimed to develop an infection risk prediction model for COVID-19 based on an analysis of the settlement of the aerosolized particles generated during dental procedures. Materials and Methods. The settlement of aerosolized particles during dental aerosol-generating procedures (AGPs) performed on phantoms was evaluated using colored saliva. The gravity-deposited particles were registered using a filter paper within the perimeter of the phantom head, and the settled particles were recorded in standardized photographs. Digital images were processed to analyze the stained area. A logistic regression model was built with the variables ventilation, distance from the mouth, instrument used, area of the mouth treated, and location within the perimeter area. Results. The largest percentage of the areas stained by settled particles ranged from 1 to 5 µm. The maximum settlement range from the mouth of the phantom head was 320 cm, with a high-risk cutoff distance of 78 cm. Ventilation, distance, instrument used, area of the mouth being treated, and location within the perimeter showed association with the amount of settled particles. These variables were used for constructing a scale to determine the risk of exposure to settled particles in dentistry within an infection risk prediction model. Conclusion. The greatest risk of particle settlement occurs at a distance up to 78 cm from the phantom mouth, with inadequate ventilation, and when working with a high-speed handpiece. The majority of the settled particles generated during the AGPs presented stained areas ranging from 1 to 5 µm. This model was useful for predicting the risk of exposure to COVID-19 in dental practice.

Tooth- and Patient-Related Conditions May Influence Root Canal Treatment Indication

Aim. To investigate predisposing aspects related to the indication for root canal treatment (RCT) at Dental Schools of Brazil. Methods. Data of 207 patients referred to endodontic treatment at undergraduate Dental Schools of Brazil were collected over a period of 8 months. Patient-related data included age, gender, first dental visit, tooth brushing frequency, number of remaining teeth, and previous endodontic treatment, and tooth-related information regarding number, type, and location in the mouth of teeth that need RCT, waiting time for the endodontic treatment, endodontic diagnosis, pain report, and dental crown condition was collected for each participant. Bivariate analysis (Chi-square test; p < 0.05 ) associated gender and tooth/patient-related conditions. Poisson regression analysis compared multiple endodontic need and exposure variables. Results. Patients were mainly comprised of women (65.2%), aged 18–39 years (69.6%). Previous RCT was significantly more prevalent in women when compared to men p = 0.005 . First dental visit at later moment (after 20 years of age) demonstrated 400% greater prevalence of multiple RCT demand when compared to patients that attended the dental office at age below seven years p = 0.032 . Most of the patients presented only one tooth needing RCT (80.2%), mainly premolars (44.9%). Interestingly, women underwent more RCT in maxillary teeth p = 0.016 and significantly contributed with their report to the diagnosis process when compared to men p = 0.014 . Regarding dental crown condition, 45.4% of all teeth registered unsatisfactory restorations, which were more pronounced in female patients p = 0.018 . Unsatisfactory restorations or dental caries had 75% and 82%, respectively, less prevalence of multiple RCT indication when compared to sound dental crown p = 0.001 . Conclusions. RCT was undertaken more frequently in young female adults’ premolars presenting unsatisfactory restorations. First dental visit, number of teeth with previous endodontic treatment, tooth group, and dental crown condition were significantly associated with the necessity of multiple endodontic treatments.