Anuj Singh Parihar
@peoplesuniversity.edu.in
Reader, Dept. of Periodontics
People's Dental Academy
Dr. Anuj S. Parihar is a Specialist in Periodontology, Certified and Proficient in Dental Implantology. He consults at various dental care centres in Bhopal Area, India. He is active in clinical research related to bone and soft tissue augmentation, as well as novel techniques in Implant and Periodontal Therapy. Dr. Parihar has published more than 50 scientific papers and books in the fields of Periodontology.
Dr Anuj S. Parihar's Pubmed Bibliography:
RESEARCH INTERESTS
Dental Implants, Periodontal Regeneration, Periodontal Microbiology
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Abhigyan Manas, Munaz Mulla, Shubhi Grover, Mirna Garhnayak, Mushir Mulla, and Anuj Singh Parihar
Medknow
ABSTRACT Objectives: To examine the impact of bisphosphonates (BPs) on dental implant treatment and alveolar bone in post-menopausal ladies Materials and Methods: Twenty post-menopausal ladies who had at least one dental implant within the previous 5 years participated in the current study. Ten subjects were categorized into two groups: Group A had BP medication for 1.5 years, and group B received parathyroid hormone (PTH). Both groups’ bone thickness and bone mineral density (BMD) were measured. Result: Group A had 5%, and group B had 5% of dental implants failures. BMD of cortical bone was 1468 ± 136 mg/mL and 1008 ± 84 mg/mL in groups A and B, correspondingly. The cortical and cancellous bone densities in both the groups were statically significant. Cortical bone thickness was insignificant in comparison Conclusion: Both cortical and cancellous bones’ bone mineral density decreased in both groups. With continued usage of BPs, the cortical bone thickness increased.
Abdullah Saeed Algethmi, Koduru Ranga Roy Chowdary, Hosain Mohammed Hosain Almansour, Angurbala Dhal, Nubesh Khan, Anuj Singh Parihar, and Naveen Reddy
Medknow
ABSTRACT Objectives: To evaluate the loss of crestal bone height around dental implants placed in various tissue biotypes Materials and Methods: 20 patients with single edentulous sites were allocated randomly, with 10 samples in each into Group I (implants were placed in thick tissue biotype) and Group II (implants were placed in thin tissue biotype). Baseline cone-beam computed tomography (CBCT) was performed after implant placement in both groups, and follow-up CBCT was taken at the time of cementation prior to occlusal loading to assess the crestal bone loss around the mesial and distal side of implants in both groups. Result: A significant loss of crestal bone at both the distal and mesial sides of the implants at the time of cementation was observed in both groups but Group II showed more crestal bone loss as compared to Group I Conclusion: Mean crestal bone loss was more in Group II (thin tissue biotype) in comparison to Group I (thick tissue biotype). The thick biotype causes less crestal bone changes than the thin biotype, which evokes more loss of crestal bone during the period of peri-implant healing.
Anuj Singh Parihar, Reghunathan S Preethanath, Nubesh Khan, Abhijita Mohapatra, Arunima Padmakumar Reshma, Pavithra Rangarajan Seshadri, and Minal Vaibhav Awinashe
Medknow
ABSTRACT Objectives: To assess the function of platelet-rich plasma (PRP) both only and in combination with bioactive glass in intrabony defects. Materials and Method: Twenty patients were split into two groups with 10 samples each: group I with PRP alone, whereas group II was done with PRP in addition to bioactive glass. Following local anesthesia, full-thickness mucoperiosteal flaps were elevated in the afflicted site, the defect was debrided, and root planning with curettes was performed. Irrigation was then used while in group II- PRP along with bone graft (BG) preservationwas done. Suturing in group I was contained. At day 0 (baseline) and 6 months after surgery, the clinical parameters for probing depth, clinical attachment stage, and radiographic assessment were noted for both groups. Result: When comparing both groups, there was no statistically considerable variation. However, the intragroup comparison for pocket depth and clinical attachment level between baseline and 6 months was significant. Radiographic bone level was not considerably dissimilar across groups; however, it was significantly different between groups Conclusion: Reduced probing depth, higher clinical attachment level, and radiographic evidence of bone fill are clinical outcome measures that are associated with effective regenerative therapy.
K. C. Vinaya, Vaibhav Awinashe, Dipak Baliram Patil, Prashant Babaji, Nazargi Mahabob, B Kaushik Shetty, and Anuj Singh Parihar
Medknow
ABSTRACT Objectives: The current research was conducted to evaluate the use of a diode laser and a bone graft (hydroxyapatite [HA] + β-tricalcium phosphate [β-TCP]) in healing of intrabony defects. Materials and Methods: In this split-mouth evaluation, 40 patients with bilateral intrabony defects were treated with, Group I (control) - bone graft alone (HA + β-TCP) and Group II, (test) - bone graft with a diode laser. The clinical and radiologic parameters of all patients, such as plaque index (PI), probing depth (PD), gingival index (GI), gingival recession (GR), and relative clinical attachment level (RCAL) were recorded at baseline, after 3 months and after 6 months. Results: Reductions in PI, PD, GI, GR, and RCAL were found after 6 months. Furthermore, significant differences were displayed in the intra-group comparison while those of the inter-group evaluation (P > 0.05) were insignificant. Conclusion: In both groups, considerable decrease in intrabony pockets was discovered; however, the inter-group comparison was insignificant in relation to GR and RCAL.
Arundhati Singh, Shreedevi Bhoi, Pravin M Parmar, TS Deepak, Abdullah Khalid Almutairi, Anuj Singh Parihar, and Vardharajula Venkata Ramaiah
Medknow
ABSTRACT Objectives: This research was done to assess how much bone is lost around dental implants in smokers. Material and Method: There were 80 participants total in the study, 40 of whom were smokers (Group I) and 40 of who were non-smokers (Group II). By evaluating the patients’ clinical and radiographic data, the marginal bone-level measurements were determined. The acquired information underwent statistical analysis. Results: Smokers were found to have worse overall clinical parameters than non-smokers (P 0.05). Smokers experience more marginal bone loss around implants than non-smokers do. Conclusion: Smoking has a negative impact on the outcome rate of dental implants.
Soumyadev Satpathy, Jyothi Gupta, Pavan Tenglikar, Rosaish Kanapathy, Dipanshu Shah, Anuj Singh Parihar, and Vardharajula Venkata Ramaiah
Medknow
ABSTRACT Objective: The current study looked at how well bone graft (hydroxyapatite + platelet-rich plasma (PRP)) and a diode laser treated infrabony defects. Materials and Method: Twenty patients with bilateral infrabony deficiency were treated in a split-moth evaluation with bone graft (hydroxyapatite + PRP) alone (group I) (control) and bone graft combined with a diode laser (group II) (test). Clinical and radiologic measures such as the relative clinical attachment level (RCAL), probing depth (PD), gingival index (GI), and plaque index (PI) were recorded at baseline, 3 months later, and 6 months later in all patients. Result: At the 6-month follow-up, there was a decline in the plaque index, probing depth, gingival index, and relative clinical attachment level. Conclusion: When compared across groups, the intrabony pocket was significantly reduced with either the bone graft (hydroxyapatite + PRP) or in conjunction with the laser.
G Kavitha, Subhash Sonkesriya, K Anil Kumar, Faris Jaser Almutairi, Pravin M Parmar, Anuj Singh Parihar, and Tanu Priya Sonkar
Medknow
ABSTRACT Objectives: To assess the outcome of implant diameter and length on THE distribution of stress using a three-dimensional (3D) finite elements (FE) analysis, with immediate loading implants. Materials and Methods: This study made use of a 3D FE model of an implant encased in a chunk of bone. The LEADER/ITALIA-Fix type implant was created specifically for immediate loading. To create a solid model of the implant and bone and to carry out the FE analysis, the ANSYS V.12 programme was used. Results: The findings indicated that the neck of dental implants is the area of highest stress for all implant diameters and lengths, with an increase in implant length from 10 mm to 12 mm resulting in a slight raise in stress at the interface of implant-bone, and an increase in diameter from 3.75 mm to 4.25 mm having no appreciable impact on the value of stresses around dental implants. Conclusion: It was concluded that an increase in length has a negative effect on stress, while a diameter increase has no discernible impact on stress values.
S. C. Bidyasagar Bal, V. Awinashe, P. Jindal, A. Khader, F. Almutairi, A. Parihar and Vardarajula Ramaiah
Objectives: The goal of the current research was to compare the failure rate of dental implants in medically compromised patients to healthy individuals. Materials and Methods: In this seven years retrospective study, 50 patients from Group A who were medically compromised had 63 implants, while 50 patients from Group B who were healthy had 67 implants. Over 1 mm of bone loss around the implant in the first year and over 0.2 mm of bone loss per year after that were considered failure rates. Result: Two (2.9%) of the dental implants in Group B and 18 (28.6%) in Group A, both failed. The average bone loss around the implant in Group A during the first year was 1.21 mm, compared to 0.3 mm in Group B. Conclusion: Uncontrolled diabetes mellitus group had greater implant failure.
Nidhi Singh, Subhash Sonkesriya, Shivanand B Bagewadi, Sana Anwar, Sajith Abraham, Anuj Singh Parihar, and Azhar Mohammed
Medknow
ABSTRACT Objectives: The current research was done to assess the bone quality at implant site using CBCT. Materials and Methods: The present study was conducted on 50 partially edentulous patients of both genders. All subjects had their chests scanned using a Kodac machine set to 120 kVp, 12 mA, and a 17-second exposure time. Using Hounsfield units, bone quality was classified as D1, D2, D3, D4, and D5 (HU). Result: Out of 50 patients, 27 were males and 23 were females. The average HU was 786.1 at the anterior maxilla, 1174.3 at the anterior mandible, 332.1 at the posterior maxilla, and 742.4 at the posterior mandible. The variation was considerable (P-0.01). Conclusion: The anterior mandible, anterior maxilla, posterior mandible, and posterior maxilla were found to have the highest densities. Based on Hounsfield units, CBCT is helpful in determining the bone density at the implant site.
Anjaneyulu Gasthi, Udayagiri Madhusudhana Rao, Naji Alharethi, Vaibhav Awinashe, Arshad Jamal Sayed, Anuj Singh Parihar, and Abhigyan Manas
Medknow
ABSTRACT The study evaluated the implant bone loss and stability of implant changes with diverse designs with early placement at eight weeks and eight months’ time. The subjects for the current study had partial tooth loss in the posterior mandibular arch. A total of 30 samples were split into two groups of 15, one with a flared crest module and a buttress thread design, the other with a parallel crest module and a V-shaped thread design. Ostell assessed each subject’s implant stability four times, at baseline, eight weeks, four months, and eight months. At intervals of eight weeks, four months, and eight months, intraoral periapical radiographs were examined using ImageJ software to measure crestal bone loss. When Group I and Group II’s implant stability quotient (ISQ) values at baseline, eight weeks, four months, and eight months were compared; Group I’s ISQ values at each of the four measured time periods were statistically significant. At eight weeks in Group I, the ISQ value was very considerable. At eight weeks, four months, and eight months, there was a statistically significant bone loss in Group II in comparison to Group I. At eight months, Group II’s bone loss value was very considerable. In contrast to Group II implant designs, it was found that Group I implants demonstrated enhanced implant-less bone loss and stability.
AnujSingh Parihar, PradyumnaKumar Sahoo, Vaibhav Awinashe, Yashika Bali, Nitika Gupta, KyatsandraNarasimhaiah Jagadeesh, and Prashant Babaji
Medknow
Objectives: The bone quantity and quality determine the prosthetic success outcome. This research was performed to evaluate the bone density for insertion of pterygoid implants in edentulous and dentulous participants with cone-beam computed tomography (CBCT). Materials and Methods: CBCT evaluation was done for 66 dentate and edentulous patients for pterygoid implants at the pterygomaxillary region. The calculation of joint width, height, and volume of bone was done. Density of the bone was evaluated at the superior and inferior aspects of the pterygomaxillary column. Results: It was observed that average pterygomaxillary joint height for dentulous (dentate) was −12.7 ± 7.2 mm, edentulous −12.4 ± 7.1 mm, the average pterygomaxillary joint width for dentulous was 8.15 ± 7.3 mm, and 8.13 ± 6.2 mm for edentulous. The average pterygomaxillary joint volume in dentulous participants was 279.4 ± 189.2 mm3 and for edentulous was 254.5 ± 176.4 mm3. There was expressively greater density of the bone in dentulous participants over edentulous participants (P < 0.05). Conclusion: There was better bone density found in dentate participants in comparison to edentulous participants. CBCT is a recent investigative device which measures pterygoid area efficiently. Pterygoid implants may be deliberated as an alternative method for resorbed (atrophic) maxilla.
A. Parihar, S. Narang, S. Dwivedi, A. Narang and S. Soni
Predictable esthetic root coverage has evolved into conventional treatment modalities making cosmetic procedures an integral part of periodontal treatment. The advent of second-generation platelet concentrates, i.e., platelet-rich fibrin (PRF), has broad clinical application in medical as well as dental field with its recent use for recession defects. The simplicity of PRF procurement and its low cost makes it most suitable for use in daily clinical practice. This particular case report foregrounds the benefit of PRF membrane along with coronally repositioned flap for mucogingival surgery on the labial surface of an upper anterior tooth.
AnujSingh Parihar, Sachin Bhagat, Parthivi Singh, Gurpreet Kaur, Harsh Takkar, and Rathi Rela
Medknow
Aim: The primary purpose of the study was to evaluate the levels of oxidative stress in plasma in patients with aggressive periodontitis (AgP) before and after full-mouth disinfection. Materials and Methods: Twenty-five healthy controls and 25 participants with aggressive periodontal were assessed for plaque index, probing pocket depth, papillary bleeding index, and clinical attachment level. Periodontal bone support was assessed by taking full mouth periapical radiographs. Full-mouth disinfection of the patient was done within 24 h of clinical assessment of AgP. These parameters were assessed at the baseline and after 8 weeks of initial periodontal therapy. Plasma samples were taken and evaluated for various oxidative stress markers. Results: Strong positive correlation was observed among periodontal parameters and levels of enzymatic/nonenzymatic biomarkers for oxidative stress (thiobarbituric acid-reactive substances [TBARS], glutathione peroxidase [GPX], and catalase [CAT]) (P < 0.05), before and after periodontal management. The patients with AgP had high levels of TBARS, GPX, and CAT levels in the plasma matched to the healthy individuals (P < 0.05). Conclusion: Enzymatic and nonenzymatic oxidative stress may have a role in the pathogenesis AP. Initial periodontal treatment can lead to the reduction of these stresses.
Kunal Kumar, Jasvinder Kaur, Randhir Kumar, Anuj Singh Parihar, Kyatsandra N Jagadeesh, and Sudhanshu Kumar
Jaypee Brothers Medical Publishing
AIM AND OBJECTIVE
The aim of this study was to determine the stability of immediate-loaded single implants with periotest.
MATERIALS AND METHODS
In this in vivo study, dental implants with a length ranging from 10 to 13 mm and diameter of 3.0-4.2 mm were utilized. Stability of dental implant was evaluated using the Periotest® M handheld device before loading, at 1 month, 3 months, 6 months, and 1 year.
RESULTS
Implants 11.5 mm in length had the highest mean periotest value (0) after placement, whereas 10 mm-long implant had a value of -0.31 and 13 mm had a value of -0.48. After 1 month, 10 mm had a value of 1.23, 11.5 mm had a value of -0.32, and 13.0 mm had a value of -0.24. After 6 months, 10 mm had a value of 1.78, 11.5 mm had a value of -0.4, and 13.0 mm had a value of -0.41. After 1 year, 10 mm had a value of -0.54, 11.5 mm had a value of -0.51, and 13.0 mm had a value of -0.48. There was an unconstructive relationship between implant length and the average periotest score. There was also an unconstructive association between the implant diameter and the mean periotest value.
CONCLUSION
The implant with long and greatest diameter had higher stability. Periotest can be used to determine dental implant stability.
CLINICAL SIGNIFICANCE
Periotest is useful in determining dental implant stability. Large-scale studies may be helpful in obtaining useful results.
AnujSingh Parihar, Prince Jain, Aditi Ved, Rajat Dubey, Neha Singh, and Rochira Maytreyee
Medknow
Background: Tumor necrosis factor-alpha (TNF-α), a ” major inflammatory cytokine,” not only plays an important role in periodontal destruction but also is extremely toxic to the host. Till date, there are not many studies comparing the levels of TNF-α in serum and its relationship to periodontal disease. Aim: Our study aimed to compare the serum TNF-α among the two study groups, namely, healthy controls and chronic periodontitis patients and establish a correlation between serum TNF-α and various clinical parameters. Hence, an attempt is made to estimate the level of TNF-α in serum, its relationship to periodontal disease and to explore the possibility of using the level of TNF-α in serum as a biochemical ” marker” of periodontal disease. Materials and Methods: Forty individuals participated in the study and were grouped into two subgroups. Group A – 20 systemically and periodontally healthy controls. Group B – twenty patients with generalized chronic periodontitis. The serum samples were assayed for TNF-α levels by enzyme-linked immunosorbent assay method. Results: The mean serum TNF-α cytokines for Group B Generalized chronic periodontitis (GCP) was 2.977 ± 1.011, and Group A (healthy) was 0.867 ± 0.865. The range of serum TNF-α was from (0.867 to 2.977). Serum TNF-α cytokines had highly significant correlation with all clinical parameters (plaque index, probing pocket depth, clinical attachment loss, and gingival index) among all study participants (P = 0.001). Conclusion: These observations suggest a positive association between periodontal disease and increased levels of TNF-α in serum. It can be concluded that there is a prospect of using the estimation of TNF-α in serum as a ” marker” of periodontal disease in future. However, it remains a possibility that the absence or low levels of TNF-α in serum might indicate a stable lesion and elevated levels might indicate an active site but only longitudinal studies taking into account, the disease ” activity” and ” inactivity” could suggest the possibility of using TNF-α in serum as an ” Indicator” of periodontal disease.
AnujSingh Parihar, Neeta Sinha, Daya Shankar, Vikas Vaibhav, Tarun Vyas, and Anju Singh
Medknow
Background: Kids and teenagers are more prone to oral diseases. Poor oral health has a significant impact on oral well-being–associated quality of life. Thus, we performed an investigation to examine the outcome of oral health status on the quality of life of children and adolescents in Indian population, by using the Oral Health Impact Profile-14 (OHIP-14). Materials and Methods: A total of 100 children, ranging between 1 and 19 years of age who attended Indian hospitals from November 2016 to October 2019, were included in the study. The DMFT Index (Decayed, Missing, and Filled Teeth) and OHIP-14 were used as data collection tools. Association of the total OHIP-14 score and seven subscales associated with it was evaluated using Spearman’s correlations. Results: The results showed statistically noteworthy association between the toothbrushing regularity, number of dental appointments, history of oral trauma, smoking, and subdomains of OHIP-14 (P < 0.05)Conclusion: Dental and oral health of an individual has a great impact on their quality of life.
G. Sharma, S. Gokulraj, A. Bharadwaj, K. Jagadeesh, A. Parihar and Shruthi S Hegde
Introduction: Increased consumption of tobacco can lead to various oral mucosal lesions. The study was done to assess the oral mucosal lesions among tobacco users. Materials & Methods: This cross-sectional study was conducted on 5240 subjects who found to have a history of tobacco usage. Subjects with presence of oral mucosal lesions were subjected to vital tissue staining with toluidine blue dye (TB). Factors such as socio-economic status, occupation, type of tobacco usage, education status and type of lesions were recorded. Results: Hyperkeratosis was seen in 562 patients followed by smoker’s melanosis in 360, leukoplakia in 252 patients, squamous cell carcinoma in 190 patients, smoker’s palate in 130 patients, erythroplakia in 96, lichen planus in 80 and OSMF in 70 patients. Cases were due to Cigarette/bidi, were due to gutkha usage, 252 (14.4%) due to hookah, hukli and 214 (12.2%) due to zarda/pan masala. Oral mucosal lesions were significantly higher in patients with the habit of smoking cigarette/beedi 974 (55.9%) compared to those patients that were chewing gutkha 300(17.2%) or panmasala 214 (12.2%) (P < 0.05). There was significantly maximum lesions seen in buccal mucosa (812) followed by the retromolar pad area in 302, floor of mouth in 199, palate in 176, gingiva in 128, tongue in 90 and lip in 33 cases (P < 0.05). Conclusion: Authors found that most common oral mucosal lesion was hyperkeratosis followed by leukoplakia and smokers melanosis. Most common type of tobacco use was cigarette/bidi and gutkha.
Prashant Babaji, Anuj Singh Parihar, Anuj Singh Parihar, Kyatsandra N Jagadeesh, Sami Alduwayhi, Sridhar Annapoorneshwari, and Faiz Muslimveetil Khalid
Jaypee Brothers Medical Publishing
AIM
The higher success rate (>90%) of dental implants over 5 years has made this treatment option favorable for dental surgeons as well as for patients. The present in vitro study was conducted to assess microleakage and microgap of two dissimilar internal implant-abutment associations.
MATERIALS AND METHODS
Forty dental implants were divided into two groups: trilobe internal connection fixtures in group I and internal hexagonal geometry fixtures in group II. For the immersion of implant abutment assemblies, sterilized tubes containing 4 mL of Staphylococcus aureus broth culture were incubated at 37°C for 2 weeks. Gram's stain and biochemical reactions were used for identification of colonies.
RESULTS
The mean log10 colony-forming unit (CFU) in group I was 8.6 and was 9.3 in group II. The disparity among two groups was found to be significant (p < 0.05). The mean microgap in group I was 7.2 μm and was 10.4 μm in group II. The disparity among the two groups was found to be significant (p < 0.05).
CONCLUSION
Authors found that microscopic space between implant and abutment may be the site of penetration of bacteria. There was significant higher log10 CFU in dental implant fixtures with an internal hexagonal geometry compared to the dental implant fixtures with a trilobe internal connection.
CLINICAL SIGNIFICANCE
Microscopic space between implant and abutment may be the site of penetration of bacteria. This information will help to avoid microleakage to improve implant success rate.
Parveen Rajora, Purushottam Singh, AnujSingh Parihar, Prabhjot Kaur, Piyush Gandhi, and Vaishali Gandhi
Medknow
Background: Gestational diabetes mellitus (GDM) is one of the commonly occurring high-risk obstetric complications that accounts for 4%–9% of total pregnancies. The present study was an attempt to assess the effect of GDM on composition of the neonatal oral microbiota. Materials and Methods: In this study, oral samples from 155 full-term vaginally delivered newborns were collected with sterile swabs. Seventy-five mothers diagnosed with GDM group and 80 were nondiabetic mothers (control). The oral microbiota was evaluated and analyzed by SPSS software. Results: The mean gestational age in Group I was 38.1 weeks and in Group II was 39.6 weeks. Firmicutes was present in 38.1% in Group I versus 77.6% in Group II patients, Actinobacteria was seen in 15.2% in Group I and 7.4% in Group II, Bacteroidetes in 27.6% in Group I and 7.9% in Group II, Proteobacteria in 9.5% in Group I and 3.8% in Group II, and Tenericutes in 9.6% in Group I and 3.3% in Group II. There was a significant difference in major genera Prevotella, Bacteroidetes, Bifidobacterium, Corynebacterium, Ureaplasma, and Weissella in both groups (P < 0.05). Conclusion: There was increased bacterial microbiota in neonates born to mothers with GDM as compared to neonates born to nondiabetic mothers. Assessment of initial oral microbiota of neonates could help in assessing the early effect of GDM on neonatal oral microbial flora.
Abhaya C Das, Anuj Singh Parihar, Kyatsandra N Jagadeesh, Amit Kumar Verma, and Mohammed A Razi
Jaypee Brothers Medical Publishing
AIM
To assess the survival rate of short dental implants in medically compromised patients.
MATERIALS AND METHOD
This follow-up study was conducted on 342 medically compromised patients of both genders (580 dental implants). The failure rate of dental implants was assessed.
RESULTS
There were 142 diabetes mellitus patients with 254 dental implants, 108 patients with hypertension with 190 dental implants, 26 patients with mental disabilities with 40 dental implants, 20 oral cancer patients with 36 dental implants, and 46 osteomyelitis subjects with 60 dental implants. There were 60 (10.5%) short dental implant (SDI) failures of which a maximum of 25 (22.7%) were seen with 4 mm diameter. Maximum failure was seen with osteomyelitis patients 8 (13.3%) followed by diabetes mellitus 32 (12.5%). Out of 270 dental implants in 130 control patients, implant failure was seen in 11 (4.07%). There was a significant (p < 0.05) bone loss on follow-up at 6 months, 1 year, and 2 years.
CONCLUSION
Medically compromised patients are more prone to dental implant failure as compared to healthy subjects.
CLINICAL SIGNIFICANCE
Since medically compromised patients are prone for implant failure, careful selection of cases is necessary.