Zeina Majzoub | Lebanese University (original) (raw)

Papers by Zeina Majzoub

Research paper thumbnail of Marginal and internal fit of pressed lithium disilicate inlays fabricated with milling, 3D printing, and conventional technologies

Journal of Prosthetic Dentistry, May 1, 2018

Synthetic lithium disilicate glass-matrix ceramics (IPS e.max) are widely used in the fabrication... more Synthetic lithium disilicate glass-matrix ceramics (IPS e.max) are widely used in the fabrication of tooth-and implant-supported prostheses because of their excellent esthetics and mechanical properties. 1,2 IPS e.max lithium disilicate (Ivoclar Vivadent AG) restorations can be fabricated by using either computer-aideddesigned and computer-aidedmanufactured (CAD-CAM) milling procedures (IPS e.max CAD) or the lost-wax techniques (IPS e.max Press). 3 The patterns used to generate e.max Press restorations are conventionally fabricated with wax shaped by laboratory technicians. Despite the advantages of convenient laboratory manipulation and precise shaping, 4 this approach has inherent drawbacks related to thermal sensitivity and the high coefficient of the thermal expansion of wax. 4 This method is also time-consuming and techniquesensitive. 5,6 Digital dentistry allows fabrication of patterns with more advanced technologies such as subtractive milling/ machining with CAD-CAM systems or additive Ivoclar Vivadent AG provided part of the IPS e.max Press and CAD materials.

Research paper thumbnail of Comparison of fit accuracy of pressed lithium disilicate inlays fabricated from wax or resin patterns with conventional and CAD-CAM technologies

Journal of Prosthetic Dentistry, Oct 1, 2018

STATEMENT OF PROBLEM The use of resin patterns to produce partial coverage restorations is poorly... more STATEMENT OF PROBLEM The use of resin patterns to produce partial coverage restorations is poorly documented. PURPOSE The purpose of this in vitro study was to compare the marginal and internal fit accuracy of lithium disilicate glass-ceramic inlays obtained from wax or resin patterns and fabricated with digital and conventional techniques. MATERIAL AND METHODS A dentoform mandibular first molar was prepared for a mesio-occlusal ceramic inlay. Six groups of 15 inlays were obtained by conventional impression and manual wax (group CICW) or resin patterns (group CICR); conventional impression, laboratory scanning of the stone die, CAD-CAM milled wax (group CIDW), or polymethylmethacrylate (PMMA) blocks (group CIDR); and scanning of the master preparation with an intraoral scanner, CAD-CAM milled wax (group DSDW), or PMMA blocks (DSDR). The same design was applied to produce the wax and PMMA patterns in the last 4 groups. The replica technique was used to measure marginal and internal fit under stereomicroscopy. Mixed-model ANOVA was applied to assess differences according to the techniques, materials, and discrepancy location (=.05). RESULTS The results demonstrated significant effects of the technique (P<.001), material (P=.009), and discrepancy location (P<.001) on fit measurements. Marginal discrepancy was only affected by the technique (P<.001), with the digital approaches yielding the smallest marginal discrepancy (23.5 ±3.6 m), followed by the conventional digital techniques (31.1 ±5.6 m) and finally by the conventional (42.8 ±7.2 m) techniques. Internal fit was significantly influenced only by the material with lower discrepancy in wax (75.2 ±9.0 m) than in resin patterns (84.7 ±15.1 m). The internal discrepancy was significantly larger than the marginal discrepancy in all groups (P<.001). CONCLUSIONS Inlays generated from conventional wax and resin patterns tend to show higher marginal discrepancies than conventional digital and full digital patterns. Wax and resin materials yield similar marginal fit accuracies irrespective of the impression/manufacturing technique. Better internal fit was shown in wax than in resin patterns, regardless of the technique.

Research paper thumbnail of Applicability of the dimodent equation of sex prediction in a Lebanese population sample

The Journal of forensic odonto-stomatology, 2007

Sexual dimorphism represents a group of morphologic characteristics that differentiate a male fro... more Sexual dimorphism represents a group of morphologic characteristics that differentiate a male from a female. Among these dimorphic traits, tooth size has been evaluated in various populations for its interest in anthropologic and forensic applications. Recent studies have shown that dental dimorphism is population-specific and that the most dimorphic tooth is the mandibular canine. In addition to the dimension of single teeth in dimorphic dental assessment, dimorphism has been evaluated, using equation of prediction, applying various dimensions of one or more teeth or indices. The objective of this preliminary study was to evaluate the applicability of the Dimodent predictive equation in sex determination in a sample of Lebanese young individuals. Mesiodistal widths of the mandibular canine and lateral incisor were measured from dental casts of the permanent teeth of 60 Lebanese University dental students (30 males and 30 females), aged 18-25 years. The sex-predictive equation of Fr...

Research paper thumbnail of Effect of patient- and surgery-related factors on supracrestal tissue reestablishment after crown lengthening procedure

Quintessence international, 2019

OBJECTIVES The standard application of a mean value of 2.04 mm for the biologic width has been de... more OBJECTIVES The standard application of a mean value of 2.04 mm for the biologic width has been demonstrated to result in inconsistent amounts of tooth extension following a crown lengthening procedure. Biologic width has been replaced by the supracrestal gingival tissue dimension, which includes the biologic width and sulcular depth. The question whether supracrestal gingival tissue dimension established at tissue maturation following a crown lengthening procedure is not significantly different from the presurgical dimension has not been fully answered. The primary objectives of the present prospective clinical study were to compare the preoperative and the 24-week dimensions of supracrestal gingival tissue following a crown lengthening procedure and assess the alterations in gingival margin position. A secondary objective was to assess selected patient- and surgery-related factors on supracrestal gingival tissue reestablishment. METHOD AND MATERIALS Twenty adult systemically health...

Research paper thumbnail of Fit Accuracy of Pressed and Milled Lithium Disilicate Inlays Fabricated From Conventional Impressions or a Laboratory-Based Digital Workflow

The European journal of prosthodontics and restorative dentistry, 2019

PURPOSE The impact of material on the adaptation of lithium disilicate inlays is poorly documente... more PURPOSE The impact of material on the adaptation of lithium disilicate inlays is poorly documented. This in vitro study aims at comparing the fit accuracy of pressed and milled inlays obtained from conventional impression and laboratory-based computer-aided design and computer-aided manufacturing. MATERIAL AND METHODS A typodont molar was prepared for a mesio-occlusal ceramic inlay. The stone die generated from one conventional impression was scanned once using a laboratory scanner and the same design was used to produce 15 pressed lithium disilicate inlays from milled wax patterns (group CIDW), and 15 inlays from lithium disilicate blanks (group CICAD) with a 5-axis milling machine. Marginal and internal discrepancies were measured using the replica technique. Mixed-model ANOVA was applied to assess differences according to material and gap location at P⟨0.05. RESULTS Material and discrepancy location had a significant effect on fit measurements. Group CIDW showed significantly sma...

Research paper thumbnail of Factors Affecting Implant Stability Quotients at Immediately and Conventionally Loaded Implants in the Posterior Maxilla: A Split‐Mouth Randomized Controlled Trial

Journal of Prosthodontics

PURPOSE To assess primary and secondary stability of variable-thread tapered implants in the post... more PURPOSE To assess primary and secondary stability of variable-thread tapered implants in the posterior maxilla and analyze the impact of various factors on implant stability quotients (ISQs). MATERIALS AND METHODS Twenty six subjects received 3-4 adjacent implants in the maxillary premolar-molar sextants to replace bilateral tooth loss. The implants on one side were immediately loaded with a provisional fixed prosthesis regardless of their primary stability. The contralateral control implants were conventionally loaded. Bone quality was subjectively recorded and primary stability was assessed by means of insertion torque values (ITVs) and ISQs in 4 directions. Secondary stability was measured by ISQ at definitive prosthesis delivery (3 to 3.5 months postoperatively), and 12 months after definitive loading. The impact of measurement direction, loading protocol, time, site-related (bone quality, implant position, crestal buccal bone thickness, apical cortical anchorage), and implant-related (implant dimensions, abutment height) variables on ISQs was assessed. RESULTS For logistic reasons, ISQs were obtained for only 18 patients with 60 test and 60 control implants. Most of the implants (82%) at baseline had their lowest ISQ on the buccal aspect. There were no significant differences between ISQs measured in the buccal and palatal directions, or between ISQs in the mesial and distal directions. The mean of buccal and palatal ISQs was significantly lower than the mean of the 2 interproximal measurements at all evaluation periods. ISQs were not significantly different between the 2 loading groups at any time point. All implants showed a time-dependent increase in ISQs. Baseline ISQ correlated weakly with bone quality and ITV. None of the variables had a significant impact on baseline ISQs, except for implants in second molar sites which showed poorer primary stability than first premolars. CONCLUSION measurement direction and time are the most significant parameters affecting ISQs of variable-thread tapered implants in the posterior maxilla. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Clinical and Patient-Centered Outcomes Following Treatment of Multiple Gingival Recessions Using Acellular Dermal Matrix Allografts

The International journal of periodontics & restorative dentistry

The aim of this case series was to evaluate clinical and patient-centered outcomes when treating ... more The aim of this case series was to evaluate clinical and patient-centered outcomes when treating multiple recessions (Miller Class I, II, and III) affecting five or more teeth in a single procedure using acellular dermal matrix in 18 eligible participants (mean of 7.4 ± 1.7 recessions/patient). Low mean visual analog scale pain scores (0.7 ± 0.8) and analgesic consumption (2.3 ± 2.5 tablets) were reported from days 0 to 6 postoperatively. Mean baseline recession depth was 2.1 ± 1 mm. At 1 year postsurgery, mean percent root coverage was 87.1% ± 18.3%, and complete root coverage was achieved in 61.7% of recessions with statistically significant differences between smokers and nonsmokers.

Research paper thumbnail of Caractéristiques craniofaciales dans le sens sagittal : étude céphalométrique chez de jeunes adultes libanais

International Orthodontics, 2017

Resume Objectifs L’objectif de cette etude etait d’evaluer les caracteristiques cephalometriques ... more Resume Objectifs L’objectif de cette etude etait d’evaluer les caracteristiques cephalometriques sagittales de jeunes adultes libanais et d’apprecier les disparites liees a la difference de sexe. Materiaux et methodes Des cephalogrammes lateraux conventionnels ont ete obtenus sur 117 sujets. Huit valeurs lineaires/angulaires ont ete relevees combinant des parametres sagittaux bases sur les analyses de McNamara et de Steiner. Le test t apparie a ete utilise pour evaluer les differences entre les deux sexes ainsi que les classes squelettiques. Resultats Les hommes ont affiche une longueur maxillaire et mandibulaire plus importante que les femmes. L’ANB etait plus important chez les femmes sans differences significatives des valeurs SNA, ce qui indique que les femmes libanaises ont une tendance plus grande a un profil convexe que leurs compatriotes masculins. Les sujets presentant une Classe III squelettique avaient une tendance a la retrognathie maxillaire plutot qu’a une prognathie mandibulaire. Conclusions Le dimorphisme sexuel est manifeste chez les jeunes adultes libanais en ce qui concerne les dimensions squelettiques lineaires quelle que soit leur classe squelettique. Les determinants squelettiques des malocclusions de Classe III peuvent differer de ceux affectant d’autres groupes de population.

Research paper thumbnail of Re: Tooth morphology following root resection procedures in maxillary first molars

Research paper thumbnail of Insertion Torque of Variable-Thread Tapered Implants in the Posterior Maxilla: A Clinical Study

Journal of Prosthodontics, 2018

PURPOSE Primary stability is a key factor for successful implant osseointegration, especially in ... more PURPOSE Primary stability is a key factor for successful implant osseointegration, especially in poor bone quality and early/immediate loading. In the immediate loading protocol, insertion torque values (ITVs) have been suggested to be the most valid prognostic factor for osseointegration of maxillary implants. The objectives of this study were to: (1) evaluate ITVs achieved by a variable-thread tapered implant in the posterior maxilla; and (2) assess the impact of bone quality, implant dimensions, bicortical anchorage, and implant location on ITVs. MATERIALS AND METHODS Twenty-six adult, systemically healthy patients received 173 variable-thread tapered implants in maxillary premolar and molar healed edentulous sites with a minimum subsinus height of 8 mm. Implant sites were prepared using the bone-quality adjusted drilling sequence according to manufacturer's recommendations. Bone quality was recorded subjectively during drilling based on Misch criteria (D1-D4), and ITVs were measured with a manual torque wrench. Univariate and multivariate analyses were performed at the 0.05 significance level. RESULTS First and second molar sites accounted for 46.8% of all implants. D4 bone was encountered in 61.3% of the sites. Most of the implants were 4.3 mm in diameter (59.5%), and lengths of 11.5 and 13 mm were most commonly used (75.2%). Approximately half of the implants were associated with apical cortical anchorage (51.4%). The overall mean ITV was 44.5 ± 23.0 Ncm, with 65.5 ± 15.6 Ncm, 55.5 ± 19.6 Ncm, and 36.6 ± 21.7 Ncm for D2, D3, and D4 bone, respectively. Bone quality and implant location significantly affected ITVs, while implant dimensions and apical cortical anchorage did not. CONCLUSIONS ITVs of variable-thread implants were significantly influenced by variations in bone quality and implant position in the posterior maxilla. Despite the influence of bone quality on primary stability, the mean ITVs attained with variable-thread tapered implants in poor bone quality were within the recommended range for immediate loading.

Research paper thumbnail of Master cast accuracy in single-tooth implant replacement cases: an in vitro comparison. A technical note

PURPOSE This in vitro study evaluated the accuracy of master casts obtained by using (1) copings ... more PURPOSE This in vitro study evaluated the accuracy of master casts obtained by using (1) copings modified by sandblasting and coating their roughened surfaces with impression adhesive before final impression procedures and (2) gold machined UCLA abutments as impression copings in final impression procedures for single-tooth implant replacement cases. MATERIALS AND METHODS A polymeric resin model with a standard single implant was used to simulate a clinical situation. A group of 20 impressions were made using square impression copings sandblasted to roughen their external surfaces at a supragingival level and then coated with Impregum polyether adhesive; a second group of 20 impressions were made using gold machined UCLA abutments as impression copings. The castable part of the UCLA abutments was secured with resin to the gold machined section of the UCLA abutment to prevent movement of the castable part itself on the gold machined portion during the impression procedures; the casta...

Research paper thumbnail of Evaluation of gold-machined UCLA-type abutments and CAD/CAM titanium abutments with hexagonal external connection and with internal connection

International Journal of Oral & Maxillofacial Implants

The purpose of this study was to assess the precision at the implant interface of gold-machined U... more The purpose of this study was to assess the precision at the implant interface of gold-machined UCLA-type abutments and computer-assisted design and manufacture (CAD/CAM) titanium abutments with both external-hexagonal connection and internal-hexagonal connection. Fifteen gold-machined UCLA-type abutments with external-hexagonal connection, 15 gold-machined UCLA-type abutments with internal-hexagonal connection, 15 CAD/CAM titanium abutments with external-hexagonal connection, and 15 CAD/CAM titanium abutments with internal-hexagonal connection were produced. The rotational freedom of all the abutments was assessed to detect the precision of fit of each abutment on the top of the implant platform. Measurements of rotational freedom were compared among groups. The quantitative differences among groups were assessed using 1-way analysis of variance (alpha = .05). Significant differences relative to rotational freedom were not found among the 4 groups (P > .19). Both types of abutme...

Research paper thumbnail of Canal Straightening Following Overinstrumentation with Three Nickel-Titanium Rotary Instruments

Journal of International Society of Preventive & Community Dentistry, 2018

Aim: The aim of the present in vitro study to compare canal straightening following shaping of cu... more Aim: The aim of the present in vitro study to compare canal straightening following shaping of curved canals with three types of new generation nickel-titanium (NiTi) rotary instruments-ProTaper Next (PTN)®, BT RaCe (BTR)®, and WaveOne Gold (WOG)®- and three different levels of protrusion beyond the major apical foramen. Materials and Methods: Forty-five extracted human maxillary and mandibular molars with at least one curved canal were distributed in three comparable groups of 15 canals each. The canals were instrumented to the major foramen and then overinstrumented with the final file 0.5 mm, 1 mm, and 1.5 mm beyond the foramen using PTN (Group PTN = 15), BTR (Group BTR = 15), and WOG (Group WOG = 15). Standardized pre- and post-instrumentation radiographs of the root canal were obtained for all groups using digital intraoral radiographs coupled with software. Differences in the degree of curvature were regarded as straightening and canal curvature was evaluated based on Schneide...

Research paper thumbnail of An in vitro evaluation of titanium, zirconia, and alumina procera abutments with hexagonal connection

The International journal of oral & maxillofacial implants, 2006

PURPOSE The purpose of this study was to assess the precision at the implant interface of titaniu... more PURPOSE The purpose of this study was to assess the precision at the implant interface of titanium, zirconia, and alumina Procera abutments with a hexagonal connection for single-tooth restorations. MATERIALS AND METHODS Twenty Procera abutments were produced with commercially pure titanium, 20 with zirconia, and 20 with alumina using computer-assisted design and manufacture (CAD/CAM). The rotational freedom of the abutments was assessed to detect the precision of fit of each abutment on the top of the implant hexagon. RESULTS Significant differences relative to rotational freedom were found between groups: the titanium group and the zirconia group did not differ significantly, but both demonstrated significantly smaller mean rotational freedoms than the alumina group (P < .05). Rotational freedom was less than 3 degrees for all abutments. CONCLUSIONS The hexagonal misfit of the Procera abutment on the implant hexagon may be implicated in screw joint loosening. In the present stu...

Research paper thumbnail of Cemented versus screw-retained implant-supported single-tooth crowns: a 4-year prospective clinical study

The International journal of oral & maxillofacial implants, 2004

PURPOSE The purpose of this controlled prospective clinical study was to compare cemented and scr... more PURPOSE The purpose of this controlled prospective clinical study was to compare cemented and screw-retained implant-supported single-tooth crowns followed for 4 years following prosthetic rehabilitation with respect to peri-implant marginal bone levels, peri-implant soft tissue parameters, and prosthetic complications. MATERIALS AND METHODS Twelve consecutive patients were selected from a patient population attending the Implantology Department at the University of Padova. They all presented with single-tooth bilateral edentulous sites in the canine/premolar/molar region with adequate bone width, similar bone height at the implant sites, and an occlusal scheme that allowed for the establishment of identical occlusal cusp/fossa contacts. Each patient received 2 identical implants (1 in each edentulous site). One was randomly selected to be restored with a cemented implant-supported single-tooth crown, and the other was restored with a screw-retained implant-supported single-tooth cr...

Research paper thumbnail of Immediate vs conventional loading of variable-thread tapered implants supporting three- to four-unit fixed partial dentures in the posterior maxilla: 1-year interim results of a split-mouth randomised controlled trial

PURPOSE To compare the outcome of immediately loaded and one-stage conventionally loaded variable... more PURPOSE To compare the outcome of immediately loaded and one-stage conventionally loaded variable-thread tapered implants in the posterior maxilla. MATERIALS AND METHODS This study was designed as a split-mouth randomised controlled trial. Twenty-six patients missing teeth bilaterally in the posterior maxilla received three to four implants in each of the posterior sextants. Bone quality was recorded based on Misch criteria (D1-D4) and insertion torque values were measured using a manual wrench. The implants on one side were immediately loaded with a temporary resin fixed partial denture on definitive multi-unit abutments. The implants in the contralateral side received definitive multi-unit abutments according to the one-stage unloaded protocol. Three to 3.5 months following implant placement, the implants were restored with metal-ceramic fixed prostheses. Outcome measures were implant and prosthesis failure rates, complications, and peri-implant bone level changes at 1 year follow...

Research paper thumbnail of Craniofacial characteristics in the sagittal dimension: A cephalometric study in Lebanese young adults

International Orthodontics, 2017

The purpose of this study was to assess the sagittal cephalometric characteristics of young adult... more The purpose of this study was to assess the sagittal cephalometric characteristics of young adult Lebanese individuals and assess gender-related differences. Conventional lateral cephalograms were obtained from 117 subjects. Eight linear/angular measurements combining sagittal parameters selected form McNamara and Steiner analyses were recorded. Paired t-test was applied to evaluate differences between genders and skeletal classes. Males showed significantly greater maxillary and mandibular length than females. ANB was larger in females with no significant differences in SNA values indicating that Lebanese females tend to have a more convex profile than their male counterparts. Subjects with skeletal Class III tended to have a retrognathic maxilla rather than a prognathic mandible. Sexual dimorphism is evident in young Lebanese adults relative to linear skeletal dimensions regardless of the skeletal class. Skeletal determinants of Class III malocclusions may be different from those of other population groups.

Research paper thumbnail of Local and Systemic Effects of Cyclosporine A on the Severity of Gingival Overgrowth in Post-Transplant Renal Patients

Background: Cyclosporine A (CsA) is a potent immunosuppressant widely used to prevent renal post ... more Background: Cyclosporine A (CsA) is a potent immunosuppressant widely used to prevent renal post transplantation rejection. Gingival overgrowth (GO) is among various side effects of the long-term administration of CsA. Up to 90% of the patients under CsA therapy has been reported to develop CsA-induced GO. Objectives: The aim of the present prospective pilot study is to determine the local and systemic effects of Cyclosporine A (CsA) on the severity of gingival overgrowth and its relationship with periodontal parameters in post-transplant renal patients Methods: Twenty post-transplant renal patients, 12 females and 8 males, presenting gingival overgrowth were selected from Rizk Hospital’s clinic in Beirut. Patient’s CsA plaque levels were evaluated when CsA is administered by syrup and capsules mode. Periodontal parameters including gingival overgrowth, papillary bleeding, plaque and gingival indices were assessed for all patients. Results: Plaque concentration CsA levels, when admi...

Research paper thumbnail of Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: a 7-year retrospective study

PURPOSE Placement of small-diameter implants often provides a solution to space-related problems ... more PURPOSE Placement of small-diameter implants often provides a solution to space-related problems in implant restoration. This 7-year retrospective study presents results from 192 small-diameter implants placed in 165 patients from 1992 to 1996. MATERIALS AND METHODS The dental records of each patient were reviewed. The implants, which were either 2.9 mm or 3.25 mm in diameter, were placed by 2 different surgeons. All prosthetic appliances were fabricated by the same prosthodontist. Ninety-four implants supported single-tooth cemented restorations; the remaining 98 implants supported cemented or screw-retained partial prostheses. RESULTS The total implant survival rate was 95.3%. Four implants were lost at second-stage surgery, and 5 more were lost after loading. DISCUSSION Small-diameter implants demonstrated a survival rate similar to those reported in previous studies of standard-size implants. CONCLUSIONS The results suggest that small-diameter implants can be successfully includ...

Research paper thumbnail of Evaluation of the papillary gingival vasculature in smokers and nonsmokers with chronic periodontitis: A clinical in vivo study

Journal of International Society of Preventive and Community Dentistry

Aim: Cigarette smoking has been recognized as an important risk factor in periodontal diseases. O... more Aim: Cigarette smoking has been recognized as an important risk factor in periodontal diseases. One of the suggested mechanisms behind this association is that nicotine alters the microcirculation and causes vasoconstriction and reduced blood flow through the periodontal tissues. Scarce information is currently available relative to the microvascular alterations associated with smoking and the distribution of capillaries through the various areas of the gingival tissues. The aims of this study were to assess, in human interproximal gingival biopsies, the number and diameter of gingival capillaries in periodontally affected smokers and nonsmokers using the CD34 immunohistochemical staining method. The pattern of distribution of vessels in the different areas of the gingival tissues was also assessed. Materials and Methods: Systemically healthy patients with moderate chronic periodontitis and ranging in age between 30 and 60 years were recruited for the study from the patient population attending the Periodontology Department of the Faculty of Dental Medicine at the Lebanese University of Beirut. The patients were selected to have a group of 10 patients (Group SP) of smokers (&gt;10 cigarettes/day for the last 10 years) and a second group (Group NP) consisting of nonsmoking periodontally affected patients. Three to four weeks following initial preparation, one interproximal gingival biopsy was obtained from each patient. Immunohistochemical staining with CD34 mouse monoclonal antibody was used to identify the endothelial cells of the blood vessels within each sample. Twelve biopsy samples (five in Group NP and seven in Group SP) were chosen for the measurement of the number and diameter of vessels in three regions of the connective tissue of the biopsy under a blinded protocol. Results: In the two groups, the quantitative distribution of small, medium, and large vessels followed a similar trend with the number of small vessels being significantly greater than both medium and large vessels. Small vessels prevailed in the peripheral regions, whereas large vessels were more abundant in the deeper connective tissue areas. The total number of vessels seemed unaffected by chronic cigarette smoking in both groups in the entire biopsy area and in the separate connective tissue regions. Quantitative alteration in the total number of gingival capillaries was not observed in chronic smokers. A redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla was noted as a result of smoking in periodontal patients. Conclusion: The quantitative distribution of small, medium, and large vessels follows a similar trend with the content in small vessels being significantly more important than both medium and large vessels. Smoking and periodontitis result in a redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla compared to nonsmoking periodontal patients. The significance and clinical implications of such rearrangement of vasculature within the gingival tissue need to be further investigated.

Research paper thumbnail of Marginal and internal fit of pressed lithium disilicate inlays fabricated with milling, 3D printing, and conventional technologies

Journal of Prosthetic Dentistry, May 1, 2018

Synthetic lithium disilicate glass-matrix ceramics (IPS e.max) are widely used in the fabrication... more Synthetic lithium disilicate glass-matrix ceramics (IPS e.max) are widely used in the fabrication of tooth-and implant-supported prostheses because of their excellent esthetics and mechanical properties. 1,2 IPS e.max lithium disilicate (Ivoclar Vivadent AG) restorations can be fabricated by using either computer-aideddesigned and computer-aidedmanufactured (CAD-CAM) milling procedures (IPS e.max CAD) or the lost-wax techniques (IPS e.max Press). 3 The patterns used to generate e.max Press restorations are conventionally fabricated with wax shaped by laboratory technicians. Despite the advantages of convenient laboratory manipulation and precise shaping, 4 this approach has inherent drawbacks related to thermal sensitivity and the high coefficient of the thermal expansion of wax. 4 This method is also time-consuming and techniquesensitive. 5,6 Digital dentistry allows fabrication of patterns with more advanced technologies such as subtractive milling/ machining with CAD-CAM systems or additive Ivoclar Vivadent AG provided part of the IPS e.max Press and CAD materials.

Research paper thumbnail of Comparison of fit accuracy of pressed lithium disilicate inlays fabricated from wax or resin patterns with conventional and CAD-CAM technologies

Journal of Prosthetic Dentistry, Oct 1, 2018

STATEMENT OF PROBLEM The use of resin patterns to produce partial coverage restorations is poorly... more STATEMENT OF PROBLEM The use of resin patterns to produce partial coverage restorations is poorly documented. PURPOSE The purpose of this in vitro study was to compare the marginal and internal fit accuracy of lithium disilicate glass-ceramic inlays obtained from wax or resin patterns and fabricated with digital and conventional techniques. MATERIAL AND METHODS A dentoform mandibular first molar was prepared for a mesio-occlusal ceramic inlay. Six groups of 15 inlays were obtained by conventional impression and manual wax (group CICW) or resin patterns (group CICR); conventional impression, laboratory scanning of the stone die, CAD-CAM milled wax (group CIDW), or polymethylmethacrylate (PMMA) blocks (group CIDR); and scanning of the master preparation with an intraoral scanner, CAD-CAM milled wax (group DSDW), or PMMA blocks (DSDR). The same design was applied to produce the wax and PMMA patterns in the last 4 groups. The replica technique was used to measure marginal and internal fit under stereomicroscopy. Mixed-model ANOVA was applied to assess differences according to the techniques, materials, and discrepancy location (=.05). RESULTS The results demonstrated significant effects of the technique (P<.001), material (P=.009), and discrepancy location (P<.001) on fit measurements. Marginal discrepancy was only affected by the technique (P<.001), with the digital approaches yielding the smallest marginal discrepancy (23.5 ±3.6 m), followed by the conventional digital techniques (31.1 ±5.6 m) and finally by the conventional (42.8 ±7.2 m) techniques. Internal fit was significantly influenced only by the material with lower discrepancy in wax (75.2 ±9.0 m) than in resin patterns (84.7 ±15.1 m). The internal discrepancy was significantly larger than the marginal discrepancy in all groups (P<.001). CONCLUSIONS Inlays generated from conventional wax and resin patterns tend to show higher marginal discrepancies than conventional digital and full digital patterns. Wax and resin materials yield similar marginal fit accuracies irrespective of the impression/manufacturing technique. Better internal fit was shown in wax than in resin patterns, regardless of the technique.

Research paper thumbnail of Applicability of the dimodent equation of sex prediction in a Lebanese population sample

The Journal of forensic odonto-stomatology, 2007

Sexual dimorphism represents a group of morphologic characteristics that differentiate a male fro... more Sexual dimorphism represents a group of morphologic characteristics that differentiate a male from a female. Among these dimorphic traits, tooth size has been evaluated in various populations for its interest in anthropologic and forensic applications. Recent studies have shown that dental dimorphism is population-specific and that the most dimorphic tooth is the mandibular canine. In addition to the dimension of single teeth in dimorphic dental assessment, dimorphism has been evaluated, using equation of prediction, applying various dimensions of one or more teeth or indices. The objective of this preliminary study was to evaluate the applicability of the Dimodent predictive equation in sex determination in a sample of Lebanese young individuals. Mesiodistal widths of the mandibular canine and lateral incisor were measured from dental casts of the permanent teeth of 60 Lebanese University dental students (30 males and 30 females), aged 18-25 years. The sex-predictive equation of Fr...

Research paper thumbnail of Effect of patient- and surgery-related factors on supracrestal tissue reestablishment after crown lengthening procedure

Quintessence international, 2019

OBJECTIVES The standard application of a mean value of 2.04 mm for the biologic width has been de... more OBJECTIVES The standard application of a mean value of 2.04 mm for the biologic width has been demonstrated to result in inconsistent amounts of tooth extension following a crown lengthening procedure. Biologic width has been replaced by the supracrestal gingival tissue dimension, which includes the biologic width and sulcular depth. The question whether supracrestal gingival tissue dimension established at tissue maturation following a crown lengthening procedure is not significantly different from the presurgical dimension has not been fully answered. The primary objectives of the present prospective clinical study were to compare the preoperative and the 24-week dimensions of supracrestal gingival tissue following a crown lengthening procedure and assess the alterations in gingival margin position. A secondary objective was to assess selected patient- and surgery-related factors on supracrestal gingival tissue reestablishment. METHOD AND MATERIALS Twenty adult systemically health...

Research paper thumbnail of Fit Accuracy of Pressed and Milled Lithium Disilicate Inlays Fabricated From Conventional Impressions or a Laboratory-Based Digital Workflow

The European journal of prosthodontics and restorative dentistry, 2019

PURPOSE The impact of material on the adaptation of lithium disilicate inlays is poorly documente... more PURPOSE The impact of material on the adaptation of lithium disilicate inlays is poorly documented. This in vitro study aims at comparing the fit accuracy of pressed and milled inlays obtained from conventional impression and laboratory-based computer-aided design and computer-aided manufacturing. MATERIAL AND METHODS A typodont molar was prepared for a mesio-occlusal ceramic inlay. The stone die generated from one conventional impression was scanned once using a laboratory scanner and the same design was used to produce 15 pressed lithium disilicate inlays from milled wax patterns (group CIDW), and 15 inlays from lithium disilicate blanks (group CICAD) with a 5-axis milling machine. Marginal and internal discrepancies were measured using the replica technique. Mixed-model ANOVA was applied to assess differences according to material and gap location at P⟨0.05. RESULTS Material and discrepancy location had a significant effect on fit measurements. Group CIDW showed significantly sma...

Research paper thumbnail of Factors Affecting Implant Stability Quotients at Immediately and Conventionally Loaded Implants in the Posterior Maxilla: A Split‐Mouth Randomized Controlled Trial

Journal of Prosthodontics

PURPOSE To assess primary and secondary stability of variable-thread tapered implants in the post... more PURPOSE To assess primary and secondary stability of variable-thread tapered implants in the posterior maxilla and analyze the impact of various factors on implant stability quotients (ISQs). MATERIALS AND METHODS Twenty six subjects received 3-4 adjacent implants in the maxillary premolar-molar sextants to replace bilateral tooth loss. The implants on one side were immediately loaded with a provisional fixed prosthesis regardless of their primary stability. The contralateral control implants were conventionally loaded. Bone quality was subjectively recorded and primary stability was assessed by means of insertion torque values (ITVs) and ISQs in 4 directions. Secondary stability was measured by ISQ at definitive prosthesis delivery (3 to 3.5 months postoperatively), and 12 months after definitive loading. The impact of measurement direction, loading protocol, time, site-related (bone quality, implant position, crestal buccal bone thickness, apical cortical anchorage), and implant-related (implant dimensions, abutment height) variables on ISQs was assessed. RESULTS For logistic reasons, ISQs were obtained for only 18 patients with 60 test and 60 control implants. Most of the implants (82%) at baseline had their lowest ISQ on the buccal aspect. There were no significant differences between ISQs measured in the buccal and palatal directions, or between ISQs in the mesial and distal directions. The mean of buccal and palatal ISQs was significantly lower than the mean of the 2 interproximal measurements at all evaluation periods. ISQs were not significantly different between the 2 loading groups at any time point. All implants showed a time-dependent increase in ISQs. Baseline ISQ correlated weakly with bone quality and ITV. None of the variables had a significant impact on baseline ISQs, except for implants in second molar sites which showed poorer primary stability than first premolars. CONCLUSION measurement direction and time are the most significant parameters affecting ISQs of variable-thread tapered implants in the posterior maxilla. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Clinical and Patient-Centered Outcomes Following Treatment of Multiple Gingival Recessions Using Acellular Dermal Matrix Allografts

The International journal of periodontics & restorative dentistry

The aim of this case series was to evaluate clinical and patient-centered outcomes when treating ... more The aim of this case series was to evaluate clinical and patient-centered outcomes when treating multiple recessions (Miller Class I, II, and III) affecting five or more teeth in a single procedure using acellular dermal matrix in 18 eligible participants (mean of 7.4 ± 1.7 recessions/patient). Low mean visual analog scale pain scores (0.7 ± 0.8) and analgesic consumption (2.3 ± 2.5 tablets) were reported from days 0 to 6 postoperatively. Mean baseline recession depth was 2.1 ± 1 mm. At 1 year postsurgery, mean percent root coverage was 87.1% ± 18.3%, and complete root coverage was achieved in 61.7% of recessions with statistically significant differences between smokers and nonsmokers.

Research paper thumbnail of Caractéristiques craniofaciales dans le sens sagittal : étude céphalométrique chez de jeunes adultes libanais

International Orthodontics, 2017

Resume Objectifs L’objectif de cette etude etait d’evaluer les caracteristiques cephalometriques ... more Resume Objectifs L’objectif de cette etude etait d’evaluer les caracteristiques cephalometriques sagittales de jeunes adultes libanais et d’apprecier les disparites liees a la difference de sexe. Materiaux et methodes Des cephalogrammes lateraux conventionnels ont ete obtenus sur 117 sujets. Huit valeurs lineaires/angulaires ont ete relevees combinant des parametres sagittaux bases sur les analyses de McNamara et de Steiner. Le test t apparie a ete utilise pour evaluer les differences entre les deux sexes ainsi que les classes squelettiques. Resultats Les hommes ont affiche une longueur maxillaire et mandibulaire plus importante que les femmes. L’ANB etait plus important chez les femmes sans differences significatives des valeurs SNA, ce qui indique que les femmes libanaises ont une tendance plus grande a un profil convexe que leurs compatriotes masculins. Les sujets presentant une Classe III squelettique avaient une tendance a la retrognathie maxillaire plutot qu’a une prognathie mandibulaire. Conclusions Le dimorphisme sexuel est manifeste chez les jeunes adultes libanais en ce qui concerne les dimensions squelettiques lineaires quelle que soit leur classe squelettique. Les determinants squelettiques des malocclusions de Classe III peuvent differer de ceux affectant d’autres groupes de population.

Research paper thumbnail of Re: Tooth morphology following root resection procedures in maxillary first molars

Research paper thumbnail of Insertion Torque of Variable-Thread Tapered Implants in the Posterior Maxilla: A Clinical Study

Journal of Prosthodontics, 2018

PURPOSE Primary stability is a key factor for successful implant osseointegration, especially in ... more PURPOSE Primary stability is a key factor for successful implant osseointegration, especially in poor bone quality and early/immediate loading. In the immediate loading protocol, insertion torque values (ITVs) have been suggested to be the most valid prognostic factor for osseointegration of maxillary implants. The objectives of this study were to: (1) evaluate ITVs achieved by a variable-thread tapered implant in the posterior maxilla; and (2) assess the impact of bone quality, implant dimensions, bicortical anchorage, and implant location on ITVs. MATERIALS AND METHODS Twenty-six adult, systemically healthy patients received 173 variable-thread tapered implants in maxillary premolar and molar healed edentulous sites with a minimum subsinus height of 8 mm. Implant sites were prepared using the bone-quality adjusted drilling sequence according to manufacturer's recommendations. Bone quality was recorded subjectively during drilling based on Misch criteria (D1-D4), and ITVs were measured with a manual torque wrench. Univariate and multivariate analyses were performed at the 0.05 significance level. RESULTS First and second molar sites accounted for 46.8% of all implants. D4 bone was encountered in 61.3% of the sites. Most of the implants were 4.3 mm in diameter (59.5%), and lengths of 11.5 and 13 mm were most commonly used (75.2%). Approximately half of the implants were associated with apical cortical anchorage (51.4%). The overall mean ITV was 44.5 ± 23.0 Ncm, with 65.5 ± 15.6 Ncm, 55.5 ± 19.6 Ncm, and 36.6 ± 21.7 Ncm for D2, D3, and D4 bone, respectively. Bone quality and implant location significantly affected ITVs, while implant dimensions and apical cortical anchorage did not. CONCLUSIONS ITVs of variable-thread implants were significantly influenced by variations in bone quality and implant position in the posterior maxilla. Despite the influence of bone quality on primary stability, the mean ITVs attained with variable-thread tapered implants in poor bone quality were within the recommended range for immediate loading.

Research paper thumbnail of Master cast accuracy in single-tooth implant replacement cases: an in vitro comparison. A technical note

PURPOSE This in vitro study evaluated the accuracy of master casts obtained by using (1) copings ... more PURPOSE This in vitro study evaluated the accuracy of master casts obtained by using (1) copings modified by sandblasting and coating their roughened surfaces with impression adhesive before final impression procedures and (2) gold machined UCLA abutments as impression copings in final impression procedures for single-tooth implant replacement cases. MATERIALS AND METHODS A polymeric resin model with a standard single implant was used to simulate a clinical situation. A group of 20 impressions were made using square impression copings sandblasted to roughen their external surfaces at a supragingival level and then coated with Impregum polyether adhesive; a second group of 20 impressions were made using gold machined UCLA abutments as impression copings. The castable part of the UCLA abutments was secured with resin to the gold machined section of the UCLA abutment to prevent movement of the castable part itself on the gold machined portion during the impression procedures; the casta...

Research paper thumbnail of Evaluation of gold-machined UCLA-type abutments and CAD/CAM titanium abutments with hexagonal external connection and with internal connection

International Journal of Oral & Maxillofacial Implants

The purpose of this study was to assess the precision at the implant interface of gold-machined U... more The purpose of this study was to assess the precision at the implant interface of gold-machined UCLA-type abutments and computer-assisted design and manufacture (CAD/CAM) titanium abutments with both external-hexagonal connection and internal-hexagonal connection. Fifteen gold-machined UCLA-type abutments with external-hexagonal connection, 15 gold-machined UCLA-type abutments with internal-hexagonal connection, 15 CAD/CAM titanium abutments with external-hexagonal connection, and 15 CAD/CAM titanium abutments with internal-hexagonal connection were produced. The rotational freedom of all the abutments was assessed to detect the precision of fit of each abutment on the top of the implant platform. Measurements of rotational freedom were compared among groups. The quantitative differences among groups were assessed using 1-way analysis of variance (alpha = .05). Significant differences relative to rotational freedom were not found among the 4 groups (P > .19). Both types of abutme...

Research paper thumbnail of Canal Straightening Following Overinstrumentation with Three Nickel-Titanium Rotary Instruments

Journal of International Society of Preventive & Community Dentistry, 2018

Aim: The aim of the present in vitro study to compare canal straightening following shaping of cu... more Aim: The aim of the present in vitro study to compare canal straightening following shaping of curved canals with three types of new generation nickel-titanium (NiTi) rotary instruments-ProTaper Next (PTN)®, BT RaCe (BTR)®, and WaveOne Gold (WOG)®- and three different levels of protrusion beyond the major apical foramen. Materials and Methods: Forty-five extracted human maxillary and mandibular molars with at least one curved canal were distributed in three comparable groups of 15 canals each. The canals were instrumented to the major foramen and then overinstrumented with the final file 0.5 mm, 1 mm, and 1.5 mm beyond the foramen using PTN (Group PTN = 15), BTR (Group BTR = 15), and WOG (Group WOG = 15). Standardized pre- and post-instrumentation radiographs of the root canal were obtained for all groups using digital intraoral radiographs coupled with software. Differences in the degree of curvature were regarded as straightening and canal curvature was evaluated based on Schneide...

Research paper thumbnail of An in vitro evaluation of titanium, zirconia, and alumina procera abutments with hexagonal connection

The International journal of oral & maxillofacial implants, 2006

PURPOSE The purpose of this study was to assess the precision at the implant interface of titaniu... more PURPOSE The purpose of this study was to assess the precision at the implant interface of titanium, zirconia, and alumina Procera abutments with a hexagonal connection for single-tooth restorations. MATERIALS AND METHODS Twenty Procera abutments were produced with commercially pure titanium, 20 with zirconia, and 20 with alumina using computer-assisted design and manufacture (CAD/CAM). The rotational freedom of the abutments was assessed to detect the precision of fit of each abutment on the top of the implant hexagon. RESULTS Significant differences relative to rotational freedom were found between groups: the titanium group and the zirconia group did not differ significantly, but both demonstrated significantly smaller mean rotational freedoms than the alumina group (P < .05). Rotational freedom was less than 3 degrees for all abutments. CONCLUSIONS The hexagonal misfit of the Procera abutment on the implant hexagon may be implicated in screw joint loosening. In the present stu...

Research paper thumbnail of Cemented versus screw-retained implant-supported single-tooth crowns: a 4-year prospective clinical study

The International journal of oral & maxillofacial implants, 2004

PURPOSE The purpose of this controlled prospective clinical study was to compare cemented and scr... more PURPOSE The purpose of this controlled prospective clinical study was to compare cemented and screw-retained implant-supported single-tooth crowns followed for 4 years following prosthetic rehabilitation with respect to peri-implant marginal bone levels, peri-implant soft tissue parameters, and prosthetic complications. MATERIALS AND METHODS Twelve consecutive patients were selected from a patient population attending the Implantology Department at the University of Padova. They all presented with single-tooth bilateral edentulous sites in the canine/premolar/molar region with adequate bone width, similar bone height at the implant sites, and an occlusal scheme that allowed for the establishment of identical occlusal cusp/fossa contacts. Each patient received 2 identical implants (1 in each edentulous site). One was randomly selected to be restored with a cemented implant-supported single-tooth crown, and the other was restored with a screw-retained implant-supported single-tooth cr...

Research paper thumbnail of Immediate vs conventional loading of variable-thread tapered implants supporting three- to four-unit fixed partial dentures in the posterior maxilla: 1-year interim results of a split-mouth randomised controlled trial

PURPOSE To compare the outcome of immediately loaded and one-stage conventionally loaded variable... more PURPOSE To compare the outcome of immediately loaded and one-stage conventionally loaded variable-thread tapered implants in the posterior maxilla. MATERIALS AND METHODS This study was designed as a split-mouth randomised controlled trial. Twenty-six patients missing teeth bilaterally in the posterior maxilla received three to four implants in each of the posterior sextants. Bone quality was recorded based on Misch criteria (D1-D4) and insertion torque values were measured using a manual wrench. The implants on one side were immediately loaded with a temporary resin fixed partial denture on definitive multi-unit abutments. The implants in the contralateral side received definitive multi-unit abutments according to the one-stage unloaded protocol. Three to 3.5 months following implant placement, the implants were restored with metal-ceramic fixed prostheses. Outcome measures were implant and prosthesis failure rates, complications, and peri-implant bone level changes at 1 year follow...

Research paper thumbnail of Craniofacial characteristics in the sagittal dimension: A cephalometric study in Lebanese young adults

International Orthodontics, 2017

The purpose of this study was to assess the sagittal cephalometric characteristics of young adult... more The purpose of this study was to assess the sagittal cephalometric characteristics of young adult Lebanese individuals and assess gender-related differences. Conventional lateral cephalograms were obtained from 117 subjects. Eight linear/angular measurements combining sagittal parameters selected form McNamara and Steiner analyses were recorded. Paired t-test was applied to evaluate differences between genders and skeletal classes. Males showed significantly greater maxillary and mandibular length than females. ANB was larger in females with no significant differences in SNA values indicating that Lebanese females tend to have a more convex profile than their male counterparts. Subjects with skeletal Class III tended to have a retrognathic maxilla rather than a prognathic mandible. Sexual dimorphism is evident in young Lebanese adults relative to linear skeletal dimensions regardless of the skeletal class. Skeletal determinants of Class III malocclusions may be different from those of other population groups.

Research paper thumbnail of Local and Systemic Effects of Cyclosporine A on the Severity of Gingival Overgrowth in Post-Transplant Renal Patients

Background: Cyclosporine A (CsA) is a potent immunosuppressant widely used to prevent renal post ... more Background: Cyclosporine A (CsA) is a potent immunosuppressant widely used to prevent renal post transplantation rejection. Gingival overgrowth (GO) is among various side effects of the long-term administration of CsA. Up to 90% of the patients under CsA therapy has been reported to develop CsA-induced GO. Objectives: The aim of the present prospective pilot study is to determine the local and systemic effects of Cyclosporine A (CsA) on the severity of gingival overgrowth and its relationship with periodontal parameters in post-transplant renal patients Methods: Twenty post-transplant renal patients, 12 females and 8 males, presenting gingival overgrowth were selected from Rizk Hospital’s clinic in Beirut. Patient’s CsA plaque levels were evaluated when CsA is administered by syrup and capsules mode. Periodontal parameters including gingival overgrowth, papillary bleeding, plaque and gingival indices were assessed for all patients. Results: Plaque concentration CsA levels, when admi...

Research paper thumbnail of Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: a 7-year retrospective study

PURPOSE Placement of small-diameter implants often provides a solution to space-related problems ... more PURPOSE Placement of small-diameter implants often provides a solution to space-related problems in implant restoration. This 7-year retrospective study presents results from 192 small-diameter implants placed in 165 patients from 1992 to 1996. MATERIALS AND METHODS The dental records of each patient were reviewed. The implants, which were either 2.9 mm or 3.25 mm in diameter, were placed by 2 different surgeons. All prosthetic appliances were fabricated by the same prosthodontist. Ninety-four implants supported single-tooth cemented restorations; the remaining 98 implants supported cemented or screw-retained partial prostheses. RESULTS The total implant survival rate was 95.3%. Four implants were lost at second-stage surgery, and 5 more were lost after loading. DISCUSSION Small-diameter implants demonstrated a survival rate similar to those reported in previous studies of standard-size implants. CONCLUSIONS The results suggest that small-diameter implants can be successfully includ...

Research paper thumbnail of Evaluation of the papillary gingival vasculature in smokers and nonsmokers with chronic periodontitis: A clinical in vivo study

Journal of International Society of Preventive and Community Dentistry

Aim: Cigarette smoking has been recognized as an important risk factor in periodontal diseases. O... more Aim: Cigarette smoking has been recognized as an important risk factor in periodontal diseases. One of the suggested mechanisms behind this association is that nicotine alters the microcirculation and causes vasoconstriction and reduced blood flow through the periodontal tissues. Scarce information is currently available relative to the microvascular alterations associated with smoking and the distribution of capillaries through the various areas of the gingival tissues. The aims of this study were to assess, in human interproximal gingival biopsies, the number and diameter of gingival capillaries in periodontally affected smokers and nonsmokers using the CD34 immunohistochemical staining method. The pattern of distribution of vessels in the different areas of the gingival tissues was also assessed. Materials and Methods: Systemically healthy patients with moderate chronic periodontitis and ranging in age between 30 and 60 years were recruited for the study from the patient population attending the Periodontology Department of the Faculty of Dental Medicine at the Lebanese University of Beirut. The patients were selected to have a group of 10 patients (Group SP) of smokers (&gt;10 cigarettes/day for the last 10 years) and a second group (Group NP) consisting of nonsmoking periodontally affected patients. Three to four weeks following initial preparation, one interproximal gingival biopsy was obtained from each patient. Immunohistochemical staining with CD34 mouse monoclonal antibody was used to identify the endothelial cells of the blood vessels within each sample. Twelve biopsy samples (five in Group NP and seven in Group SP) were chosen for the measurement of the number and diameter of vessels in three regions of the connective tissue of the biopsy under a blinded protocol. Results: In the two groups, the quantitative distribution of small, medium, and large vessels followed a similar trend with the number of small vessels being significantly greater than both medium and large vessels. Small vessels prevailed in the peripheral regions, whereas large vessels were more abundant in the deeper connective tissue areas. The total number of vessels seemed unaffected by chronic cigarette smoking in both groups in the entire biopsy area and in the separate connective tissue regions. Quantitative alteration in the total number of gingival capillaries was not observed in chronic smokers. A redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla was noted as a result of smoking in periodontal patients. Conclusion: The quantitative distribution of small, medium, and large vessels follows a similar trend with the content in small vessels being significantly more important than both medium and large vessels. Smoking and periodontitis result in a redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla compared to nonsmoking periodontal patients. The significance and clinical implications of such rearrangement of vasculature within the gingival tissue need to be further investigated.