Impact of three-dimensional stabilization thread design on biomechanical fixation and osseointegration of endosteal implants

BACKGROUND

Implant's primary stability is determined by the intimate and immediate contact between the implant and osteotomy wall, whereas secondary stability is primarily influenced by healing chambers that facilitate the bone formation and remodeling processes following placement. Therefore, modifications to macro-geometric parameters are essential to elicit the desired in vivo response and to ensure successful osseointegration. Three-dimensional (3D) stabilization thread forms comprise both curved and linear geometric surfaces across the thread's crest maximizing retention forces while constraining lateral movement under load relative to conventional buttress-threaded implants.

METHODS

This study utilized Ti-6Al-4V ELI implants with (i) a buttress thread design [Tapered Pro, BioHorizons®, Birmingham, AL, USA] (TP - control) compared to (ii) a novel, patented, 3D stabilization trimmed-thread design (TP 3DS - experimental). Implants were placed in the mandible of sheep (N = 14 sheep, 6 implants per group per sheep) and allowed to heal for 3- and 12-weeks (N = 7 sheep per time point). During implant placement (T = 0 weeks), the maximum insertion torque value (ITV) and implant stability quotient (ISQ) were measured by torque-in testing and resonance frequency analysis, respectively. After the healing periods, subjects were euthanized, and samples harvested en bloc for biomechanical evaluation via lateral loading tests in addition to histomorphometric and nanoindentation analysis.

RESULTS

ITV values were significantly lower in the TP 3DS group compared to TP (p < 0.001). Both groups presented ISQ values ≥ 70, indicating high primary stability. Relative to the TP group, TP 3DS exhibited a significant (∼1.85-fold) increase in lateral load at 3 weeks (p = 0.029) and comparable load values at 12 weeks (p > 0.05). No quantitative differences in percentage of bone-to-implant contact (BIC) and bone-area-fraction-occupancy (BAFO) were observed at either time points between the two thread designs (p > 0.05). Similarly, no differences in bone's mechanical properties (Young's modulus (E) and Hardness (H)) between TP and TP 3DS were observed at 3- and 12- weeks (p > 0.05). Qualitatively, scattered microcracks were apparent at the outer threads of the implant, particularly within the TP group, whereas small bone chips were interspersed between threads of the 3DS implant serving as additional nucleation sites for bone formation.

CONCLUSION

The TP 3DS design reduced insertion torque, improved lateral loading competence, and resulted in a healing pattern, that are beneficial during early stages of osseointegration compared to TP implants.

Fracture resistance of a second generation of zirconia implants after artificial ageing: An in vitro study

OBJECTIVES

The aim of this study was to determine the bending moments of a further developed generation of a one-piece zirconia implant system, which, for example, has a reduced diameter in the neck area compared to the predecessor model.

METHODS

A total of 48 one-piece ceramic implants with diameters of 3.6 mm and 4.1 mm were included. After preparation of the abutments of 50 % of the implants, 32 out of the 48 implants were subjected to artificial ageing in a chewing simulator (Force: 98 N; 1.2 or 5 million loading cycles; thermocyclicing: 5 °C / 55 °C). The implants were then subjected to static loading until fracture in order to determine the maximum load forces to calculate the bending moments.

RESULTS

Implants tested after 1.2 million loading cycles exhibited the highest bending moments (3.6 mm diameter without abutment preparation: 496.1 ± 50.6 Ncm; 3.6 mm diameter with abutment preparation: 507.9 ± 53.5 Ncm; 4.1 mm diameter without abutment preparation: 612.5 ± 49.0 Ncm; 4.1 mm diameter with abutment preparation: 656.9 ± 26.8 Ncm). In contrast, unloaded implants showed the lowest values (3.6 mm diameter without abutment preparation: 443.0 ± 38.6 Ncm; 3.6 mm diameter with abutment preparation: 436.1 ± 42.8 Ncm; 4.1 mm diameter without abutment preparation: 570.3 ± 64.8 Ncm; 4.1 mm diameter with abutment preparation: 560.9 ± 51.5 Ncm), while implants subjected to 5 million cycles of loading showed bending moment values between these two groups.

CONCLUSIONS

Within the limits of the present study, preparation of the abutment did not appear to have a negative effect on stability. Also, artificial ageing did not seem to have a negative effect on the fracture resistance; a possible negative effect on the bending moment would have to be investigated with >5 million loading cycles. The measured maximum fracture loads were generally higher than the masticatory forces described in the literature.

CLINICAL SIGNIFICANCE

The investigated zirconia implants seem to be a viable alternative to titanium implants.

Evaluation of the success rate, prosthesis-related quality of life, and satisfaction in patients undergoing rehabilitation with an implant-supported auricular prosthesis

The aim of this study was to evaluate the success rate, prosthesis-related quality of life (QoL), and satisfaction of patients undergoing rehabilitation with endosseous implants in the auricular region. This was a retrospective mixed cohort study involving 22 consecutive eligible patients (11 female, 11 male) with ear defects, treated during 1999-2019. The variables analysed were sex, age at the time of implant placement, date of last prosthesis delivery, level of education, aetiology of the deformity, and radiation history. The questionnaire results were analysed using IBM SPSS Statistics software. The correlation between QoL and satisfaction was evaluated using the Pearson correlation coefficient. Implant success was calculated clinically using the number of integrated implants, mobility, and presence of a purulent discharge. For the 22 patients, the mean duration since prosthesis placement was 10.2 ± 5.2 years. Among 47 implants inserted, one failed because of osseointegration failure. Hence, the overall success rate of the auricular implants was 97.9%. The mean ± standard deviation total QoL score and satisfaction score were 52.5 ± 7.10 (maximum possible score 80) and 42.1 ± 6.29 (maximum possible score 55), respectively. The results demonstrate the importance of prosthetic rehabilitation for improved patient QoL and satisfaction.

Calcifying odontogenic cyst: a detailed international multicentric study

OBJECTIVE

To elucidate the histopathological, immunohistochemical, and ultrastructural characteristics of a large series of calcifying odontogenic cysts (COCs).

STUDY DESIGN

This was a multicenter cross-sectional retrospective study of seven oral pathology department laboratories from four countries. Clinical, demographic, and radiographic data of the patients were collected. Histopathological, immunohistochemical, and microstructural analyses were based on formalin-fixed, paraffin-embedded tissues. All variables were described, and associations were analyzed using Pearson's chi-square and Fisher's exact tests.

RESULTS

A total of 146 cases of COC were analyzed, including 141 central and 5 peripheral cases. Male patients were most involved, with a mean age of 27.8 years. The main clinical presentation was an asymptomatic swelling in the anterior maxilla. Radiographically, most cases appeared as a single well-defined unilocular radiolucency. Forty cases of COC were associated with other odontogenic lesions, including odontoma, ameloblastic fibroma, and odontogenic keratocyst. Immunohistochemical study showed cytoplasmic positivity for CK AE1/AE3, CK14, CK19, and Bcl-2 protein. Nuclear expression of β-catenin was observed in most cases.

CONCLUSIONS

COC mainly affects adult males between the second and third decades of life. Asymptomatic maxillary swellings with diverse radiographic and histopathological presentations were noted. Moreover, COC may present associations with other odontogenic lesions, particularly odontomas in younger patients.

Comparative Effect of Different Preoperative Antibiotics on Dental Implant Failure: A Retrospective Cohort Study

BACKGROUND

There is a lack of standardized guidelines for the prescription of antibiotics prior to implant surgery. The purpose of this study was to compare the effect of different antibiotics preoperatively on dental implant treatment outcome.

METHODS

This retrospective analysis involved a cohort of patients who received dental implant treatment at ten university dental clinics participating in the BigMouth network. All patients records who received antibiotic medication prior to implant surgery including amoxicillin, amoxicillin/clavulanic acid, clindamycin, azithromycin, ciprofloxacin, doxycycline, and metronidazole were analysed. The treatment outcome was assessed as a binary outcome, classified as either survival or failure of the implant.

RESULTS

A total of 41,135 implants inserted in 17,483 individuals and followed-up for a mean time of 81 ± 52.33 months. The implant failure rate was 3% at the patient level and 1.6% at the implant level. Hispanic and non-Hispanic ethnic groups showed higher likelihood to have an implant failure than other races, as well as White and African-American races, were more likely to experience implant loss compared to Hispanic patients. Implants placed in patients who received Ciprofloxacin preoperatively showed significantly lower cumulative survival implant time than those who had amoxicillin.

CONCLUSIONS

Within the limitations of this retrospective study, premedication with Ciprofloxacin led to statistically significant lower implant survival time than with amoxicillin. Future prospective randomized clinical trials are needed to validate the present findings.

THE MANAGEMENT OF TEETH IN ODONTOGENIC KERATOCYST AND AMELOBLASTOMA AND ITS PROGNOSTIC ROLE IN RECURRENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH TRIAL SEQUENTIAL ANALYSIS

INTRODUCTION

Odontogenic Keratocystic (OKC) and Ameloblastoma (AB) are pathological entities characterized by aggressive behavior, slow growth, local invasiveness, and high recurrence rates. The aim of this systematic review with meta-analysis and trial sequential analysis (TSA) is to assess the prognostic role of extracting involved teeth during the surgical enucleation of OKCs and ABs in terms of recurrence risk.

MATERIALS AND METHODS

A search was conducted in PubMed/Medline, Scopus, and Web of Science databases for studies reporting data on teeth extraction and recurrence rates. This systematic review was performed according to guidelines in the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Meta-analysis was performed using the Mantel-Haenszel method with a random-effects model due to heterogeneity. The TSA was conducted to control and reduce for type I and II errors of statistical analysis.

RESULTS

Six studies were identified and analyzed qualitatively and quantitatively. A total of 737 lesions (674 OKCs and 64 ABs) were included, of which 508 had involved teeth. The meta-analysis included 451 OKCs; 367 lesions were treated with teeth extraction, and in 141 cases, the teeth were preserved. The overall Risk Ratio was 0.17 (95% CI: [0.04, 0.74]; P < .0001) for OKCs. Quantitative analysis could not be performed for ABs.

CONCLUSION

The analysis revealed that tooth extraction contextually to the enucleation of the lesion reduces the risk of recurrence by approximately 83% in the OKCs; this appears to have the same trend for ABs, but more evidence is needed.

Update on the nature of central giant cell granuloma of the jaw with a focus on the aggressive subtype

Central giant cell granuloma (CGCG) is a benign, localised osteolytic lesion of the jaw ​that is categorised into non-aggressive and aggressive subtypes. In contrast to non-aggressive CGCG, aggressive CGCG is characterised by pain, paraesthesia, root resorption, rapid growth, a size of >5 cm, cortical perforation, or recurrence after surgical treatment. However, the nature of CGCG, especially aggressive CGCG, remains unclear. This study was performed to analyse the systematic and comprehensive characteristics of CGCG of the jaw, especially the aggressive subtype, and first explored the genetic variation of aggressive CGCG by whole-exome sequencing. In total, 42 CGCGs were analysed (including 25 non-aggressive and 17 aggressive subtypes). H3F3A mutations were not detected in these CGCGs through immunohistochemistry and Sanger sequencing. The inability to detect H3F3A mutations could help differentiate CGCG from giant cell tumour of bone, indicating the two diseases are not different stages of the same pathological entity. Additionally, fluorescence in situ hybridisation did not reveal USP6 gene rearrangement in CGCG, which could distinguish it from aneurysmal bone cysts, especially the solid type. Therefore, H3F3A mutation and USP6 gene rearrangement detection have great significance in the clinicopathological diagnosis of CGCG of the jaw in terms of their ability to exclude giant cell tumour of bone and aneurysmal bone cyst. Moreover, the whole-exome sequencing data indicated that LRP1B gene abnormalities might be related to the aggressive biological behaviour of CGCG, and that NOTCH4 mutation could be a novel therapeutic target for aggressive CGCG.

Redefining and Identifying Evidence-Based Indications for Open Reduction and Internal Fixation in Mandibular Condylar Fractures: A Comprehensive Systematic Review and Evidence Analysis

A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding precise indications for ORIF remain unclear and non-uniform. We aimed to refocus the debate regarding the optimal treatment for CFs by identifying the recent indications for ORIF in the literature and assessing the quality of the existing evidence for each indication. This systematic review searched Medline, Embase and the Cochrane Central Register of Controlled Trials for eligible studies. The included studies consisted of articles from the past 15 years involving patients with any type of CF who underwent ORIF based on specified indications. From 4711 papers, 100 studies were included. In these, 121 indications were identified. The most cited indications for ORIF were those proposed by Zide and Kent, namely displacement/angulation ≥10° and ramus height shortening of ≥2 mm. Evidence supporting these indications is weak, relying mainly on expert opinion rather than robust data, with a focus on treatment comparisons. Clear, evidence-based cutoffs regarding when ORIF is the only viable treatment option are needed for a consensus.

Exploring mandibular buccal bifurcation cysts: a case series and a comprehensive literature review

OBJECTIVE

The objective of this study was to explore the clinical and microscopic findings of mandibular buccal bifurcation cysts (MBBCs) in an original case series and to perform a literature review of this lesion.

STUDY DESIGN

Paraffin-embedded tissue blocks from patients microscopically diagnosed with MBBCs were retrieved from 4 oral and maxillofacial pathology archives. Data, including clinical, radiographic, and microscopic characteristics, treatments used, and follow-up status, were collected from the pathology records.

RESULTS

A total of 23 cases were examined, consisting of 10 male subjects (43.47%) and 13 female subjects (56.52%). The mean age of the subjects was 10.52 years, with a range from 6 to 42 years. The majority involved the first molar, accounting for 19 cases (82.60%), whereas the second molar was affected in 4 cases (17.39%). Only 2 cases presented with bilateral lesions (8.69%), with the remaining 21 cases showing unilateral occurrence (91.30%). Treatment predominantly involved enucleation, utilized in 16 cases (69.56%). The average follow-up period was 6.5 months, ranging from 1 to 27 months.

CONCLUSIONS

This study highlights the diagnostic challenges and treatment considerations associated with MBBC, emphasizing the importance of a conservative approach, particularly in young patients, to preserve dental function and normal facial growth.

Bruxism and direct and indirect restorations failure: A scoping review

OBJECTIVE

To analyze and present the relationship between bruxism and the failure of direct and indirect dental restorations.

METHODOLOGY

The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Human studies reporting on the failure of dental restorations in relation to bruxism were included.

SOURCES

MEDLINE (Ovid), Scopus and Pub Med databases were searched from 2012 to 2024. Additional hand searching was made using Google Scholar, and Scopus were utilized for snowball searching.

STUDY SELECTION

An initial systematic search was made of bruxism and dental restorations failures based on key terms using MeSH and other thesaurus terms appropriate for each database published between 2012 and 2024. Two reviewers screened ten articles using the established criteria for inclusion and exclusion, and a level of agreement of 90 % was established. The available literature on the frequency of studies of the relationship between Bruxism and failure of direct and indirect dental restorations and also identify gaps in the literature for further investigation.

CONCLUSIONS

There were 66 manuscripts for full-text evaluation. After further exclusion, 46 manuscripts were selected for data charting. The studies were on the relationship between bruxism and restorations failure: dental implants studies were 58.7 %; mixed restorations were 10.9 %; indirect restoration (Full Coverage Crowns and Fixed Partial Dentures) 15.2 %; indirect partial coverage restoration (inlays/onlays/overlays/crowns) 6.5 %; indirect restoration (veneers) 4.3 %; direct restoration also 4.3 %. The 87.5 % of the implant studies addressed the effects of bruxism on single implant restorations failure.

LIMITATIONS OF EVIDENCE

Most of the included studies were retrospective, with few prospective studies or clinical trials. However, Bruxism is a risk factor for the failure of direct and indirect restorations.

CLINICAL SIGNIFICANCE

Clinicians should be aware that direct and indirect restorations are at risk of failure in the presence of bruxism, with the exception of indirect monolithic Zirconia.

Changes in stability and marginal bone level around implants with hydrophilic and hydrophobic surfaces for posterior tooth replacement: A 1-year randomized clinical trial

AIM

This two-group parallel, double-blind, randomized clinical trial compared the 1-year changes in longitudinal stability and marginal bone level (MBL) between implants with hydrophilic (HPL) and hydrophobic (HPB) surfaces.

MATERIALS AND METHODS

Patients with single posterior edentulous spaces were randomly assigned to two groups (HPL and HPB), and implants were inserted using a guided protocol. Screw-retained provisional and metal-ceramic crowns were provided per the manufacturer's loading protocol. The implant stability quotient (ISQ) was measured immediately and after 15, 30, 45 (HPL loading), 60, 90 (HPB loading) days, and then at 15, 30, 45 days, 6 and 12 months after final loading. Bone level was assessed at baseline, and 2-weeks, 6 and 12 months after loading. Generalized Estimating Equations regression was used for data analysis due to dependent longitudinal measurements and pooled data from multiple implants within patients.

RESULTS

Thirty-two patients received 48 implants (HPL=22; HPB=26). The initial Mean ISQ was 65.4±10.7Ncm (HPL=63.3±10.4; HPB=67.4±10.7; p=0.191). There was an increase in ISQ in the short-term post-insertion period from T0 to T3 (45 days) in both groups, and no significant changes occurred until T2 (30 days). ISQ comparisons between the final restoration and 1-year follow-up showed significant improvement for HPB (p=0.007) and HPL (p=0.045) groups. The final regression model confirmed that ISQ measures were affected by the progression of time after insertion until 60 days (p=0.003), 180 days (p<0.001), and 1-year (p<0.001). HPB group showed higher ISQ at any time (p=0.048).

CONCLUSION

There was a progressive increase in secondary stability up to approximately 60 days, and the hydrophobic group showed slightly higher ISQ measurements at all time points.

CLINICAL SIGNIFICANCE

This study provides evidence on the comparative longitudinal performance of implants with hydrophilic and hydrophobic surfaces in the posterior region, showing a progressive increase in the secondary stability up to approximately 60 days in both groups. The hydrophobic surface group showed slightly higher ISQ measurements at all time points, however, with no relevant clinical impact on survival and marginal bone changes.

Treatment approaches in cases of mandibular osteoradionecrosis: A systematic meta-analysis

BACKGROUND

Osteoradionecrosis (ORN) refers to necrotic bone that remains unhealed for a minimum of 3 months following radiotherapy in an irradiated region. The aim of this systematic meta-analysis was to evaluate the efficacy of hyperbaric oxygen therapy and surgery alone or in combination in the treatment of patients with ORN.

METHODS

A systematic review and analysis of literature were performed to ascertain the role of surgery and HBO in the treatment of ORN. In May 2024 we updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 1), MEDLINE, EMBASE, DORCTIHM and reference lists of articles.

RESULTS

Among patients who underwent both HBO and surgery, the success rate of the treatment was 69 % (95 % Confidence Interval [CI]: 0.47-0.85, df = 9). Patients who solely received HBO had a success rate of 38 % (CI: 0.20-0.61, df = 4), while those who only had surgery had a success rate of 36 % (CI: 0.19-0.58, df = 3). The statistical analysis showed no significant difference in the results between patients who received only hyperbaric oxygen therapy or surgical treatment (z=0.139, p=0.889). The analysis indicated significant disparities in treatment success rates among patients receiving a combination of HBO and surgery compared to those treated solely with HBO or surgery alone (z = 2.428, p = 0.015 for HBO vs HBO+surgery, z = 2.655, p = 0.008 for surgery vs HBO+surgery).

CONCLUSION

The findings of this study indicate that the combination of HBO and surgery is a more effective approach for managing ORN, with better results observed when treatments are combined rather than used individually.

Clinical and Histologic Outcomes of Biologically Oriented Alveolar Ridge Preservation: A Prospective Observational Study

INTRODUCTION

This study aimed to evaluate the efficacy of Biologically oriented Alveolar Ridge Preservation (BARP) in minimizing post-extraction ridge modifications compared with unassisted socket healing.

METHODS

A prospective controlled observational study was conducted involving 30 patients requiring single-rooted upper premolar extractions. Patients were divided into two groups: the test (15 patients), which underwent a ridge preservation procedure combining absorbable collagen sponge in the middle and apical third of the socket and collagenated xenogeneic bone substitute in the most coronal part (BARP), and the control (15 patients), which healed spontaneously. Soft tissue contour changes after 6 months were analyzed using digital impressions. Moreover, histomorphometric analysis of the regenerated tissue was performed in the test group.

RESULTS

BARP significantly reduced post-extractive mucosal ridge modifications compared to the control group. Mean vertical shrinkage at the mid-buccal part of the edentulous site was 1.61 ± 0.61 mm (BARP) vs. 2.51 ± 0.64 mm (control; t-test, df = 28, p < 0.001), and mean horizontal reduction was 3.37 ± 0.63 mm (BARP) vs. 4.34 ± 0.48 mm (control; t-test, df = 28, p < 0.001). Histomorphometric analysis of the regenerated tissue showed 39.7% ± 9.1% newly formed bone with minimal residual graft material (5.0% ± 5.4%).

CONCLUSION

BARP technique effectively minimizes post-extractive soft tissue contour modifications and supports natural bone regeneration, resulting in adequate bone dimensions for implant rehabilitation.

Gap arthroplasty with disc repositioning for pediatric TMJ ankylosis secondary to intracranial condylar dislocation: A case report

INTRODUCTION AND IMPORTANCE

A rare consequence of maxillofacial trauma of an intracranial dislocation of the mandibular condyle into the middle cranial fossa. We present a case involving the management of this dislocation, complicated by temporomandibular joint (TMJ) ankylosis.

CASE PRESENTATION

An 11-year-old boy was transferred to a tertiary hospital following a road traffic accident. Examination revealed a dislocation of the right mandibular condyle into the middle cranial fossa. After closed reduction by intermaxillary fixation (IMF), the patient developed TMJ ankylosis and the initial mouth opening was 8 mm due to prolonged IMF. He subsequently referred to the National Maxillofacial Unit in Muscat, Oman for expert management and treatment.

CLINICAL DISCUSSION

A pre-operative CT scan revealed an ankylotic bone mass in the left TMJ area. The patient underwent TMJ gap arthroplasty and disc repositioning under general anesthesia. Post-operatively, the patient's mouth opening improved to 43 mm.

CONCLUSION

Multidisciplinary team for management and close monitory such cases is crucial to prevent further surgical complications.

Factors leading to implant failure: An umbrella review of meta-analyses of observational studies and trials

STATEMENT OF PROBLEM

The evidence concerning factors leading to implant failure remains inconclusive. Existing systematic reviews have reported mixed results for patient-related, surgical, and prosthetic factors contributing to implant failure.

PURPOSE

The purpose of this umbrella review was to summarize the evidence and assess existing biases from meta-analyses of randomized controlled trials (RCTs) and observational (cohort and case-control) studies to establish clinically relevant factors associated with implant failure.

MATERIAL AND METHODS

The study had been registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025634487). The Scopus, PubMed, the Cochrane Database of Systematic Reviews, and Epistemonikos databases were searched from inception until June 2024, and the effect sizes were recalculated using a random-effects model for each meta-analysis. Between-study heterogeneity, 95% prediction interval, small-study effects, excess significance, and credibility ceilings were evaluated. The credibility of evidence from meta-analyses of cohort and case-control studies was ranked by established criteria as nonsignificant, weak, suggestive, highly suggestive, or convincing.

RESULTS

A total of 2922 publications were identified, 224 full-texts were evaluated, and 25 articles describing 35 associations were included in the study. Among meta-analyses of RCTs (n=9), 6 (67%) statistically significant associations were identified (P<.05). According to the GRADE assessment, turned versus anodized implants, submerged versus nonsubmerged implant healing, and bone augmentation with long implants versus short implants were associated with a higher risk of implant failure (high certainty evidence). Short implants (<10 mm) versus long implants (>10 mm) and immediate versus delayed implant placement were associated with higher risk for implant failure (moderate certainty evidence). Among the meta-analyses of cohort and case-control studies (n=26), 18 (69%) associations were statistically significant (P<.05). None were graded as convincing. Highly suggestive evidence was established for the association between smoking and implant failure. Suggestive evidence emerged for associations including periodontally compromised versus periodontally healthy patients, proton pump inhibitor therapy, Crohn's disease, bone quality type II versus type IV, bone quality type III versus type IV, nonsubmerged immediately loaded versus submerged delayed loaded implants, short implants (<10 mm) versus long implants (>10 mm), selective serotonin re-uptake inhibitor therapy, turned versus anodized implants, and immediately loaded versus conventionally loaded implants. These findings remained robust after sensitivity analyses.

CONCLUSIONS

Observational studies suggest that smoking is associated with an increased incidence of implant failure. Evidence from observational and randomized trials has supported using anodized implants for better outcomes. Several factors were identified as leading to an increased risk of dental implant failure. The remaining factors require additional high-quality studies for better assessment and clinical recommendations.

Relation between CAD dimensional parameters and framework fracture in zirconia full arch implant rehabilitation: An observational cohort study

OBJECTIVES

To evaluate the influence of different dimensional parameters on the incidence of framework fractures in a large sample of 151 implant-supported, screw-retained monolithic zirconia fixed complete dental prostheses (IFCDPs).

METHODS

This retrospective observational study evaluated all patients rehabilitated with screw-retained zirconia IFCDPs at a private practice between October 2021 and May 2023. Inclusion criteria required a documented minimum follow-up period of 12 months after occlusal loading. Cantilever length (CL), distal cross-sectional connector area (CSCA), and screw access opening length (SAOL) were digitally measured on a computer-aided designed digital wax-up before framework milling. If the parameter ratios were below previously established cut-off values (CL/CSCA<0.51; CL/SAOL<1.48), the prostheses were produced; otherwise, the digital design was modified, and the ratios were recalculated. All prostheses were digitally produced using monolithic zirconia veneered on the gingival portion only. The primary outcome investigated was framework type II fractures (fractures of the distal cantilever).

RESULTS

A total of 151 prostheses delivered to 117 patients were analyzed. No type II fractures occurred. Two implants failed in two patients during the temporary phase, and two failed after delivery of the definitive prosthesis. Six prostheses failed (3.97% prosthetic failure rate): one due to implant failure and five due to type I fractures (fractures occurring between, but not involving, the two most posterior SAOs). In one case, implant failure did not result in prosthetic failure.

CONCLUSIONS

In this study, no cantilever fractures were observed in patients restored with zirconia IFCDPs manufactured following specific parameters. Further studies are needed to confirm this positive outcome.

CLINICAL SIGNIFICANCE STATEMENT

This study provides prosthetic dimensional parameters that may help prevent cantilever fractures in IFCDPs. In addition to CL, both CSCA and SAOL should be considered during framework digital design. In this study, no cantilever fractures were observed during the follow-up period when the cut-off values (CL/CSCA < 0.51; CL/SAOL < 1.48) were met.

Fully guided, flapless zygomatic implants for oncological rehabilitation-a technical note

Midface defects following head and neck cancer surgery present significant functional and aesthetic challenges. While free-tissue transfer is a favoured reconstructive approach, it may be contraindicated in the medically comorbid and failure may be catastrophic, resulting in significant morbidity. In such cases, zygomatic implant-retained prosthetic obturators provide an effective alternative. However, traditional zygomatic implant placement often requires the elevation of large full-thickness mucoperiosteal flaps, risking osteoradionecrosis in irradiated bone following postoperative radiotherapy. This technical note describes a novel method for fully guided, flapless zygomatic implant placement that was applied in a 74-year-old with a Brown Class IId maxillary defect following hemi-maxillectomy of a pT4aN0M0 right maxillary squamous cell carcinoma. Using virtual surgical planning, two zygomatic implants were placed utilizing 3D-printed tissue-borne drill guides based on the patient's obturator. These guides were designed with low tolerance flutes to minimize angular deviation and utilized hard and soft tissue undercuts to ensure stability. By using a flapless technique, trauma to the irradiated tissues was minimized, whilst achieving accurate zygomatic implant placement. This case highlights the importance of a multidisciplinary approach between the surgical, prosthetic, and engineering teams. Further studies are needed to validate the accuracy and predictability of this innovative approach.

Integrative Approaches in the Management of Hypertrophic Cardiomyopathy: A Comprehensive Review of Current Therapeutic Modalities

Hypertrophic cardiomyopathy (HCM) is often associated with left ventricular outflow tract (LVOT) obstruction, which affects a substantial proportion of patients. This obstruction results from a range of anatomical abnormalities involving both the valvular and subvalvular structures. Pharmacological therapies play a pivotal role in the management of LVOT obstruction, with a range of drug classes exhibiting distinct mechanisms of action. Beta-blockers, including atenolol and nadolol, are considered the first-line treatment due to their ability to reduce heart rate and myocardial contractility and enhance diastolic filling. Non-dihydropyridine calcium channel blockers, such as verapamil and diltiazem, are utilized as second-line agents when beta-blockers are ineffective or contraindicated. Disopyramid, a Class 1A antiarrhythmic agent, is employed for patients who do not respond to initial therapeutic interventions and can reduce LVOT gradients. Recent advancements in cardiac myosin modulators, such as Mavacamten and Aficamten, offer targeted therapies by modulating myosin-actin interactions to reduce LVOT gradients and improve symptoms, with promising results from clinical trials. Although gene therapy is still in its nascent stages, it has the potential to address the genetic basis of HCM by employing techniques such as genome editing, gene replacement, and the modulation of signaling pathways. For patients exhibiting severe symptoms or demonstrating unresponsiveness to medical treatment, invasive therapies, such as septal reduction therapy and alcohol septal ablation, are considered. Ultimately, the treatment and prevention of atrial fibrillation and sudden cardiac death are two key points of HCM management in both obstructive and non-obstructive forms. This review aims to provide an overview of current pharmacological and invasive strategies, as well as emerging therapies, in the management of HCM.

Digital functionally generated path vs. traditional CAD-CAM methods for single posterior crowns: An in vivo study of the effects on patient satisfaction and crown volume

PURPOSE

To determine the effect of using the digital functionally generated path (FGP) method and the traditional computer-aided design and computer-aided manufacturing (CAD-CAM) method to design and mill single posterior crowns in terms of patient satisfaction and crown volume analysis.

MATERIALS AND METHODS

An intraoral scanner (IOS) was used to record maxillary and mandibular arch scans and record buccal and laterotrusive records of thirteen selected participants. Two zirconia crowns were fabricated for each patient: a conventional crown, designed using only the buccal interocclusal record, and a new technique crown, where adjustments were made using both buccal and laterotrusive records. After milling and sintering, adhering to the manufacturer's instructions, patient satisfaction was analyzed using Likert's 3-point scale, and crown volume was analyzed using Blender software. Paired t-test and Wilcoxon signed-rank test were performed for analyzing differences between groups (p-value ≤ 0.05).

RESULTS

Conventional crowns had a Likert scale score of 1.00, significantly higher than the new technique crowns' median score of 0.0 (p < 0.05). Conventional crowns had a mean volume of 161.9 ± 15.51 mm3, significantly larger than new technique crowns (148.6 ± 12.71 mm3, p = 0.025).

CONCLUSION

CAD-CAM zirconia crowns designed with consideration of the FGP technique exhibited superiority in terms of patient satisfaction when contrasted with CAD-CAM zirconia crowns designed based on static occlusion data. Utilizing virtual mandibular movement replication may serve as a reliable method for locating interferences and adjusting zirconia crown designs.

Evaluation of the effects of geometric design and surface properties of dental implants on marginal bone loss and bone quality by fractal analysis

BACKGROUND

The aim of this study is to investigate the effects of surface properties and geometric design on marginal bone loss in dental implants and to compare the parallelism of bone loss and fractal analysis results.

METHODS

A total of 378 implants from 114 patients were evaluated in this study using panoramic and periapical radiographs. Implants were categorized into 19 subgroups according to the jaw where they were placed, length, diameter, surface preparation, type of prosthetic superstructure, and neck design. Radiological evaluations were conducted based on radiographs obtained at the time of implant placement and 3 months after prosthetic loading. After obtaining measurements of marginal bone loss and fractal analysis data, the significance of differences between groups was statistically evaluated.

RESULTS

Marginal bone loss was significantly higher in the maxilla compared to the mandible when considering the changes between jaws (p < 0.05). Analysis of variations among prosthetic superstructures revealed that implant-supported removable prostheses had the highest marginal bone loss (p < 0.05). Additionally, marginal bone loss was significantly lower in implants with coronal microthreads not exceeding 1 mm compared to those exceeding 1 mm (p < 0.05). Also the increase in fractal values was significantly higher in implants with coronal microthreads 1 mm compared to 3 mm.

CONSLUSION

This study demonstrates that the geometric design of dental implants may have an impact on marginal bone loss, which is a determinant of long-term success. However, considering that marginal bone loss has a multifactorial etiology, further studies are needed to identify other potential factors contributing to marginal bone loss.

Finite element method of subperiosteal implants: a systematic review on biomechanical performance and stress distribution

BACKGROUND

Severe jaw atrophy limits the success of conventional implants, making subperiosteal implants a viable alternative. Advances in CBCT imaging, 3D printing, and finite element method (FEM) simulations allow precise biomechanical assessment of implant performance and stress distribution. This review evaluated FEM studies on subperiosteal implants to determine their biomechanical behavior and compare them with conventional implants.

MATERIALS AND METHODS

A systematic search was conducted in Web of Science, PubMed, Scopus, and Lilacs until February 2025, following PRISMA guidelines. Studies using FEM to analyze subperiosteal implant stress distribution were included. Risk of bias was assessed using the ROBINS-I tool adapted for in silico studies.

RESULTS

Twelve studies met the inclusion criteria. FEM analyses showed that subperiosteal implants distribute stress more evenly than conventional implants, reducing peak stress at bone/implant interfaces. Dual-configuration implants demonstrated better biomechanical stability, while material choice (e.g. titanium vs PEEK), screw fixation, and implant thickness significantly affected performance. Oblique loading increased displacement risks.

CONCLUSION

Subperiosteal implants offer a promising solution for severe jaw atrophy. FEM simulations suggest improved stress distribution and mechanical stability, but further optimization of fixation methods and material selection is needed. Clinical validation and standardized FEM methodologies are essential to confirm long-term success.

Association Between Tobacco and Periodontal Disease in Latin America from 2000 to 2024: Cross-Sectional Analysis of Global Burden of Disease Study

Objectives: This study aims to examine the ecological-level association between active and passive tobacco use and periodontal disease in Latin America from 2000 to 2024. Methods: A cross-sectional ecological study was conducted using secondary data from the Global Burden of Disease Study. Data from 20 Latin American countries were analyzed, stratified by country, sex, and age group. Multiple regression models were used to assess the relationship between tobacco consumption and periodontal disease prevalence, adjusted for age and sex. Results: The prevalence of periodontal disease was high in both sexes, particularly among individuals older than 55 years. The countries with the highest age-standardized rates were Colombia, Panama, and Costa Rica, with nearly 35,000 cases per 100,000 population. Regression models indicated that passive tobacco exposure explained 90.4% of the variability in women (R2 = 0.9041) and 92.5% in men (R2 = 0.9253). Active tobacco use showed weaker associations, with R2 values of 0.3721 in women and 0.4601 in men. Passive exposure demonstrated better predictive accuracy, with lower Root MSE values (3192.8 and 3261.7). Conclusions: There is a significant ecological-level association between tobacco use and periodontal disease in Latin America, particularly for passive exposure. These findings highlight the need to strengthen tobacco control policies and preventive strategies targeting environmental exposure. However, due to the ecological nature of the study, these associations do not imply causality at the individual level. Longitudinal studies with individual-level data are needed to explore the underlying biological and contextual factors.

Marginal bone changes in cement-retained implant-supported crowns: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Despite extensive research on the individual factors associated with marginal bone changes around cement-retained implant-supported crowns, there remains a substantial knowledge gap concerning the cumulative impact of multiple factors on this outcome.

PURPOSE

The purpose of this systematic review and meta-analysis was to identify factors associated with marginal bone changes around cement-retained implant-supported crowns and to compare these bone changes with those of screw-retained implant-supported crowns.

MATERIAL AND METHODS

A comprehensive literature search was conducted in the PubMed, Embase, and Scopus databases before November 2024, supplemented by a manual search of relevant reference lists. Two independent reviewers screened studies, extracted data, and assessed study quality. The included studies involved bone-level dental implants with platform-switching and internal connection designs supporting cement-retained crowns adjacent to natural teeth. Relevant data were extracted and analyzed using meta-regression to identify significant factors influencing marginal bone changes. Pairwise meta-analysis was performed to compare the mean marginal bone changes between cement- and screw-retained implant-supported crowns.

RESULTS

Thirty-one studies, comprising 17 randomized controlled trials (RCTs) and 14 prospective nonrandomized studies, were included in the analysis. Meta-regression analysis revealed that mandibular implant placement was associated with greater bone loss compared with maxillary implant placement. Additionally, baseline bone measurements made at implant loading were linked to less bone loss than those made at implant placement. Certain loading and placement protocols demonstrated lower bone loss, while glass ionomer, zinc phosphate, polycarboxylate, and resin cements were associated with less bone loss compared with zinc oxide cement (P<.05). Over a period of 6 months to 7.5 years, the pooled mean marginal bone change was 0.201 mm (95%CI: 0.147, 0.256) for cement-retained crowns, while for the screw-retained crowns it was 0.105 mm (95%CI: 0.058, 0.151). However, no significant difference in mean marginal bone change was observed between the 2 groups (P=.888).

CONCLUSIONS

The findings indicated that several factors significantly impacted marginal bone loss, including implant placement site, baseline marginal bone measurement, implant placement and loading protocols, and cement type. Cement-retained crowns exhibited statistically similar bone loss compared with screw-retained crowns.

The Global Burden of Maxillofacial Trauma in Critical Care: A Narrative Review of Epidemiology, Prevention, Economics, and Outcomes

Background and Objectives: Maxillofacial trauma represents a significant global health challenge with substantial physical, psychological, and socioeconomic consequences. Materials and Methods: This narrative review analyzed 112 articles published between 2000 and 2024 examining epidemiology, prevention, economics, and outcomes of maxillofacial trauma in critical care settings. Results: Road traffic accidents remain the primary cause globally, followed by interpersonal violence and occupational injuries. Effective prevention strategies include seat belt laws, helmet legislation, and violence prevention programs. Economic burden encompasses direct healthcare costs (averaging USD 55,385 per hospitalization), productivity losses (11.8 workdays lost per incident), and rehabilitation expenses (USD 3800-18,000 per patient). Surgical management has evolved toward early intervention, minimally invasive approaches, and advanced techniques using computer-aided design and 3D printing. Complications affect 3-33% of patients, with significant functional disabilities and psychological sequelae (post-traumatic stress disorder in 27%, depression/anxiety in 20-40%). Conclusion: Maxillofacial trauma management requires multidisciplinary approaches addressing both immediate treatment and long-term rehabilitation. Despite technological advances, disparities in specialized care access persist globally. Future efforts should implement evidence-based prevention strategies, reduce care disparities, and develop comprehensive approaches addressing physical, psychological, and socioeconomic dimensions through collaboration among healthcare professionals, policymakers, and community stakeholders.

Cardiac Device-Related Infective Endocarditis Caused by Salmonella Infantis-Case Report and Review of Clinical and Epidemiologic Implications

BACKGROUND

Salmonella enterica serovar Infantis (S. Infantis) is a widespread pathogen in agriculture, causing epidemics in chicken flocks. Despite being primarily an animal pathogen, it may pose significant health risks to immunocompromised individuals.

METHODS

This report describes the first known case of cardiac device-related infective endocarditis (CDRIE) attributed to S. Infantis, highlighting its emerging pathogenic potential. It also reviews the literature for microbiologic and epidemiologic perspectives.

RESULTS

A 61-year-old male with a history of high-grade multiple myeloma presented with nonspecific symptoms, including low-grade fever and exertional dyspnoea. Blood cultures identified a pure culture of S. Infantis, and transoesophageal echocardiography revealed vegetations on pacing leads. Following pacemaker extraction and appropriate antimicrobial therapy, the patient's condition temporary improved, but later deteriorated due to the progression of underlying malignancy.

CONCLUSIONS

This case underscores the importance of considering S. Infantis in the differential diagnosis of endocarditis in immunocompromised patients, along with the critical need for stringent food safety measures to mitigate infection risks from contaminated poultry products.

CBCT Evaluation of Maxillary Incisive Canal Characteristics Among Population in Regard to Possibility of Implant Cortical Anchorage-A Multicenter Study

Background/Objectives: Implant placement in cases of severe bone atrophy or compromised alveolar bone requires careful planning, especially in the anterior maxilla. The nasopalatine canal (NPC) and its cortical walls offer potential anchorage sites. This study evaluates the NPC's anatomical characteristics using cone beam computed tomography (CBCT) to assess its suitability for implant anchorage. Methods: A retrospective analysis of 150 CBCT scans from three dental clinics in Poland was conducted. NPC measurements-including length, width, number of canals, and distances to adjacent anatomical structures-were taken in the sagittal, coronal, and axial planes. Statistical tests included Pearson correlation and Student's t-test to explore relationships between NPC dimensions and gender. Results: The mean NPC length was 10.27 mm and mean width 3.55 mm. Significant gender differences were observed in the canal length, width, and distances to the labial and palatal plates (p < 0.05). Strong positive correlations were found between the canal width at the palate base and other parameters, such as the midpoint width (r = 0.58) and diameter (r = 0.44). The distance from the palatal opening to the labial plate showed the strongest correlation (r = 0.67), indicating enhanced cortical anchorage potential with increased canal dimensions. Discussion: NPC morphology varied (cylindrical, funnel-like, hourglass), aligning with prior studies. Larger diameters were linked to single-canal configurations. Implant placement strategies-such as direct canal insertion or lateralization-can be effective, especially with polished, single-piece implants that reduce soft tissue ingrowth and improve primary stability. Conclusions: Understanding NPC anatomy is crucial for implant planning in atrophic maxillae. With the proper technique, NPC use for cortical anchorage is a viable treatment option.

Classic Desmoplastic Ameloblastoma: Should It Be a Distinct Subtype of Ameloblastoma?-Based on Clinicopathological, Radiological, Immunohistochemical and Molecular Study of a Large Cohort

OBJECTIVES

To identify whether the classic desmoplastic ameloblastoma (DA) is an independent subtype of ameloblastoma.

MATERIALS AND METHODS

Eighty-six classic DA and 28 hybrid DA cases were retrieved, and available clinical, radiological, and histopathological data were collected. DNA from microdissected tumor tissues were utilized for BRAF V600E, SMOL412F, and CTNNB1 mutation detection. Data of classic DA and hybrid DA were analyzed and compared with each other and with previous reports of conventional ameloblastoma (CA).

RESULTS

69.8% (60/86) of classic DA occurred in the mandible, with the majority affecting the anterior-premolar regions. They were characterized as osteolytic bone expansion (33.8 ± 12.8 mm) with internal bone/calcification (57/58, 98.3%) in radiology. Genetically, classic DA exhibited a high incidence of BRAF V600E mutation (58/62, 93.5%) but no CTNNB1 and SMO L412F mutations. Hybrid DA exhibited similarities to CA in jawbone location, tumor size, and radiology. The recurrence rate of classic DA (9.2%) was lower than that of CA (25.8%).

CONCLUSION

High anterior-premolar distribution, a mixture of osteolytic and internal high-density shadows in radiology, smaller tumor size, compressed epithelium with abundant stroma and scattered bone, consistent mutation of BRAF V600E, and better prognosis all suggest that classic DA may be a distinct clinicopathological subtype of ameloblastoma.

Influence of crown-implant ratio on photofuntcionalized short implants success rates: 5 year follow-up prospective study

OBJECTIVE

To evaluate the influence of crown-to-implant ratio(C/I) on marginal bone level changes and survival rate of implants during function.

METHODS

The study included 68 patients with completely or partial edentulous and severe vertical bone atrophy, which were restored with a single crown(46) or a partial fixed(48) denture supported by 152 short implants. Implants were divided into three groups according to the C/I ratio (1.5:1, 1,75:1, 2:1). The results were evaluated: failures of the implant, any complications, implants marginal bone loss (MBL), implants success rates the follow up for 5 years. MBL was assessed by taking x-rays after restoration fixation, after 1,3,5 years post operatively.

RESULTS

During implantation and in the post-implantation period, no serious biological or prosthetic complications were recorded. After 1 years in Group 1 mean MBL 0.86 ± 0.4 mm, after 3 years 0,98 ± 0.2 mm), after 5 years 1.05 ± 0.3 mm. After 1 years in Group 2 mean MBL 0.97 ± 0.3 mm, after 3 years 1,07 ± 0.4 mm), after 5 years MBL was 1.12 ± 0.6 mm.Аfter 1 years in Group 3 mean MBL 1,08 ± 0.6 mm, after 3 years 1,19 ± 0.2 mm, after 5 years MBL was 1.27 ± 0.3 mm. Short implants cumulative success of implantation after 5 years was 97.8% for group 1, 97.6% for group 2, and 97.3% for group 3. Patients were satisfied with the results of treatment.

CONCLUSIONS

The study showed that different C/I ratios of short implants did not affect the survival rate and their use can be considered favorable and completely justified.

CLINICAL TRIAL NUMBER

Not applicable.

Analysis of Neurosensory Changes in Orthognathic Surgery Using Saw or Piezoelectric Devices: A Scoping Review

Orthognathic surgery is a successful surgical method for correcting facial deformities, and the piezoelectric system can be used in place of or in addition to traditional tools like the reciprocating saw to perform osteotomies. This study assesses how using a reciprocating saw or a piezoelectric device exclusively affects neurosensory impairment. A review was performed following the PRISMA-ScR recommendations. A search was conducted until December 2024 in PubMed, Embase, and Web of Science. Clinical trials and quasi-experimental studies in English and Spanish were included. A total of nine articles were obtained for full-text review using inclusion and exclusion criteria. The selected articles included a total of 731 subjects. The age range of the studies included was between 18 and 49 years. Three of the six analyzed state that piezoelectric surgery positively correlates with neurosensory recovery, showing less surgical time and a less painful and faster postoperative recovery than the use of a saw. However, only two reported no significant statistical difference in sensitivity recovery between the saw and piezoelectric instruments. Despite the methodological heterogeneity among the studies included, the sample size, and the variability of factors, using a piezoelectric system typically shows a better postoperative recovery of sensitivity compared to using a saw.

Influence of intermediate abutment height and timing of placement on marginal bone loss in single implant-supported crowns: a 12-month follow-up randomized clinical trial

OBJECTIVES

To determine the most effective combination of abutment height and timing of placement in reducing marginal bone loss (MBL).

MATERIALS AND METHODS

54 patients received at least one single screw-retained crown on an implant replacing a posterior tooth (60 implants). Implants were divided into six groups based on intermediate abutment height (1.5 mm, 2 mm, 3 mm) and timing of placement (immediate: surgery 1; delayed: surgery 2): Group A3I (height 3, surgery 1), Group A2I (height 2, surgery 1), Group A15I (height 1.5, surgery 1), Group A3D (height 3, surgery 2), Group A2D (height 2, surgery 2), Group A15D (height 1.5, surgery 2). Mesial and distal linear radiographic measurements were taken at five follow-up points: implant surgery, crown placement (T1), and 3 (T2), 6 (T3), and 12 months after loading (T4). Partial and total MBL were compared between groups.

RESULTS

After 12 months, the lowest MBL was found in groups A3I (0.13 ± 0.11 mm) and A2I (0.24 ± 0.11 mm), with no statistical difference between them. Groups A15I (0.70 ± 0.12 mm), A3D (0.66 ± 0.11 mm), A2D (0.62 ± 0.12 mm), and A15D (0.78 ± 0.11 mm) showed significantly higher MBL than groups 1 and 2, with no statistical difference among them.

CONCLUSIONS

Immediate abutments of 2-3 mm resulted in lower MBL compared to 1.5 mm immediate abutments or any delayed abutments.

CLINICAL RELEVANCE

This study provides data on the optimal combination of intermediate abutment height and placement timing in preventing MBL.

CLINICAL TRIAL REGISTRATION

Clinical trial registration number: NCT06667531. link: https://clinicaltrials.gov/study/NCT06667531 .

New Insights into Ameloblastic Fibromas, Fibrodentinomas, and Fibro-Odontomas: Findings from an International Multicenter Study

INTRODUCTION

Ameloblastic fibroma (AF), ameloblastic fibrodentinoma (AFD), and ameloblastic fibro-odontoma (AFO) are rare mixed odontogenic tumors. While some authors propose that some cases may evolve into odontomas, other tumors with aggressive clinical features suggest a neoplastic origin. A subset of AF and AFD/AFO harbor the pathogenic BRAF p.V600E mutation. SOX9, known for its role in the differentiation of various cell types, particularly in chondrogenesis, has not been previously studied in odontogenic tumors. In this study, we report the clinicopathologic features of a large international cohort of AF and AFD/AFO cases and analyze the immunohistochemical expression of BRAF p.V600E and SOX9.

MATERIALS AND METHODS

Clinical and radiographic data were collected from four Oral and Maxillofacial Pathology service archives spanning from 1991 to 2024. Deidentified slides were reviewed by two independent oral pathologists. Immunohistochemical staining for BRAF p.V600E and SOX9 was performed on non-decalcified tissue samples from cases with available specimens.

RESULTS

A total of 62 tumors were identified, including 30 AF cases and 32 AFD/AFO cases. The cohort consisted of 33 male and 29 female patients, with average ages of 15.3 years for AF and 12.3 years for AFD/AFO. Tumors predominantly affected the posterior mandible and appeared as unilocular or multilocular radiolucent or mixed lesions, often causing tooth impaction and cortical expansion, with an average size of 3.7 cm for AF and 2.5 cm for AFD/AFO. Two cases were classified as peripheral AF/AFD. Microscopically, all cases exhibited cellular mesenchymal components resembling dental papilla, with branching strands and islands of odontogenic epithelium. AFD/AFO cases also displayed dental hard tissue, and occasional chondromyxoid differentiation was observed within the stroma. Rare hybrid tumors were identified, including associations with calcifying odontogenic cysts, cemento-ossifying fibroma and central giant cell granuloma. BRAF p.V600E showed cytoplasmic positivity in the mesenchymal component of AF (81%) and AFD/AFO (54%). SOX9 exhibited diffuse nuclear immunoreactivity in both epithelial and mesenchymal components (92%).

CONCLUSION

This study represents one of the largest well-documented series of AF and AFO/AFD, providing valuable clinicopathologic and immunohistochemical insights. Additionally, the diffuse expression of SOX9 in both epithelial and mesenchymal components suggests a potential role in odontogenic differentiation, a novel finding that may have implications for understanding the histogenesis of these lesions. The aggressive behavior of some AFs and AFD/AFOs in our study supports their classification as odontogenic neoplasms rather than hamartomas.

Influence of implant internal thread deformation and repair on screw torque maintenance. An in vitro study

STATEMENT OF PROBLEM

Abutment or screw fracture is a complication of implant-supported prostheses that can damage the internal threads of the implant. Thread tapping can restore the function of the damaged implant but could affect mechanical performance.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of the damage to and subsequent repair of the internal threads of dental implants on the maintenance of screw torque after functional loading.

MATERIAL AND METHODS

Ten external connection implants (Biomimetic Coral EC; Avinent) with 17-degree angled abutments for cemented restorations were used for the CONTROL group. The recommended torque (35 Ncm) was applied, and initial retrieval torque values (RT PRE) were recorded with a surgical motor (iChiropro; Bien Air). The specimens were subjected to the cyclic loading equivalent of 1 year of in vivo use (300 000 cycles, at 200 N and 2 Hz), and the final retrieval torque values (RT POST) were recorded. The specimens were subjected to internal thread deformation by the pressurized insertion of a drill, and the threads were repaired with a manual thread tapping tool to constitute the repaired implant group (REP). The same variables were recorded as in the CONTROL group. The data were evaluated for normality with the Shapiro-Wilk test; the Student t test was used for the variables that met normality, and the Mann Whitney U-test was used for nonnormal variables (α=.05).

RESULTS

Initial torque values (RT PRE) showed significant differences (P=.002) between the groups, with mean ±standard deviation values of 28.41 ±3.18 Ncm for the CONTROL group and 18.77 ±1.88 Ncm for the REP group. However, no statistically significant differences (P=.499) were observed in the final retrieval torque (RT POST) values between the groups, with mean ±standard deviation values of 18.66 ±3.26 Ncm for the CONTROL group and 20.38 ±5.53 Ncm for the REP group. Statistically significant differences were found in the difference in torque (ΔRT) between the groups (P<.001). No loosening was recorded, but one of the screws in the REP group fractured during cyclic loading.

CONCLUSIONS

The deformation and repair of the internal threads of implants negatively impacted the maintenance of the initial torque but did not affect the final torque after functional loading. Within the limitations of this study, thread repair could be an effective method of extending the lifespan of implants with damaged threads, as it is straightforward, conservative, and cost-effective. Further research in this area is required to evaluate the potential increase of stress generated in the screw.

DATA AVAILABILITY STATEMENT

The datasets used and analyzed during the current study are available from the corresponding author on request.

Validation of a digital, partly automated three-dimensional cast analysis for evaluation of orthodontic treatment assessment

BACKGROUND

Plaster models have been considered the gold standard in traditional orthodontic model analysis. Modern imaging techniques and ever-advancing technologies have expanded the scope of digital diagnostic tools. These innovations allow the use of devices specifically designed for the diagnosis of 3D structures. The aim of this method comparison study was to determine the accuracy and efficiency of digital measurements compared to conventional manual measurements on plaster models.

MATERIALS AND METHODS

The present cohort constitutes the evaluation of pretherapeutic situation models of 247 orthodontically treated patients (129 females and 118 males, average age 16.76 +- 9.49 years) with mixed or permanent dentition who were treated at the University Hospital RWTH Aachen between January 2018 and December 2020. Plaster models were digitised using a model scanner, and an experienced examiner performed various measurements on blinded plaster models using a calliper and on digital models using the specially developed 'Tooth width analysis Aachen' patch in the OnyxCeph3TM-3D software. The intra-rater and inter-rater reliability were determined by a second, blinded assessor. Measurements included tooth width, crown height, arch width, arch length and arch circumference, as well as overjet and overbite. Differences between analogue and digital methods were calculated.

RESULTS

Differences of up to 0.3 mm were observed between manual and partially automated digital measurements for sagittal, transversal and vertical parameters. Teeth with close proximal contact to adjacent teeth and teeth in jaws with a negative space analysis result showed an increased difference between manual and partially automated digital measurements, although this was not clinically relevant. The time required to perform digital measurements was statistically significantly reduced.

CONCLUSIONS

Partially automated digital impression analysis offers an accurate, highly efficient and time-saving alternative to traditional manual impression analysis.

Dimensional Accuracy of Regular- and Fast-Setting Vinyl Polysiloxane Impressions Using Customized Metal and Plastic Trays-An In Vitro Study

The aim of this study was to compare the dimensional accuracy of vinyl polysiloxane impressions differing in terms of curing time (regular-setting (RS) or fast-setting (FS)) in combination with different tray materials (metal (M) and plastic (P)). A typodont reference model simulated a partially edentulous maxilla. Reference points were given by center points of either precision balls welded to specific teeth or finishing-line centers of prepared teeth. These reference points enabled the detection of dimensional deviations between the digitized reference and the scans of the models achieved from the study impressions. Twenty impressions were made for each of the following four test groups: RS-M, RS-P, FS-M and FS-P. Global scan data accuracy was measured by distance and tooth axis deviations from the reference, while local accuracy was determined based on the trueness and precision of the abutment tooth surfaces. Statistical analysis was conducted using ANOVA accompanied by pairwise Tukey post hoc tests (α = 0.05). Most of the distances tended to be underestimated. Global accuracy was favorable; even for long distances, the mean absolute distance deviations were < 100 µm. Local accuracy was excellent for all test groups, with trueness ≤ 11 µm and precision ≤ 9 µm. Within the limitations of this study, all impression and tray materials were suitable to fabricate models with clinically acceptable accuracy.

Lateral periodontal cyst of the anterior maxilla: a rare case report

BACKGROUND

The lateral periodontal cyst (LPC) is a rare developmental odontogenic cyst, constituting approximately 0.4% of all odontogenic cysts and 0.7% of all jawbone cysts. It is an intraosseous, non-keratinized, non-inflammatory, developmental odontogenic cyst of epithelial origin, typically occurring adjacent to the root of a vital tooth. The lesion usually measures less than one centimeter in diameter. However, in the present case, the lesion was larger, measuring 3.5 × 2.4 × 2.4 cm. Radiographically, LPCs present as unilocular, round, oval or teardrop-shaped radiolucent lesions with a sclerotic border, located laterally to the tooth roots.

CASE PRESENTATION

A 42-year-old female presented to the Oral and Maxillofacial Surgery outpatient department with a chief complaint of swelling on the anterior maxilla for one year. The swelling was asymptomatic, with no associated pain or discomfort. Clinical examination revealed a non-tender, fluctuant swelling on the left side of the anterior maxilla, located between the lateral incisor and canine teeth. A computed tomographic scan confirmed the presence of a lytic lesion on the left side of the anterior maxilla. Surgical enucleation of the cyst was performed through an intraoral crevicular approach under general anesthesia. The excised specimen was sent for histopathological examination. Histopathological examination of the cyst wall revealed a non-keratinized, non-ciliated stratified squamous epithelial lining, ranging from 1 to 5 cell layers in thickness. Interspersed among the epithelial cells were foci of Periodic Acid-Schiff (PAS) positive, glycogen-rich clear cells. Additionally, focal nodular areas of epithelial thickening with a whorled, swirling architecture were observed in continuity with the epithelial lining. The underlying subepithelial connective tissue was fibrous and exhibited a zone of hyalinization. These features were consistent with a diagnosis of lateral periodontal cyst. The healing process was uneventful, and no complications were observed during the one-year follow-up.

CONCLUSION

Although the lateral periodontal cyst is a rare developmental odontogenic cyst, it should be considered in the differential diagnosis of cystic lesions adjacent to the root of a vital tooth. Surgical enucleation remains the treatment of choice, with histopathological examination confirming the diagnosis. Recurrence of lateral periodontal cysts is infrequent.

Effects of Bisphosphonates and Denosumab on Dental Implants: A Systematic Review With Meta-Analysis

OBJECTIVE

This review aimed to evaluate the effects of bisphosphonates (BP) and denosumab on dental implants, including implant failure (IF), marginal bone loss (MBL), and medication-related osteonecrosis of the jaw (MRONJ).

MATERIALS AND METHODS

A literature search was conducted in four databases and OpenGrey. Studies examining IF/MBL/MBRONJ associated with BP or denosumab were included. ROBINS-I was used to assess the risk of bias. Trial sequential analysis and the GRADE approach were used to examine the certainty of evidence. Statistical analyses were conducted using R version 4.3.1.

RESULTS

Twenty-one studies were included. BP was associated with IF only at the implant level (RR 1.74; 95% CI: 1.10-2.75) but not at the patient level (RR 1.01; 95% CI: 0.35-2.91). The analysis of two studies indicated no significant correlation between BP and MBL (MD 0.05; 95% CI: -0.12 to 0.21). BP was associated with MRONJ (RR 3.45; 95% CI: 2.56-4.65), whereas denosumab showed no significant statistical correlation with MRONJ (RR 25.98; 95% CI: 0.31-2165.63).

CONCLUSION

In patients with dental implants, the existing very low certainty level evidence suggests that BP intake may be associated with greater risks of IF and MRONJ but not with MBL, whereas it is currently unknown whether denosumab is associated with MRONJ.

Assessing Precision in All-Ceramic Fixed Restorations: Unveiling the Marginal Fit Through Digital and Traditional Impressions-A Comprehensive Systematic Review and Meta-Analysis

The marginal fit of all-ceramic fixed restorations is critical to long-term success. This comprehensive study and meta-analysis assessed the marginal fit of restorations manufactured using digital versus conventional impression procedures. We conducted a comprehensive search of electronic databases such as PubMed, Cochrane CENTRAL, Web of Science, and Scopus for publications published up to 2023. Eligible papers comparing the marginal fit of all-ceramic permanent restorations made using digital and conventional impressions were considered. A total of 19 studies met the inclusion criteria. The pooled analysis revealed that restorations fabricated from digital impressions exhibited a significantly better marginal fit than those from conventional impressions and showed a mean marginal gap of -13.76 µm (95% confidence interval: [-24.77, -2.76], p-value = 0.01). Subgroup analysis by type of digital impression system demonstrated consistent superiority of zironica material over other ones. However, high heterogeneity was observed among the included studies (I 2 = 90.74%). Digital impression restorations show superior marginal fit compared with conventional impressions, but high heterogeneity requires cautious interpretation and further well-designed studies to validate results.

Selective Serotonin Reuptake Inhibitors May Increase Implant Failure

BACKGROUND

Patients receiving dental implants may take selective serotonin reuptake inhibitors (SSRI). There may be an association with taking an SSRI at implant placement and implant failure.

PURPOSE

The study's purpose was to estimate the association between SSIR exposure and implant failure.

STUDY DESIGN

The study design was a retrospective cohort study. The sample was patients who received dental implants between December 1, 2007, and February 29, 2020. Patients were excluded if the follow-up was <12 months.

PREDICTOR VARIABLE

The predictor variable was SSRI exposure at the time of implant placement coded as exposed or not exposed.

OUTCOME VARIABLE

The primary outcome variable was implant status at 1 year, coded as survived or failed.

COVARIATES

The covariates were age, sex, and implant location and per subject, and comorbidities included smoking, diabetes, osteoporosis, and frailty.

ANALYSES

Bivariate statistics assessed the association between SSRI exposure at the time of implant placement and failure with significance at P value < .05.

RESULTS

The sample was composed of 1,611 subjects (mean age 57.3 ± 15.8 years, 893 (55.4%) females) with 3,184 implants placed. There were 1,514 (94%) subjects who did not take an SSRI at implant placement (mean age 57.5 ± 15.5 years, 813 (53.7%) females) and there were 97 (6%) subjects who did take an SSRI at implant placement (mean age 61.6 ± 13.1 years, 80 (82.5%) females). The failure rate was 6.7% (101 subjects) for non-SSRI exposed subjects and 18.6% (18 subjects) who took an SSRI at implant placement. SSRI exposure was associated with implant failure at 1-year relative risk = 2.8; 1.8-4.4 (relative risk, 95% confidence interval). Covariates with association with failure: smoking odds ratio (OR) = 0.98, 1.5-5.5 (OR, 95% confidence limits, P < .0001), diabetes (OR = 1.8, 95% confidence interval [CI], P = .048), alcohol (OR = 1.9, 95% CI, P = .045), osteoporosis (OR = 14.1, 95% CI, P < .0001), debilitation (OR = 20.7, 95% CI, P < .0001), and bisphosphonates (OR = 0.09, 95% CI, P = .004).

CONCLUSIONS

Patients who take SSRI at the time of implant surgery may have an increased risk for implant failure.

Antiresorptive Therapy to Reduce Fracture Risk and Effects on Dental Implant Outcomes in Patients With Osteoporosis: A Systematic Review and Osteonecrosis of the Jaw Taskforce Consensus Statement

OBJECTIVE

Placement of a dental implant in a patient on antiresorptive therapy has been hypothesized to increase the risk of medication-related osteonecrosis of the jaw (MRONJ) and/or impact implant survival. In patients with osteoporosis, the risk of MRONJ with antiresorptive therapy is only marginally higher than observed in the general population.

METHODS

The International ONJ Taskforce conducted a systematic review of the literature and evaluated the outcomes of implant placement in individuals with osteoporosis receiving antiresorptive therapy.

RESULTS

The data were reviewed by the International Taskforce, and consensus was achieved on the following GRADEd recommendation. In patients with osteoporosis on antiresorptive therapy, the Taskforce suggests that antiresorptive therapy does not need to be stopped prior to proceeding with dental implant (weak recommendation, very low-quality evidence). Long-term bisphosphonate use maybe associated with a small increase in the risk of MRONJ (3 cases per 1000 patients; adjusted hazard ratio: 4.09, 95% CI: 2.75-6.09, P < .001, moderate certainty).

CONCLUSION

Current evidence does not suggest an association between antiresorptive therapy in patients with osteoporosis and dental implant failure. Implants may be safely placed in the presence of concomitant use of bisphosphonates or denosumab in patients with osteoporosis with no evidence of an increased risk of implant failure/compromise.

Cumulative success rate and marginal bone loss for immediate and early loading protocols in a single implant-supported crown: A randomized controlled split-mouth clinical trial

STATEMENT OF PROBLEM

New loading protocols with reduced treatment time have gained popularity because of their advantages. However, whether the success rate with immediate loading (IL) is worse than with early loading (EL) is still unclear.

PURPOSE

The purpose of this randomized controlled trial with a split-mouth design was to evaluate the marginal bone loss and the cumulative success rate (CSR) 1 year after an IL protocol in single implant-supported crowns. The test groups were loaded after less than 24 hours (test group) and EL at 60 days (control group).

MATERIAL AND METHODS

Seventeen participants received 34 implants. The recall appointments were at baseline, 30 days, 60 days, and 1 year. The outcome measures evaluated were pain, implant clinical mobility, probing depth measurements, peri-implant disease, marginal bone loss, implant insertion torque, implant stability quotient (ISQ) value, and the CSR. A 2-way repeated measures ANOVA identified the significant differences for probing depth and ISQ. A 3-way repeated measures ANOVA followed by a pairwise t test analyzed marginal bone loss, and a nonparametric Wilcoxon test analyzed insertion torque (α=.05).

RESULTS

No differences were found between the insertion torque, ISQ, and marginal bone loss values (P>.05). When analyzing probing depth, no differences were found when comparing IL versus EL at baseline, 30 days, and 1 year (P>.05). The global CSR was 91.17%, 88.23% for the IL group and 94.11% for the EL group.

CONCLUSIONS

When analyzing marginal bone loss, the groups were similar. The global CSR was 91.17%, 88.23% for the IL group, and 94.11% for the EL group.

Combined Effect of Abutment Height and Restoration Emergence Angle on Peri-Implant Bone Loss Progression: A Retrospective Analysis

INTRODUCTION

This study aimed to investigate the combined effect of trans-mucosal abutment height (TmAH) and restorative emergence angle (REA) on marginal bone loss (MBL) around bone-level implants.

METHODS

Implant radiographs 12-18 months after crown placement (T0) and at least one year later (T1) were retrospectively analyzed. Sites were separated into four groups: Long/Narrow-Angle (LN) with TmAH > 2 mm and REA < 30°, Long/Wide-Angle (LW) with TmAH > 2 mm and REA ≥ 30°, Short/Narrow-Angle (SN) with TmAH < 2 mm and REA < 30°, and Short/Wide-Angle (SW) with TmAH < 2 mm and REA ≥ 30°. MBL was calculated, and multiple linear regression analysis was performed to control for patient-level and implant/prosthesis-level factors.

RESULTS

192 implants pertaining to 119 patients were included. Group significantly influenced MBL experience (p < 0.001). Group SW experienced on average 0.48 mm (95% CI: 0.25-0.71, p < 0.001), 0.43 mm (95% CI: 0.18-0.68, p = 0.001), and 0.25 mm (95% CI: 0.00-0.45, p = 0.013) greater MBL compared to Groups LN, LW, and SN, respectively. Group was also a significant factor impacting the development of peri-implantitis (p = 0.041), with Group SW displaying a roughly 4× greater likelihood of having peri-implantitis (PI) diagnosed compared to Groups LN (OR: 4.04; p = 0.091) and LW (OR: 4.19; p = 0.013). Every 1 mm increase in TmAH significantly decreased the likelihood of MBL > 0 mm (OR = 0.63; p = 0.003).

CONCLUSIONS

Abutment height > 2 mm may play a role in reducing PI and MBL related to ≥ 30° REA around bone-level implants. REA was found to only be a significant factor when TmAH is less than 2 mm.

Treatment of mandibular condyle fractures with a rhombic 3D condylar fracture plate - Does the surgical approach matter?

Fractures involving the mandibular condyle are a significant subset of mandibular fractures, demanding specialized implant design considerations for effective surgical treatment. The core objective of this study was to assess the clinical and radiographic results in patients treated with a single rhombic-shaped implant according to the surgical approach used. This retrospective cohort investigation, spanning a ten-year recruitment window, included individuals with unilateral fractures who underwent surgical treatment with a rhombic-shaped implant. These patients were subject to follow-up examinations at one, three, and six months post-surgery, along with corresponding orthopantomograms and clinical assessments. Patients were allocated into four groups depending on the fracture pattern and level as well as the approach used for fracture treatment. The primary outcome variables under scrutiny encompassed parameters such as occlusion, maximum interincisal distance, mandibular excursion across different postoperative time points, and radiographic measurements of mandibular height and the gonion angle. A total of 236 patients, comprising 161 males and 75 females, with an average age of 40.2 ± 19.2 years, were included in the study. Satisfactory occlusion was exhibited in 99.6% of patients at the six-month follow-up. Furthermore, all parameters associated with mandibular excursion displayed significant enhancements (p < 0.01). These improvements were accompanied by a reduction in ramus height and increased gonion angle on the fractured side. The investigation of the clinical and radiographic results suggest a tendency of the choice of the approach depending on the fracture pattern, but no statistically significant recommendations could be identified.

Clinical behavior of two-piece zirconia implants. A systematic review

BACKGROUND

This systematic review aimed to evaluate the clinical behavior of two-piece zirconia implants (T-PZI) in terms of overall implant survival and success rates, marginal bone loss (MBL) complication rates, and others biological parameters.

MATERIAL AND METHODS

PRISMA guidelines were followed, and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An automated search was conducted in four databases (Medline/PubMed, Scopus, Web of Science, and Cochrane Library), as well as a manual search for relevant clinical articles published until 18 May 2024. The review included human studies with at least five patients in which T-PZI were placed. Quality of evidence was evaluated using the Newcastle-Ottawa Quality Assessment Scale and the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2).

RESULTS

Six studies met the inclusion criteria and were included for analysis, with a total of 298 T-PZI. A survival rate of 96.31% was recorded with follow-up periods ranging from 18.4±10.4 months to 111.1±2.2 months. The success rate ranged from 63 to 100% and MBL ranged from 0.130.6 to 1.38±0.81mm Conclusions: T-PZI may offer a reliable alternative to titanium dental implants, achieving a survival rate of 96.31%, acceptable rates of MBL and adequate biological parameters. However, the findings of the review must be treated with caution, as the data obtained are derived from the early stages of this new development in ceramic dental implants. More comparative studies are needed in order to determine the viability of T-PZI in different clinical situations.

Advances in Imaging Techniques for Assessing Myocardial Microcirculation in People with Diabetes : An Overview of Current Techniques, Emerging Techniques, and Clinical Applications

Microangiopathy is a key complication of diabetes, adversely effecting several organs including the heart, kidneys, eyes, and nerves. This review focuses on myocardial microvascular dysfunction, a condition characterized by altered vasomotion and long-term structural changes to coronary arterioles, resulting in impaired regulation of blood flow in response to varying oxygen demands of cardiomyocytes. Presence of myocardial microvascular dysfunction is associated with increased risk of cardiovascular disease, even in the absence of obstructive coronary artery disease. Several noninvasive imaging techniques to assess coronary physiology have significantly enhanced our understanding of the myocardial microcirculation. These methods allow for detailed visualization and quantification of blood flow, endothelial function, and inflammation in the microvasculature, providing critical insights into the early stages of microvascular disease in diabetes. A significant area of development is the use of advanced hybrid imaging techniques such as positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MRI). The integration of advanced imaging technologies with artificial intelligence is also a key future direction. Overall, these advancements aim to improve the early detection and management of microvascular complications in diabetes, ultimately enhancing outcomes and quality of life. The aim of this review is to provide an overview of both established and emerging noninvasive imaging techniques for assessing myocardial microvascular dysfunction.

Five-Year Results of One-Piece Zirconia Oral Implants Supporting Three-Unit Fixed Dental Prostheses

OBJECTIVES

The purpose of the present prospective case series was to investigate the clinical and radiological outcome of one-piece zirconia implants fabricated from 3Y-TZP with a moderately roughened endosseous surface (Sa = 1.24 μm) to support three-unit fixed dental prostheses (FDP) after five years in function.

MATERIALS AND METHODS

Twenty-seven patients received a total of 54 implants in a one-stage surgery with immediate provisionalization. Peri-implant bone loss was assessed using standardized radiographs. Additionally, soft-tissue parameters were analyzed. Statistical analyses were conducted using linear mixed regression models and Wilcoxon Signed Rank tests (p < 0.05). All patients participated in an annual maintenance program.

RESULTS

Eighteen implants were lost up to the 5-year follow-up, resulting in a cumulative survival rate of 66.67%. The mean marginal bone loss of the remaining implants amounted to 1.89 mm. Probing depth, clinical attachment loss, and bleeding on probing increased from prosthesis insertion to the 5-year follow-up, while the plaque index showed no significant changes during the same period.

CONCLUSIONS

The investigated one-piece zirconia implant showed low survival rates as compared to previously reported survival rates of one-piece zirconia or two-piece titanium implants. Implant failure was attributed to peri-implantitis, leading to the necessity of implant removal. The implant is not commercially available.

Antibacterial and osteogenic gain strategy on titanium surfaces for preventing implant-related infections

Infection and insufficient osseointegration are the primary factors leading to the failure of titanium-based implants. Surface coating modifications that combine both antibacterial and osteogenic properties are commonly employed strategies. However, the challenge of achieving rapid antibacterial action and consistent osteogenesis with these coatings remains unresolved. In this study, a functional composite coating (PDA/PPy@Cu/Dex) was prepared on titanium surfaces using layer-by-layer self-assembly and electrochemical deposition techniques. The hydroxyl groups grafted by polydopamine's (PDA) self-polymerization and the enhanced conductivity and uniform electric field distribution provided by polypyrrole (PPy) allowed for the even dispersion of copper nanoparticles and dexamethasone (Dex) on the titanium surface. This synergistically coupled the photothermal ion antibacterial properties of copper nanoparticles with the osteogenic promotion of dexamethasone. In vitro antibacterial experiments revealed that the heat generated by photothermal effects and reactive oxygen species enhanced the antibacterial activity of copper ions, reducing the antibacterial time to six h and achieving antibacterial enhancement. In vitro cell experiments showed that the long-term slow release of copper ions and dexamethasone enhanced the osteogenic differentiation of stem cells, thereby achieving osteogenic benefits. Moreover, in vivo toxicity experiments demonstrated that the composite coating had no adverse effects on normal tissues. Therefore, the antibacterial and osteogenic enhancement strategy for titanium surfaces presented in this study offers a new potential approach for preventing implant-associated infections.

Relationship Between Cigarette Smoking and Awake Bruxism: Does Smoking Increase the Frequency of Masticatory Muscle Activities?

BACKGROUND

Despite the aetiology of awake bruxism (AB) being prevalently linked to psychological factors, several studies suggested that the use of certain substances, such as tobacco smoking, can contribute to the increase in masticatory muscle activities (MMA) during wakefulness.

OBJECTIVE

The aim of this study is to assess whether there is a correlation between the frequency of awake bruxism behaviours and smoking habits.

METHODS

Participants were recruited, without gender or ethnic restriction, at the University of Siena, Siena, Italy, by advertising. Participants completed a questionnaire containing the four-item patient health questionnaire for anxiety and depression (PHQ-4) and some items from the Global Adult Tobacco Smoking (GATS) questionnaire. Moreover, they performed one week of awake bruxism behaviours monitoring via the ecological momentary assessment (EMA).

RESULTS

A total of 100 participants (university employees, dentists, undergraduate and post-graduate students) were included in the study (34 males and 66 females, mean age 24.5 years). Of them, 39% were smokers and 61% were non-smokers. The multiple variable linear regression analysis results showed a statistically significant correlation between the frequency of awake bruxism behaviours and the PHQ-4 scores. Specifically, for every 1% increase in PHQ-4 score, the mean frequency of the AB behaviours increases 5-fold. Awake bruxism behaviours did not show any statistically significant correlation with the number of smoked cigarettes (p > 0.05). Mandible bracing significantly correlated with the number of years of smoking (B = 1.58, p = 0.002).

CONCLUSIONS

According to the present study's findings, the frequency of awake bruxism behaviours correlated with symptoms of anxiety and depression but not with smoking status.

Novel Histologic Features in Ameloblastoma With RASQ61R Mutation

Ameloblastoma is characterized histologically by evidence of ameloblastic differentiation and molecularly by MAPK pathway alterations, most frequently BRAFV600E mutation and RAS mutations, as well as by SMO mutations. This mutational profile is present across all histologic variants, including those occasionally lacking overt histologic evidence of ameloblastic differentiation, such as desmoplastic ameloblastoma and granular cell ameloblastoma. Recently, we have come across 4 cases of maxillary ameloblastoma demonstrating peculiar histologic features not accounted for by recognized histologic variants. Three intraosseous tumors were remarkably similar in histologic appearance and demonstrated a proliferation of spindled to basaloid cells in solid/sheet-like, cystic, and ribbon-like growth patterns within dense fibrous connective tissue. One case had numerous squamous morules and only 1 case, focally, demonstrated ameloblastic differentiation, yet all 3 cases harbored NRASQ61R mutation. A fourth case harbored HRASQ61R mutation and arose peripherally, in palatal (maxillary) gingiva, as a follicular-patterned neoplasm with bland squamoid morphology and scattered foci of ameloblastic differentiation. RAS Q61R immunohistochemistry was positive in both the tumor and overlying surface epithelium, in support of surface derivation. These 4 cases demonstrate that ameloblastoma may occasionally present with non-traditional histologic features, lacking categorization into known histologic variants and sometimes lacking any evidence of ameloblastic differentiation. In this setting, the differential diagnosis may be broad and include more indolent odontogenic neoplasms such as adenomatoid odontogenic tumor or squamous odontogenic tumor, odontogenic carcinomas, and non-odontogenic neoplasms. A high index of suspicion, followed by confirmatory molecular testing or mutation-specific immunohistochemistry, is necessary for accurate diagnosis.