Full-arch implant rehabilitation in extremely atrophic edentulous mandibles is still challenging due to the high risk of fracture and the limited bone availability. The approach proposes using short implants with immedia...Full-arch implant rehabilitation in extremely atrophic edentulous mandibles is still challenging due to the high risk of fracture and the limited bone availability. The approach proposes using short implants with immediate loading for final prostheses as a treatment option, which offers shorter treatment times and fewer invasive procedures. A 66-year-old female patient with an edentulous mandible and severe alveolar bone resorption was treated with 4 short implants in the interforaminal area. The final hybrid metal-plastic full-arch lower prosthesis was delivered 3 days after the surgery, and the patient was instructed on cleaning methods and requested to maintain a soft diet for the first 2 postoperative months. After 6 months of follow-up, the patient experienced no problems; the prosthesis underwent a mechanical examination, each multiunit abutment's peri-implant tissue was assessed, and implants presented no mobility, fibrointegration, or signs of failure. X-ray images demonstrated stable bone levels around implants. Also, it was observed that the integrity of the entire jaw was preserved, and no signs of fracture were observed.
Peri-implantitis (PI) is an inflammatory disease that affects supportive tissues around dental implants, and its progression eventually leads to bone loss and implant failure. However, PI effects may be different based o...Peri-implantitis (PI) is an inflammatory disease that affects supportive tissues around dental implants, and its progression eventually leads to bone loss and implant failure. However, PI effects may be different based on the presence or absence of adjacent teeth. The objective was to investigate the differences in bone loss and inflammation between implants placed adjacent to a tooth or edentulous area in a ligature-induced PI model. Materials and methods include the following: Three-week-old C57BL/6J male mice underwent maxillary first (AT; n = 12) or first and second (AE; n = 8) left molar extractions. In both groups, implants were placed in the first molar region 8 weeks after tooth extraction. Each group was further divided into control (C) or ligature (PI) 4 weeks after osseointegration. The mice were euthanized 12-14 days after ligature placement. The samples were analyzed using micro-computed tomography and histology. Statistical analysis was performed using analysis of variance and Tukey multiple comparison test (P < .05). Radiographic linear analysis revealed no statistically significant differences in bone levels between the two C and PI groups. Linear bone loss was significantly greater in the PI group than in the C group. Volumetric analysis yielded similar results. Histologically, hematoxylin and eosin staining revealed no notable differences between the two C and PI groups. The PI groups showed increased levels of inflammatory infiltrates and bone resorption. Qualitative assessment of collagen through picrosirius red staining demonstrated increased collagen disorganization in the PI group compared with that in the C group. No notable differences were observed between the AT and AE groups. The presence or absence of an adjacent tooth does not influence PI-induced soft and hard tissue alterations.
Periodontal surgery often requires flap advancement for adequate coverage of the surgical site with tension-free primary closure essential for successful outcomes. Although the periosteal releasing incision is frequently...Periodontal surgery often requires flap advancement for adequate coverage of the surgical site with tension-free primary closure essential for successful outcomes. Although the periosteal releasing incision is frequently performed, it may necessitate deeper or more incisions, which could result in consequences such as edema, bleeding, paresthesia, and discomfort for the patient. To address these issues, the modified periosteal releasing incision was proposed to minimize trauma into the submucosa. In this paper, we update the technique, emphasizing its application in visualizing the mental nerve to avoid nerve damage during significant flap advancement in the posterior mandible. The technique provides an alternative approach to traditional techniques, ensuring patient safety and improving surgical outcomes. Future research is needed to explore its benefits and applications in various clinical scenarios.
The present pilot clinical trial was planned to evaluate the effect of particulate deproteinized bovine bone graft mixed with blood used as a vertical ridge augmentation material without covering with any form of collage...The present pilot clinical trial was planned to evaluate the effect of particulate deproteinized bovine bone graft mixed with blood used as a vertical ridge augmentation material without covering with any form of collagen membrane in a tunnel pouch technique, resulting in sufficient bone formation to allow placement of dental implants with maintenance of the newly formed bone after final restoration. Eight patients (3 males and 5 females) were selected for this procedure and treated between February 2016 and December 2017. All these patients had a deficient vertical height of the posterior mandibular alveolar bone above the inferior alveolar canal. The particulate deproteinized organic bovine bone graft (Bio-Oss) mixed with blood was placed through the tunnel in the defected area and compacted firmly to form a dense pack. The average gain of alveolar bone in the first implant site immediately postoperative was 13.51 ± 0.85 and in the second implant site was 13.84 ± 0.62. Histomorphometric analysis showed that about 70.31% of the area analyzed was occupied by the vital bone, the newly formed bone, whereas only 29.69% of the residual graft remained. In the present pilot study, the deproteinized bovine bone graft placed to enhance vertical and horizontal bone gain showed positive results in regaining the bone needed to place implants and maintaining the bone around restored implants for 4 years of follow-up.
A multifaceted study compared transgingival (flapless) implant placement with conventional flapped placement, which employed clinical, radiographic, biochemical, and patient-centered parameters. The study was approved by...A multifaceted study compared transgingival (flapless) implant placement with conventional flapped placement, which employed clinical, radiographic, biochemical, and patient-centered parameters. The study was approved by the institutional ethics committee and was conducted according to the ethical standards in the 1964 Declaration of Helsinki and its amendments. Seventy-five implants were placed, 37 by flapless method (Group 1) and 38 by flapped method (Group 2). The Group 1 subjects underwent flapless implant placement, while Group 2 underwent flapped implant placement. The Modified Plaque Index was significantly higher in Group 2 at 6 weeks (Mann-Whitney U test, z = -3.08, P = .002). Modified Sulcus Bleeding Index was also significantly higher in Group 2, up to the 12-week follow-up (Mann-Whitney U test, z = -4.63, P < .001). Crestal bone loss revealed no significant intergroup difference. Under biochemical evaluation, matrix metalloproteinase-8 was significantly higher in flapped implants up to the 6-week follow-up. The patient-reported questionnaire-based acceptability assessment showed that the flapless technique is better regarding the perceived duration of the surgery and postoperative comfort.
This study aimed to compare the angular, platform, and apical deviation of zygoma implants placed with the aid of a dynamic navigation (DN) device compared with the implants placed freehand. Eight cadaver heads were used...This study aimed to compare the angular, platform, and apical deviation of zygoma implants placed with the aid of a dynamic navigation (DN) device compared with the implants placed freehand. Eight cadaver heads were used for the study. Preoperative cone beam computerized tomography (CBCT) scans were made for the heads, and an implant-planning software was used to plan zygoma implants bilaterally in each scanned head. A total of 16 zygoma implants were placed using each surgical technique. Postimplant CBCT scans were merged with the preoperative plan to evaluate and compare the accuracy of the implants using each technique. Angular and linear deviations of the implants were measured and compared. The effect of implant length and position on the deviation was also investigated. The results showed a mean angular deviation of 2.44° ± 1.10° for implants placed using DN compared with 6.63° ± 4.81° for implants placed freehand. The mean apical deviation for implants placed using DN and for implants placed freehand was 2.14 ± 1.02 mm and 3.80 ± 2.49 mm, respectively. Finally, the mean platform deviation for implants placed using DN and for implants placed freehand was 1.66 ± 0.9 mm and 2.81 ± 2.1 mm, respectively. The analysis showed a significant difference between the two techniques in angular and apical deviation (p = .001 and .029, respectively). Zygoma implants placed with a DN device resulted in less apical and angular deviation than implants placed freehand.
This controlled in vivo experimental study examines the impact of 2 periosteum preparation techniques on microcirculation during bone augmentation with isogenic bone grafts in rats. Twenty female Lewis rats were divided...This controlled in vivo experimental study examines the impact of 2 periosteum preparation techniques on microcirculation during bone augmentation with isogenic bone grafts in rats. Twenty female Lewis rats were divided into 2 groups (n = 10 each). In one group, the periosteum was prepared with a conventional periosteal elevator; in the other, a piezoelectric device was used. After graft implantation at calvarial sites, intravital microscopy was performed postoperation (day 0) and on days 3, 8, and 28 immediately to assess microvascular parameters: functional capillary density, blood flow velocity, and vessel diameter. Statistical analysis was conducted using analysis of variance on ranks with P < .05. The piezoelectric device group showed higher mean values for functional capillary density, blood flow velocity, and vessel diameter than the conventional instrument group, though differences were not statistically significant. This study suggests that periosteum preparation with a piezoelectric device does not significantly differ from conventional methods regarding microcirculatory outcomes. Either method appears viable for preserving microcirculatory integrity during bone augmentation. Further research in larger models and clinical contexts is recommended to confirm these findings.
This study evaluated the efficacy of poly(lactic-co-glycolic acid) (PLGA) mesh sheets for alveolar bone reconstruction in the anterior maxilla with significant bone defects. This prospective case series included 4 male p...This study evaluated the efficacy of poly(lactic-co-glycolic acid) (PLGA) mesh sheets for alveolar bone reconstruction in the anterior maxilla with significant bone defects. This prospective case series included 4 male patients (mean age, 34.5 years; range, 20-49 years) with anterior maxillary bone defects. Bone augmentation was performed using a staged guided bone regeneration technique with PLGA mesh sheets as barrier membranes and a 1:1 mixture of autogenous and xenogeneic bone as grafting material. The effectiveness of bone augmentation was evaluated using preoperative and postoperative computerized tomography data at 1 and 6 months. Secondary outcomes included complications such as wound infection and dehiscence. The treatment of the 4 patients required 7 PLGA mesh sheets and particulate bone, followed by 9 implant placements. Wound healing was uneventful except for 1, wherein wound dehiscence and graft loss were observed. One patient had an exposed PLGA mesh sheet during healing, necessitating its removal. The mean vertical bone gain was 2.3 ± 0.5 mm, and the mean horizontal gain was 3.7 ± 1.3 mm at 1 month postoperatively. Sites without wound dehiscence exhibited a bone decrease rate of 6.5%-21.1%, whereas successful bone height and width increases were observed across treated sites. Bone augmentation using PLGA mesh sheets proved effective in reconstructing horizontal and vertical alveolar bone dimensions. This technique provides adequate support for implant placement, demonstrating its potential utility in cases of substantial alveolar bone deficiency.
Tactile function and thermal perception are 2 primary functions of oral structures. Implants without periodontal ligaments and pulp might fail to sense tactile and temperature changes. This study aimed to investigate imp...Tactile function and thermal perception are 2 primary functions of oral structures. Implants without periodontal ligaments and pulp might fail to sense tactile and temperature changes. This study aimed to investigate implants' tactile, thermal, and electrical perception by detailed psychophysical assessments. A total of 48 patients with single implant restoration were recruited. Mechanical (5 intensities), cold (4 temperatures), and electrical stimulation were, respectively, applied to implants and natural teeth, and the psychophysical results were recorded with a visual analog scale and compared between implants and natural teeth. For tactile perception, at low and medium forces, implants were significantly poorer than natural teeth (P ＜ .01), but at the largest force, there were no significant differences (P > .05). Regarding thermal perception, thermal changes on implants could be detected although the signals were weaker when compared with natural teeth (P ＜ .01). Implants were less sensitive to electrical stimulation than natural teeth (P ＜ .01). Even though there is no periodontium and pulp, dental implants could perceive the mechanical, thermal, and electrical stimulation weakly.
Cemento-osseous dysplasia (COD) is a benign fibro-osseous pathology in which fibrous connective tissues, osteoid and cementum-like materials, replace bone. Concerning the hypovascularization and increased mineralization...Cemento-osseous dysplasia (COD) is a benign fibro-osseous pathology in which fibrous connective tissues, osteoid and cementum-like materials, replace bone. Concerning the hypovascularization and increased mineralization of bone that occurs in these patients, the clinician may face 2 types of problems: infectious complications, such as osteomyelitis, and increased implant failure. The present study aims to report the successful and innovative management of a COD patient complicated by mandibular osteomyelitis and the implant rehabilitation of this area. We report the management of a 54-year-old patient presenting with florid cemento-osseous dysplasia complicated by mandibular osteomyelitis, which required antibiotic administration and 2 surgeries to resolve. This area was then reconstructed with guided bone regeneration before 3 implants were placed using guided surgery, including 1 implant in a dysplastic area and 1 in the graft site. Osseointegration of the implants allowed rehabilitation with a supraimplant bridge. An optimal functional rehabilitation and complete integration of implants were observed 13 months after the surgery. Eight cases of implant placement in COD patients have been reported before in the literature (n = 35 implants). The success rate of dental implants in nondysplastic areas is comparable to the general population, but it decreases when implants are placed in dysplastic areas. Guided implant surgery is an interesting tool for placing implants outside dysplastic regions.
Secondary reconstruction of the maxillary defect with discontinuity after partial maxillectomy is extremely challenging due to extensive, severe adhesions between the maxillary sinus membrane and oral mucosa, resulting i...Secondary reconstruction of the maxillary defect with discontinuity after partial maxillectomy is extremely challenging due to extensive, severe adhesions between the maxillary sinus membrane and oral mucosa, resulting in no space for the grafted bone and a lack of soft tissue to cover the graft. This case reports a 23-year-old female patient who underwent secondary reconstruction for a bone defect caused by a partial maxillectomy to remove an ameloblastoma that had invaded the maxillary sinus. We incised the existing soft tissue ridge at the bone defect and extensive adhesions below the maxillary sinus to create space for the grafted bone and to form an adequate buccal flap. To ensure the grafted bone's stability and to support the surrounding soft tissues, a cortical bone from the iliac crest was placed beneath the sinus membrane, with cancellous bone grafted underneath, and a titanium mesh was applied at the alveolar region. This approach allowed robust bone regeneration at the graft site, demonstrating dense, well-integrated new bone formation that facilitated successful implant treatment with good primary stability for 2 implants. This surgical approach, when indicated, can be less invasive than vascularized bone grafts.
Peri-implant bone necrosis (PIBN) is a rare yet potentially serious phenomenon contributing to implant failure. It can be challenging to determine the exact etiology, especially when multiple intricate factors are involv...Peri-implant bone necrosis (PIBN) is a rare yet potentially serious phenomenon contributing to implant failure. It can be challenging to determine the exact etiology, especially when multiple intricate factors are involved. This case series reports on the successful management of PIBN during early and late implant placement and peri-implantitis-associated bone necrosis, with likely causes being bone overcompression during implant placement or a consequence of peri-implantitis. This case series presents 5 cases of peri-implant bone necrosis, with 3 cases occurring immediately after implant placement and the other 2 presenting a delayed inflammatory process of peri-implantitis between 1 and 5 years after implant placement. Clinical presentation and histopathological evaluation data present 10 failed implants managed with the removal of implants and the associated necrotic bone. All the cases were successfully managed without any signs of recurrence. Two cases confirmed bone necrosis via biopsy, illustrating the typical pattern of bone necrosis: multiple nonvital bone fragments surrounded by acute and chronic inflammatory cells and empty lacunae. All cases were successfully managed by removing necrotic bone and associated implants, with no indication of bone necrosis recurrence. This case series report highlights the unusual early and delayed implant failure associated with peri-implant bone necrosis. This condition most likely results from bone overcompression during implant placement or is a sequela of the inflammatory process of peri-implantitis.
Treatment of gunshot injuries to the maxillofacial region requires a multidisciplinary approach with specialist collaboration. The primary goals of treatment are to stabilize fractures, control bleeding, reconstruct the...Treatment of gunshot injuries to the maxillofacial region requires a multidisciplinary approach with specialist collaboration. The primary goals of treatment are to stabilize fractures, control bleeding, reconstruct the affected tissues, and restore function. This case report discusses a patient's treatment sequence resulting from a gunshot injury to the right posterior mandible. The initial stabilization and debridement, followed by mandibular augmentation, and finally prosthodontic restoration of lost teeth and the alveolar process are illustrated. Understanding the consequences of gunshot injuries to the maxillofacial region underscores the importance of coordinated quality care for a successful result.
This clinical report details the functional and esthetic rehabilitation of a patient with a severe maxillary defect secondary to subtotal maxillectomy for oral squamous cell carcinoma using a maxillary prosthesis anchore...This clinical report details the functional and esthetic rehabilitation of a patient with a severe maxillary defect secondary to subtotal maxillectomy for oral squamous cell carcinoma using a maxillary prosthesis anchored by 4 zygomatic implants. The procedure involved meticulous subtotal maxillectomy and defect repair with zygomatic implant support, incorporating advanced digital surgical methods, including 3D reconstruction, computer-guided surgery, and photogrammetry (Icam4D). A 3D finite element analysis was conducted to assess the method's efficacy in analyzing stress distribution around the zygomatic implants. The patient expressed high satisfaction with the prosthesis's functionality, esthetics, speech, and swallowing capabilities, underscoring the value of zygomatic implant-supported maxillofacial prosthetics. This synergy of advanced planning, surgical precision, and biomechanical analysis marks a significant advancement in maxillofacial prosthetics.
A postoperative maxillary cyst (POMC) is a delayed complication of the original Caldwell-Luc operation, which was once widely performed to treat chronic rhinosinusitis. Two patients who had previously undergone Caldwell-...A postoperative maxillary cyst (POMC) is a delayed complication of the original Caldwell-Luc operation, which was once widely performed to treat chronic rhinosinusitis. Two patients who had previously undergone Caldwell-Luc operations desired dental implant treatment. In both cases, preoperative cone-beam computerized tomography (CBCT) revealed a POMC occupying the entire maxillary sinus on the side where the implants were to be placed. The residual bone height was 3-4 mm. Furthermore, the sinuses were divided into compartments by septum-like structures. An intraoral approach was applied for POMC enucleation and implant placement. The implants were placed with sinus floor penetration due to the small residual bone height. No bone substitute material was grafted in the sinus. Postoperative healing was uneventful. All implants were successfully osseointegrated and performed well (4 and 5 years for each patient). No sinonasal complications were reported. Follow-up CBCTs showed that the exposed implant parts were covered by newly formed bone. The intraoral approach is a feasible option for implant placement in a pneumatized maxillary sinus with POMC.
The purpose of this study was to examine the impact of abutment screw head sizes on preload stability when secured to a standard external hex implant under oblique compressive forces. Fifteen metal crowns were divided in...The purpose of this study was to examine the impact of abutment screw head sizes on preload stability when secured to a standard external hex implant under oblique compressive forces. Fifteen metal crowns were divided into 3 equal groups. The first group had 5 angulated cemented crowns connected to a 3-mm-tall straight hexagonal abutment with an external hex abutment screw. The second and third groups each had 5 straight cemented crowns attached to a tapered abutment with flat-slotted and internal hex abutment screws, respectively. Samples were subjected to a static cyclic load until failure. Kruskal-Wallis H, Dunn, and one-way analysis of variance with Tukey honestly significant difference tests were performed. Cemented straight crowns supported by an angled abutment connected to implants with flat-slotted and internal hex abutment screw heads failed at an average of 4.24 × 106 cycles ± 3.31 SD and 12.67 × 106 cycles ± 5.47 SD, respectively. Cemented angled crowns supported by a straight abutment connected to identical implants with an external hex abutment screw survived 18.02 × 106 cycles ± 4.49 SD. The periotest value rate of change increased at a higher rate in crowns supported by angled abutments compared with straight abutments (p < .05). No cement failure was observed. Under the experimental conditions, larger abutment screw head sizes demonstrated greater stability of the abutment-abutment screw joint interface. Based on the in vitro findings, no cement failure was observed between the cemented crown and abutment connection. Future research with standardized comparative setups and larger sample sizes is needed.
Electronic cigarettes (e-cigarettes) are offered to consumers as a healthier option than traditional tobacco. However, the long-term effect of non-heat-burning tobacco and e-cigarettes on periodontal and peri-implantitis...Electronic cigarettes (e-cigarettes) are offered to consumers as a healthier option than traditional tobacco. However, the long-term effect of non-heat-burning tobacco and e-cigarettes on periodontal and peri-implantitis is unknown. The present review evaluates the impact of electronic cigarettes on peri-implantitis and compares the results with traditional cigarettes and nonsmokers. Systematic/meta-analysis studies were searched in PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar until December 30, 2022. Five systematic/meta-analysis studies were identified based on the search strategy in the selected databases. The overall quality assessment of the studies showed acceptable evidence with high quality. All systematic review studies showed that compared with traditional tobacco smoke, electronic cigarettes might reduce or not change the clinical inflammatory symptoms of periodontitis and peri-implantitis, such as bleeding on probing, probing depth, peri-implant bone loss, and response to treatments. Electronic cigarettes contain nicotine, which can harm periodontal and implant health. On the other hand, a wide range of oral health consequences may be associated with using e-cigarettes. E-cigarette is a potential risk factor for the healing process and the results of implant treatment.
During implant placement, dehiscence defects can result in complications such as mucosal recession and peri-implantitis. Whereas guided bone regeneration (GBR) is a common approach to managing these defects, it is often...During implant placement, dehiscence defects can result in complications such as mucosal recession and peri-implantitis. Whereas guided bone regeneration (GBR) is a common approach to managing these defects, it is often complex and time-intensive. This case series evaluates an alternative method using a collagen matrix (Collagen Graft2) applied to peri-implant dehiscence defects without GBR. Through three case series, this approach effectively preserves buccal contour, enhances gingival thickness, and supports bone regeneration, leading to favorable peri-implant conditions. These findings suggest that collagen matrix application is a viable and less invasive option for treating peri-implant dehiscence defects; however, further studies are required to validate these results.