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.

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.

Adjunctive photochemical therapy for management of inflammatory peri-implant diseases: A systematic review and meta-analysis

This study aimed to systematically review the data on interventions involving adjunctive photochemical therapy in treating peri-implant mucositis (PIM) and peri-implantitis (PI). The electronic search was conducted through six databases in October 2023, seeking studies relying on any kind of adjunctive photochemical therapy in treating inflammatory peri-implant diseases (PIDs). To showcase the effect size, mean differences along with 95% confidence intervals were utilized. Forty-seven studies were deemed eligible for qualitative synthesis, 14 of which were included in the meta-analysis. Low-level light therapy and photodynamic therapy led to enhanced improvements in clinical and radiographic indices, such as bone level (BL), bleeding on probing (BoP), clinical attachment level (CAL), and probing depth (PD), during the 3-month follow-up. However, the differences in efficacy between treatments incorporating adjunctive photochemical therapy and those relying solely on mechanical debridement, considered the gold standard, lessened over extended follow-up periods of 6, 9, and 12 months. Significant differences were observed when comparing the treatment outcomes following adjunctive photochemical therapy between obese and smoker patients with healthy subjects. Incorporating adjunctive photochemical therapy for PID treatment might improve clinical and radiographic parameters in a short-term follow-up of 3 months, but longer-term benefits appear comparable to routine treatments.

Complete-arch implant rehabilitation and adjunctive orthognathic surgery of a patient with hypohidrotic ectodermal dysplasia utilizing a digital workflow: A clinical report

Hypohidrotic ectodermal dysplasia (HED) is a rare genetic disorder characterized by congenital anomalies in ectodermal tissues, with dental manifestations commonly including hypodontia or oligodontia. Addressing the significant aesthetic, functional, and psychosocial challenges associated with HED requires early surgical and prosthodontic intervention following skeletal maturation. This clinical report details a digital workflow for complete-arch implant rehabilitation of the maxilla and mandible, combined with orthognathic surgery, in an adolescent patient with HED. Integrating digital technologies enhanced treatment planning, surgical precision, and prosthetic outcomes, improving aesthetics, functionality, and overall patient quality of life.

Optimizing implant osseointegration, soft tissue responses, and bacterial inhibition: A comprehensive narrative review on the multifaceted approach of the UV photofunctionalization of titanium

Titanium implants have revolutionized restorative and reconstructive therapy, yet achieving optimal osseointegration and ensuring long-term implant success remain persistent challenges. In this review, we explore a cutting-edge approach to enhancing implant properties: ultraviolet (UV) photofunctionalization. By harnessing UV energy, photofunctionalization rejuvenates aging implants, leveraging and often surpassing the intrinsic potential of titanium materials. The primary aim of this narrative review is to offer an updated perspective on the advancements made in the field, providing a comprehensive overview of recent findings and exploring the relationship between UV-induced physicochemical alterations and cellular responses. There is now compelling evidence of significant transformations in titanium surface chemistry induced by photofunctionalization, transitioning from hydrocarbon-rich to carbon pellicle-free surfaces, generating superhydrophilic surfaces, and modulating the electrostatic properties. These changes are closely associated with improved cellular attachment, spreading, proliferation, differentiation, and, ultimately, osseointegration. Additionally, we discuss clinical studies demonstrating the efficacy of UV photofunctionalization in accelerating and enhancing the osseointegration of dental implants. Furthermore, we delve into recent advancements, including the development of one-minute vacuum UV (VUV) photofunctionalization, which addresses the limitations of conventional UV methods as well as the newly discovered functions of photofunctionalization in modulating soft tissue and bacterial interfaces. By elucidating the intricate relationship between surface science and biology, this body of research lays the groundwork for innovative strategies aimed at enhancing the clinical performance of titanium implants, marking a new era in implantology.

Evaluation of factors affecting implant failure: A 13-year retrospective cohort study

Dental implant failure remains a significant concern in oral rehabilitation, with multiple risk factors contributing to early and late implant failure. While numerous studies have examined implant failure rates, limited research distinguishes between early implant failure (EIF) and late implant failure (LIF) based on patient-related, implant-specific, and surgical variables. This study aimed to evaluate the risk factors associated with EIF and LIF and to determine the impact of patient-related, implant-specific, and surgical variables on implant survival. This retrospective cohort study was conducted at Ondokuz Mayıs University. It is based on the treatments provided by an experienced surgeon to individuals who applied for implant treatment between January 2011 and January 2024. This study analyzed 490 patients who met the inclusion criteria out of 3720 who received implant treatment during the relevant years. The patients' ages ranged from 21 to 90, with a mean age of 53.92 ± 13.82 years. Sex, smoking, and implant length (≤10 mm) were identified as risk factors in analyzing parameters affecting EIF, while maxilla, implant length (<8 mm), SLA surface modification, sinus lift procedures, smoking, and short osteointegration duration were identified as risk factors in analyzing parameters affecting LIF. Our findings highlight the distinct risk profiles for EIF and LIF, emphasizing the importance of patient selection, surgical technique, and implant characteristics in optimizing long-term success rates. Recognizing EIF and LIF risk factors enables clinicians to refine treatment protocols and reduce implant failure rates, ultimately improving patient outcomes.

Implant failure of facial prostheses: systematic review and meta-analysis

The aim of this systematic review was to evaluate craniofacial implant failure in the auricular, orbital, and nasal regions, including the impact of radiotherapy and evaluation of early (<1 year) and late (>1 year) implant failure. Five electronic databases were searched for articles reporting studies on implant failure in auricular, nasal, and/or orbital prostheses. The PRISMA guidelines were followed. Sixteen studies (3630 implants in 1127 patients) were included. The pooled implant failure rate was 3.5% in the auricular region, 18.7% in the orbital region, and 8.8% in the nasal region. Compared to the auricular region, implants inserted in the orbital (risk ratio (RR) 4.54) and nasal (RR 3.00) regions had a significantly higher risk of failure. Auricular (RR 2.17) and orbital (RR 2.07) implants had an increased risk of failure in irradiated bone. Regarding early failure (<1 year), 79.8% of nasal implants that failed were found to fail early, compared to 21.4% and 35.4% of failed auricular and orbital implants, respectively. This meta-analysis is novel in studying the timing of implant failure. Future studies should cover long observation periods and adequately report failure rates. There is a lack of high-quality studies and well-defined standardized outcome parameters. Results should be interpreted with caution due to low levels of evidence. DATA AVAILABILITY: This review has been registered with the Open Science Framework (doi:10.17605/OSF.IO/EBUC4). The study protocol and data files are publicly accessible.

Graftless complete arch rehabilitation using a facial approach for enhanced bone anchorage and prosthetic outcomes: A clinical report

This clinical report introduces a novel approach to the placement of anterior implants in maxillae with severe atrophy, with the objective of reducing anterior cantilever length and enhancing bone anchorage. By sagittally tilting the anterior implants to emerge facially rather than palatally, the procedure enhances the prosthetic screw position and decreases the risk of a bulky prosthesis. Two zygomatic implants were placed posteriorly for additional support, and bilateral paranasal prostheses helped restore midfacial contours. Early follow-up showed stable implants and good soft tissue health. Longer-term studies and clear patient selection criteria are needed to confirm the effectiveness of the technique.

The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis

To examine the CT-imaging features of subjects with bacterial osteomyelitis (OM), osteoradionecrosis (ORN), and medication-related osteonecrosis of the jaw (MRONJ) with histopathological confirmation, and to examine the diagnostic efficacy of panoramic radiography and MRI in detecting these disease features. 150 cases with preoperative CT data were selected: 61 bacterial OM, 19 ORN, and 70 MRONJ. 143 cases underwent panoramic X-ray examination, and 47 underwent MRI. The assessment criteria for imaging findings included: (1) bone resorption, (2) osteosclerosis, (3) clarity of the mandibular canal, (4) periosteal reactions, (5) cortical bone perforation, (6) sequestrum, and (7) pathological fractures. CT was considered the gold standard for assessing these features. Compared with CT, all panoramic radiographs were detectable for diagnostic features of the disease. Bone resorption was detected in 123 cases (sensitivity 91.1%), and osteosclerosis was detected in 131 cases (sensitivity 98.5%). With panoramic radiography, most changes to clarity of the mandibular canal and pathological fractures were detected (sensitivities of 87.8% and 68.8%, respectively). However, the sensitivities for detection of periosteal reactions, cortical bone perforation and sequestration were low (19.6%, 17.8% and 19.4%, respectively). Sensitivity of MRI for detecting periosteal reactions, cortical bone perforation, sequestration, and pathological fractures (27.3%, 73.5%, 35.7%, and 60.0%, respectively) was equivalent or superior to panoramic imaging. MR-specific characteristics of bone marrow edema were depicted on almost all examinations. Panoramic radiography may be adequate for identifying bone resorption and osteosclerosis. However, MRI provides more value than panoramic radiography in detecting periosteal reactions, cortical bone perforation, sequestration, and bone marrow edema.

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.

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.

Ex vivo comparison of drilling techniques for optimizing primary stability of zirconia dental implants in different bone densities

PURPOSE

The objective of this study was to investigate the primary stability of zirconia implants using varying drilling protocols, with a focus on the impact of thread cutting on insertion torque in both mixed (D2/D3) and soft (D4) bone types. The study aimed to evaluate whether reducing thread cutting could increase insertion torque and consequently improve primary stability.

METHODS

Four drilling protocols were developed, each varying in the degree of thread cutting: no thread cut, one-third thread cut, two-thirds thread cut, and full thread cut. Implants were placed into fresh porcine hip and tibia bones simulating D2/D3 and D4 bone. The protocols followed each implant system's manufacturer recommendations. Insertion torque was measured using a torque indicator, and statistical analysis was conducted with the Mann-Whitney U test, with p < 0.05 considered statistically significant.

RESULTS

Significant differences in primary stability were observed between implant systems and drilling protocols, particularly in D4 bone. Three of the four implant systems showed improved primary stability in D4 bone when the thread cut was reduced (p < 0.05). One system achieved the recommended insertion torque with a full thread cut. In contrast, in D2/D3 bone, all implant systems required a full thread cut to remain within the manufacturer's torque guidelines.

CONCLUSIONS

Zirconia implant systems exhibit substantial variability in primary stability based on the selected drilling protocol and bone quality. Reducing thread cutting demonstrated improved stability in soft bone. However, excessive torque should be avoided to prevent mechanical failure, especially in systems with lower fracture resistance.

Understanding Radiology and Imaging for the Prosthodontic Patient

Radiology is essential in prosthodontics for diagnosis and treatment planning, utilizing intraoral radiographs, panoramic imaging, and cone beam computed tomography (CBCT) while adhering to the as low as reasonably achievable principle. CBCT provides 3 dimensional (3D) evaluations of bone quality, dimensions, and proximity to vital structures, aiding implant placement and reducing surgical risks. Artificial intelligence (AI) and computer-assisted surgery have transformed prosthodontics, improving treatment planning and implant precision and reducing complications. The future of prosthodontic radiology will increasingly integrate AI-driven imaging and robotic assistance to enhance precision and treatment success.

Efficacy of non-surgical mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implantitis among patients undergoing chemotherapy

OBJECTIVE

Studies have shown that a single session of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) is effective for treating peri‑implant diseases. The objective was to assess the efficacy of MD with and without adjunct aPDT in treating peri‑implantitis among patients undergoing chemotherapy.

METHODS

Patients with peri‑implantitis were included. These individuals were divided into two groups (a) patients with peri‑implantitis undergoing chemotherapy; (b) systemically healthy patients with peri‑implantitis. These individuals were further subclassified into two subgroups: (a) individuals that received NSMD alone and (b) individuals that underwent NSMD with adjunct aPDT. Non-surgical MD was performed using plastic curettes. The aPDT was performed using a 680 nm diode laser at a power and power density of 150 mW and 1.1 mW/cm2, respectively. The photosensitizer was placed in the peri‑implant pocket and left in place for 60 s following which the laser was applied using a using an optical fiber with a diameter of 600 μm. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and after three months. Group comparisons were performed using one way analysis of variance and Bonferroni post-hoc adjustment tests. P-values <0.05 were considered statistically significant.

RESULTS

At baseline, there was no statistically significant difference in peri‑implant mPI, mGI, PD and CBL among patients undergoing chemotherapy and systemically healthy individuals with peri‑implantitis. At three months' follow up, there was no statistically significant difference in peri‑implant mPI, mGI, PD and CBL among patients undergoing chemotherapy and systemically healthy individuals with peri‑implantitis compared to their respective baseline scores.

CONCLUSION

Among patients undergoing chemotherapy and systemically healthy individuals, a single session of aPDT and NSMD is ineffective in the treatment of peri‑implantitis. Nevertheless, poor oral hygiene of the participants and the short-term follow-up may have influenced the results. Hence further long-term follow-up clinical trials involving multiple sessions of aPDT after MD are needed.

Trends in Research of Odontogenic Keratocyst and Ameloblastoma

Odontogenic keratocyst (OKC) and ameloblastoma (AM) are common jaw lesions with high bone-destructive potential and recurrence rates. Recent advancements in technology led to significant progress in understanding these conditions. Single-cell and spatial omics have improved insights into the tumor microenvironment and cellular heterogeneity in OKC and AM. Fibroblast subsets in OKC and tumor cell subsets in AM have been analyzed, revealing mechanisms behind their biological behaviors, including OKC's osteolytic features and AM's recurrence tendencies. Spatial transcriptomics studies of AM have identified engineered fibroblasts and osteoblasts contributing to matrix remodeling gene and oncogene expression at the invasion frontier, driving AM progression. Three-dimensional culture technologies such as organoid models have refined analysis of AM subtypes; uncovered the role of AM fibroblasts in promoting tumor cell proliferation and invasion; and identified signaling pathways such as FOSL1, BRD4, EZH2, and Wnt as potential therapeutic targets. Organoid models also served as preclinical platforms for testing potential therapies. Although preclinical models for AM exist, reliable in vitro and in vivo models for OKC remain scarce. Promising mimic models, including human embryonic stem cells-derived epithelial cells, human oral keratinocytes, human immortalized oral epithelial cells, and HaCaT keratinocytes, show promise, but the advancements in 3-dimensional culture technology are expected to lead to further breakthroughs in this area. Artificial intelligence, including machine learning and deep learning, has enhanced radiomics-based diagnostic accuracy, distinguishing OKC and AM beyond clinician capability. Pathomics-based models further predict OKC prognosis and differentiate AM from ameloblastic carcinoma. Clinical studies have shown positive outcomes with targeted therapies. In a study investigating SMO-targeted treatments for nevoid basal cell carcinoma syndrome, nearly all OKC lesions resolved in 3 patients. A recent clinical trial with neoadjuvant BRAF-targeted therapy for AM demonstrated promising radiologic responses, potentially enabling organ preservation. This review highlights recent advancements and trends in OKC and AM research, aiming to inspire further exploration and progress in these fields.

Linear Computed Tomographic Measurement of Soft Tissue Herniation into the Maxillary Sinus as an Indicator for Orbital Floor Fracture Surgery: A Preliminary Study

Introduction

Computed tomography (CT) is the gold standard radiological assessment for orbital floor fractures and several evaluation methods have been developed. However, no definitive consensus has yet been achieved. We propose a new, linear radiological parameter that may help surgeons to decide when to treat an orbital floor fracture.

Materials and Methods

This study retrospectively analysed 328 patients with orbital floor fractures. Both operative or conservative treated patients were included. All CT scans were examined and the linear extents of soft tissue herniation into the maxillary sinus were calculated.

Results

The 328 patients were subdivided into three groups: Group A who did not undergo surgery (77.74%); group B (12.2%) who underwent surgery to treat maxillofacial fractures, not orbital floor fractures (12.2%); and group C (10.06%) who underwent surgical repair of the orbital floor. The mean soft tissue herniations were 2.72, 3.21 and 7.48 mm in groups A, B, and C. An ROC (Receiver Operating Characteristics) curve was drawn to identify the optimal cutoff dividing patients who did or did not undergo surgical repair of orbital floor fractures; this was 4.3 mm (sensitivity = 90.91%; specificity = 73.56%).Our proposed radiological parameter seems to accurately correlate with the surgical indications for orbital floor fracture treatment.

Marginal bone level of dental implants using computer-aided design/computer-aided manufacturing customized abutment and prefabricated abutment-A five-year follow-up

Background/purpose

Computer-aided design/computer-aided manufacturing (CAD/CAM) allows for the customization of implant abutments as an alternative to prefabricated options. The purpose of this study was to compare the marginal bone levels of dental implants using CAD/CAM customized abutments (CA) versus prefabricated abutments (PA) over a five-year follow-up period.

Materials and methods

Implants were divided into two groups based on abutment type: CA and PA. Marginal bone level (MBL), changes in MBL and bone-to-implant contact ratio (BIC), were assessed from baseline to 5 years post-prosthetics loading. Additionally, the study analyzed based on dental arches, opposing structure types, and the distance from implant platform to the cementoenamel junction of adjacent teeth (CEJ-PL).

Results

Overall, MBL increased significantly for all implants from baseline to 5 years. The CA group in the mandible showed significantly higher MBL compared to the PA group (0.98 ± 0.71 mm vs. 0.54 ± 0.55 mm). Implants opposed by fixed restorations (FRs) experienced significantly more MBL compared to those opposed by natural teeth (NT) after 5 years. Implants placed at a depth greater than 3 mm (CEJ-PL > 3 mm) exhibited significantly greater changes in MBL on the distal side after 5 years compared to those placed at a shallower depth (CEJ-PL ≤ 3 mm).

Conclusion

The MBL and changes in MBL showed similar trend between the CA and PA groups in the five-year follow-up. The CA group exhibited significantly more bone remodeling after one year, particularly for implants opposing FRs and those with a CEJ-PL distance exceeding 3 mm.

Accuracy of freehand surgery, static and dynamic computer assisted surgery on zygomatic implant placement: A systematic review and meta-analyses

Real-time surgical navigation systems (dynamic computer-aided surgery, d-CAIS) and static guided surgery (static computer-aided surgery, s-CAIS) have been shown to enhance the accuracy of zygomatic implant (ZI) placement. The objective of this systematic review was to evaluate and compare the accuracy and risk of complications associated with d-CAIS and s-CAIS in ZI placement. A systematic review of published studies involving more than 4 patients was conducted to assess and compare the accuracy of d-CAIS and s-CAIS in zygomatic implant placement. Only one study included freehand ZI placement as a control. The primary outcomes measured were the accuracy of implant placement relative to preoperative planning, with a secondary focus on evaluating any potential complications. Out of 903 screened studies, 14 met the inclusion criteria. Freehand zygomatic implant placement was used as a control in only 1 study. The results revealed a mean apex deviation of 2.07 mm (95% CI: 2.01 to 2.13; I2 = 83.14%) for d-CAIS, 1.29 mm (95% CI: 1.15 to 1.43; I2 = 94.5%) for s-CAIS, and 4.98 mm (95% CI: 3.59 to 6.37; I2 = not assessable) for freehand placement. Reported complications included mucositis, reversible bilateral sinusitis, oroantral fistula, unspecified reversible postoperative complications, and fracture of the anterior wall of the zygoma. Both CAIS systems demonstrated high accuracy and safety in ZI placement, with a nearly 99% success rate at 6 months of follow-up. These findings suggest that both d-CAIS and s-CAIS are reliable methods for improving the precision and reducing the risks associated with ZI procedures.

A novel system for classification for midpalatal suture ossification based on pseudocolored and multilayer reconstructed coronal slices: Indication for selection of maxillary expansion methods

INTRODUCTION

A novel method was established for the staging of midpalatal suture (MPS) ossification based on a pseudocoloring stack of anterior and posterior MPS coronal slices obtained by cone-beam computed tomography (CBCT).

METHODS

CBCT scans of 240 subjects aged 5-35 years were pseudocolor processed. The slice thickness of stacked anterior and posterior coronal observation planes was set at 5.0 mm. The ossification status of both anterior or posterior MPS was classified as the tunnel, partially ossified, or ossified type. MPSs were classified into 5 stages: stage I, anterior and posterior MPSs are the tunnel type; stage II, anterior and posterior MPSs are the tunnel and partially ossified type, respectively; stage III, anterior and posterior MPSs are the partially ossified type; stage IV, anterior and posterior MPSs are the tunnel or partially ossified type and ossified type, respectively; and stage V, anterior and posterior MPSs are the ossified type. The weighted κ value was used to assess the intraexaminer and interexaminer agreement of the MPS classifications.

RESULTS

Intraexaminer and interexaminer reliability of the proposed staging method was substantial. The largest proportions of patients aged 5-15 years and 16-35 years were classified as stages I and III, respectively. Among adults, 31.0% of males and 7.1% of females were classified as stage I or II.

CONCLUSIONS

The pseudocolor imaging technique and the stack of CBCT slices provide relatively intuitive and comprehensive information on MPS ossification. The novel classification of MPS ossification is expected to serve as an indication of the necessity of surgical intervention for maxillary expansion treatment.

Fixation of Medially Displaced High Condylar Fracture of Mandible Using Lag Screw: A Twin Case Report

Management of high condylar fractures involves never-ending controversies between open and closed management. Conservative treatment is the preferred treatment in high condylar head fractures. This article aims to report two clinical cases of high condylar fractures, where medial pole was fixed with open treatment, using lag screw fixation using a modified preauricular approach according to AO/ASSIF protocols and recommendations. We advocate open surgical treatment for the management of high condyle fractures, it provides an immediate physiological function to the TMJ joint and restores form.

Is there any relation between proton pump inhibitors and risk of dental implant failure? A large-scale retrospective study using the BigMouth repository

The aim of this retrospective large-scale study was to investigate long-term the association between proton pump inhibitors (PPIs) and risk of dental implant failure. This is a retrospective analysis of a cohort of patients rehabilitated with dental implants in the dental clinics of the universities that contribute data to the BigMouth network. Patients' characteristics including age, gender, ethnicity, race, tobacco use, systemic medical conditions, and intake of PPIs were analysed. Implant failure was defined as the removal of a dental implant for any reason. A total of 20,274 patients who received a total of 50,333 dental implants over a 12-year period were included. At the patient level, omeprazole users exhibited 1.77 (95% CI: 1.30 to 2.42) odds of experiencing implant loss compared with non-users. The use of PPIs was significantly associated with implant loss, with PPI users demonstrating 1.40 (95% CI: 1.04 to 1.88) odds of implant failure. At the implant level, implants placed in pantoprazole users showed a significant protection against implant loss, while implants in omeprazole users demonstrated a significantly lower survival time compared with those in non-users. Cox regression analysis demonstrated that implants placed in omeprazole users exhibited a significantly higher hazard ratio (HR: 1.45, 95% CI: 1.07 to 1.96) compared with those placed in non-users. Within the limitations of this study, omeprazole was significantly associated with implant failure both at a patient and implant level. At patient level, PPI users demonstrated a significantly higher risk of dental implant failure.

Time to Recurrence of Ameloblastoma and Associated Factors in a Multi-institutional Black Patient Cohort

Ameloblastoma is a highly recurrent odontogenic neoplasm with variable global distribution. However, impact of race and ethnicity on ameloblastoma recurrence are still unclear. The primary aim of this study was to assess duration of time between primary and recurrent ameloblastomas in a predominantly Black multi-institutional patient cohort and secondarily to determine whether recurrent ameloblastomas are more readily discovered when clinically-symptomatic rather than by radiographic surveillance. A retrospective cross-sectional design was used to evaluate demographic, clinical, and pathological information on recurrent ameloblastomas patients. Outcome variable was time to recurrence, determined as period between the diagnosis of primary and recurrent ameloblastomas. We assessed associations between outcome variable and race, time lapse between primary and recurrent ameloblastomas and clinical symptoms of recurrent ameloblastomas at time of diagnosis. Among 115 recurrent ameloblastomas identified, 90.5% occurred in adults, 91.3% in Blacks, and similarly, 91.3% were conventional ameloblastomas. About 41% affected the posterior mandible. 93.9% were clinically symptomatic at time of presentation while 6.1% non-symptomatic lesions were discovered by routine diagnostic radiology. Median time to presentation of recurrent tumor was significantly longer in females (90 months, p = 0.016) and clinically symptomatic group of ameloblastoma patients (75 months, p = 0.023). Ameloblastoma recurrence was distinctively high in Black patients, occurred faster in males than females and was located mostly in the posterior mandible. Concomitant with delayed access to healthcare of Black individuals, routine post-surgical follow-up is essential because time lag between primary and recurrence tumors was longer in clinically symptomatic ameloblastomas at the time of diagnosis.

The Accuracy of Immediate Implantation Guided by Digital Templates and Potential Influencing Factors: A Systematic Review

BACKGROUND

Immediate implantation guided by digital templates has drawn a great attention in the aesthetic zone, while the accuracy of immediate implantation guided by digital templates has yielded mixed results and many potential factors are known to affect its accuracy. The purpose of our systematic review was to evaluate the accuracy of implant placement guided by the digital template and summarizing its potentials influencing factors.

MATERIALS AND METHODS

We conducted an electronic search of publications upto July 2023, using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science to identify studies on accuracy of immediate implant placement surgery guided by digital templates. We selected cohort studies (prospective and retrospective studies) and randomized controlled trials (RCTs). The primary outcome was accuracy of immediate implant placement surgery guided by digital templates.

RESULTS

Seven studies in total fulfilled the inclusion criteria, comprising two prospective studies and five retrospective studies. We collected data including names of authors, publication period, study design, total sample size, clinical conditionas, planning/preoperative details, surgical procedure information, and evaluation criteria. Average global coronal deviation, apical deviation, depth deviation and angular deviation were respectively 0.74 mm (95% confidence interval [CI] 0.41-1.08, I2 = 99.0%), 1.01 mm (95% CI 0.83-1.20, I2 = 94.0%), 0.50 mm (95% CI 0.36-0.65, I2 = 75.3%) and 2.34° (95% CI 1.68-3.00, I2 = 94.5%). The quality assessment was conducted at a medium to high level.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Our systematic review demonstrates that immediate implantation guided by digital templates generally achieves acceptable accuracy. Factors influencing accuracy include the type of surgical guide, method of guide fabrication, surgical protocols, anatomical variability, and preoperative planning challenges. To improve clinical application, it is crucial to enhance the reporting of patient-centred outcomes and socioeconomic benefits.

Three-dimensional assessment of mandibular canal in different sagittal and growth patterns for safe placement of temporary skeletal anchorage devices: A prospective study

INTRODUCTION

The primary objective of this study was to assess the 3-dimensional position of the mandibular canal (MC) in different craniofacial patterns to know about the safe placement of temporary skeletal anchorage devices using cone-beam computed tomography (CBCT). The secondary objectives were to assess sex differences and correlate the MC position with various factors.

METHODS

This prospective, observational study was conducted on 90 patients, divided into 3 groups based on the sagittal pattern: skeletal Class I, Class II, and Class III. Similarly, based on the growth pattern of the patients, the sample was divided into 3 groups: horizontal, average, and vertical growth pattern. The skeletal and growth patterns were assessed using lateral cephalograms, and the position of the MC was assessed using CBCT. The position of the MC was assessed in 3 regions: the distal surface of the second molar (region 1), the interdental area between the first and second molars (region 2), and the interdental area between the first molar and second premolar (region 3). Data were subjected to statistical analysis.

RESULTS

The statistically significant differences were noticed in the buccolingual position of MC in regions 2 and 3 in different skeletal patterns, whereas no statistically significant differences were noticed for the superoinferior position. In region 1, the MC was positioned closest to the alveolar crest among vertical growers. No statistically significant sex differences were observed between groups. A statistically significant positive correlation was observed between the buccolingual position of the MC and the skeletal pattern.

CONCLUSIONS

It is essential to know the 3-dimensional position of the MC in different craniofacial patterns using CBCT for safe placement of temporary skeletal anchorage devices.

A scientometric study on research trends and characteristics of ameloblastoma

Background/purpose

Ameloblastoma is a benign tumor derived from odontogenic epithelium in the jaws. The purpose of this study was to analyze the scientometric characteristics and research trends of ameloblastoma.

Materials and methods

All the papers on ameloblastoma were comprehensively retrieved from the Scopus database. The years of publication were divided into before 2014 and 2014-2024 in the analysis of research trends.

Results

There were 2507 papers on ameloblastoma, with total citations of 34,691 and the h index of 70. The related disorders of the diagnosis of ameloblastoma were mandibular neoplasms, maxillary neoplasms, ameloblastic carcinoma, odontogenic cyst, lung neoplasms, and teratoma. Before 2014, bone graft/transplantation, osteotomy, reconstructive surgical procedures, surgical flaps, cell differentiation, and cytology were more frequent keywords. After 2014, biology research on BRAF protein, gene mutation, cytokeratin 19, biomarkers, epithelial mesenchymal transition, signal transduction, tumor microenvironment, and carcinogenesis were more frequent keywords. Clinical studies on cohort analysis, cone beam computed tomography, quality of life, fine needle aspiration biopsy, incisional biopsy, surgical margin, and hemi-mandibulectomy were more common. Experiment methods such as dog, tumor cell line, cell migration, gene expression, real time polymerase chain reaction, and western blotting were also more frequent keywords after 2014.

Conclusion

This scientometric study elucidated the current scenario and research trends of ameloblastoma, and would help in improving in reciprocal collaboration and communication for investigations on this tumor.

Sustained release of Sr and Ca from a micronanotopographic titanium surface improves osteoblast function

The surface chemistry and topographical features of dental implants play a crucial role in influencing the osseointegration process. Alkaline earth elements such as strontium (Sr) and calcium (Ca) exert beneficial effects in promoting bone formation. This study aimed to evaluate micronanotopographic cpTi substrates that doped these elements, Sr and Ca. The composition and morphology were analyzed by X-ray photoelectron spectroscopy, scanning electron microscopy (SEM), and atomic force microscopy (AFM). Wettability assays, Sr and Ca release tests, and electrochemical behavior were also conducted. Proliferation, adhesion, and differentiation of MC3T3-E1 cells on this surface were evaluated in vitro. Direct fluorescence assays and SEM, cell viability, alkaline phosphatase (ALP) activity, and mineralization nodule formation were performed. The biological results showed the absence of cytotoxicity after the treatments, increased cell spreading on the micronanotopographic substrates, and greater mineralization nodule formation on surfaces doped with Sr and Sr/Ca. Gene and protein expression of osteoblastic markers were assessed through PCR and ELISA, and some genes were regulated on the doped surfaces at three and seven days of cell culture, like Bglap, Ibsp, Spp, Col1a1, and Runx2. The micronanotopographic substrates modified the physicochemical properties and morphology of the pre-osteoblasts. The results indicate that the biological effect of implants treated with Sr and Sr/Ca was significantly superior to that of polished surfaces and undoped micronanotopographic implants. Furthermore, the addition of Sr alone was sufficient to improve events related to osseointegration.

Management of an Atypical Case of Adenomatoid Odontogenic Tumor

Adenomatoid Odontogenic Tumor (AOT) is a benign tumor of rare recurrence, most prevalent in females and anterior region of the maxilla. We report an atypical occurrence of follicular AOT in the anterior mandibular region in male patient and its surgical approach. Twenty-six years-old male presented swelling in the right anterior mandibular region. Radiography showed a radiolucent well-circumscribed lesion, associated with unerupted tooth right permanent mandibular canine. Incisional biopsy and installation of decompressive device were performed. First histopathological diagnosis was not conclusive suggesting dentigerous cyst, however follow-up of 1-year showed non-regression of the lesion. A new approach was performed through enucleation and curettage, and the second diagnosis was conclusive of AOT. At 18-months follow-up, bone formation was observed and patient presented no complaints. Surgical enucleation is the treatment indicated for AOT, which is easily removed due to its fibrous capsule. Due to its mimetic features, AOT can be misdiagnosed. Therefore, the correct diagnosis is important to offer the patient adequate treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-025-05404-9.

Investigating the Anatomy and Location of the Infraorbital Canal in Relation to the Adjacent Structures in Cone Beam Computed Tomography (CBCT) Images

Background

Although the canal protects the infraorbital nerve and artery, they can be easily injured during manipulation in this area. This study aimed to examine the structure and position of the infraorbital canal (IOC) and nearby features using cone beam computed tomography (CBCT) images.

Methods

This study was conducted on 94 CBCT images (47 men and 47 women of 20-55 years). The infraorbital groove (IOG), infraorbital foramen (IOF) and infraorbital canal (IOC) points, and other related parameters are investigated bilaterally using OnDemand3D software. Data were studied by paired t, independent t, and Kruskal-Wallis statistical tests (α = 0.05).

Results

The average angle between IOC, sagittal, axial planes, and IOG 29.08° (SD = 7.33), 56.01° (SD = 10.39), and 121.44° (SD = 43.44). The average IOC and IOG lengths were 10.83 (SD = 3.87) and 19.01 (SD = 5.81) mm. The average IOF vertical diameter was 5.5 (SD = 1.80) mm. The mean skin thickness over IOF was 10.38 (SD = 2.42) mm. The average length between the IOF and the infraorbital rim, the lateral nasal wall, the midsagittal plane, the line perpendicular to the axis of the canine apex, the occlusal plane of the premolar, the vertical axis of the lateral rim of the frontozygomatic suture 9.7 (SD = 2.52), 11.76 (SD = 2.92), 16.4 (SD = 6.42), and 91.11 (SD = 4.15), 42 (SD = 7.61) and 22.55 (SD = 3.25) mm. Images showed the presence of accessory IOF in 13.45% of cases, and the presence of Haller cells in 17.75% of cases, and sex did not affect the studied variables.

Conclusion

CBCT is an accurate 3-dimensional imaging modality for assessment of the anatomy of the IOC, IOG, and IOF. Knowledge of the IOC/G anatomy for preoperative treatment planning utilizing CBCT can assist surgeons in avoiding potential surgical complications and improving treatment efficacy.

Mechanical property of Ti6Al4V cylindrical porous structure for dental implants fabricated by selective laser melting

The commonly used titanium alloy dental implants currently apply solid structures. However, issues such as stress shielding and stress concentration may arise due to the significant difference in elastic modulus between the implant and host. In order to address these problems, this paper proposes five porous structures based on the Gibson-Ashby theoretical model. We utilized selective laser melting technology to shape a porous structure using Ti-6Al-4V material precisely. The mechanical properties of the porous structure were verified through simulation and compression experiments. The optimal porous structure, which best matched the human bone, was a circular ring structure with a pillar diameter of 0.6 mm and a layer height of 2 mm. The stress and strain of the porous implant on the surrounding cortical and cancellous bone under different biting conditions were studied to verify the effectiveness of the optimal circular ring porous structure in alleviating stress shielding in both standard and osteoporotic bone conditions. The results confirm that the circular ring porous structure meets implant requirements and provides a theoretical basis for clinical dental implantation.

Histological assessment of extensive or unresectable central giant cell granulomas treated with denosumab: a case series

OBJECTIVE

The management of large central giant cell granuloma (CGCG) can pose a significant surgical challenge. In such circumstances, the use of denosumab has been proposed with the literature reporting varying degrees of success. Histopathological assessment of CGCG post-denosumab treatment remains unknown. The current case series aims to address this lack of information and supplement the literature and the debate with evidence.

STUDY DESIGN

The current case series is a retrospective review of historic cases accumulated from 3 different hospitals. Patients treated with denosumab for large or unresectable GCGC who subsequently underwent either surgical debulk or resection post drug treatment with histological tissue for assessment were included.

RESULTS

A total of 4 patients were included in this study. All cases showed radiographic response. However histological assessment identified giant cells in 3 of the 4 cases, 2 of which showed clinical recurrence. All cases demonstrated irregular woven bone formation toward the periphery of the lesion suggesting partial response.

CONCLUSIONS

The current case series provides some insight regarding the response of CGCG to denosumab and preliminary histopathological information toward the ongoing debate regarding the medical management of CGCG. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

ZygoPlanner: A three-stage graphics-based framework for optimal preoperative planning of zygomatic implant placement

Zygomatic implant surgery is an essential treatment option of oral rehabilitation for patients with severe maxillary defect, and preoperative planning is an important approach to enhance the surgical outcomes. However, the current planning still heavily relies on manual interventions, which is labor-intensive, experience-dependent, and poorly reproducible. Therefore, we propose ZygoPlanner, a pioneering efficient preoperative planning framework for zygomatic implantation, which may be the first solution that seamlessly involves the positioning of zygomatic bones, the generation of alternative paths, and the computation of optimal implantation paths. To efficiently achieve robust planning, we developed a graphics-based interpretable method for zygomatic bone positioning leveraging the shape prior knowledge. Meanwhile, a surface-faithful point cloud filling algorithm that works for concave geometries was proposed to populate dense points within the zygomatic bones, facilitating generation of alternative paths. Finally, we innovatively realized a graphical representation of the medical bone-to-implant contact to obtain the optimal results under multiple constraints. Clinical experiments confirmed the superiority of our framework across different scenarios. The source code is available at https://github.com/Haitao-Lee/auto_zygomatic_implantation.

Effect of manufacturing trinomial and restoration thickness on the fabrication trueness, fit, and margin quality of additively manufactured resin-based ultrathin laminate veneers

OBJECTIVE

To evaluate the effect of the manufacturing trinomial (manufacturing technology, three-dimensional printer, and material) and restoration thickness on the fabrication trueness, fit, and margin quality of additively manufactured resin-based ultrathin laminate veneers (LVs) by comparing to those produced subtractively.

METHODS

Reference LVs were designed from the scan files of two identical maxillary central incisor typodonts prepared for 0.3 mm and 0.5 mm LVs. LVs were manufactured additively with resins of different compositions, either using a tilting stereolithography (Irix Max [AM-IX] and Irix Plus [AM-IP]) or a digital light processing printer (VarseoSmile Crown Plus [AM-VS] and Tera Harz TC- 80DP [AM-GR]), and subtractively (Tetric CAD [SM-TC]) (n = 10). All LVs were digitized to evaluate their fabrication trueness and fit. The margin quality was assessed through visual examination. The trueness and fit data were analyzed with two-way analysis of variance and Tukey tests, while the chi-squared test was used to evaluate the margin quality (α = 0.05).

RESULTS

The interaction between the main factors and the manufacturing trinomial affected the fabrication trueness and fit, while restoration thickness affected the fit of tested LVs (P ≤ 0.001). AM-IP mostly had the lowest deviations, followed by AM-IX, and mostly had the lowest gaps (P ≤ 0.037). Thinner LVs had lower gaps (P < 0.001). Tested LVs mostly had slightly rough margins with small defects.

CONCLUSIONS

LVs fabricated with the tilting stereolithography printer mostly had higher trueness. Using AM-IP or fabricating 0.3 mm LVs improved the fit. Nevertheless, all tested LVs had clinically accep fit.

CLINICAL SIGNIFICANCE

Ultrathin laminate veneers fabricated with the manufacturing trinomial involving tested tilting stereolithography printer and resins may require less clinical adjustments. In addition, one of the resins (AM-IP) within this manufacturing trinomial or fabricating 0.3 mm laminate veneers may improve the fit.

A method of removing the stripped abutment screw from the angled screw channel: Technical details and a clinical report

An angled screw channel (ASC) avoids a facial screw hole by correcting the pathway of the screwdriver. However, the structure of the specially designed screw is prone to mechanical complications, including screw-head stripping. Removing an angled screw is challenging because regular screw-removal tools cannot access the ASC. A safe and convenient method for the retrieval of the stripped screw is reported.

Retrospective analysis of dental implant fracture following loading: A retrospective clinical study

STATEMENT OF PROBLEM

Fracture of an osseointegrated implant (FOI) is a rare complication that occurs primarily after loading and may lead to other complications including failure or fracture of the implant-supported prosthesis. Risk factors for FOI are not well understood.

PURPOSE

The purpose of this retrospective clinical study was to determine the frequency of occurrence of FOI among participants treated with dental implants in an academic setting and to identify and analyze the possible risk indicators and contributing factors.

MATERIAL AND METHODS

A retrospective analysis was performed using dental records of participants who received dental implant treatment at the Faculty of Dentistry, University of Toronto, from January 1979 until January 2020, and experienced post-loading FOI. A systematic search of the dental records was conducted, and clinical situations with FOI were identified. Data related to patient factors, implant factors, and prosthesis factors were collected from the identified clinical situations with FOI. The data were analyzed to determine the incidence of FOI. A descriptive analysis was used to identify the possible risk indicators for FOI.

RESULTS

A total of 7712 implants had been placed at the Faculty of Dentistry, University of Toronto, from January 1979 until January 2020. During the 41-year period, a total of 27 fractured implants were identified. The incidence of FOI following loading was 0.35%. Overall, the mean ±standard deviation time between loading and occurrence of implant fracture was 10.6 ±7 years. Implant fractures occurred in 23 different study participants; 16 men, and 7 women, with a mean ±standard deviation age of 65.4 ±8.0 years at the time of FOI. Factors associated with implant fracture include narrow-diameter implants (≤3.75 mm), implants placed in posterior mandible (molar or premolar regions), presence of a long cantilever, and unfavorable implant design (such as the Tri-Channel design). Among the 27 fractured implants, 19 were removed, 6 were buried, and 2 were adjusted or smoothed and restored with a new prosthesis.

CONCLUSIONS

The incidence rate of FOI was very low, but might have been increased by an increased presence of predisposing risk factors.

The Effects of Cervical Manipulation Compared with a Conventional Physiotherapy Program for Patients with Acute Whiplash Injury: A Randomized Controlled Trial

Whiplash injuries (WLs) are the most frequent cause of emergency room visits after motor vehicle collisions. In clinical practice, massage, electrotherapy, mobilization, or therapeutic exercise are used. As part of manual therapy, high-velocity, low-amplitude manipulative techniques can also be used. Objectives: To evaluate the effect of the cervical Specific Adjustment Technique (SAT) in adults affected by whiplash on pain, functionality, cervical mobility, and radiological changes in cervical curvature through a prospective, single-blind, randomized clinical trial. Methods: One hundred and nineteen patients with grade II acute WL were randomly assigned to either the manipulation group (MAN group = 59) or the rehabilitation group (RHB group = 60) to receive 3 or 20 sessions of treatment, respectively. Both groups were measured at baseline and 15, 30, and 120 days after starting treatment. Results: Statistically significant differences were found in the MAN group in flexion (p = 0.041) and left-side bending (p = 0.022); similar statistical values were found in the other measures. According to the interaction treatment-time effect, statistical significance for the Cobb angle was obtained in the MAN group (p = 0.047). Conclusions: the effects of SAT were comparable in terms of pain, functionality, and mobility of the cervical spine. Although further research is needed on its effects in the acute phase, due to its effectiveness and lower associated cost, SAT could be considered a useful technique, at least during the first 3 months after a traffic collision.

Recapitulation of endochondral ossification by hPSC-derived SOX9+ sclerotomal progenitors

Endochondral ossification generates most of the load-bearing bones, recapitulating it in human cells remains a challenge. Here, we report generation of SOX9+ sclerotomal progenitors (scl-progenitors), a mesenchymal precursor at the pre-condensation stage, from human pluripotent stem cells and development of osteochondral induction methods for these cells. Upon lineage-specific induction, SOX9+ scl-progenitors have not only generated articular cartilage but have also undergone spontaneous condensation, cartilaginous anlagen formation, chondrocyte hypertrophy, vascular invasion, and finally bone formation with stroma, thereby recapitulating key stages during endochondral ossification. Moreover, self-organized growth plate-like structures have also been induced using SOX9+ scl-progenitor-derived fusion constructs with chondro- and osteo-spheroids, exhibiting molecular and cellular similarities to the primary growth plates. Furthermore, we have identified ITGA9 as a specific surface marker for reporter-independent isolation of SOX9+ scl-progenitors and established a culture system to support their expansion. Our work highlights SOX9+ scl-progenitors as a promising tool for modeling human skeletal development and bone/cartilage bioengineering.

Retrospective analysis of removable partial denture treatment in a state-sponsored dental school

STATEMENT OF PROBLEM

Removable partial dentures (RPDs) provide an important treatment option for replacing missing teeth, particularly for vulnerable populations. However, RPDs have been associated with damage to the remaining dentition, which can lead to treatment failure.

PURPOSE

The purpose of this retrospective clinical study was to investigate the failure rates of RPD treatments among patients at a state-sponsored dental school and identify factors contributing to these failures.

MATERIAL AND METHODS

A retrospective analysis was conducted using electronic health records (EHRs) from 4941 individuals for a total of 7529 patient-arches. The outcome of RPD treatment was defined as failure when any major procedure was performed on any tooth adjacent to a treated edentulous span. The time to event was measured from the date of RPD placement to the first recorded failure or the last follow-up visit (censored). A multivariable Cox proportional hazards model was employed to assess the hazard ratios for the variables of interest (α=.05).

RESULTS

The average age of the cohort was 59 years, 52% female, and the mean follow-up period was 35 months. Among the arches that experienced failure (24.2%), the average time to failure was 33 months. In the multivariable model, statistically significant associations with RPD failure were found for several variables: Kennedy classification without distal extension (HR=1.23, P<.001), older age (HR=1.01, P<.001), male sex (HR=1.17, P=.008), maxillary arch (HR=1.60, P<.001), lack of insurance (HR=0.78, P<.001), cast metal framework (HR=0.55, P<.001), tobacco use (HR=1.21, P=.002), and dental fear (HR=1.26, P=.003).

CONCLUSIONS

While the associations were not particularly strong, dental school patients who smoked, experienced dental anxiety, or received maxillary RPDs or RPDs without a cast metal framework demonstrated an elevated risk of requiring major treatment to the abutment teeth, leading to the failure of the RPD treatment.

A Large Retrospective Study on Long-Term Complications From Osseointegrated Orbitofacial Prosthetic Implants

PURPOSE

To evaluate long-term complications of osseointegrated orbitofacial prosthetic implantation following exenteration.

METHODS

This retrospective review included 40 patients who received orbital reconstruction with osseointegrated orbitofacial prosthetics between 2008 and 2024. Patient demographics, exenteration indication, orbitofacial radiation exposure, osseointegration approach, and postoperative complications were recorded. Collection and evaluation of protected patient health information were Health Insurance Portability and Accountability Act compliant. This manuscript adheres to the tenets of the Declaration of Helsinki.

RESULTS

A total of 134 implants were placed after orbital exenteration (average per orbit: 3). Most patients (75.0%, n = 30) had no implant failure/replacement within the follow-up period (range: 5 months to 16 years). Ten of the 134 placed implants failed (7.46%). Nine patients (22.5%) had an implant replaced within 5 years of implantation, and 1 patient (2.5%) had an implant replaced after 16 years. Implant failure was most often due to peri-implant bone instability (n = 6, 60.0%). Implants placed in the inferolateral orbital rim were most likely to fail (30%, n = 3). One failed implant (10%) was associated with a patient history of radiation treatment. General orbitofacial prosthetic discomfort (n = 22, 55%) was the most cited patient concern. Other common long-term complications included peri-implant discharge (n = 15, 37.5%), malodor (n = 15, 37.5%), and soft tissue dermatitis (n = 13, 32.5%).

CONCLUSIONS

There are long-term complications associated with osseointegrated orbitofacial prosthetics. There are practical perioperative and intraoperative opportunities to improve the outcome of osseointegrated orbitofacial prosthetic rehabilitation. Postoperative daily implant hygiene is critical for successful long-term rehabilitation.

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.

Calcifying Epithelial Odontogenic Tumour (Pindborg Tumour): A Report of 20 Cases and Review of the Literature

AIM

The aim of the present work was to analyze 20 cases of calcifying epithelial odontogenic tumour (CEOT), also known as "Pindborg tumour", and contrast the data with findings reported in the literature.

MATERIALS AND METHODS

Twenty cases of CEOT filed in the archives of the Surgical Pathology Laboratory of the Oral Pathology Department, School of Dentistry, University of Buenos Aires, over a period of 63 years (1960-2023) were retrieved. Their histopathological, histochemical-immunohistochemical, and clinical-radiographic features were evaluated, and the obtained data were compared with those reported in the literature.

RESULTS

CEOT accounted for 1% of odontogenic tumours and 0.02% of oral pathologies filed over the study period. Seventeen cases (85%) were intraosseous lesions (solid: 14 cases; cystic: three cases). Three cases (15%) were extraosseous (solid: two cases; cystic: one case). One case, an intraosseous tumour, was malignant. Three cases (15%) showed clear cells (intraosseous location: two cases; extraosseous location: one case), and two cases (10%) (intraosseous) had fusiform cells. All cases showed amyloid deposits and calcifications. Mean age was 36 years (10-71 years). A female predominance was observed (12 cases, 60%), and the prevalent location was the mandible (14 cases, 70%).

CONCLUSIONS

CEOT is infrequent and presents a wide range of morphological features, making diagnosis challenging. Two cases in our series, intraosseous tumours, showed spindle cell epithelial proliferation, and one extraosseous case was cystic. To our knowledge, this is the first study to report these findings.

Clinical, Radiographic, and Histological Features of Buccal Bifurcation Cysts: A Systematic Review to Aid Accurate Diagnosis and Treatment Decisions

OBJECTIVE

This systematic review delves into the nuanced landscape of buccal bifurcation cysts (BBCs), emphasizing their clinical significance amid the diagnostic challenges in oral and maxillofacial pathology. We trace the evolution of BBC classification from historical perspectives to its current status in the World Health Organization's classification system, aiming to equip dental professionals with crucial insights for accurate diagnosis and effective management.

METHODS

This systematic review (PROSPERO: CRD42023405169) followed PRISMA guidelines to examine the epidemiological characteristics of BBCs. Observational studies were included, while reviews, meta-analyses, and experimental studies were excluded. A comprehensive search across five databases identified eligible studies. Two independent reviewers screened articles, resolving disagreements by consensus or a third reviewer. Data extraction included clinical, histological, and imaging findings. Risk of bias was assessed using Murad's framework for case reports/series and the Newcastle-Ottawa Scale for other study types, with studies rated as low, moderate, or high quality.

RESULTS

The information presented here is crucial for preventing past treatment errors associated with BBC. In addition, this review confirms that BBCs predominantly affect the posterior mandible of pediatric patients and exhibit consistent clinical and histopathological features, aiding in their differentiation from similar maxillofacial lesions. Thus, well-informed clinicians should be able to diagnose BBC and make a proper treatment choice after familiarizing themselves with this review, which will ultimately lead to a favorable prognostic outcome and reduced risk of lesion recurrence.

CONCLUSION

This study provides a comprehensive analysis of BBC, aiming to enhance clinical understanding and ultimately improve patient care.

Progress of surface modifications of temporary anchorage devices: a review

Temporary anchorage devices (TADs) have evolved as useful anchorage providers for orthodontic tooth movements. To improve the stability of TADs, a number of modifications on their surface have been developed and investigated. This review comprehensively summarizes recent findings of clinically applied surface modifications of TADs and compared the biological improvement of these modifications. We focused on sandblasting, large-grit, acid etching (SLA), anodic oxidation (AO) and ultraviolet photofunctionalization (UVP).In vitro, in vivoand clinical studies of these surface modifications on TADs with clear explanations, low possibility of bias and published in English were included. Studies demonstrated that SLA, AO and UVP enhance cell attachment, proliferation, and differentiationin vitro. The biocompatibility and osteoconductivity of TAD surface are improvedin vivo. However, in clinical studies, the changes are generally not so impressive. Furthermore, this review highlights the promising potential in combinations of different modifications. In addition, some other surface modifications, for instance, the biomimetic calcium phosphate coating, deserve to be proposed as future strategies.

New mechanistic approach of TiCN film-coated NiTi substrate toxicity: impairment in mitochondrial electron transfer in Diabetic Rat Tooth Gum Cells

In recent years, researchers have focused on using new materials for screws in bone jaw tissue replacement. However, concerns regarding the cytotoxicity and biocompatibility of these materials for cells remain a subject of ongoing discussion. In this study, a novel implant for bone jaw tissue regeneration was fabricated by depositing the titanium carbo-nitride (TiCN) film on NiTi shape memory alloy substrate using the Cathodic Arc Physical Vapor Deposition (CAPVD) technique. Our study emphasized positive cellular responses of TiCN-coated NiTi substrate on diabetic rat tooth gum cells for 1, 15, and 30 days. Initially, the evaluation focused on the characterization and distribution of NiTi alloy in tissues. Then, the levels of factors such as components of White Blood Cells (WBC), ATP, oxidative stress parameters, cytochrome c release and damage to the lysosomal membrane were evaluated in all groups. The results indicated that in the group of diabetic rats with TiCN-coated NiTi substrate, the level of oxidative stress parameters decreased. In addition, the cell viability, glutathione (GSH) intracellular and ATP increased and the rate of cytochrome c release, and damage to the lysosome membrane decreased. It can be concluded that the TiCN-coated NiTi screw is a promising material for bone jaw tissue replacement in diabetic patients due to its low cytotoxicity.

Early marginal peri-implant bone loss around tissue-level implants: a retrospective radiographic evaluation

OBJECTIVES

To retrospectively assess the potential impact of biological and host factors on radiographic bone loss following tissue-level implant placement and prosthetic rehabilitation.

METHODS

The University database was reviewed to identify patients treated with tissue-level implants between 2006 and 2020 at the University of Zurich, Switzerland. The study included patients who received screw-retained implant rehabilitations in the posterior area without simultaneous hard- or soft-tissue augmentations and had a follow-up period of at least 12 months. Radiographic measures of marginal bone loss and supracrestal tissue height were conducted using periapical x-rays at different time points. Additional factors analysed included age, gender, smoking status, history of periodontitis, jaw of treatment, type of reconstruction, and prosthetic emergence angle. Associations between marginal bone loss and potential explanatory variables were visualised and analysed. Elastic net regressions were applied to examine potential relationships with marginal bone loss.

RESULTS

A total of 1,479 patients were treated with tissue-level implants. After applying inclusion and exclusion criteria, 106 patients with 106 implants were included in the statistical evaluation after one year (T1, n = 106 implants), and 59 patients with 59 implants were evaluated after three years (T2, n = 59 implants). The mean marginal bone loss was 0.93 mm (SD 0.83) at T1 and 1.04 mm (SD 0.97) at T2. A strong correlation (Spearman) was found between mesial and distal bone loss. Smoking status and the jaw undergoing treatment were associated with bone loss. While these associations were observed in the univariate analysis, a more comprehensive multivariate analysis revealed that these variables had a limited effect on explaining radiographic bone loss.

CONCLUSIONS

During the initial rehabilitation period in tissue-level implants in this cohort smoking status and jaw of treatment seemed to influence early peri-implant bone loss. Further, a strong correlation between mesial and distal MBL was observed. Additional research is required to determine factors contributing to early bone loss following implant-prosthetic rehabilitation.

Kidney Toxicity of Drugs for the Heart: An Updated Perspective

Cardiovascular drugs are widely used for the prevention and treatment of various cardiac and vascular disorders. However, some of these drugs can also cause adverse effects on the kidney, leading to acute or chronic renal dysfunction, electrolyte imbalances, and increased mortality. The mechanisms of drug-induced renal toxicity vary depending on the type and class of the drug, the dose and duration of exposure, and the patient's characteristics and comorbidities. In this review, we summarize the current knowledge on the renal effects of some common cardiovascular drugs, such as diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, antiplatelet agents, anticoagulants, and statins and proton-pump inhibitors. We also discuss the clinical implications and management strategies for preventing or minimizing drug-induced nephrotoxicity, as well as the potential role of oxidative stress in its pathogenesis.

Glyphosate is a transformation product of a widely used aminopolyphosphonate complexing agent

Diethylenetriamine penta(methylenephosphonate) (DTPMP) and related aminopolyphosphonates (APPs) are widely used as chelating agents in household and industrial applications. Recent studies have linked APP emissions to elevated levels of the herbicide glyphosate in European surface waters. However, the transformation processes and products of APPs in the environment are largely unknown. We show that glyphosate is formed from DTPMP by reaction with manganese at near neutral pH in pure water and in wastewater. Dissolved Mn2+ and O2 or suspended MnO2 lead to the formation of glyphosate, which remains stable after complete DTPMP conversion. Glyphosate yields vary with the reaction conditions and reach up to 0.42 mol%. The ubiquitous presence of manganese in natural waters and wastewater systems underscores the potential importance of Mn-driven DTPMP transformation as a previously overlooked source of glyphosate in aquatic systems. These findings challenge the current paradigm of herbicide application as the sole source of glyphosate contamination and necessitate a reevaluation of water resource protection strategies.

Multimodality Imaging Approach to Infective Endocarditis: Current Opinion in Patients with Congenital Heart Disease

Although advances in medical and surgical management have significantly improved clinical outcomes, infective endocarditis (IE) remains a significant threat to patients with congenital heart disease (CHD). The complexity of cardiac anatomy, the presence of prosthetic materials, and the emergence of novel pathogens pose unique diagnostic challenges in this specific population. However, the use of personalized imaging, integrating the strengths of each modality, has the potential to refine the diagnostic process, thereby optimizing diagnostic accuracy, guiding therapeutic decisions, and, ultimately, improving patient clinical outcomes. This review delves into the critical role of the multimodality imaging approach in the care of patients with IE and CHD, underscoring the importance of tailored and patient-centered management strategies in this vulnerable cohort.

Pterygoid implant: extensometric and photoelastic analysis of a maxillary rehabilitation model

Pterygoid implants have been demonstrated to have a high success rate. Nevertheless, there are few biomechanical tests to evaluate the tensile forces induced by force dissipation in peri-implant tissues. This study employed photoelasticity and extensometry to demonstrate and compare the biomechanical behavior of non-axial implants in a pterygoid model and a conventional model of oral rehabilitation, thus allowing for qualitative and quantitative analysis. Two models received an implant measuring 3.75 x 13 mm in the canine pillar at a 90 ° angle to the Frankfurt plane. In the control group, an implant with a diameter of 3.75 mm and a length of 11 mm was placed in the maxillary tuberosity parallel the medial implant. In the study group, an implant with a diameter of 3.75 mm and a length of 11 mm was installed with an angulation of 45 degrees in the antero-posterior direction and 15 degrees in the buccal-palatal direction, with apical anchorage in the pterygoid process of the sphenoid bone. In the extensometric analysis, the models were subjected to five cycles of repeated axial tensile loading (100 N) at a rate of 0.5 mm/min. A computer was connected to the amplifier in order to record the output signal of the polyurethane surface, and the acquisition system software was employed to record the data. The data were analyzed in accordance with data distribution, as determined by the Shapiro-Wilk test and equality of variance. Subsequently, the data were classified according to the variables. The Student's t-test was employed when normal distribution of variances was identified, whereas the Mann-Whitney U test was utilized for data with non-normal distribution. A 5% significance level was employed. In the photoelastic analysis, replicas of both configurations were produced using photoelastic resin. The models were subjected to a single axial loading cycle, with a load of 100 N applied at a rate of 0.5 mm/min, and the resulting stress was observed under a circular polariscope. Photographs were taken at two time points: before and after loading. These images were then processed by the same operator using a computer graphics program, allowing for a more straightforward analysis of stress distribution. This was achieved by the formation of isochromatic fringes. The results of the strain gauge analysis revealed no statistically significant differences between the two groups (p = 0.37) or between the anterior (p = 0.08) and posterior (p = 0.74) implants. The photoelasticity analysis revealed the presence of high-intensity isochromatic fringes at the apex of the axial implant in the control model, as well as in the cervical-distal and apical regions of the pterygoid implant, where a high concentration was also observed. Although no statistically significant results were obtained from the quantitative analysis, our findings suggest that the favorable outcomes observed in the clinical studies are due to the high force dissipation observed in the pterygoid plate, which is composed of dense cortical bone.