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Objective: The purpose of this report was to document clinical responses to Nd:YAG laser energy in patients with surgical injury to terminal branches of the trigeminal nerve. Background: Limited evidence from in vitro, animal, and human studies suggests infrared laser energy may positively influence recovery after peripheral or cranial nerve injury, although clinical effects of neodymiumdoped yttrium aluminum garnet (Nd:YAG) lasers remain unstudied in this context. Methods: We applied Nd:YAG laser energy in the treatment of three consecutive patients presenting with altered neurosensory function following various oral and maxillofacial procedures. The time interval between surgical injury and laser photobiomodulation ranged from one week to two years. Results: All patients exhibited reduction in the area of diminished sensation and partial recovery of normal neurosensory function. The two patients with long-standing neurosensory deficiency experienced near complete recovery of intraoral sensation, with residual zones of diminished sensation from the perioral skin. Conclusions: Although all patients in this case series demonstrated clinical improvements compared with baseline, controlled studies are needed to determine whether Nd:YAG laser energy accelerates or enhances recovery of neurosensory function after surgical nerve injury. Studies establishing the relative efficacies of Nd:YAG and diode lasers appear warranted. [ABSTRACT FROM AUTHOR]

Introduction: Guided bone regeneration (GBR) is the most commonly utilized procedure for augmenting deficient alveolar ridges in support of dental implant placement. In a GBR procedure, barrier membrane dimensions, bone graft volume, and surgical complexity may influence the risk of postsurgical morbidity. Case presentation: A 25-year-old female in good general health received GBR at two mandibular first molar sites exhibiting horizontal ridge deficiency. High-density polytetrafluoroethylene membranes were intentionally limited in size, and small-volume freeze-dried bone allografts were applied only where clinically beneficial for implant site development. Treatment resulted in clinically favorable ridge augmentation with no appreciable swelling and minimal postoperative discomfort. Conclusion: At dental implant sites exhibiting modest alveolar ridge deficiency, limiting GBR barrier membrane dimensions and bone graft volumes may enhance patient-centered outcomes while accomplishing clinical goals. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to illustrate the efficacy of a novel imaging analysis technology to capture horizontal and vertical dimensional changes following horizontal alveolar ridge augmentation (HRA). Methods: Cone-beam computed tomography (CBCT) volumes from 65 HRA sites in 57 patients were available for evaluation, employing a three-dimensional analysis software to overlay preoperative and post-augmentation CBCT volumes. Horizontal and vertical alveolar ridge dimensional (HRD/VRD) changes were recorded considering a panel of patient-, site-, and procedure-related explanatory variables. Results: VRD changes ranged from -2.9 to 3.0 mm, more than half anterior sites losing alveolar ridge height. Mean HRD increase at the 3- and 5-mm levels apical to the alveolar crest amounted to 2.3±1.6 and 2.4±1.3 mm, respectively, membrane fixation and non-resorbable membrane use associated with significantly greater gains. Conclusions: To date, studies reporting dimensional changes following HRA predominantly rely on serial in situ orofacial caliper recordings omitting vertical alterations. The protocol employed in this study allows simultaneous HRD and VRD evaluations and assures baseline and post-augmentation recordings are made at the same alveolar ridge position. Compared with in situ recording, CBCT overlay analysis may achieve a more complete characterization of dimensional changes following HRA. [ABSTRACT FROM AUTHOR]

A considerable percentage of dental implant patients experience biofilm-mediated peri-implant disease following transmucosal abutment application. Bacterial adhesion is an early step in biofilm development. Our purpose was to assess adhesion of specific bacterial species to titanium over short exposure periods. Eight bacterial species were selected for this analysis: Streptococcus oralis, Streptococcus mitis, Gemella haemolysans, Streptococcus gordonii, Streptococcus sanguinis, Neisseria flavescens, Streptococcus salivarius, and Pseudomonas aeruginosa. We cultured each species with appropriate media and exposed titanium foil discs to the bacteria for 60, 15, 5, 1, or 0.25 minutes. Optical density at 600-nm wavelength (OD600) was assessed for the baseline inoculum and each species/exposure combination. The proportion of bacteria adherent to titanium was determined for each experimental condition. Striking titanium adhesion was noted for all evaluated species even when exposure time was limited to 15 seconds. Strategies to limit bacterial adhesion at dental implant surfaces may offer potential for improved treatment outcomes and preservation of peri-implant health. [ABSTRACT FROM AUTHOR]

Introduction: Retained cement following delivery of an implant-supported crown is strongly associated with peri-implant mucositis and peri-implantitis, and screw retention is a strategy for avoiding this problem entirely. In the esthetic zone, screw retention compromises esthetics unless the screw access in the crown is concealed to the palatal of the incisal edge. To avoid positioning the implant platform excessively toward the palate, practitioners can design an angled screw access channel in the crown. Case Presentation: A healthy 22-year-old patient with nonrestorable tooth #9 received extraction and immediate implant placement with immediate provisionalization. The screw access channel for the provisional restoration involved the incisal edge. Rather than placing a custom abutment and cementing the definitive restoration, an angled screw access channel was employed. The implant-supported restoration exhibited favorable esthetics, and the possibility of retained cement was avoided. Conclusion: Up to a point, positioning maxillary anterior implants toward the palate is favorable. When the long axis of the implant is directed between the incisal edge and the cingulum of adjacent teeth, the implantsupported crown can be screw retained without compromising esthetics. In immediate implant situations, such positioning also increases the distance between the implant and the facial alveolar bone and encourages a favorable position of the marginal peri-implant mucosa. However, an excessively palatal platform position compels a restoration with irregular contours, which can frustrate proper oral hygiene and professional maintenance. Angled screw access channels allow screw retention without excessive palatal positioning of the platform, avoiding the possibility of cement-related peri-implant disease. [ABSTRACT FROM AUTHOR]

The article looks at a study regarding the risk of cigarette smoking for periodontitis as bacteria appear necessary for initiation of inflammatory periodontal tissue destruction. Topics discussed include possible effect of smoking on the attendant pathogenic ecosystem, neutrophils exhibit reduced chemotaxis and various other functional abnormalities and surgical treatment of periodontitis tends to cluster within patients who smoke.

Objectives: Emerging therapies designed to improve soft tissue flap survival include the use of angiogenic factors. However, endogenous expression patterns for these factors have not been characterized. The purpose of this study was to identify spatial and temporal variations in expression patterns of angiogenesis-associated genes in ischemic rat skin flaps. Study Design: This is an observational animal study characterizing spatial and temporal angiogenesis associated gene expression patterns in rat ischemic skin flaps. Methods: Dorsal skin flaps were created on 15 male Sprague-Dawley rats. The flap tissue was harvested and sectioned at 1, 3, or 7 days postsurgery. Total RNA was isolated, amplified, labeled with biotin, and hybridized to microarrays containing probes for 113 angiogenesis-associated genes. Microarray analysis revealed unique spatial and temporal patterns with statistically significant gene modulation over the length of the flap (P<.05). Results: The molecular analysis performed in this study correlates with the hemodynamic profile previously published. Expression patterns associated with blood flow were markedly different from patterns associated with stasis and avascularity. Conclusions: To our knowledge, this study is the first to characterize endogenous spatial and temporal angiogenesisassociated gene expression in rat ischemic skin flaps. Further characterization of expression patterns may allow clinicians to differentiate ischemic tissue that may be rescued via pharmacological or surgical intervention from tissue destined to succumb. Additionally, comparison of the expression profiles observed in this study with profiles generated from pharmacologically treated rats may suggest mechanisms for enhanced healing. [ABSTRACT FROM AUTHOR]

elevated sex hormones such as puberty and pregnancy. Possible molecular mechanisms responsible for the appearance of pyogenic granuloma in this demographic have been suggested. Increased incidence of pyogenic granuloma in post menopausal women on hormone replacement therapy has not been reported. A 49-year-old woman with preexisting titanium implant placement in the left posterior mandible presented with complaint of food impaction and slight discomfort associated with the implant. Clinical examination revealed slight soft tissue erythema and edema, but no foreign body could be identified. Subsequently, a nodular gingival lesion associated with the implant developed and was treated by conservative surgical excision. Histologic characteristics of the lesion were consistent with pyogenic granuloma. The patient was informed of the diagnosis. No evidence of recurrence could be identified after 6 months. Like peripubertal and pregnant women, postmenopausal women treated with hormone replacement therapy may be at increased risk for pyogenic granuloma. Observational studies designed to establish an association between hormone replacement therapy and pyogenic granuloma have not been conducted. Dentists should be aware of putative pathophysiologic mechanisms for pyogenic granuloma formation and the possibility that hormone replacement may trigger these mechanisms. [ABSTRACT FROM AUTHOR]