Objective: The aim of this study is to assess effect of sub-gingival application of hyaluronic acid (HA) gel .8% adjunctive to non-mechanical debridement in treatment of chronic periodontitis based on clinical scoring and microbiological study. Subjects and Methods: The present study was carried out on 20 patients with chronic periodontitis with at least two quadrants with pocket depth ≥5 mm within the same arch. Split-mouth study design was used where control side received (SRP) only and study side received both (SRP) and subgingival application of high molecular weight 0.8% hyaluronic acid gel in a 3 months follow-up study. After clinical assessment and plaque sample collection all patients received full mouth SRP in both study and control sites at the baseline, 2 nd , 4 th and 6 th weeks. Study sites additionally received 0.8% HMW HA gel sub-gingivally till the depth of pocket, this done once a week starting at the baseline then repeated at weeks 1, 2, 3, 4, 5 and 6 for a total seven applications. Subgingival plaque samples were collected prior to clinical measurements from both study and control sites at the baseline, 6 th and 12 th weeks for PCR examination. Evaluation included clinical and microbiological parameters that recorded at the base line, th 6 th and then in 12 th week. Clinical parameters included: Plaque index (PI), Gingival index(GI), Periodontal probing depths (PPD), Clinical attachment loss (CAL) and clinical attachment regain where, micriobiological assessment included qualitative polymerase chain reaction (PCR) for detection of both provotella intermedia and porphyromonus gingivalis in both sides . Results: In the present study, there were highly significant clinical improvements in all measured clinical
Objective:The aim of this study is to compare between both of strontium ranelate and metallic substitute of hydroxyapatite as grafting materials in the treatment of peri-implant bony defects with immediate placement of dental implant in type I extraction sites within maxillary esthetic zone among clinical and experimental levels. This assessment was based on clinical, radiographic and histological studies. Subjects and Methods: The present study was carried on two types of population among both experimental levels on experimental white albinus rabbits and on clinical level among human patients for replacement of non-restorable maxillaryanterior and/or premolar teeth within esthetic zone by immediate implant. A written informed consent was obtained from all patients before their participation in this study.Patients were classified into two groups: the first one was with five patients with non-restorable maxillary anterior or premolar tooth that was treated by an immediately placed implant in conjunction with metallic substituted hydroxyapatite while the second one was treated by an immediately placed implant in conjunction with strontium ranelate as grafting material.The second sample population of study was carried out among ten male white (newzland) experimental rabbits with average body weight between 2.5 and 3 KG and within suitable environmental conditions in Medical Experimental Research Center (MERC) in faculty of medicine, Mansoura University. All rabbits sample was also divided equally and randomly in two groups with five rabbits within each one by the same criteria as mentioned where the first group was composed of five rabbits that received dental implant within intentionally made defect in tibia by trephine bur in conjunction with metallic substituted hydroxyl apatite as grafting material within gap between implant and defect and the second group was with the same criteria and procedures with strontium ranelategafting material within the defect. Pre-oparative photographs and cone beam computed topography (CBCT) were taken for study sample population. Within clinical patients, immediately paced dental implant have been placed in anterior esthetic zone with bone grafting around dental implant according to each group, Immediate CBCT and implant stability measurements has been taken after surgery followed by six months follow-up period to evaluate marginal bone loss, bone density, papillary esthetic score, implant stability and probing depth around dental implants. While within experimental animals trephine bur was used to intentionally create the bony defect that will simulate defect around immediate dental implant with grafting material around according to each group with six months follow-up to evaluate marginal bone loss, implant stability,bone density and for histological examination around implant within grafted area. All data were collected and statistically analyzed. Results:Generally among both clinical and experimental levels within both of clinical patients and experimental rabbits, metal substituted hydroxyl apatite (MSHAP) showed better results with significant difference than that presented in other group that has received Strontium ranelate (Sr) as a grafting material to fill the bony marginal gap around immediate dental implant during six months follow-up study period. Results presented high difference of significance between two groups in experimental and clinical levels in concern with both implant stability, marginal bone loss and even in bone quality and denisty when measured after six months follow-up. On the other hand there was no significant difference in concern with soft tissue response after six months in relation with peri-implant probing depth and MSHAP showed slight better results than that of Sr in records of papillary esthetic scores among clinical patients. Histological results showed better response of surrounding bony tissues towards MSHAP than that of Sr with more affinity of osteoblasts and osteocytes to the site of the grafted area. Conclusions:Metallic substituted hydroxyl-apatite (MSHAP) with its additive magnetic molecules within hydroxyapatite structure has better bony response from surrounding bony tissues than that provided by Strontium Ranelate (Sr) according to bone filling and preservation with less marginal loss, more affinity of new osteoblasts and mature osteocytes, long term implant stability after grafting and better bone density and quality at the grafted area around immediate dental implants in anterior maxillary area.
To compare in-vivo conventional 4 parallelimplant placement and bar attachment with cantilever supporting complete overdenture with All-on four configuration supporting fixed screw-retained denture in the term of crestal bone loss around implants Materials and methods:Twelve male patients with good health and firm mucosa were selected to participate in this study. Each patient received four implants in the canine and second premolar areas of the mandible. The patients were randomly classified according to posterior implants angulation into two equal groups,Group(A) received four parallel implants in the canine and second premolar areas, bar-clip attachment with cantilever retaining complete overdenture while Group(B) recievedTwo anterior parallel implants in the canine region and two posteriorly 30° tilted implants in the second premolar area supporting fixed screw retained prosthesis. Crestal bone loss around implants was measured for each patient by using cone beam computed tomography (CBCT) and evaluation made at T6 and T12 Results:Therewassignificantdifference during comparing Marginal bone loss at 6 months with that of 12 months at mesial, distal, buccal and palatal bone for Group (A)(P=0.01, 0.025, 0.0001 and 0.007 respectively) and Group (B) (P=0.03, 0.028, 0.007 and 0.001 respectively). Comparing the two groups, there was no statistical difference at 6 months or 12 months. Conclusion: Despite the limitations in this study, it can be denoted than both treatment options provide the same values of marginal bone loss Only the patient desire is still the contributing factor for choosing the type of restoration, if the patient desire fixed prosthesis with reduced extensions then treatment option used for group(B) (fixed detachable prosthesis screwed to four implants with the posterior implants tilted 30° posteriorly) however when access for oral hygiene measures is more important with patients that cant maintain hygiene with fixed prosthesis, then the selection of group (A) will be more appropriate.
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