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Dental implants provide a reliable treatment option for completely or partially edentulous patients. In case of a membrane perforation, the gap can be closed using a piece of resorbable collagen membrane or by suturing the Schneiderian membrane using a resorbable suture. The present study shows a new development in this technique, which involves modifying the design of the absorbable membrane and using pins to fix the membrane. This study concluded that the novel design of the collagen membrane and its fixation with the pins led to greater stability of the bone graft and led to subsequent bone gain that enables dental implantation. Still, this technique requires a histological study to determine the nature of the bone formed.

The current review aimed to critically and systematically evaluate the available evidence regarding the effectiveness of periodontally accelerated osteogenic orthodontics (PAOO) in accelerating orthodontic tooth movement and supporting the alveolar bone. Additionally, this review aimed to analyze the untoward effects of this procedure and the patient-reported outcome measures. A comprehensive electronic search was performed on 10 databases in addition to a manual search to retrieve all relevant studies. Randomized controlled trials (RCTs) were only included in this review. The interventional group was the PAOO procedure, whereas the control group was either a non-accelerated traditional fixed orthodontic treatment or an accelerated treatment using any other intervention. The Cochrane risk of bias tool for randomized controlled trials (RoB 2) was employed to estimate the risk of bias in the included studies. The current review included eight RCTs evaluating 175 participants (63 males and 112 females) with a mean age ranging from 18.8 to 29.6 years. Five of them assessed the effectiveness of PAOO versus traditional orthodontic treatment, i.e. without any adjuvant surgical intervention. At the same time, the remaining three studies evaluated the effectiveness of PAOO versus corticotomy-only as an adjunctive procedure. The PAOO accelerated the leveling and alignment stage from 39% to 47% and accelerated the retraction of the upper anterior teeth from 41% to 61% compared to conventional orthodontic treatment. One study only indicated that PAOO reduced treatment time by 30.3% versus a corticotomy-only as an adjunctive procedure. No significant side effects have been reported with the PAOO procedure. The PAOO procedure was effective in accelerating orthodontic movement and tended to increase the thickness of the alveolar bone. But most periodontal outcome measures regarding PAOO application were not comprehensively covered in the included trials.

Background and objective Zoledronic acid (ZA) has been reported to aid with the formation of new bone, inhibit osteoclastic bone resorption, and improve osteoblast proliferation. This split-mouth randomized clinical research aimed to evaluate the effect of the local application of ZA on bone regeneration after the removal of bilateral mandibular third molars. Methods A randomized, split-mouth study involving 12 patients aged 19-35 years requiring extraction of bilaterally mandibular third molars was conducted. The extraction of mandibular third molars on both sides was conducted in one session for all patients. In each participant, a gelatin sponge (Gelfoam) soaked with ZA was randomly applied to one cavity of the extraction socket. A gelatin sponge soaked with normal saline was applied to the opposite cavity; all patients were blinded as to which socket the drug was applied to. The study was conducted over a period of two months. The changes in bone density (BD) in the socket were assessed through cone-beam CT (CBCT) images; two images were taken for each patient at two different time points: immediately after extraction (T0) and after two months (T1). Results BD values in the socket on both sides of extraction increased from T0 to T1. There were statistically significant differences when comparing the amount of change in radiographic BD from T0 to T1 between the two sides of the extraction (p<0.05); the increase in radial BD between the two different time points was more significant in the ZA group. Conclusions Within the limitation of this study, the local application of ZA radiographically improved bone healing in a statistically significant manner and could be a cost-effective and simple way to activate bone regeneration.

Dental implants provide a reliable treatment option for completely or partially edentulous patients. In case of a membrane perforation, the gap can be closed using a piece of resorbable collagen membrane or by suturing the Schneiderian membrane using a resorbable suture. The present study shows a new development in this technique, which involves modifying the design of the absorbable membrane and using pins to fix the membrane. This study concluded that the novel design of the collagen membrane and its fixation with the pins led to greater stability of the bone graft and led to subsequent bone gain that enables dental implantation. Still, this technique requires a histological study to determine the nature of the bone formed.

IntroductionCystic lesions of the jaws and the impacted teeth are two of the most common cases that require surgical intervention in oral and maxillofacial surgery; however, surgeons also frequently use a traditional technique that involves the removal of the buccal bone plate. This study was conducted to compare the clinical and radiologic outcomes of the bone lid technique and the traditional technique.MethodsThis randomized controlled trial included 20 patients who were randomly divided into two groups (n = 10 each): the T group, in which the lesions were accessed using the traditional technique with classical rotating instruments, and the BL group, in which the lesions were accessed with the bone lid technique performed using a piezoelectric device, with repositioning of the buccal bone plate. Operative time, pain, edema, inferior alveolar nerve injury, and bone defect healing were measured during clinical and radiological follow-ups at 24 h, 72 h, one week, one month, and six months after the surgery.ResultsNormal soft tissue and bone healing were observed in all cases except one case in the BL group. The T group had a shorter mean operative time than the BL group. In terms of pain, edema, and inferior alveolar nerve injury, the groups did not differ statistically significantly. The percentage of bone defect healing was significantly greater in the BL group than in the T group after six months of follow-up.ConclusionThe bone lid technique performed using a piezoelectric device was effective and safe for managing lesions in the posterior mandibular region and was not associated with increased postoperative complications. The disadvantages of this technique include a longer operative time and the need for fixation tools in some cases. In contrast, this technique outperforms the traditional technique in terms of reducing bone loss and improving the healing of bone defects.

Background No study has evaluated the diagnostic accuracy of cone-beam computed tomography (CBCT) imaging in detecting bone defects in orthodontic patients with Class I malocclusions. This study aimed to evaluate the accuracy of CBCT in detecting dehiscences and fenestrations before orthodontic treatment compared to the gold standard i.e., the actual clinical detection of bone defects on surgical exposure. Methods A validation study was undertaken at the Department of Orthodontics, University of Damascus between 29 August 2018 and 1 November 2020. The sample included 16 patients who had Class I malocclusion with moderate crowding on the lower anterior teeth. Results The proportion of dehiscence diagnosed on CBCT images was approximately two-and-a-half times greater than that found on direct examination i.e., 42.7% versus 17.7%, respectively. The proportion of fenestrations was almost three times greater when diagnosed on CBCT images compared to the gold standard i.e., 39.5% versus 13.5%, respectively. The sensitivity of CBCT imaging in detecting dehiscence and fenestration was 100%. The specificity of CBCT imaging ranged from 45.5% to 86.7% and from 50% to 86.7% for dehiscence and fenestration detection, respectively. Also, the diagnostic accuracy of CBCT imaging ranged from 44% to 87.5% and from 56% to 87.5% for dehiscence and fenestration detection, respectively. Conclusions The proportion of dehiscence diagnosed on CBCT images was approximately two-and-a-half times greater than that found on direct examination, and the proportion of fenestrations was almost three times greater when diagnosed on CBCT images compared to the gold standard. The CBCT overestimates the dimensions of the linear measurements compared to those measured by the gold standard.

Introduction Botulinum toxin (Botox®) is considered an effective treatment for nocturnal bruxism when injected into the masseter muscle. Several studies have used different dosages of Botox for this purpose. The objective was to determine whether 10 MU of botulinum toxin type A (BTXA) injections into the masseter muscle could lessen nocturnal bruxism. Material and methods The sample consisted of 22 patients who suffered from pain in the masseter muscle and sensitivity of the teeth as a result of its wear due to nocturnal bruxism. The sample was randomly divided into two groups. The Botox (BO) group included 11 patients injected with 10 MU of BTXA, and the placebo (PL) group included 11 patients who received a sham intervention. Pain perception was assessed on visual analogue scales, whereas muscle activity was recorded by electromyography (EMG) to evaluate the effectiveness of this treatment protocol on nocturnal bruxism. Results A total of 20 patients entered data analysis with one dropout from each group. The differences in the perceived pain values between the BO and the PL groups before and after the injection were statistically significant (p<0.05). In the BO group, the changes in the perceived pain values over time were statistically significant (p<0.05). The pain levels significantly decreased at two weeks, one month, and three months following the injection. However, the levels increased again at the fourth- and sixth-month assessment times with statistically significant differences (p>0.05). The differences in the EMG recorded values were statistically significant between the two groups (p<0.05). Conclusions Within the current study's limitations, injecting 10 MU of BTXA into the masseter muscle reduced muscular activity in this muscle, resulting in decreased muscle spasms and pain symptoms associated with nocturnal bruxism for about three months before symptoms gradually relapsed.

IntroductionThe pain and discomfort associated with orthodontic treatment are considered undesirable complications which may negatively affect the patient’s cooperation and reduce the efficiency of orthodontic treatment. This trial aimed to assess patient-centered outcomes in the treatment of class I malocclusion with severe crowding using self-ligating brackets (SLBs) with or without an acceleration procedure (piezocision) compared to the traditional brackets (TBs) in a three-arm trial.Materials and MethodsSixty-six patients (51 females, 15 males; mean age ± SD: 20.08 ± 2.61 years) attending the Department of Orthodontics, the University of Damascus, Damascus (Syria) from April 2019 to October 2020 participated in this study. The patients were randomly allocated to three groups: the TBs s group (n = 22; mean age ± SD: 18.72 ± 2.42), the SLBs group (n = 22; mean age ± SD: 20.48 ± 2.84), and the SLBs with the piezocision group (SLBs+P; n = 22; mean age ± SD: 19.17 ± 2.59). Patient-centered outcomes were assessed using two standardized questionnaires depending on visual analog scales (VAS) for the majority of the questions and a binary scale (Yes/No) for the last two questions in the second questionnaire. The levels of pain, discomfort, swelling, difficulties with mastication, swallowing, and jaw movement restriction were measured at five assessment times: one day (T1), 3 days (T2), 7 days (T3), 14 days (T4), and 28 days (T5) after the beginning of treatment. The satisfaction levels, acceptance to undergo the applied treatment again, and willingness to advise a friend to receive similar treatment were measured at the last assessment time (T5). One-way ANOVA test or its alternative nonparametric test (i.e., Kruskal-Wallis test) was utilized to compare the three groups.ResultsThere were statistically significant differences between the three groups regarding pain, discomfort, swelling, difficulties with mastication, problems with swallowing, and jaw movement restriction during the first three assessment times only (T1, T2, and T3; P < 0.001). The differences were mainly between the SLBs+P group and the other two groups, where the mean values were greater in the SLBs+P group. Otherwise, there were no significant statistical differences between the SLBs and the TBs groups. Concerning patients’ satisfaction with the provided treatment, a statistically significant difference between the three groups was detected after 28 days (T5; P < 0.001). The SLBs+P group showed the lowest mean values, whereas there were no significant differences between the two other groups.ConclusionThe levels of pain and discomfort, swelling, difficulties in mastication and swallowing, and restriction of jaw movement were greater in SLBs with the piezocision group compared to the sole use of SLBs or TBs in the first week only. The patients showed a high level of satisfaction with the applied therapeutic procedures, which means that SLBs alone or in combination with piezocision can be an accepted treatment modality by patients in the acceleration of orthodontic tooth movement.

Introduction Dental crowding is one of the most common types of malocclusions. It can be treated with or without extraction, depending on the severity of the crowding. Extraction-based orthodontic treatments are the preferred treatment option in cases of severe crowding, but they take longer than non-extraction cases. Objective This study aimed to evaluate the dentoalveolar changes following the orthodontic treatment of severely crowded maxillary anterior teeth in adults using self-ligating brackets alone or combined with flapless piezocision. Materials and methods The participants in this study were 63 patients (46 females and 17 males; mean age SD: 19.71 ± 2.74 years) who attended the Department of Orthodontics at the University of Damascus from January 2020 to December 2021. The participants were divided into three groups at random: Group (1): traditional brackets group, Group (2): self-ligating brackets group; and Group (3): self-ligating brackets with flapless piezocision group. Little's Irregularity Index (LII) was measured at five assessment times: before the onset of orthodontic treatment (T0), after one month (T1), after two months (T2), after three months (T3), and at the end of the leveling and alignment phase (T4). The intercanine width (lingual), the intercanine width (cusp), and the canine rotation angle were measured at two assessment times: before the onset of orthodontic treatment (T0) and at the end of the leveling and alignment phase (T4). Results The three studied groups had statistically significant differences in terms of LII during the first three months, and the most significant improvement of LII was in the self-ligating brackets with the piezocision group (P < 0.001). In addition, the intercanine width (cusp) at the end of the leveling and aligning phase revealed greater mean values in both self-ligating brackets groups compared to the traditional brackets group, and the differences were statistically significant (P < 0.001). Otherwise, no statistically significant differences were found at the end of the leveling and aligning phase in the intercanine width (lingual) or the canine rotation angle between the three studied groups (P > 0.05). Conclusion Using self-ligating brackets with flapless piezocision revealed more significant results concerning LII as compared to other groups. Thus, combining these two acceleration methods could get more effective results in aligning severely crowded teeth. Self-ligating brackets, whether used alone or with flapless piezocision, resulted in greater intercanine width at the cusp level. The type of brackets (traditional or self-ligating) did not affect the canine rotation angle.

Dental implants provide a reliable treatment option for completely or partially edentulous patients. In case of a membrane perforation, the gap can be closed using a piece of resorbable collagen membrane or by suturing the Schneiderian membrane using a resorbable suture. The present study shows a new development in this technique, which involves modifying the design of the absorbable membrane and using bins to fix the membrane. This study concluded that the novel design of the collagen membrane and its fixation with the bins led to greater stability of the bone graft and led to subsequent bone gain that enables dental implantation. Still, this technique requires a histological study to determine the nature of the bone formed.