Objectives: Periostin is an extracellular matrix protein that has a vital role in maintaining periodontal tissue integrity by forming a major part of the extracellular matrix (ECM). However, its role in vivo is yet to be elucidated. Hence this study was designed to assess the relationship between levels of periostin in the periodontium in healthy, diseased and healing humans. Methods: A total of 30 subjects were divided into two groups based on Russel’s Periodontal Disease Index (PDI) – healthy periodontium (group I; healthy) and chronic generalised periodontitis (group II; diseased). Gingival crevicular fluid (GCF) samples were collected using microcapillary pipettes from each participant at baseline, and at 2 weeks and 4 weeks after scaling root planing (SRP)in both groups, and at 2 weeks and 4 weeks after flap surgery in group II. Immunoblot assays were performed using a dot blot technique with appropriate antibodies. Spot densitometry analysis was performed with image analysis software. The correlation between periostin levels and various clinical parameters was analysed at baseline in both groups. Results: We found a mean level of periostin in the healthy group (I) as 423.6 ± 25.67, which was higher than that in the diseased group II (mean 148.07 ± 7.89). GCF levels of periostin correlated highly and positively (and statistically significantly) with PDI scores (p increased to 158.8 ± 10.93 at 2 weeks and to 170.2 ± 12.51 at 4 weeks post-SRP. These values further increased to 182.87 ± 12.41 at 2 weeks and 196.87 ± 19.01 ) at 4 weeks after flap surgery. All results were statistically significant (p Conclusion: These results confirm that periostin is highly expressed in healthy tissues and helps to maintain tissue homeostasis, and ;levels are downregulated during inflammation, as seen in the diseased group. Increasing levels of periostin after periodontal therapy indicate its role in wound healing.

Content With a maxillary sinus recess reaching far into the alveolar process of the maxilla, the maxillary sinus can sometimes be opened when maxillary incisors are extracted. An oro-antral communication is determined by a nose-blowing test or by sounding out of the alveolus with blunt probes. After an inflamed, cystic, or tumorous maxillary sinus illness has been excluded, an oro-antral communication should be closed immediately with plastic surgery within the first 24 hours after extraction to prevent the germ-free maxillary sinus from being contaminated. Plastic covering by plastic surgery using a cheek flap with vestibular stem is demonstrated. After a mucoperiosteal flap with vestibular stem has been formed, the flap is lengthened by slitting the periosteum so that a tension-free sealing of the opened maxillary sinus will be possible without endangering the flap's blood flow at the same time. Outline: - Diagnostics of an oro-antral communication - Exclusion of inflammatory, cystic, or tumorous maxillary sinus illnesses - Cheek flap plastic surgery for plastic covering of an oro-antral communication - Cutting direction for the formation of a mucoperiosteal flap with vestibular stem - De-epithelalization of wound margins - Mobilization of the flap by slitting the periosteum - Periosteal holding stitches for tension -free closure of the oro-antral communication - Stitching technique for saliva-proof wound closure - Demonstration of buccal flap plastic surgery - Demonstration of bridge flap plastic surgery - Demonstration of palatal flap plastic surgery - Postoperative reaction measures

Objectives: Alveolar ridge resorption occurs as a consequence of tooth extraction, and bone grafting materials are recommended to reduce these volume changes. In this study, β-TCP blocks were manufactured from randomly organised β-TCP particles with a luminal structure to investigate the effect of these blocks on alveolar ridge preservation after extraction in cases of buccal bone plate deficiency. Methods: Tunnel β-TCP particles are cylindrical with an outer diameter of 500μm, a length of 1mm and a centre hole with an inside diameter of 300 μm. They were manufactured by gathering and fixing randomly organised particles, with a porosity of about 70%, and were shaped into 5 × 5 × 5mm blocks. Six beagle dogs were used. The first premolar of the maxilla was extracted after the buccal bone plate covering the root surface was removed. The extraction sockets with the buccal bone defect were trimmed to 4 ×4 ×5mm (mesiodistal width × buccopalatal width × depth). Bilateral bone defects were filled with tunnel β-TCP blocks at the test sites, and no graft materials were placed in control sites. After two months of healing, histologic and histometric evaluation in the region of interest (ROI) corresponding to the bone defect size was performed. The width and area of new bone formation was measured in the ROI, including bone marrow, basic multicellular units, woven bone formation, and residual TCP. Statistical analysis was performed using the Student’s t-test (p Results: There was no inflammation or wound dehiscence at either experimental or control sites. The new bone formation and residual ß-TCP ceramics were observed inside the tunnel β-TCP blocks at the test sites. Small amounts of new bone and large amounts of connective tissue were observed at control sites. The buccal width of new bone at the test sites was 3.2 ± 0.5, 3.6 ± 0.4 and 3.4 ± 0.2mm at the coronal, middle and apical positions, respectively. For the control sites, the corresponding widths were 1.2 ± 0.3, 2.0 ± 0.6 and 3.0 ± 0.6mm. The width of newly formed bone was significantly greater in the test group, compared to controls, at the coronal and middle positions. The woven bone at the test sites (62.4 ± 7.9%) was significantly higher than that of the controls (26.8 ± 5.3%). The amount of the bone marrow was 4.1 ± 2.2% at test sites and 16.0 ± 6.9% in controls, whereas the amount of connective tissue was 10.7 ± 5.7% at test sites and 38. 1±6. 2% in controls. In both outcome measures, the control sites were significantly higher than the test sites. In terms of the percentage of BMUs, there was no significant difference between the test and control sites (0.5 ± 0.1% and 0.6 ± 0.1%). Conclusion: We compared extraction alone with the use of tunnel β-TCP blocks for alveolar ridge preservation in extraction sockets with buccal bone defects. This is the first study to evaluate the effectiveness of this novel material on ridge preservation after tooth extraction. Clinical healing was uneventful and the material appears to be safe for use in extraction sockets. Histology revealed statistically significant differences between the two groups. The results suggest that ridge preservation using tunnel β-TCP blocks after extraction with deficient buccal bone was effective after two months, but more time is required for replacement by new bone.