Patterns and Outcomes of Craniomaxillofacial Trauma in Puerto Rico: Insights From a Five-Year Retrospective Study

Background Craniomaxillofacial (CMF) trauma is a significant problem in the United States, with estimated costs of nearly one billion dollars annually. Facial fractures occur based on factors such as facial structure, the direction and intensity of the impact, and the mechanism of injury. The most frequent facial fractures include the nose, orbits, zygomatic complex, mandible, maxilla, and frontal bone. Additionally, demographic, social, cultural, and environmental factors can contribute to particular trauma mechanisms like falls and motor vehicle accidents (MVAs), leading to different CMF injury rates among populations. Overall, CMF traumas have a significant potential for morbidity and mortality. This study aims to provide the first overview of the prevalence of CMF trauma in Puerto Rico. Methods This retrospective study includes patients aged 0-100 who presented with CMF trauma from 2018 to 2022 to the only trauma center in Puerto Rico. Demographic and clinical data were collected, including the mechanism of injury, craniofacial structures involved, treatment, and outcomes. Frequencies of demographic and clinical data were documented, and statistical analysis using one-way ANOVA and t-tests was performed. Results A total of 1,102 patients (83.1% male and 16.4% female) with CMF injuries were included. The mean age of the group was 40.67 years. The most common mechanisms were non-car-related MVA (23.6%), car-related MVA (22.9%), pedestrian accidents (18.4%), falls (15.9%), and gunshot wounds (10.4%). Cranial fractures occurred in 32.7% of patients with the following affected regions: temporal (16.2%), frontal (10.6%), parietal (7.8%), and occipital (5.3%). Facial fractures occurred in 70% of patients with the following affected regions: middle face including maxilla, nose, zygoma, and orbits (61.8%), lower face including mandible (17.7%), and upper face including frontal bone (9%). Approximately 19.8% of patients with CMF fractures underwent surgical management. The mortality rate in the cohort was 11.8%. The Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) were significantly worse in patients with cranial (p < 0.001) and/or facial (p < 0.001) fractures when compared to patients who suffered from CMF traumas without fractures. Conclusion To our knowledge, this is the first study characterizing CMF traumas in Puerto Rico. The majority of the affected patients were male and belonged to the adult population. Common etiologies of injury were comparable to others reported in the literature, including MVA, falls, and gunshot wounds. Facial fractures were more prevalent than cranial fractures in our cohort. Patients with high-severity injuries were more likely to be managed surgically. By establishing the epidemiological picture of CMF traumas in Puerto Rico, public health and clinical efforts may be employed to allow for improved patient outcomes.

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.

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.

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.

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).

The Influence of Abutment Selection in the Tridimensional Implant Position: Considerations for Predictable Implant Restorative Long-Term Outcomes

OBJECTIVE

To explore the influence of abutment selection on 3D implant positioning, emphasizing the synergy between surgical and prosthetic considerations for achieving predictable long-term outcomes in implant-supported restorations.

MAIN CONSIDERATIONS

Implant dentistry has transitioned from a purely surgical approach to a prosthetically driven methodology that prioritizes implant-supported restoration (ISR). This shift has been bolstered by advancements in digital technologies and abutment designs, which allow for more precise implant positioning and better management of biological, mechanical, and esthetic outcomes. The selection of appropriate abutments plays a pivotal role in optimizing the 3D implant position, influencing peri-implant tissue stability and the overall success of the restoration. This manuscript explores into the biorestorative concept, highlighting how virtual planning can preemptively assess abutment configurations and their interactions with surrounding tissues, guiding implant placement to achieve desired results.

CLINICAL SIGNIFICANCE

The integration of digital planning and strategic abutment selection prior to implant placement ensures optimal 3D implant positioning respecting fundamental biological and prosthetic parameters. This approach minimizes complications, improves long-term tissue stability, and enhances patient outcomes by aligning surgical procedures with the specific prosthetic needs.

Rehabilitation of a patient with extensive odontogenic myxoma treated conservatively: A case report with 14 years of follow-up

Odontogenic myxoma is an odontogenic tumor of mesenchymal origin that presents locally invasive behavior. Its treatment is surgical, and the approach can be more conservative or radical. This article presents the rehabilitation of a patient with extensive odontogenic myxoma in the mandible treated conservatively with follow-up for 14 years. A 17-year-old male patient sought care with a painless swelling in the mandibular region causing facial asymmetry. Imaging exams showed a mixed image, with intralesional septa, involving the left anterior and posterior regions of the mandible with a small remaining basilar and lingual bone. An incisional biopsy was performed which confirmed the diagnosis of odontogenic myxoma. Due to the extent of the lesion, a conservative approach was chosen, with excision of the lesion and peripheral ostectomy, with recurrence of the lesion after 48 months, with a new approach being performed. After 14 years of follow-up, without further recurrence of the lesion, the patient was rehabilitated with dental implants and protocol-type prosthesis. Conservative treatment led to bone remodeling and enabled patient rehabilitation with oral implants and an implant-supported prosthesis. Thus, conservative treatment of odontogenic myxomas is a viable alternative for similar cases, and its longitudinal postoperative follow-up is essential. Key words:Conservative Treatment, Dental Implants, Myxoma; Oral Pathology, Oral Surgery.

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.

Fracture resistance of fixed partial dentures: the influence of restoration geometry and material in additive manufacturing

PURPOSE

The location of the edentulous area in the dental arch can influence the design of the bridge prosthesis in the surrounding region and the forces it will encounter. This study assessed the fracture strength of restorations with various geometric designs produced using different additive and subtractive manufacturing methods.

MATERIALS AND METHODS

Co-Cr metal and zirconia fixed partial denture (FPD) frameworks were designed in both linear and curved geometries. The Co-Cr metal frameworks were produced through casting (C) and laser sintering (L), while the zirconia (Z) frameworks were obtained through milling (n = 10). After veneering the frameworks, a four-point bending test was conducted on the specimens to assess their fracture strength. All obtained values were statistically analyzed (P < .05).

RESULTS

In both linear and curved groups, Z group showed the lowest fracture resistance values followed by C and L groups and the differences between the groups were found statistically significant (P < .05). In L group, curved FPDs showed statistically significantly higher fracture resistance values than linear FPDs (P < .05). In both Z and C groups, curved FPDs showed statistically significantly lower fracture resistance values than linear FPDs (P < .05).

CONCLUSION

The geometric configuration of the restoration and manufacturing technique affects the fracture resistance of different framework materials in FPDs.

Analysis of Risk Factors for Early Implant Failure in the Anterior Region: A Retrospective Study of 2620 Implants

OBJECTIVES

This study aimed to identify risk factors associated with early implant failure in the anterior maxillary and mandibular regions.

MATERIALS AND METHODS

A total of 2023 patients with 2620 implants placed in the maxillary and mandibular anterior regions between January 2020 and June 2023 were included in this study. Clinical and radiographic data were extracted from medical records and imaging software. In organizing the information, 19 variables were categorized into patient-related factors (gender, age, periodontitis, reasons for tooth loss, bone quality, and penicillin allergy), implant-related factors (implant system, bone level/soft tissue level, diameter, and length), and surgical factors (jaw position, placement timing, bone grafting, bone compression/splitting surgery, concentrated growth factors (CGFs), bone graft materials, barrier membrane, torque, and healing style). Univariate and multivariate Cox proportional hazards regression models were used to identify significant risk factors for early failure.

RESULTS

The cumulative survival rate (CSR) of all implants after a 0- to 43-month observation period was 95.6% (95% confidence interval [CI]: 94.8%-96.4%). Independent risk factors for early implant failure included non-submerged healing (hazard ratio [HR] = 3.000, 95% CI = 1.712-5.256), torque < 30 N/cm (HR = 13.193, 95% CI = 8.439-20.626), and Type I bone quality (HR = 3.220, 95% CI = 1.413-7.342) (all p < 0.05). Conversely, bone compression or splitting surgery was identified as a protective factor (HR = 0.344, 95% CI = 0.186-0.634). No significant associations were observed for age, reasons for tooth loss, penicillin allergy, use of CGF, or implant characteristics (location, type, length, and diameter).

CONCLUSION

After 0-43 months of observation, the CSR for 2620 implants placed in 2023 patients was 95.6% (95% CI = 94.8%-96.4%). Torque < 30 N/cm, non-submerged healing, and Type I bone quality were considered independent risk factors for early implant failure in the anterior region.

Clinical evaluation of tapered-straight-tapered dental implants: a retrospective analysis

PURPOSE

This retrospective study aimed to evaluate the long-term survival rate and marginal bone loss (MBL) of tapered-straight-tapered dental implants, considering various associated factors, over an observational period of ≥5 years.

METHODS

This study included 186 patients who underwent tapered-straight-tapered dental implant placement at Seoul National University Dental Hospital from 2014 to 2019. Digital panoramic radiographic images and dental records were examined. We evaluated multiple variables, such as sex, age, diabetes mellitus (DM), smoking status, placement region, jaw type (maxilla and mandible), implant diameter, implant length, staged surgery, immediate placement, splinted prosthesis, and implant placement depth (IPD). We first determined the implant survival rate using Kaplan-Meier analysis and analyzed potential risk factors for implant survival using mixed-effects Cox proportional hazards regression. Next, the Mann-Whitney and Kruskal-Wallis tests were used to examine differences in MBL across variables. Linear mixed-effects models with backward stepwise selection were used to identify associations between risk factors and MBL.

RESULTS

This study included 316 implants in 186 patients, monitored over a follow-up period of 7.0±1.36 years. The cumulative survival rate of the implants was 98.1%. The average mesial and distal MBLs were 0.59±1.36 mm and 0.68±1.36 mm, respectively. Linear mixed-effects models indicated that MBL exhibited statistically significant positive correlations with DM (Coeff.=0.614, P=0.026) and staged surgery (Coeff.=0.410, P=0.002). Additionally, greater mesial IPD was associated with reduced MBL (Coeff.=-0.143, P=0.046), and a similar trend was observed for distal IPD (Coeff.=-0.316, P=0.068).

CONCLUSIONS

This study demonstrated a high cumulative survival rate for tapered-straight-tapered dental implants over a 5-year period. DM, staged surgery, and IPD showed strong associations with increased MBL. The results suggest that tapered-straight-tapered implants offer advantages in terms of peri-implant MBL and consistent clinical outcomes. These findings underscore the importance of considering these variables in clinical decision-making to optimize implant outcomes.

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.

Predicting New-Onset Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Review

Hypertrophic cardiomyopathy (HCM) is a condition characterized by left ventricular hypertrophy, with physiopathological remodeling that predisposes patients to atrial fibrillation (AF). The electrocardiogram is a basic diagnostic tool for evaluating heart electrical activity. Key electrocardiographic features that correlate with AF onset are P-wave duration, P-wave dispersion, and electromechanical delay in left atrium (LA). Clinical markers, including age, body mass index, New York Heart Association functional class, and heart failure symptoms, are also strong predictors of AF in HCM. Risk scores have been created using multiple variables to better predict AF development. Increasing knowledge of genetic subsets in HCM and cardiovascular pathology in general has provided novel insight in this context. Structural and mechanical LA remodeling, including fibrosis, altered LA function, and changes in atrial size, further contribute to AF risk prediction. Cardiovascular magnetic resonance (CMR) and echocardiographic measures provide accurate information about atrial structure and function. Machine learning models are increasingly being utilized to refine risk prediction, incorporating a wide range of variables. This review highlights the multifaceted approach required to understand and predict AF development in HCM. Such an approach is imperative to enhance prognostic accuracy and improve the quality of life of these patients. Further research is necessary to refine patient outcomes and develop customized management strategies for HCM-associated AF.

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.

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.

Intraoperative Profiling of the Supracrestal Implant Complex Minimizes Peri-Implant Crestal Bone Remodeling: The Guided Bone Profiling Concept

(1) Background: Early-stage bone resorption following implant placement can significantly impact the long-term success of implants. This study evaluates whether a fully digitally planned implant position based on the E-point concept, along with guided profiling of the supracrestal complex, contributes to improved stability of peri-implant bone levels. (2) Methods: 29 implants were placed in 27 patients utilizing both immediate (Group 1; n = 19) and delayed placement (Group 2; n = 10) protocols. Implant position and emergence profile were preoperatively determined and consistently executed through guided surgery and CAD/CAM-fabricated restorations. Due to the subcrestal positioning of the implant, a corresponding bone profiler with a guide pin was used to shape the emergence profile and prevent the provisional restoration from impinging on the proximal bone. Provisional restorations were immediately placed to support the emergence profile. Bone level changes were documented radiographically over a two-year period. The first Bone-to-Implant Contact Level (∆ fBIC), change in highest approximal Bone Level (∆ haBL), and formation of an emergence profile width (WEP) were measured. (3) Results: All implants and restorations survived after two years, no significant change in first Bone-to-Implant Contact Level (∆ fBIC = 0 ± 0.02 mm), no change in highest approximal Bone Level (∆ haBL) of -0.23 mm ± 0.71 mm, and formation of an emergence profile width (WEP) averaging 0.18 ± 0.19 mm. (4) Conclusions: Despite the initial stress on the bone caused by bone profiling, guided implant placement and bone shaping, supported by an immediate provisional, have a positive effect on peri-implant bone stability.

Fifteen-Year Follow-Up: Treatment of Recurrent Mandibular Giant Cell Lesion-From Resection to Rehabilitation

Aim: This case report details the long-term management of a recurrent central giant cell granuloma (CGCG) in the anterior mandibular arch of a 28-year-old female. Case Report: Following initial surgical resection in 2007, which resulted in a significant bony defect, a multidisciplinary approach was employed to restore mandibular integrity and function. In 2009, alveolar distraction osteogenesis was performed using a DePuy Synthes alveolar distractor. Subsequently, in 2011, autogenous onlay bone grafting was carried out to optimize the alveolar ridge contour. Four Neodent CM implants were placed in 2012, followed by prosthetic rehabilitation. The 15-year follow-up in 2024 revealed excellent outcomes, with stable peri-implant tissues, maintained bone levels, and a fully functional prosthesis. This case highlights the efficacy of combining advanced surgical techniques, including distraction osteogenesis and autogenous bone grafting, in managing complex CGCG cases. Results and Conclusion: The successful long-term outcome underscores the importance of a comprehensive treatment approach and regular follow-up in addressing the challenges posed by aggressive and recurrent CGCGs. This report provides valuable insights into the potential for fully functional and aesthetic restoration following extensive CGCG treatment, emphasizing the benefits of a well-coordinated, multidisciplinary approach in maxillofacial reconstruction.

The influence of platform switching and platform matching on marginal bone loss in immediately inserted dental implants: a retrospective clinical study

PURPOSE

The aim of this retrospective study was to investigate and compare the effects of platform switching (PS) and platform matching (PM) on marginal bone loss (MBL) and clinical parameters in immediately inserted dental implants.

METHODS

Thirty-seven patients were included (PS group: twenty-one patients, PM group: sixteen patients), with follow-up periods ranging from six months to 23 years. MBL was measured using orthopantomograms (OPG), and implant success was evaluated using the Buser, Albrektsson, and Attia criteria. Regression analysis was conducted to assess total bone loss.

RESULTS

The BEGO RI implant system was used in 83.8% of cases. Mesial MBL averaged 0.26 mm in the PS group and 0.75 mm in the PM group, while distal MBL was 0.68 mm for the PS group and 0.53 mm for the PM group. A significant difference was observed in mesial MBL, with the PS group showing less bone loss (p. = 0.044). Regression analysis indicated that PM implants were associated with significantly greater mesial bone loss compared to PS implants (p. = 0.039). No significant differences in implant success were observed between the PS and PM groups based on the Buser score, Albrektsson criteria, and Attia score.

CONCLUSION

Both PS and PM implants showed comparable long-term functionality. No significant differences were found in total bone loss between the groups, but PS implants showed significantly lower mesial MBL. While both systems are viable for immediate implantation, PS implants may offer advantages in preserving peri-implant bone. Further prospective studies are needed to validate these findings.

Conservative vs. Surgical Management of Condylar Fractures in Pediatric Populations: Complications and Factors for Consideration

BACKGROUND

The optimal treatment decision for pediatric condylar fractures is influenced by various factors, including the child's age, fracture type, degree of displacement, and the presence of concomitant injuries. While non-surgical treatments are generally preferred due to high remodeling capacity in children, there remains a lack of comprehensive research comparing the long-term outcomes of open reduction internal fixation (ORIF) versus conservative management.

METHODS

Retrospective analysis of medical records of 71 pediatric patients (aged 0-18 years) treated for condylar fractures at the Department of Oral and Maxillofacial Surgery, Rambam Healthcare Campus, between 2010 and 2020 was completed. Gender, age, admission date, cause of injury, treatment methods, length of hospital stay, follow-up duration, and follow-up status were studied to help determine association with modality of treatment and complications.

RESULTS

No statistically significant differences were seen in complication rates across different age groups, genders, trauma etiologies, fracture sites (head/neck/base), laterality of fractures, nor was there an impact on choice of surgical vs. conservative intervention. Similar length of hospital stay was observed, even in cases with delayed surgical intervention. There was also no statistical significance of injury distribution based on socioeconomic standing.

CONCLUSIONS

Our research showed similar rates of complications in both surgically treated and conservatively treated cases. This solidifies the importance of practitioner experience, as well as comprehensive anamnesis to help caretakers most effectively determine the optimal treatment for each patient. As the surgical study group is substantially smaller than the conservatively treated group, large-scale prospective studies with extended follow-up will more conclusively help solidify results and establish guidelines.

Methods for assessing peri-implant marginal bone levels on digital periapical radiographs: a meta-research

OBJECTIVES

This meta-research assessed methodologies used for evaluating peri-implant marginal bone levels on digital periapical radiographs in randomized clinical trials published between 2019 and 2023.

METHODS

Articles were searched in four databases. Data on methods for assessing peri-implant marginal bone levels were extracted. Risk of bias assessment was performed.

RESULTS

During full-text reading, 108 out of 162 articles were excluded. Methodological issues accounted for these exclusions, including the absence of radiograph-type information, the lack of radiographic positioners, the missing anatomical references, and the use of panoramic radiographs or tomography. Fifty-four articles were included, most from Europe (70%) and university-based (74%). Radiographic positioners were specified in 54% of articles. Examiner calibration was unreported in 54%, with 69% lacking details. In 59%, no statistical measure assessed examiner agreement. Blinding was unreported or unused in 50%. Marginal bone level changes were the primary outcome of 61%. Most articles (59.3%) raised "some concerns" regarding bias, while 37% showed a high risk of bias, and only two articles (3.7%) demonstrated a low risk of bias.

CONCLUSIONS

Several limitations and areas for improvement were identified. Future studies should prioritize protocol registration, standardize radiographic acquisitions, specify examiner details, implement calibration and statistical measures for agreement, introduce blinding protocols, and maintain geometric calibration standards.

Bone quality analysis of the mandible in alcoholic liver cirrhosis: Anatomical, microstructural, and microhardness evaluation

OBJECTIVES

Alcoholic bone disease has been recognized in contemporary literature as a systemic effect of chronic ethanol consumption. However, evidence about the specific influence of alcoholic liver cirrhosis (ALC) on mandible bone quality is scarce. The aim of this study was to explore microstructural, compositional, cellular, and mechanical properties of the mandible in ALC individuals compared with a healthy control group.

MATERIALS AND METHODS

Mandible bone cores of mаle individuаls with ALC (n = 6; age: 70.8 ± 2.5 yeаrs) and age-matched healthy controls (n = 11; age: 71.5 ± 3.8 yeаrs) were obtаined postmortem during аutopsy from the edentulous аlveolаr bone in the mandibular first molаr region аnd the mаndibulаr аngulus region of each individual. Micro-computed tomogrаphy wаs used to аssess bone microstructure. Analyses based on quаntitаtive bаckscаttered electron microscopy included the characterization of osteon morphology, osteocyte lаcunаr properties, and bone mаtrix minerаlizаtion. Composition of bone minerаl аnd collаgen phаses was assessed by Rаmаn spectroscopy. Histomorphometry wаs used to determine cellulаr аnd tissue chаrаcteristics of bone specimens. Vickers microhardness test was used to evaluate cortical bone mechanical properties.

RESULTS

The ALC group showed higher closed cortical porosity (volume of pores thаt do not communicаte with the sаmple surfаce) (p = 0.003) and smaller lacunar area in the trabecular bone of the molar region (p = 0.002) compared with the Control group. The trabecular bone of the angulus region showed lower osteoclast number (p = 0.032) in the ALC group. There were higher carbonate content in the buccal cortex of the molar region (p = 0.008) and lower calcium content in the trabecular bone of the angulus region (p = 0.042) in the ALC group. The cortical bone showed inferior mechanical properties in the ALC cortical bony sites (p < 0.001), except for the buccal cortex of the molar region (p = 0.063). There was no significant difference in cortical thickness between the groups.

CONCLUSIONS

Bone quality is differentially altered in ALC in two bony sites and compartments of the mandible, which leads to impaired mechanical properties.

CLINICAL RELEVANCE

Altered mandible bone tissue characteristics in patients with ALC should be considered by dental medicine professionals prior to oral interventions in these patients. Knowledge about mandible bone quality alterations in ALC is valuable for determining diagnosis, treatment plan, indications for oral rehabilitation procedures, and follow-up procedures for this group of patients.

Clinicopathological Correlation of Pericoronal Radiolucency in Pediatric Patients

An odontogenic epithelium-derived developing cyst of the mandible is known as an odontogenic keratocyst (OKC). According to the World Health Organization (WHO) classification from 2005, OKCs were referred to as keratocystic odontogenic tumors (KCOTs) and were thought to be cystic neoplasms. As of 2017, the WHO again switched KCOT back to OKC, as there was a lack of support for their justification as a tumor entity. This article presents a rare case report of single and multiple OKCs located in both the maxilla and mandible in male and female pediatric patients, demonstrating conservative as well as surgical management of OKCs. A dentigerous cyst was the provisional diagnosis in all three instances based on clinical and radiographic evidence. We planned both conservative and surgical treatment after considering the type and size of the lesion in the respective cases. A tissue specimen was then sent for histological examination, which confirmed our provisional diagnosis. Histological findings revealed a parakeratinized stratified epithelial lining with a thick columnar basal cell layer, surface corrugation, and neutrophils and lymphocytes organized against extravasated red blood cells (RBC), which confirmed the diagnosis of OKC in all three patients. Clinically and radiographically, OKC might resemble other benign, less aggressive tumors. Thus, it's critical to distinguish them from other cysts and tumors in order to provide appropriate care and lower the risk of recurrence.

How to cite this article

Dua R, Gangwar A, Singh HP, et al. Clinicopathological Correlation of Pericoronal Radiolucency in Pediatric Patients. Int J Clin Pediatr Dent 2025;18(3):321-326.

Bone graft substitutes and dental implant stability in immediate implant surgery: a systematic review and meta-analysis

INTRODUCTION

Implant dentistry is currently being revolutionized by breakthroughs in techniques, technology, and material, there are few systematic reviews and meta-analyses that examine the effects of utilizing different bone graft substitutes in immediate implant placement surgeries.

AIM

The purpose of this research is to systematically review and meta-analyze the effect that different bone graft substitutes have on implant stability when concurrently utilized in patients undergoing immediate implant surgeries.

METHODOLOGY

The PICO criteria were used to construct the focused question, and the systematic review has been outlined as per the PRISMA guidelines. The revised Cochrane risk-of-bias method for randomized trials was used to assess the risk of bias for the selected articles. To derive estimates for the results, random effects meta-analysis was conducted on the selected articles.

RESULTS

The electronic databases were searched and a total of 1583 articles were identified. After title and abstract screening and due to problems in retrieval a further 1358 articles were eliminated. Fifteen articles were finally chosen to be qualified for review. Of which full text evaluation of 5 articles were found to meet the eligibility criteria and were therefore included in the systematic review.

CONCLUSION

This systematic review and meta-analysis on the stability of dental implants and bone graft substitutes in immediate implant surgery, was unable to draw any conclusions and established no statistically significant correlation between the different types of grafts used and implant stability.

A rare case of recurrent calcifying epithelial odontogenic tumor in an adolescent patient: Case report and review of literature

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic epithelial tumor characterized by the presence of amyloid material within the tumor that can undergo calcification. CEOT affects individuals across a broad age range, typically between 20 and 60 years, with an average onset age of 40 years. However, it is extremely rare in children and adolescents. According to the literature, only 31 cases of CEOT in children and adolescents have been reported from 1971 to 2023, accounting for approximately 7 % of all CEOT cases. In the 2022 WHO classification of odontogenic tumors, CEOT is classified as a benign tumor, but it is inherently locally aggressive, capable of invading surrounding normal jawbone tissues, with a recurrence rate of 10-15 %. In this paper, we report a case of a 13-year-old male with a recurrence of CEOT in the mandible 43 months after surgery, covering clinical, imaging, histologic, immunohistochemical, and surgical aspects, and discuss its histopathologic features and treatment options.

Lateral periodontal cyst in an interdental molar site: Novel presentation in a geriatric patient

OBJECTIVE

This report describes an unusual case of a lateral periodontal cyst (LPC) residing between the roots of a mandibular first and second molar.

BACKGROUND

The LPC is a developmental odontogenic cyst, the majority situated along the lateral roots of the mandibular canines and premolars. The occurrence of an LPC solely confined to the molar region is extremely rare. Limited information regarding the LPC has appeared in the geriatric literature.

PATIENT PRESENTATION

A unilocular cyst-like lesion was incidentally discovered on extraoral and intraoral radiographic examinations involving a 68-year-old patient. It was initially considered an infected odontogenic keratocyst or unicystic ameloblastoma.

RESULTS

Histologic examination of the excised specimen revealed a thin cuboidal epithelial lining with focal nodular thickenings and underlying fibrovascular connective tissue wall. The lesion was diagnosed as an LPC. At a 6-month follow-up, the patient has remained asymptomatic and exhibited radiographic osseous regeneration.

CONCLUSIONS

The LPC should be added to the differential diagnosis of developmental odontogenic cysts found in the inter-molar region. A preoperative cone beam computed tomography scan may be helpful to optimise the surgical approach. Timely removal of any suspected cystic lesion, particularly in the context of infection in an older patient, may reduce postoperative sequelae and rule out malignancy.

Prospective Clinical Study on the Accuracy of Static Computer-Assisted Implant Surgery in Patients With Distal Free-End Implants. Conventional Versus CAD-CAM Surgical Guides

OBJECTIVES

To compare the accuracy of CAD-CAM and conventional guides in the static computer-assisted implant surgery (sCAIS) placement of distal free-end implants.

MATERIAL AND METHODS

A prospective, controlled, and blinded quasi-experimental study was done involving 27 patients (76 implants) distributed into two groups according to the surgical guide manufacturing approach used: conventional (control group [CG]) or CAD-CAM (test group [TG]). The implants were planned in the software and the surgical guides were manufactured. Fully guided implant placement was carried out and the deviations were measured along with secondary variables as potential confounding factors. Descriptive analyses were performed on mean, standard deviation (SD), and interquartile range (IQR). In the comparative/inferential analysis hypothesis, contrasts were made of the quantitative and qualitative variables and multiple linear models were generated to adjust for the different confounding variables recorded.

RESULTS

Coronal horizontal deviation (CHD) was significantly greater in CG (1.52 mm) versus TG (1.04 mm) (p = 0.004). Apical horizontal deviation (AHD) in turn was 1.67 versus 1.46 mm, respectively; angular deviation was 2.87 versus 3.64; and vertical deviation was -0.1 versus -0.05 mm, with no significant differences between the groups (p > 0.05). A greater sleeve height, positioning in premolars versus molars, and the use of shorter implants, were associated with greater accuracy in relation to CHD and/or AHD (p < 0.05). The implant success rate at 1 year was 92.1%, 90.7% in TG, and 100% in CG, being statistically significant (p = 0.026) at the implant level, but not significant at the patient level.

CONCLUSIONS

The CAD-CAM surgical guides proved to be more accurate than the conventional guides in the sCAIS placement of distal free-end implants, with statistically significant differences being observed in terms of CHD. All implant failures occurred in TG (6 implants/3 patients).

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06404385.

Influence of Implant Component Materials on Peri-Implant Soft Tissue Healing: A Comparative Histological and Immunohistochemical Study in Humans

BACKGROUND

Recently, the importance of peri-implant soft tissue integration quality has been recognised as an essential factor in the long-term success of dental implant rehabilitation.

AIM

The aim of this study was to explore the influence of three materials commonly used in implant dentistry, namely titanium (Ti), dental adhesive resin (Re) and polyetheretherketone (PEEK), on the peri-implant soft tissues.

METHODS

In this clinical randomised comparative study, 37 bone-level implants were placed, and experimental transmucosal healing abutments made of different materials were randomly assigned to each implant. These abutments were removed together with the surrounding soft tissues after 8 weeks. Immunohistochemical analyses were performed to determine the presence and localisation of different immune cells. In addition, clinical and radiographic data were collected and peri-implant bone remodeling was assessed.

RESULTS

Compared to the Ti and PEEK groups, Re abutments revealed a higher infiltration of macrophages in the connective tissue (p = 0.04) and neutrophils in the adjacent epithelium (p = 0.03). In the Re abutments, peri-implant bone remodeling was higher compared to the other groups (p = 0.01).

CONCLUSION

The use of resin material as a transmucosal healing abutment should be carefully considered as it was associated with a higher presence of inflammatory cells at 8 weeks post-implantation as well as superior bone remodeling compared to PEEK and Ti.

Clinical and radiographic outcomes of mini-implant-retained maxillary and mandibular overdentures: a systematic review and meta-analysis

OBJECTIVE

To assess the clinical and radiographic outcomes of overdentures and their retaining dental mini-implants, based on a single-arm systematic literature review.

METHODS

Electronic search was undertaken in three databases, last updated in October 2023, plus manual search of journals. Cumulative implant survival rate (CSR) and the estimated marginal bone loss (MBL) under different follow-up times were calculated.

RESULTS

Thirty-nine studies were included, with 3,787 mini-implants supporting 1,026 overdentures (109 maxilla, 896 mandible) in 1,005 patients, with a mean follow-up of 28.1 ± 19.8 months (min-max 0.3-84.0). 202 mini-implants failed, after a mean of 9.4 ± 11.8 months (7-year CSR 91.4%). The implant survival was lower in the maxilla in comparison to the mandible (p < 0.001), lower for early/delayed-loaded in comparison to immediately-loaded implants (p = 0.005) and lower for 2-mini-implant in comparison to 4-mini-implant-retained mandibular overdenture (p < 0.001; Log-rank test). A high rate of transversal fracture of the prosthesis and wear of the attachment parts was observed. The estimated mean MBL gradually increased from 0.518 (≤ 6 months) to 1.260 mm (58.8-90 months). There was an estimated MBL increase of 0.011 mm per additional month of follow-up.

CONCLUSION

Although presenting a high 7-year CSR, mini-implant-retained overdentures may require frequent maintenance follow-ups, due to the high rate of technical complications. The estimated MBL of mini-implants over 80 months is low.

CLINICAL RELEVANCE

The ability to anticipate outcomes is an essential part of risk management in clinical practice. The findings reported herein set some recommendations and potential strategies for minimizing failures and complications commonly associated with this mini-implant-retained overdentures.

Angulated titanium bases screw channel abutments for single implant restorations: A systematic review and meta-analysis

PURPOSE

Screw-retained implant crowns are a common solution to rehabilitate single or multiple edentulous sites. Angulated screw channel (ASC) abutments have been developed as a new system of connection to correct the angulation of the implant and avoid a possible undesired emergence of the access hole. The purpose of this systematic review was to examine available literature related to the effects of ASC abutments in rehabilitating single implant crowns.

METHODS

A protocol was registered in the PROSPERO database (ID = CRD42022295521). An electronic search of the Cochrane Central Register of Controlled Trials and Trial Protocols, MEDLINE, SCOPUS, and Web of Science was performed up to January 16, 2024. Additionally, a manual search was carried out. The meta-analysis used a fixed or a random effects model, based on the heterogeneity between the studies, focusing on binary and continuous data. A risk of bias assessment was performed (NOS or MOGA et al.) The outcomes assessed were peri-implant marginal bone level, probing pocket depth (PPD), the prevalence of technical and mechanical complications, implant and prosthesis survival rates, and esthetics. Statistical significance was set at p < 0.05.

RESULTS

The searches resulted in a total of 10 studies included in the meta-analysis. The mean implant and prosthesis survival rates were respectively 99% (absolute quantity = 243) and 100% (absolute quantity = 239) with non-statistically significant differences observed in single crowns supported by ASC abutments compared to cemented restorations, in terms of marginal bone loss (MBL) (p = 0.22), PPD (p = 0.08), risk of complications (p = 0.53), and esthetics (p = 0.47). Follow-up intervals ranged from 14 days to more than 3 years.

CONCLUSIONS

Data based on this systematic review suggest that the clinical and radiographic outcomes of single implants restored using ASC are promising if compared to the outcomes relating to screw-retained single crowns.

From pathogenesis to precision medicine: Transformative advances in research and treatment of ameloblastoma

Odontogenic neoplasms of the jaw are dominated by ameloblastoma (AM), a locally aggressive epithelial tumor with a significant propensity for recurrence. The World Health Organization's 2022 update to the AM classification system underscores recent progress in comprehending its underlying mechanisms and refining clinical approaches. Contemporary research has yielded significant insights into the genetic underpinnings of AM, paving the way for the development of precision-based treatment strategies. Advanced genetic profiling has revealed a significant frequency of BRAF (V-raf murine sarcoma viral oncogene homolog) V600E and SMO (Smoothened) gene alterations in AM. Importantly, therapeutic interventions specifically designed to target these genetic aberrations, including BRAF and MEK pathway blockers, have shown encouraging results in terms of both effectiveness and tolerability, as documented in individual case reports and small-scale clinical investigations. This comprehensive review summarizes the recent modifications to the World Health Organization's categorization of AMs, explores progress in elucidating their underlying molecular pathways, and evaluates emerging targeted treatment modalities. Our objective is to present a thorough synthesis of contemporary scientific discoveries and therapeutic interventions, potentially paving the way for more efficacious and individualized clinical management protocols for this complex neoplasm.

Signaling pathways of pro-IL-1β production induced by mechanical stress in gingival epithelial cells

OBJECTIVES

Mechanical stress on the teeth and alveolar bone caused by bruxism, orthodontics, and implants affects the periodontal tissues, causing gingival recession and alveolar bone resorption, and entire body, including the heart and vascular system. Although the same forces exerted on the alveolar bone and teeth are exerted on gingival epithelial cells, little is known about the effects of mechanical stress on these cells. This study investigated the effects of mechanical stress on gingival epithelial cells.

METHODS

Ca9-22 cells (human gingival epithelial cells) were used. They were seeded onto the silicone and stretched cyclically. Mechanical stress-stimulated Ca9-22 cells were evaluated for pro-inflammatory interleukin (pro-IL)-1β production using Western blotting and analyzed to assess the phosphorylation level of intracellular signaling molecules.

RESULTS

Mechanical stress induced pro-IL-1β upregulation in Ca9-22 cells, which was significantly inhibited by ruthenium red. Ruthenium red significantly inhibited mechanical stress-induced phosphorylation of focal adhesion kinase (FAK), P130cas, and extracellular signal-regulated kinase 1 and 2 (ERK1/2) induced by mechanical stress. Additionally, Y15 significantly inhibited the upregulation of pro-IL-1β expression and phosphorylation of FAK, P130cas, and ERK1/2 stimulated by mechanical stress.

CONCLUSIONS

In Ca9-22 cells, mechanical stress may increase pro-IL-1β production via mechanosensitive ion channels and FAK. These findings revealed the mechanisms of inflammation in mechanically-stressed Ca9-22 cells and may aid in the development of therapeutic approaches to prevent bone resorption.

Giant Cell-Rich Tumors of the Skeleton

The accurate diagnosis of giant cell-rich tumors of bone is challenging, especially in limited tissue samples. This diverse group of neoplasms have similar and often ambiguous clinical presentations, radiologic features, and morphologic characteristics. During the last decade, the discovery of pathogenic recurrent genetic alterations has allowed the development of immunohistochemical surrogate markers and FISH assays that can help differentiate the entities of this broad group from one another. The correct diagnosis of these neoplasms is essential in the management of the affected patients.

Osteoradionecrosis Incidence and Dental Implant Survival in Irradiated Head and Neck Cancer Patients: A Systematic Review and Meta-Analysis

BACKGROUND AND AIM

The use of implants in irradiated patients has been critically questioned due to the presence of Osteoradionecrosis and other side effects of radiation therapy. Hence, our objective is to examine the likelihood of dental implant survival and the incidence of osteoradionecrosis in patients with head and neck cancer who have undergone radiation therapy. This analysis will aid in making informed therapeutic decisions on oral rehabilitation for individuals at high risk, ensuring maximal benefit.

METHOD

PubMed, Scopus, and Web of Science were queried until April 2024. The digital data were extracted using the Web plot digitizer. We utilized the most recent iteration of STATA (version 18) to perform a meta-analysis of the data. The studies were evaluated for quality using the New Castle-Ottawa Scale. Egger's test was used to evaluate the presence of publication bias caused by modest research effects.

RESULT

The study analyzed data from 21 research papers on 753 head and neck cancer patients. The majority were male, with a mean age of 60.25 years. 46% underwent radiotherapy, with 2261 dental implants inserted. The mandible was the most used implant site, accounting for 62.4%. The mean time between implant placement and radiotherapy was 5.3 weeks, with a median waiting period of 30.7 months for secondary surgery. After an average follow-up of 42.25 months, 58% of implants failed in the irradiated control group, while 6% failed in the non-irradiated control subgroup. Osteoradionecrosis was seen in 26 patients, resulting in an incident rate of 1.81%. As a result of this problem, an average of 2.5 implants per patient were not successfully retained. Radiotherapy was found to be a significant risk factor for implant survival.

CONCLUSION

Our research indicates that the survival rate of implants in patients who have undergone radiation therapy is lower compared to those who have not received radiation therapy. Additionally, although rare, osteoradionecrosis is a significant complication that every oral and maxillofacial surgeon should be ready to address. Enhancing the quality of care, mitigating hazards, and reducing treatment duration may hinge upon implementing a systematic approach to patient selection and therapy.

Adiponectin receptors agonist alters microbiota to improve implant osseointegration in diabetic mice

OBJECTIVE

Estimate the impact of Adiponectin receptors agonist (AdipoRon) on dental implant osseointegration in alveolar bone and explore the possible mechanism between saliva microbiota and AdipoRon in diabetic mice.

MATERIALS AND METHODS

Sixty C57BL/6 mice (male, 8 weeks old) were divided randomly into four groups according to different doses of AdipoRon: normoglycemic control group; DM control group; DM with a low dose of AdipoRon (5 mg/kg/day); and DM with a high dose of AdipoRon (50 mg/kg/day). Then, dental implants were placed in the palatal root socket in the first molar extraction mouse model. Micro-computed tomography, histology examination, immunohistochemical staining, and oral microbiota were explored to evaluate implant osseointegration.

RESULTS

AdipoRon treatment at 50 mg/kg markedly promoted dental implant osseointegration in diabetic mice, but AdipoRon treatment at 5 mg/kg was not effective. Moreover, distinct differences in the oral microbiota composition were shown between the diabetic mice and diabetic mice treated with AdipoRon at 50 mg/kg.

CONCLUSION

AdipoRon treatment at 50 mg/kg in diabetic mice could significantly increase dental implant osseointegration. The salivary microbiota might participate in the accelerated osseointegration progress of dental implants in AdipoRon treatment.

Survival and Complication Rates of Feldspathic, Leucite-Reinforced, Lithium Disilicate and Zirconia Ceramic Laminate Veneers: A Systematic Review and Meta-Analysis

OBJECTIVES

To analyze survival and complication rates for anterior and premolar laminate-veneers out of different ceramic materials (feldspathic, leucite-reinforced glass-ceramic [LRGC], lithium-disilicate [LDS] and zirconia).

MATERIAL AND METHODS

A systematic literature search was conducted across multiple databases for clinical studies on ceramic laminate-veneers with a minimum-follow-up of ≥ 1 year. The date of last search was on February 19, 2024. Survival, technical, esthetic and biological events were assessed for different laminate-veneer materials at three observation periods (short- [1-3 years], mid- [4-6 years] and long-term [≥ 7 years]).

RESULTS

Twenty-nine studies were included. Meta-analysis revealed a pooled survival-rate of 96.13% for feldspathic, 93.70% for LRGC and 96.81% for LDS at 10.4 years. No difference was found between materials. Complication rates (technical/esthetic/biological) were as follows: Feldspathic: 41.48%/19.64%/6.51%; LRGC: 29.87%/17.89%/4.4%; LDS: 6.1%/1.9%/0.45% at 10.4 years. Zirconia showed a 100% survival-rate with no complications at 2.6 years. No long-term data was available for zirconia.

CONCLUSIONS

Feldspathic, LRGC and LDS laminate-veneers showed high survival-rates at long-term observation. LDS slightly outperforms feldspathic and LRGC laminate-veneers with lower long-term complication rates. More studies providing long-term data on zirconia laminate-veneers are needed.

CLINICAL SIGNIFICANCE

Ceramic laminate-veneers are a reliable treatment option. LDS may be preferred as a restorative material for long-term success.

Aggressive vascularized odontogenic myxoma. Case report and literature review

INTRODUCTION AND IMPORTANCE

Odontogenic myxoma (OM) is an infrequent benign mesenchymal odontogenic tumor of the jaws composed of rounded and angular cells dispersed in an abundant mucoid stroma. An aggressive and vascularized presentation is unusual.

CASE PRESENTATION

A 68-year-old woman was evaluated for a mass located under the palate and extended to the cheek. A large flattened mass covered the entire palate, except the left lateral dental arch, and extended to the cheek as a firmed 6 × 6 × 5 cm mass. An enhancement computed tomography and a magnetic resonance imaging revealed a large, heterogenous, expansive, 80 × 64 × 58 mm mass that destroyed the right maxilla and extended to the soft tissues of the cheek. Minimally invasive endovascular angiography and embolization was performed preoperatively. Through a modified Weber-Ferguson incision, a partial right lateral maxillectomy was performed, conserving the right nasal fossa and a left canine tooth, medially, and the floor of the orbit, upward. Pathology study reported an odontogenic myxoma with compromised margins but reexcision margins were negative. One year after surgery, there is no evidence of disease.

CLINICAL DISCUSSION

Pathological and radiological differential diagnosis that includes a large number of benign and malignant lesions are discussed. All authors agree that wide surgical excision is the treatment of choice.

CONCLUSIONS

Wide excision resulted in good functional and local control. Preoperative embolization is needed in case of a vascularized lesion. No immediate surgical reconstruction should be recommended to facilitate clinical surveillance and early recurrence detection.

Dynamics of Mucosal Integration of Machined versus Anodized Titanium Implants

The long-term success of dental implants depends on the ability of soft tissues to form a protective barrier, limiting pathogen infiltration into peri-implant tissues. Here, we investigated the impact of an anodized surface modification on mucosal integration. Scanning electron microscopy and surface chemistry characterization were carried out on miniaturized implants. Following placement in fresh extraction sockets of mice, peri-implant tissues were examined at 4 time points. Histology along with quantitative immunohistochemistry for Keratin14, Vimentin, Laminin5, and CD68 were carried out on postimplant day (PID) 3 to assess early events in soft-tissue repair; on PID7, when peri-implant epithelialization was complete; at PID14, when osseointegration was complete; and at PID28, when soft-tissue maturation was nearing completion. In all cases, an intact junctional epithelium served as a reference. These analyses supported 3 conclusions: first, maturation of the peri-implant epithelium (PIE) is a protracted process, consistent with clinical observations. Second, maturation of the soft tissue-implant interface is slower than maturation of the bone-implant interface. Third, there is a benefit, albeit transient, to soft-tissue maturation around an anodized implant surface. Given its prolonged time course, strategies to improve and/or accelerate PIE maturation are likely to have significant clinical benefit.

Comparison of implant placement and loading protocols for single anterior maxillary implants: A systematic review and network meta-analysis

STATEMENT OF PROBLEM

With increasing esthetic needs, patients prefer missing anterior teeth to be restored as soon as possible, but how the timing of implantation and prosthetic loading influences peri-implant tissue and the esthetic results remains unclear.

PURPOSE

The purpose of this systematic review and network meta-analysis of randomized controlled trials was to investigate and rank the hard-tissue and soft-tissue outcomes, esthetics, and patient satisfaction of single maxillary implant placement and loading protocols.

MATERIAL AND METHODS

A systematic search was conducted to identify studies with at least a 1-year follow-up that compared different implant placement and loading protocols and reported on survival, marginal bone loss (MBL), soft tissue, and esthetics. A random effects model and a Bayesian approach were applied to compare protocols by using mean differences (MD) with 95% credible intervals (CrI) and surface under the cumulative ranking curve (SUCRA) values.

RESULTS

A total of 43 articles were included, with a follow-up of 1 to 5 years. All protocols had high survival rates and no significant differences for 1-year or 2-year MBL. Immediate placement with immediate loading ranked first in pink and white esthetic scores and satisfaction and was statistically significantly better than immediate placement with delayed loading or late placement protocols in pink esthetic scores, where its advantage over late placement with late loading was also clinically relevant [MD: -1.74, CrI: -2.34 to -1.15].

CONCLUSIONS

Immediate implantation with immediate loading showed a considerable esthetic advantage over later rehabilitation, whereas only a slight difference in MBL resulted from different protocols.

Assessing behaviours in antimicrobial prescribing and implants in the UK: a pilot study

BACKGROUND

With implant dentistry growing in popularity as a means of replacing missing teeth, there is an increasing need for guidance to support regular practice and to ensure that implantology is reinforced with an appropriate evidence base for developing safe prescribing habits. This is particularly important as the prescribing of antibiotics in implant dentistry is becoming increasingly controversial owing to the fear of any failure due to post-operative infection; the possible litigation consequences that might emerge can be a major reason for justifying such prescription protocols.

METHODOLOGY

A questionnaire-based pilot study was carried out, which assessed prescribing behaviours by UK-based dentists placing dental implants. The 11-item questionnaire sought information on implant procedures categorised as straightforward and complex implant procedures. The survey was distributed electronically through local implant study clubs and via dental social media forums.

RESULTS

A total of 54 dentists responded, with almost 89% of respondents prescribing antibiotics pre-operatively and 85% prescribing antibiotics post-operatively, with amoxicillin always the primary choice. The recommended course of treatment varied between one and seven or more days. Almost half of the respondents prescribed analgesics pre- and/or post-operatively with ibuprofen and paracetamol as the first and second choices, respectively. Dexamethasone was prescribed pre- and post-operatively by 7% of the dentists.

CONCLUSION

This study highlighted a lack of national antibiotics prescription guidelines and a lack of consistency in implant dentistry practice in the UK. It also indicated the need for multi-centre studies with large sample sizes that can support the foundation for appropriate guidelines on antibiotic prescribing in implant dentistry.