ZGZülal Deniz Güner

Zülal Deniz Güner

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Zülal Deniz Güner has a total of 19 co-authors. Here are the top co-authors by number of shared publications:


Latest Publications

  • Open Access

    Biomimetic Surface Engineering Strategies for Enhanced Osseointegration and Peri-Implant Bone Regeneration: A Systematic Review

    by Fatma Karacaoğlu, Zülal Deniz Güner, Merter Güçlü, Elif Didem Özer, Nilsun Bağış, Kaan Orhan

    Objective: This systematic review aimed to evaluate the effects of biomimetic surface engineering strategies applied to dental implants on osseointegration and peri-implant bone regeneration compared with conventional implant surfaces. Materials and Methods: A comprehensive literature search was conducted in the Web of Science, PubMed, and Scopus databases in accordance with the PRISMA guidelines, covering the period from January 2021 to January 2026. A total of 12 studies, including in vivo animal experiments and in vitro investigations, that met the inclusion criteria were analyzed. Risk of bias assessment was performed using the SYR-CLE tool and the ARRIVE guidelines. Results: Biomimetic strategies, including laser texturing, sulfonation, bioactive coatings, and growth factor/peptide functionalization (e.g., BMP-2, FGF-2, and PRF), significantly increased bone–implant contact (BIC), new bone volume (BV/TV), and biomechanical stability (pullout strength and reverse torque) compared to conventional surfaces. These surfaces enhance fixation under conditions of low bone density, such as osteoporosis, and improve infection resistance through antibacterial activity. In addition, these modifications enhance cellular adhesion, osteogenic differentiation, angiogenesis, and immune modulation. Conclusions: Current experimental evidence suggests that biomimetic implant surface engineering transforms dental implants from passive biomaterials into multifunctional bioactive interfaces capable of simultaneously regulating osteogenesis, immune response, angiogenesis, and antibacterial activity. Although promising outcomes have been demonstrated in preclinical studies, standardized long-term human clinical studies are still required to validate translational potential and long-term clinical efficacy.

  • Open Access

    The Effect of Dental Education on Students' Oral and Dental Health Attitudes and Behaviours

    by Elif Didem Ozer, Fatma Karacaoglu, Zülal Deniz Güner, Elif Cinar, Ayfer Gizem Dogru, Sena Eryilmaz, Dogukan Cakir

    Introduction: The attitudes of dental students, expected to serve as role models for patients, have the potential to enhance their oral health. Therefore, it is essential to reinforce students' oral care attitudes throughout dental education. This study aims to assess the impact of dental education on students' oral care attitudes and behaviours, as well as the effectiveness of tooth brushing and plaque removal. Materials and Methods: The study was conducted at the Department of Periodontology, Ankara University Faculty of Dentistry, with a study group consisting of 35 first‐year and 35 fifth‐year students from the 2023–2024 academic year. The Hiroshima University Dental Behaviour Inventory (HU‐DBI) was used to evaluate participants' attitudes towards oral health and their oral health habits. The Rustogi Modified Navy Plaque Index was used to assess the participants' tooth brushing efficiency and plaque scores. Results: The overall mean HU‐DBI score among students was 7.00 ± 1.39. First‐year students had a mean score of 6.51 ± 1.52, whereas fifth‐year students had a significantly higher mean score of 7.49 ± 1.07 ( p < 0.05). Plaque scores significantly decreased after brushing in both first‐year and fifth‐year students ( p < 0.05), but no significant difference was found when comparing plaque index values between the classes. Although there was no statistically significant correlation between total questionnaire scores and plaque index values, a tendency was observed in which plaque values decreased as questionnaire scores increased. Conclusion: This study indicates that dental education has a positive effect on students' attitudes and behaviours regarding oral health.


  • Open Access

    Evaluation of aesthetic parameters and changes in alveolar bone level in patients undergoing maxillary expansion with invisalign technique

    by Zülal Deniz Güner, Nilsun Bağış, Gözde Çobanoğlu, Fatma Karacaoğlu

    Orthodontic treatment in adult patients should ideally cause minimal clinical changes in alveolar bone levels while enhancing smile aesthetics. The aim of this study was to evaluate the changes in aesthetic parameters in patients undergoing maxillary expansion with the Invisalign system to determine the contribution of the orthodontic treatment to smile aesthetics, as well as to assess changes in alveolar bone levels. Retrospective data from 81 patients was analyzed. Aesthetic parameters such as smile line, lip curvature, smile index, and smile width were evaluated using pre- and post-treatment photographs. Alveolar bone level changes in the premolar regions were measured on panoramic radiographs using the Progressive Rate Index. The number of teeth visible in the smile increased significantly after treatment (p = 0.022). Although not statistically significant, improvements were observed in smile line values after treatment (p = 0.238). No significant changes were observed in upper lip curvature (p = 0.679) or smile index (p = 0.261). Percentage bone loss did not differ significantly between pre- and post-treatment measurements (p = 0.831). A non-significant increase in bone loss was observed with longer treatment durations (p = 0.071). Maxillary expansion treatment with Invisalign resulted in improvement in some aesthetic parameters with minimal changes in the bone.

  • Implant Peri-apical Lesions: Literature Review and Two Case Reports

    by Zülal Deniz Güner, Murat Akkaya, Fatma Karacaoğlu, Mehmet Hakan Kurt

    Introduction: Implant peri-apical lesion is a peri-implant complication characterized by radiographic bone loss around the implant apex. Different approaches have been proposed for the treatment of implant peri-apical lesions, including periapical surgery and regenerative surgery with or without resection of the implant apex. Method: In this systematic review, we searched the available literature on implant apical lesions using the PubMed database and described the possible etiologies and treatments of two implant peri-apical lesions that occurred at different stages of osteointegration. Case Report: Two patients presented to our clinic with pain and swelling 16 days and 7 months after implant surgery. In both patients, the operation site was opened, granulation tissues were removed and the area was irrigated with sterile saline. In the second patient, graft and membrane application was performed additionally. Both sites were closed primerally. Conclusion: No complications were observed at either site during the follow-up period. Therefore, both approaches can be considered effective in the treatment of implant peri-apical lesions.

  • Open Access

    Evaluation of the bone structure surrounding photofunctionalized implants using the fractal analysis method: a split-mouth randomized clinical study

    by Hamed Farsiani, Nilsun Bagis, Elif Polat Balkan, Fatma Karacaoglu, Zülal Deniz Güner, Kaan Orhan

    Implant failure may necessitate another surgical procedure to improve implant survival. Photofunctionalization(PF) with UV light is a promising method to enhance dental implant osseointegration. The study evaluates the effect of the PF on bone quality around the implants using Fractal Dimension Analysis (FDA). A total of 42 implants were placed in a split-mouth design and evaluated using FDA on panoramic radiographs taken pre- and post-operatively. Regions of interest (25 × 25 pixels) were analyzed using ImageJ. Statistical analysis used SPSS 26 with a 95% confidence level. Shapiro-Wilk test confirmed non-normal distribution. A statistically significant increase in Fractal dimension(FD) values was observed in the test group between pre- and post-operative images (p = 0.044). The control group showed a non-significant increase (p = 0.794). PF appears to enhance osseointegration by improving bone microstructure as shown by increased FD values. FDA is a reliable imaging-based proxy for evaluating implant-related bone changes. Current Controlled Trials NCT06821932 (Retrospectively registered) ( https://clinicaltrials.gov/study/NCT06821932 /2025-02-11).


  • Open Access

    Retrospective Analysis of Periodontology Questions Asked in the Dental Specialty Training Entrance Exam

    by Zülal Deniz Güner, Elif Didem Özer, Nilsun Bağiş

    Amaç: Ölçme, Seçme ve Yerleştirme Merkezi (ÖSYM) tarafından uygulanan Diş Hekimliği Uzmanlık Eğitimi Giriş Sınavı, temel ve klinik bilim sorularından oluşan uzmanlık eğitimi almak isteyen adayların girdikleri sınavdır. 120 sorudan oluşan sınavın 10 sorusu periodontoloji branşından sorulmaktadır. Bu çalışmanın amacı, günümüze kadar yapılmış sınavların Periodontoloji alanında sorulmuş sorularını, temel kabul edilen referans kitaplardaki içeriğe göre analiz etmek ve Periodontoloji Uzmanlık Eğitimi Çekirdek Müfredatına göre dağılımını değerlendirmektir. Gereç ve Yöntemler: Çalışmada, 16 sınava ait 158 adet periodontoloji sorusu değerlendirilmiştir. Sorular ÖSYMresmî internet sitesinden elde edilmiştir. Soruların dağılımı referans kaynak kitaba ve Periodontoloji Çekirdek Müfredatına göre belirlenmiştir. Analizler için tanımlayıcı matematiksel yüzdelik hesaplama yöntemi kullanılmıştır. Bulgular: Değerlendirilen 158 sorunun %59,9'u Temel Periodontoloji'den, %34,1'i Klinik Periodontoloji'den ve %6,0'sı Oral İmplantoloji'den sorulduğu görülmüştür. Temel periodontoloji bölümde en çok sorgulanan konu başlıkları ''Gingival Patolojiler'', ''Temel Bilgiler'' ve ''Kanıtlar'', ''Etiyoloji'' ve ''Patogenez'' olmuştur. Bu bölümünde en az sorgulanan konu başlığının ''oklüzyon'' olduğu görülmüştür. Sınav soruları sınıflandırıldığında, Periodontoloji Çekirdek Müfredatı'na göre belirlenen Girişimsel Yetkinlik ve Klinik Yetkinlik Düzeyleri'nde adayın edinmesi istenen düzeylere göre soru dağılımı yapıldığı tespit edilmiştir. Sonuç: Soru dağılımı çekirdek müfredatta belirlenen kriterlere göre temel kabul edilen konular üzerinde yoğunlaşmıştır. Bu retrospektif analiz, sınava girecek adaylara yol göstermesi açısından yararlı kabul edilebilir.