Vitamin-D Insufficiency Leads to Interleukin-10 Reduction in Peri-Implant Tissues: A Case-Control Study

OBJECTIVES

Vitamin D has been reported to be crucial for bone mineralization and to play a significant role in immune and inflammatory responses. Its deficiency has been stated to be highly prevalent and might alter osseointegration of dental implants. Successful osseointegration has been claimed to be a critical aspect of implant survival and the effects of vitamin D on implant osseointegration have not been well documented. This study aimed to evaluate bone markers and cytokine levels of patients with or without vitamin D insufficiency.

MATERIAL AND METHODS

A total of 42 patients were included and divided into two groups: vitamin D insufficient (Group IN-S; n = 21) and vitamin D sufficient (Group S; n = 21). Besides clinical periodontal parameters and implant stability measurements, the levels of RANKL, OPG, osteocalcin (OC), calcium (Ca), tumor necrosis factor alpha (TNF-α), IL-1β, caspase-1 (CASP1), and IL-10 in bone biopsy from implant preparation sockets and peri-implant crevicular fluid (PICF) were determined by enzyme-linked immunosorbent assay (ELISA). The results were represented as concentration and total amount.

RESULTS

PICF RANKL levels (both concentration and total amount) were higher in patients with Vitamin D insufficiency compared to sufficient controls (p < 0.05). Concentration and total amount of IL-10 were significantly lower in vitamin D insufficient participants than those of vitamin D sufficient group (p < 0.05). No differences were detected between the groups in terms of other parameters. Bone levels of all evaluated parameters also did not differ between the groups (p > 0.05).

CONCLUSION

It may be concluded that a low serum level of vitamin D may affect peri-implant health through altering IL-10 and RANKL.

Zygoma Bone Shell Technique: A Proof-of-Concept Surgical Protocol in Human Cadaver for Bone Reconstruction After Zygomatic Implant Failure

OBJECTIVES

This article aims to present a proof-of-concept surgical technique for immediate reconstruction of zygoma anatomy following implant failure and complications, illustrating the related clinical steps in a cadaver specimen. Zygomatic implants represent a paradigm shift, addressing challenges posed by severe maxillary bone atrophy and partial or complete maxillectomy, not suitable for conventional dental implant placement. Despite documented high survival rates, intra- and postoperative complications can occur and lead to implant failure, resulting in severe defects extended up to entire height of zygomatic bone pyramid. Such defects may infringe immediate or delayed new implant placement, requiring complex surgical procedures to restore integrity of zygomatic bone anatomy.

MATERIAL AND METHODS

The three-dimensional reconstruction of zygomatic bone defect was achieved by specific form of guided bone regeneration or shell technique, using a thin cortical plate harvested from external oblique line of the mandible. After a meticulous mechanical debridement of bone defect resulting from implant removal, a thin cortical bone block was harvested from the mandibular ramus. The cleared bone defect was filled with autogenous bone chips and thin bone shell was secured above with a bone fixation screw.

RESULTS

Zygoma Bone Shell technique was able to restore contours of zygomatic pyramid ridge. The comparable composition between mandibular and zygomatic bone, particularly in the cortical region allowed an anatomical resemblance that facilitates optimal structural compatibility, fostering seamless integration of bone graft into zygomatic area.

CONCLUSIONS

Within limitations of this proof-of-concept, zygoma bone shell technique may offer a viable surgical procedure for immediate bone reconstruction after zygomatic implant failure. Translating the previously reported clinical outcomes of bone shell technique, it may be used same day of failing implant removal to achieve reconstruction of zygomatic anatomy with limited risk of postoperative complications. Further clinical studies are needed to confirm its predictability, reliability and anticipated benefits.

The Effect of Medical Status on Long-Term Survival of Dental Implants

Successful dental implant therapy relies on a bone-implant interface that is mechanically strong and capable of dynamic remodeling in response to functional loads. There are a number of medical conditions or therapies that can affect either bone metabolism or the resistance of bone to infection. However, their effects are often mitigated by local factors or individual responses so the impact of these conditions is not clear-cut. This article will review a number of these conditions and therapies and describe existing studies that have studied these conditions to guide practitioners in their implant practice.

Effect of a calibration aid and the intraoral scanner on the registration of a partially edentulous maxilla: An in vitro study

STATEMENT OF PROBLEM

Precise data are a prerequisite for accurately fitting restorations. Therefore, intraoral scanners have to be reliable. Data on differences between the same model of intraoral scanning systems are lacking.

PURPOSE

This in vitro study evaluated differences in the scanning accuracy of a partially edentulous maxilla between combinations of new intraoral scanners of a single model from the same manufacturer (Primescan; Dentsply Sirona) and several calibration aids.

MATERIAL AND METHODS

The in vitro reference model simulated a maxilla with 6 prepared teeth for a complete arch fixed partial denture. Five precision ceramic balls were used to detect dimensional deviation between the reference model and the scan. Distances were divided into 4 categories, from short distances between 2 neighboring precision balls to the cross-arch distance with the scan path comprising all 5 balls. For each combination of 4 new intraoral scanners and their respective calibration aids, 12 model registrations were generated. The data were statistically analyzed using ANOVA (α=.05).

RESULTS

Distance deviations increased with increasing scan path length and were significantly affected by the covariates "scanner" (P≤.023) and, for 3 of 4 distance categories, the "calibration aid" (short, medium, and long distances: P≤.013). For short and medium distances, acceptable scanning results were achieved for all test groups. The largest deviation was 539 µm for the cross-arch distance.

CONCLUSIONS

Scanning accuracy depends on the scanner and the calibration aid used, in particular, for spans exceeding a single quadrant.

A calcified epithelial odontogenic tumor with extension to the maxillary, ethmoid and sphenoid sinuses

Calcified epithelial odontogenic tumor (CEOT) with extension to the maxillary, ethmoid and sphenoid sinuses is currently unreported. This extension poses a challenge for effective treatment, as CEOT is a benign neoplasm with contreversial potential aggressiveness. We report a case of CEOT that was previously misdiagnosed as an inverted papilloma. A segmental resection of the part of the tumor responsible for the symptoms was performed. Histology revealed polyhedral epithelial cells within an amorphous eosinophilic hyaline material containing round calcified structures and confirmed the diagnosis of CEOT. Postoperative CT Scan showed the partial resection of the tumoral process. A mixed radiolucent/radiopaque aspect of the remaining CEOT was clearly discernible. The patient was warned that due to the incomplete excision of the tumoral process, the risk of recurrence was significant and that a close clinical and radiological follow-up every 6 months was mandatory for a long time.

Impact of scanning interruptions on accuracy of implant-supported full-arch scans: An in-vitro pilot study

PURPOSE

To assess the impact of involuntary interruptions (simulating tracking loss by moving the scanner out of its focal distance) and voluntary interruptions (pressing the scanner's turn-on button) on the accuracy of implant-supported full-arch scans using an intraoral scanner (TRIOS 5, version 22.1.10; 3Shape; Copenhagen, Denmark).

MATERIALS AND METHODS

An edentulous model with four implants was digitized with an industrial scanner (Artec Micro II; Artec 3D) to create a reference scan. Four groups (n = 30) were established based on the number of interruptions during scanning: Zero Group (no interruptions; control group), 6-V Group (six voluntary interruptions), 6-I Group (six involuntary interruptions), and 12-I Group (twelve involuntary interruptions). Primary outcome was accuracy assessed by the Root Mean Square (RMS) method. Secondary outcomes included scanning time and the number of photograms. Data were analyzed using one-way ANOVA and post hoc Tukey multiple comparison tests (α=0.05).

RESULTS

A total of 120 digital scans were conducted. The Zero group achieved a RMS error of 291 ± 47 µm, a scanning time of 68 ± 6s, and 1320 ± 129 photograms. 6-V group significantly reduced RMS error (MD -102 µm [IC 95 %: -141, -63]), decreased scanning time (MD -20s [IC 95 %: -25, -17]), and reduced photograms (MD -415 photograms [IC 95 %: -506, -324]) compared to the control group (P<.001). Simulations of 6 or 12 involuntary interruptions did not affect accuracy compared to the control group (P>.05).

CONCLUSIONS

Voluntary interruptions during scanning, achieved by pressing the scanner's turn-on button, appear to enhance accuracy due to image preprocessing, while involuntary interruptions had no significant impact on the accuracy of implant-supported full-arch scans.

CLINICAL SIGNIFICANCE

Voluntary stop during scanning implant-supported full-arches may result in better-fitting prostheses owing to higher scan accuracy and efficiency.

Assessing the Long-Term Survival of Dental Implants in A Retrospective Analysis: Immediate Versus Delayed Placement

OBJECTIVES

This large-scale retrospective study aims to evaluate and compare the long-term survival rates of dental implants placed immediately after tooth extraction (type 1) versus those placed at a later stage (types 2, 3, and 4). Additionally, it examines how patient characteristics and implant site conditions influence the choice of implant placement.

MATERIALS AND METHODS

This study retrospectively analyzed patient data from 10 university dental clinics between 2011 and 2022 and examined dental implant treatment outcomes. Patient information, including age, sex, ethnicity, race, smoking, and medical status, was analyzed.

RESULTS

Records of 20,842 patients with 50,333 dental implants inserted between 2011 and 2022 were analyzed. The multivariate analysis resulted in significant differences for age, ethnicity, race, gender, and asthma. A 98.4% survival rate for dental implants placed immediately following extraction and a 98.6% survival rate for those placed in fully healed sockets were recorded. The type of implant placement (immediate vs. delayed) showed no significant effect on implant outcome.

CONCLUSION

Immediate implant placement resulted in high survival rates with delayed implants inserted into healed sites. Both immediate and delayed implant placements are viable therapeutic approaches demonstrating predictable outcomes.

Evaluation of Internal and External Hexagon Connections in Immediately Loaded Full-Arch Rehabilitations: A Multicenter Randomized Split-Mouth Controlled Trial With a 6-Year Follow-Up

BACKGROUND

Full-arch immediate loading rehabilitations are now a widely used rehabilitation method that guarantees predictable medium- and long-term results. Numerous factors can influence its success and stability in the medium and long term. Among these the implant-abutment connection seems to play an important role, however there is still little information on which is the most suitable in this type of treatment.

PURPOSE

The aim of the present multicenter split-mouth controlled trial is to evaluate whether external hexagonal connections (EHC) and internal hexagonal connections (IHC) can influence success, bone resorption and peri-implant parameters in immediate-load full-arch rehabilitations.

MATERIALS AND METHODS

Twenty patients were rehabilitated with immediately loaded fixed full-arch rehabilitations. All the implants presented the same macro- and micro-topography but different implant-abutment connection. IHC were used in one randomly selected side of the jaw and EHC was used in the other side. Outcome measures were implant survival rate, peri-implant marginal bone loss (MBL), plaque index (PI), probing depth (PD), and bleeding on probing (BoP) evaluated at 3, 6, 12, 36, and 72-month post-loading. Technical and biological complications were recorded.

RESULTS

In 20 patients, 43 EHC and 40 IHC implants were placed. Between 32 and 72 months of follow-up two patients withdrew (died) and no implants were lost. The cumulative survival rate (CSR) was 97.44% for EHC implants and 97.22% for IHC implants. The MBL presented a resorption of 2 mm in the EHC group and 1.9 mm in the IHC group. No statistically significant differences were found between the two groups for any of the parameters at any time. No biological or technical complications were detected between the 36th and 72nd month of follow-up.

CONCLUSIONS

After 72 months in function, both internal and external hexagon connections provided good clinical outcomes and were not associated with any significant difference in the clinical outcomes.

7. Cervical facet pain: Degenerative alterations and whiplash-associated disorder

INTRODUCTION

Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques.

METHODS

A literature search on the diagnosis and treatment of cervical facet joint pain and whiplash-associated disorders (WAD) was performed using PubMed, Cochrane, and Embase databases. All relevant literature was retrieved and summarized.

RESULTS

Facet-related pain is typically diagnosed based on history and physical examination of the patients, combined with a diagnostic block (eg, with local anesthetic) of the medial branches innervating the joints. There is no additive value for imaging techniques to diagnose cervical facet pain, but imaging may be used for procedure planning. First-line therapy for pain treatment includes focused exercise, graded activity, and range-of-motion training. Pharmacological treatment may be considered for acute facet joint pain; however, for chronic facet joint pain, evidence for pharmacological treatment is lacking. Considering the lack of evidence for treatment with botulinum toxin, intra-articular steroid injections, or surgery, these interventions are not recommended. Diagnostic blocks are not considered a viable treatment option, though some patients may experience a prolonged analgesic effect. Long-term analgesia (>6 months) has been observed for radiofrequency treatment of the medial branches.

CONCLUSIONS

Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.

20 Years of Clinical Evolution in Zygomatic Implant Rehabilitation: Long-Term Outcomes and Current States

Zygoma implants are an alternative for rehabilitating severe maxillary atrophy. Since 2004, when Prof. Branemark first reported the long-term findings on zygomatic implants using the original intra-sinus approach, various surgical techniques have been introduced. In 2006, an anatomy-guided approach was developed, applying different implant trajectories based on alveolar atrophy levels and sinus concavity. The purpose of this review is to clarify the existing techniques and long-term outcomes of ZI rehabilitation over the past 20 years. Additionally, it aims to enhance the quality of current practices and identify gaps in the understanding of ZI treatment for future studies.

Long-Term Survival of Dental Implants in Irradiated Patients

The surgical ablation of head and neck cancer followed by radiotherapy often leads to unfavorable functional and aesthetic outcomes. Studies have demonstrated that these outcomes can significantly impact quality of life. Dental implants play a crucial role in rehabilitation by facilitating the use of suprastructures and obturators. However, the long-term survival of dental implants in patients who have undergone radiotherapy remains uncertain, raising several questions. These include determining the optimal timing for dental implantation (before or after radiotherapy), identifying the radiotherapy threshold for implant loss, and considering the role of hyperbaric oxygen therapy. These and other related concerns will be addressed in the following article.

Risk factors for the failure of re-implanted dental implants: A 20-year retrospective study

BACKGROUND

Re-implantation of failed implants is common to maintain the original prosthetic plan; however, it may not always be ideal due to various factors. Few studies have thoroughly investigated the outcomes of re-implanted implants, while considering factors that can enhance their survival rates. Therefore, this study aimed to identify the risk factors that may contribute to the refailure of implants placed the second time by analyzing previously failed implants and evaluating their survival.

METHODS

Of 10,666 dental implants placed in 4063 patients at the Department of Periodontics of the Gangneung-Wonju National University Dental Hospital between December 1999 and March 2021, 259 failed implants in 170 patients were evaluated through clinical and radiographic records for patient-, surgical-, implant-, and prosthesis-related factors; survival analysis was conducted for implants that met the inclusion criteria.

RESULTS

Of the 259 failed implants, 80 second-time-placed implants met the inclusion criteria. Survival analysis showed that the 1-year survival rate of second-time-placed implants was 88.1%. Smoking (hazard ratio [HR] = 5.066, p = 0.081), implant surface (HR = 18.776, p < 0.01), and timing of reimplantation (HR = 0.086, p < 0.01) were identified as risk factors influencing the refailure of second-time-placed implants.

CONCLUSIONS

The survival rate of second-time-placed implants was lower than that of first-time-placed implants. The risk factors for second-time-placed implant failure were smoking, implant surface, and timing of reimplantation. To prevent further failure, previous failure factors should be analyzed and modifiable risk factors must be controlled before reimplantation.

Providing a monolithic zirconia fixed partial denture with rigid and nonrigid connectors to overcome nonparallel abutment teeth

This clinical report describes the fabrication of a monolithic zirconia fixed partial denture using rigid and nonrigid connectors to overcome nonparallel abutment teeth. A precise key and keyway in the ceramic material was designed with digital technology, reducing material costs, improving biocompatibility, and using esthetically superior nonmetallic materials.

Influence of different polymeric materials of implant and attachment on stress distribution in implant-supported overdentures: a three-dimensional finite element study

PURPOSE

Investigating high performance thermoplastic polymers as substitutes to titanium alloy, in fabrication of implants and attachments to support mandibular overdenture, aiming to overcome stress shielding effect of titanium alloy implants. AIM OF STUDY: Assessment of stress distribution in polymeric prosthetic components and bone around polymeric implants, in case of implant-supported mandibular overdenture.

MATERIALS AND METHODS

3D finite element model was established for mandibular overdenture, supported bilaterally by two implants at canine region, and retained by two ball attachments. Linear static stress analysis was carried out by ANSYS 2020 R1. Three identical models were created with different materials for modeling of prosthetic components (implant body, gingival former, ball attachment and matrix). The Monolithic principle was applied as the same material was used in modelling all the prosthetic components in each model (Titanium alloy grade V, poly-ether-ether-ketone (PEEK) and poly-ether-ketone-ketone (PEKK)). Simultaneous Force application of 60 N was carried out bilaterally at the first molar occlusal surface area using 3 runs (vertical, lateral and oblique).

RESULTS

PEEK and PEKK prosthetic components exhibited the highest total deformation and critical Maximum von Mises stresses values in implant body and gingival former under lateral and oblique loads. The stress values approached the fatigue limit of both polymeric materials presenting low factor of safety (< 1.5). The Peri-implant cortical bone in case of PEEK and PEKK showed nearly double maximum principal stresses compared with the titanium model. Conversely, Maximum von Mises stresses in spongy bone were lower in polymeric models than those of titanium ones. Additionally maximum equivalent strain values in spongy peri-implant bone of polymeric models were also lower than those of titanium model.

CONCLUSION

Critical high stresses were induced in implant body and gingival former under oblique or lateral loadings, accordingly, fatigue failure of both PEEK and PEKK polymer prosthetic elements was estimated due to low factor of safety. Both PEEK and PEKK Polymer models offered no advantage over titanium one regarding stress shielding effect, due to low stress and strain values generated at spongy peri-implant bone in polymer models.

Prediction models for the complication incidence and survival rate of dental implants-a systematic review and critical appraisal

PURPOSE

This systematic review aims to assess the performance, methodological quality and reporting transparency in prediction models for the dental implant's complications and survival rates.

METHODS

A literature search was conducted in PubMed, Web of Science, and Embase databases. Peer-reviewed studies that developed prediction models for dental implant's complications and survival rate were included. Two reviewers independently evaluated the risk of bias and reporting quality using the PROBAST and TRIPOD guidelines. The performance of the models were also compared in this study. The review followed the PRISMA guidelines and was registered with PROSPERO (CRD42019122274).

RESULTS

The initial screening yielded 1769 publications, from which 14 studies featuring 43 models were selected. Four of the 14 studies predicted peri-implantitis as the most common outcome. Three studies predicted the marginal bone loss, two predicted suppuration of peri-implant tissue. The remaining five models predicted the implant loss, osseointergration or other complication. Common predictors included implant position, length, patient age, and a history of periodontitis. Sixteen models showed good to excellent discrimination (AUROC >0.8), but only three had undergone external validation. A significant number of models lacked model presentation. Most studies had a high or unclear risk of bias, primarily due to methodological limitation. The included studies conformed to 18-27 TRIPOD checklist items.

CONCLUSIONS

The current prediction models for dental implant complications and survival rate have limited methodological quality and external validity. There is a need for enhanced reliability, generalizability, and clinical applicability in future models.

Effect of antiplatelet and anticoagulant medications on implant survival: a long-term retrospective cohort study

PURPOSE

This large-scale retrospective study aimed to examine the long-term effect of antiplatelet and anticoagulant medications intake on dental implant treatment outcome.

MATERIALS AND METHODS

This study retrospectively examined data from patients who underwent dental implant procedures at several university dental clinics within the BigMouth network between 2011 and 2022. Patients' characteristics including age, gender, ethnicity, race, tobacco use, systemic medical conditions and intake of antiplatelets and anticoagulants were analyzed. Implant treatment outcome was the main outcome variable. Implant failure was defined as the removal of a dental implant for any reason. Time to failure (date of procedure to date of visit with failure) was recorded, while sites without a failure were censored at the last follow-up visit.

RESULTS

A total of 50,333 dental implants in 20,842 patients over 12 years were analyzed and an implant failure rate of 1.4% at the implant level and 2.7% at the patient level were found. Asians, African-Americans, American Indians or Alaskan Natives, and White individuals were significantly more likely to receive antiplatelet medications than Hispanics or Latinos. Males and smokers exhibited significantly higher odds of being antiplatelet and anticoagulant users compared to females and non-smokers, respectively. When the implant survival rates between antiplatelet and anticoagulant users were compared to non-users, no significant differences were observed.

CONCLUSION

Within the limitations of this study, it appears that the use of anticoagulant and antiplatelet medications does not affect the risk of implant failure. Both anticoagulant and antiplatelet users and non-users exhibit similar high implant survival rates.

Discriminating between the maxillary tuberosity and the alveolar tuberosity- a critical pictorial review

PURPOSE

The maxillary tuberosity, a critical anatomical landmark in dentistry and maxillofacial surgery, is burdened by terminological confusion. This inconsistency hampers clinical practice and communication across disciplines.

METHOD

Different resources were used to argue for the necessity of standardising the terminology related to maxillary tuberosity to enhance diagnostic precision and ultimately improve patient outcomes.

RESULTS

Most clinical and surgical studies dealing with the distal alveolar bone of the maxilla erroneously indicate it as "maxillary tuberosity". By recognising the diverse definitions of this structure, errors and misinterpretation of studies could be reduced, and interdisciplinary collaboration could be improved. The term "alveolar tuberosity" is recommended to refer specifically to the distal end of the alveolar process of the maxilla. Anatomically, the maxillary tuberosity belongs to the body of the maxilla and forms part of the posterior wall of the maxillary sinus; therefore, it should not be located in the alveolar process.

CONCLUSION

Adhering to the Terminologia Anatomica will clarify the critical clinical and surgical landmarks and enhance communication in clinical and academic settings.

Patient-reported outcomes of esthetics, function and oral hygiene with single dental implants 10-15 years after placement: a cross-sectional study

AIMS

Little attention has been paid to patients' perception of function and esthetics with single dental implants. The aim of this study was therefore to describe patient-reported function and esthetic outcomes in single dental implants. A second aim was to study the objective esthetics in single dental implants.

MATERIAL AND METHODS

Patients with one single dental implant in the esthetic zone were selected. Two questionnaires with visual analog scales (VAS) were filled in by the patients, and intraoral photographs were taken. One of the questionnaires related to satisfaction with cleaning and function, and the other involved the esthetics of the single dental implant. One dentist reviewed the photographs using the pink esthetic score/white esthetic score (PES/WES) index.  Results: For chewing and for speaking, the scores were 8.8 and 9.9 respectively on a VAS (best 10). The overall esthetic score on a VAS was 8.6 (best 10). The PES/WES in the present study was 14.6 (standard deviation [SD] ± 1.9), and 3/45 (6.7%) of the single dental implants never reached clinical acceptability.  Conclusions: Patients reported high satisfaction with both the function and the esthetics of single dental implants. Both subjectively and objectively, the peri-implant mucosa was less favorable compared with the crown.

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system-the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients.

The Effect of Oral Potentially Malignant Disorders (OPMD) on Dental Implants Survival-A Systematic Review

Objectives: This research is purposed to synthesize the existing evidence on implant survival rates in patients with oral potentially malignant disorders (OPMD) and assess potential risk factors associated with peri-implant disease. Material and Methods: A comprehensive search was performed across PubMed MEDLINE, Cochrane Library, and Web of Science. This review was conducted according to the PRISMA guidelines, including studies published between 2012 and 2023. Results: The review of studies related to oral lichen planus (OLP) revealed an implant survival rate of 99.3% (50% to 100%) with a mean follow-up of 40.1 months. One retrospective study focused on patients with leukoplakia and erythroplakia, but did not provide data on implant survival; however, it reported the presence of oral squamous cell carcinomas (OSCC) in the vicinity of dental implants. Data from a patient with proliferative verrucous leukoplakia (PVL) indicated a 100% implant survival rate, while patients with systemic lupus erythematosus (SLE) showed an implant survival rate of 97.67%. For all other entities of OPMD no articles could be found. Conclusions: With the exception of OLP, there is a limited number of studies or none on all other entities of OPMD. The available literature indicates no impact of OLP on implant survival rates and does not support OLP as a risk factor for peri-implant disease. For the other entities of OPMD, no conclusion regarding implant survival or peri-implant disease risk factors can be drawn due to a lack of studies. To validate the results and evaluate OPMD on peri-implant tissue, large-scale prospective studies for all types of OPMD, especially for leukoplakia and erythroplakia, are needed.

Patient-reported outcomes of zirconia dental implants: a systematic review and future directions

PURPOSE

Zirconia dental implants show excellent biocompatibility and tissue integration, low affinity for plaque, and favorable biomechanical properties. However, these objective measures do not adequately replicate the patient's perception. This systematic review evaluated the evidence on patient-reported outcome (PROs) in zirconia dental implant treatment.

METHODS

A systematic literature review was conducted following the PRISMA guidelines, utilizing six electronic databases, and supplemented by a manual search of relevant journals and websites to ensure a thorough and comprehensive screening process. The identified studies were subjected to preidentified inclusion criteria. Only controlled clinical trials published in English were considered without limitations on the year of publication. Data on the study characteristics (follow-up, survival rate (%), implant system, number of implants, and type of treatment), PROMs, level of evidence, and Methodological Index for Nonrandomized Studies (MINORS) Bias Score were extracted.

RESULTS

The initial database and hand search yielded 596 articles; 189 were included in the title and abstract screening after excluding the duplicates. Eighteen articles were selected based on the inclusion criteria, among which six were excluded because they did not match the research question. Thus, the final selection comprised 12 articles. Most PROMs (aesthetics, speaking, comfort, chewing ability, and general satisfaction) at prosthetic delivery revealed significantly improved average scores than those at pretreatment.

CONCLUSIONS

Despite the respective limitations of the articles included in this systematic review, patients revealed high satisfaction levels with regard to zirconia dental implants. A high level of heterogeneity was observed among the instruments used for measuring the patient-reported outcomes in patients with zirconia implants, thus highlighting the need to develop specific PROMs in the future.

Cytokine expression of soft tissue cells cultured with titanium discs and their respective supernatants in vitro

OBJECTIVE

Titanium surface modifications improve osseointegration in dental and orthopedic implants. However, soft tissue cells can also reach the implant surface in immediate loading protocols. While previous research focused on osteogenic cells, the early response of soft tissue cells still needs to be better understood.

MATERIAL AND METHODS

We have established a bioassay to this aim where human gingival fibroblasts, HSC2 oral squamous carcinoma cells, and murine bone marrow cells were cultured onto titanium discs or exposed to the respective supernatants for overnight. Modifications were double acid-etching (SLA), and coating with simulated body fluid (SBF) with or without odanacatib (ODN), a selective cathepsin K inhibitor reducing bone resorption.

RESULTS

Our findings indicate that direct contact with titanium discs, with all surface modifications, slightly reduces cell viability. Growing gingival fibroblasts on discs consistently showed a trend toward increased IL8 expression. In HSC2 cells, this setting significantly increased IL1 and IL8 expression, confirmed by the immunoassay. Murine bone marrow macrophages also showed an increase in IL1 and IL6 expressions. Supernatants of the respective discs failed to cause these changes. Although ODN coating inhibited cathepsin K, osteoclastogenesis remained unchanged.

CONCLUSIONS

These findings suggest that titanium discs do not provide a favorable in vitro surface for oral soft tissue cells as they lose viability and respond with a moderately increased expression of inflammatory cytokines.

CLINICAL RELEVANCE

The soft tissue surrounding a dental implant can impact rehabilitation success. Understanding how soft tissue cells respond to titanium surface is potentially relevant to understand clinical outcomes.

Identification of the greater palatine foramen, the greater palatine artery, and palatal fibromucosa: A cross-sectional ultrasonographic clinical study

OBJECTIVES

This study aimed to evaluate with ultrasonography (US) the location of GPF, the course of the GPA, and to measure palatal fibromucosa thickness.

MATERIALS AND METHODS

This in vivo experiment was conducted on a group of healthy, young Turkish subjects. Using the US, the localization of the GPF, its diameter and opening type, maximum flow velocity (Vmax) and collateral branches (CB) of the GPA, and the thickness of the palatine mucosa were evaluated. The distance between the probe and the gingival margin (GM-P) was also measured to determine the course of GPA. Statistical analyses were performed using the chi-square test and the independent sample t-test, with the significance level set at 0.05.

RESULTS

The study included 31 participants (16 females, 15 males; mean age, 23.77±0.92). GPF predominantly showed between the second and third molars (n = 15;48.4 %) and exhibited an anterior opening type(n = 25;80.6 %). The average diameter of GPF measured 5.52±1.76 mm, with a Vmax value of GPA at 14.39±5.07 cm/sec. Collateral branches were primarily observed at the first molar level (n = 23; 74.2 %). No statistically significant gender differences were noted in localization or opening type. However, GM-P at the second molar level was significantly greater in men than women(p < 0.05).

CONCLUSION

In understanding the anatomical structure of the palate, the US provides important clinical results regarding the anatomical measurement of the GPF, the GPA, and adjacent fibromucosa.

Anatomic Variations Important for Dental Implantation in the Mandible-A Systematic Review

Background: This is a systematic review on the subject of anatomic landmarks and variations in the mandible that influence implantation placement. With this systematic review, we would like to summarize the results from different studies that are relevant to this subject and that are up to date, presenting their main findings, the measurements of mentioned landmarks, and giving clinical implications that will be helpful to practitioners in their better understanding of this topic. Methods: This study followed all of the elements of PRISMA. The criteria for inclusion and exclusion are described in detail. The following bibliographic databases were searched: PubMed (MEDLINE), The Cochrane Library, Wiley Online Library, EMBASE, and, additionally, Google Scholar. The search of articles was carried out using a combination of different keywords with a Boolean operator for each keyword. A total of 30 studies were included in this review and the risk of bias for each study was assessed. This review was registered with the PROSPERO ID number CRD42024609308. Results: The structure "SPIDER" was used to present the findings in the summation table, followed by a detailed description of the quantitative findings and overall mean values of the most commonly used measured points. The morphometric measurements of anatomic details and variations in the mandible, such as the mandibular canal, mental foramen, lingual foramina, lingual canal, incisive canal, and mandibular concavity, are of high significance for clinicians dealing with implantation where gender, ethnicity, age groups, the side of the mandible, or remaining teeth can influence implantation planning. Conclusions: The distances of the named anatomic landmarks to the surrounding bone structures that are used as a guide during planning are of huge importance, so proper and detailed measurements must be executed by experienced professionals using CBCT. Knowledge of the position and variation in these landmarks may be used for any bone-guided augmentation, surgical transpositions of anatomic landmarks, and surgery intervention planning. The results of this study can aid in choosing appropriate measurement points and give the gross picture, for clinicians, in therapy planning, considering all the landmarks of significance in the mandible.

Effectiveness of keratinized mucosa augmentation procedures around dental implants based on risk assessment: A 5-year retrospective cohort study

PURPOSE

To compare the effectiveness of keratinized mucosa (KM) augmentation with different techniques for the treatment of dental implants based on risk assessment.

METHODS

Thirty-nine patients who underwent KM augmentation at implant sites in the posterior mandible were included. Three techniques were used based on anatomy-guided risk assessment: an apically positioned flap (APF) alone, an APF plus a free gingival graft (APF plus FGG), and an APF plus a collagen matrix (APF plus CM). Clinically effective KM augmentation was defined as remaining KM ≥ 2 mm after the intervention. The effective rate, implant/prosthesis survival rates, and bone/soft tissue parameters were analyzed. The correlation between local anatomical characteristics and different techniques was also determined. The associations between the effectiveness of KM augmentation and related factors were analyzed using a linear model.

RESULTS

Overall, 74 sites received KM augmentation in the posterior mandible, for an effective rate of 94.6% at the 1-year follow-up and 93.2% at the 5-year follow-up. The KM width in the APF plus FGG group (3.85 ± 1.22 mm) was greater than that in the APF alone (3.05 ± 0.90 mm) (P = 0.016) and APF plus CM (3.21 ± 1.17 mm) groups (P = 0.038) at 5 years post-surgery. There was no significant difference in the effective/ineffective outcomes at the 1-year or 5-year follow-up among the three groups.

CONCLUSIONS

Comparable effective outcomes were achieved with three KM augmentation techniques following the decision-making criterion based on risk assessment.

Marginal bone loss in dental implants: A literature review of risk factors and treatment strategies for prevention

PURPOSE

Marginal bone loss (MBL) occurs in the periapical cervical bone after dental implant placement and abutment connection. MBL may not result in peri-implantitis; however, it is always accompanied by MBL. Recent studies have demonstrated that early MBL is a predictor of peri-implantitis. In this narrative review, we aimed to provide an evidence base for recommended treatment strategies for clinicians to prevent MBL.

STUDY SELECTION

We reviewed the recent literature and performed a narrative synthesis of the evidence, focusing on available systematic reviews and meta-analyses of implant marginal bone resorption.

RESULTS

The available evidence indicates that certain biological, material, and technical factors can influence MBL and consequently dictate the risk of developing peri-implant disease in later years. The order of the impact of the strength of each factor is unknown. Current recommendations to prevent MBL include controlling patients' smoking and hemoglobin A1c levels to sufficiently low levels before surgery and throughout their lifetime. Regarding the material, a platform-switching, conical-connecting implant system, and an abutment with a height of at least 2 mm should be selected. Placement should be performed using techniques that ensure sufficient soft tissue (keratinized gingival width > 2 mm, supracrestal tissue height > 3 mm), and non-undersized preparations in the cortical bone should be made with connected concave abutments during primary or secondary surgery. Patients should receive supportive peri-implant therapy during maintenance.

CONCLUSIONS

MBL development is multifactorial and can be reduced by considering the biological, material, and technical factors.

Gonial angle and late implant loss: A retrospective clinical study

PURPOSE

Occlusal overload can cause late implant loss. However, whether the magnitude of the occlusal force is a risk factor for late implant loss remains unclear. Thus, this clinical study aimed to determine the relationship between the gonial angle (GoA), which is associated with the magnitude of occlusal force, and late implant loss.

METHODS

All implants with fixed prostheses placed at the Niigata University Hospital between April 2006 and August 2019 were included in this retrospective study. The implants with and without late loss were compared. Relevant variables, including smoking habits, diabetes mellitus status, remaining dentition, implant length and diameter, prosthesis design, retention systems, splinting, and GoA were assessed. Log-rank test and Cox proportional hazards regression analysis were used to estimate the adjusted hazard ratio (aHR) and to calculate the corresponding 95% confidence intervals (CI) for late implant loss.

RESULTS

A total of 919 patients (349 men and 570 women) with 2512 implants were included in this study. Cox proportional hazards regression analysis revealed that a 10° decrease in the GoA (aHR, 1.588; 95% CI, 1.115-1.766; P = 0.010), smoking habits (aHR, 3.909; 95% CI, 2.131-7.168; P < 0.001), and male sex (aHR, 2.584; 95% CI, 1.376-4.850; P = 0.003) were significantly associated with late implant loss.

CONCLUSIONS

Within the limitations of this retrospective study of 2512 implants, smaller GoA, smoking habits, and male sex were risk factors for late implant loss.

Antibiotic Prophylaxis Prescribing Practices for Dental Implant Placement in Croatia: A Questionnaire-Based Cross-Sectional Study

Background/Objectives: This study aimed to explore antibiotic prescribing practices for dental implant placement in Croatia. Methods: We conducted a cross-sectional questionnaire-based study including dentists in Croatia who perform dental implant therapy. The questionnaire assessed the dentists' age, working experience, education level, and whether they use antibiotics for dental implant placement, as well as the choice of antibiotics, timing, and reasons for antibiotics use. We used snowball and convenient sampling methods for recruiting dentists. Categorical data were described as absolute numbers and percentages. Differences in the use of antibiotics for specific health conditions were analyzed using Chi-Square, with p < 0.05. Results: Overall, 74 dentists completed the survey. The dentists used antibiotics either before and after (N = 37, 48.7%), before (N = 21; 27.6%), or after dental implant placement (N = 17, 22.4%). Most used Amoxicillin (N = 47, 61.8%), or Amoxicillin-clavulanic acid (N = 22, 28.9%). Almost all dentists used antibiotics in patients with artificial heart valves (N = 73, 97.3%) and a history of infective endocarditis (N = 74, 98.7%). Also, the dentists reported using antibiotics in patients with artificial joints (N = 52, 69.3%), diabetes (N = 48, 64%), HIV (N = 51, 34.2%), or those on antiresorptive drugs (N = 46, 61.3%), with 17 dentists (22.7%) prescribing antibiotics to all (p < 0.001). The main reasons for antibiotic prophylaxis were preventing complications at the implant site (N = 56; 73.7%) and reducing the early implant failure rate (N = 32; 42.1%). Around one-third of the dentists (34.2%) used antibiotics for their own safety. Conclusions: Croatian dentists may be overprescribing antibiotics during dental implant placement. Clear recommendations concerning antibiotic prophylaxis for dental implant therapy are needed to make well-informed clinical decisions.

The Influence of Osteoporosis and Diabetes on Dental Implant Stability: A Pilot Study

Background and Objectives: Dental implants are a reliable solution for tooth loss; however, systemic conditions like osteoporosis and diabetes, which affect bone quality, healing, and stability, underline the importance of understanding their impact on enhanced outcomes. This study evaluated the comparative effects of osteoporosis and diabetes on dental implant stability over 12 months, utilizing objective implant mobility and stability measures. Materials and Methods: This prospective cohort study involved 50 patients, divided into 21 with type 2 diabetes and 29 with osteoporosis, with implant stability assessed at 6 and 12 months using Osstell ISQ and Periotest M devices and statistical analysis identifying differences between groups and time intervals at a significance level of p < 0.05. Results: At 6 months, the osteoporosis group showed higher initial stability (mean ISQ: 67.04 ± 5.42) compared to the diabetes group (mean ISQ: 62.10 ± 5.46; p = 0.0215)), and by 12 months, both groups showed significant improvements in ISQ scores (osteoporosis: 68.93 ± 4.83; diabetes: 65.79 ± 3.87), with Periotest values indicating more significant reductions in implant mobility, particularly in diabetic patients (osteoporosis: -3.34 ± 1.59; diabetes: -2.81 ± 1.44; p = 0.0001). Conclusions: Osteoporosis and diabetes significantly impact implant stability through distinct osseointegration pathways, emphasizing the need for personalized treatment plans to improve patient outcomes.

Quantitative analysis of basal bone width as an index for immediate implant placement in the aesthetic zone: A retrospective study

PURPOSE

The basal bone of the anterior maxilla plays a crucial role in maintaining primary stability of immediate implants. However, no consensus exists on the relationship between basal bone width and immediate implant success, unlike for basal bone length. This study presents a clinical scheme to predict the primary stability of immediate implants using the basal bone width.

METHODS

Cone-beam computed tomography (CBCT) images were acquired from 1000 patients to determine the quantitative characteristics of the basal bone of the anterior maxilla. Basal bone dimensions, including the length and width along the tooth and bone axes, and immediate implant-related hard tissue indices, were measured on the sagittal sections. Descriptive statistics, frequency, multiple correlation, and canonical correlation analyses were performed.

RESULTS

Basal bone indices were significantly greater in men than in women and exhibited different patterns of change with increasing age. Canonical correlation analyses revealed that the basal bone indices, especially basal bone width, correlated with other immediate implant-related indicators, among which the total width of the basal bone at 2 mm apical to the apex (Apical-2mm) exhibited the greatest contribution. Apical-2mm was positively correlated with the coronal bone dimensions, apical bone dimensions, basal bone length, and angulation.

CONCLUSIONS

The basal bone width of the maxillary anterior tooth may reflect the distribution of other implant-related anatomical indices, which may provide an additional reference for predicting the primary stability of an immediate implant.

Effectiveness of a protocol with antimicrobial photodynamic therapy for treating osteoradionecrosis: a retrospective study

OBJECTIVE

To compare the treatment of osteoradionecrosis (ORN) using a protocol that incorporates antimicrobial photodynamic therapy with a conventional treatment protocol.

METHODOLOGY

This retrospective study analyzed 55 patients diagnosed with ORN at a reference hospital between 2002 and 2021. Patients were treated using two different clinical protocols. Clinical treatment success was defined as the epithelialization of the ORN lesion, along with the absence of pain and local infection.

RESULTS

A total of 53 ORN lesions were included, with a median development time of 30 months. The patient cohort was predominantly male (83.02%), with a median age of 58 years. The main causes of ORN were prosthetic trauma (28.30%) and dental extractions due to infection (32.07%). Good oral hygiene and hygiene of the lesion were identified as protective factors for achieving clinical success, with a significant correlation to lesion epithelialization (p ≤ 0.0001). ORN developed more rapidly in tumors of the oral cavity, with a median time of 8 months, compared to oropharyngeal tumors, which had a median time of 39 months (p = 0.01).

CONCLUSION

The proposed treatment protocol, which includes antimicrobial photodynamic therapy, demonstrated greater effectiveness compared to the conventional protocol, achieving clinical success in 75% of the lesions analyzed in a shorter timeframe (p ≤ 0.0001). Additionally, maintaining proper oral and lesion hygiene is crucial for successful outcomes, and ORN develops more rapidly in patients with oral cavity tumors.

Dental implant and bone augmentation treatment in bone-compromised patients: Oral health-related quality of life outcomes

STATEMENT OF PROBLEM

Patient-reported outcomes represent an additional and often overlooked measure of dental implant and bone augmentation treatment. Few implant studies have evaluated patient-reported outcomes in those with systemic bone compromise.

PURPOSE

The purpose of this cohort study was to assess oral health-related quality of life (OHRQoL) outcomes in postmenopausal women receiving dental implants with normal bone density or mild osteopenia ("healthy" group; all DXA T-scores at femoral neck, total hip, and L1-L4 spine>-2.0) versus moderate osteopenia or osteoporosis ("bone compromised" group; any DXA T-score at femoral neck, total hip, or L1-L4 spine≤-2.0).

MATERIAL AND METHODS

A total of 115 patients were recruited at the University of Connecticut School of Dental Medicine as part of a standard of care, prospective, nonrandomized cohort study. All participants received 1 of 3 bone augmentation procedures with implant placement. At baseline and at various intervals after implant placement, OHRQoL was measured by using the Oral Health Impact Profile-14 (OHIP-14) and surveys of patient expectations and satisfaction. These measures were compared between healthy and bone compromised groups (α=.05).

RESULTS

For all OHRQoL measures across linear mixed effects models, no significant differences were found between bone groups at baseline and at each time point after implant placement (P>.05). Using the minimally important difference (MID) for OHIP-14, no definitive clinical differences were found in patient outcomes between bone groups at all postimplant time points (P>.05). From baseline to 24 months after implant placement, both healthy and bone compromised groups exhibited significant improvements in OHIP-14 and patient expectations scores (P<.05). While no within group differences were found in patient satisfaction scores, the mean satisfaction score remained high over time in both groups.

CONCLUSIONS

Patient-reported outcomes as measured through OHIP-14, patient expectations, and patient satisfaction surveys suggest similar postimplant OHRQoL improvement in healthy and bone compromised individuals. OHRQoL improvements between bone groups were similar both in continuity and in scope, with no evidence of statistically significant score differences between groups at 24 months after implant placement across all measures and with no definitive evidence of clinical differences as measured by OHIP-14 MID comparisons across all timepoints.

Connection between oral health and chronic diseases

Chronic diseases have emerged as a paramount global health burden, accounting for 74% of global mortality and causing substantial economic losses. The oral cavity serves as a critical indicator of overall health and is inextricably linked to chronic disorders. Neglecting oral health can exacerbate localized pathologies and accelerate the progression of chronic conditions, whereas effective management has the potential to reduce their incidence and mortality. Nevertheless, limited resources and lack of awareness often impede timely dental intervention, delaying optimal therapeutic measures. This review provides a comprehensive analysis of the impact of prevalent chronic diseases-such as diabetes mellitus, rheumatoid arthritis, cardiovascular disorders, and chronic respiratory diseases-on oral health, along with an exploration of how changes in oral health affect these chronic conditions through both deterioration and intervention mechanisms. Additionally, novel insights into the underlying pathophysiological mechanisms governing these relationships are presented. By synthesizing these advancements, this review aims to illuminate the complex interrelationship between oral health and chronic diseases while emphasizing the urgent need for greater collaboration between dental practitioners and general healthcare providers to improve overall health outcomes.

Recurrent Pyogenic Granuloma Progressing to Calcifying Fibroblastic Granuloma in an Adolescent Male Athlete: A Case Report

This case report highlights the clinical progression of a recurrent pyogenic granuloma (PG) in a 17-year-old male baseball player who experienced the transition of the lesion into a calcifying fibroblastic granuloma (CFG) extending into the periosteum and underlying bone. Adolescence, a period marked by significant hormonal changes and increased susceptibility to stress due to the demands of being an athlete, combined with a lack of proper oral hygiene, may have played a significant role in the lesion's development, recurrence, and progression to CFG. The initial treatment involved excisional biopsy, followed by more extensive surgical intervention, including excision of the periosteum and bone curettage, to ensure complete removal of the recurrent lesion. The surgical site healed without complications. This case underscores the importance of accurate diagnosis and the need for thorough excision to prevent recurrence. Furthermore, it highlights the significance of maintaining proper oral hygiene and managing risk factors such as stress, which can influence the recurrence and progression of PGs to CFGs.

Prevalence and predictors of bruxism in two university clinic patient populations with dental implants: A cross-sectional analysis

OBJECTIVE

To analyze the prevalence, predictors, and prosthetic complications of bruxing patients with dental implants in two tertiary clinics in Istanbul, Turkey.

METHODS

Patients with at least one dental implant and with a fixed prosthesis were examined for the evidence of probable bruxism. Factors that could be related to bruxism were analyzed in relation to patient-specific variables. Technical and mechanical complications were investigated.

RESULTS

A total of 1688 patients were analyzed. The overall rate of probable bruxism was 19.72%. Besides self-reported bruxism (p < 0.022), antidepressant use (p < 0.002), frequent headaches (p < 0.014), and observation of linea alba (p < 0.028) were the predictors for probable bruxism. Technical and mechanical complications were frequent in the probable bruxers (p < 0.05).

CONCLUSION

Overall prevalence of bruxism was 19.72%, and bruxism was associated with general and gender-specific predictors.

Factors influencing success rate of ceramic veneers on endodontically treated anterior teeth: A systematic review

STATEMENT OF PROBLEM

More conservative restorative approaches have been advocated for nonvital anterior teeth as an alternative to complete coverage crowns to maximize the preservation of tooth structure. Systematic reviews that investigated factors influencing the success rate of porcelain veneers on endodontically treated anterior teeth are lacking.

PURPOSE

The purpose of this systematic review was to investigate factors influencing the success rate of porcelain veneers on endodontically treated anterior teeth.

MATERIAL AND METHODS

Searches were performed across Medline/PubMed, Google Scholar, Scopus, and Web of Science electronic databases. In addition, articles were hand searched from references of systematic reviews concerning porcelain veneers and endodontically treated teeth.

RESULTS

After screening and applying the eligibility, inclusion, and exclusion criteria, 7 articles met the inclusion criteria. Factors that could positively influence the success rate of endodontically treated anterior veneered teeth were immediate dentin sealing, labially positioning of the endodontic access cavity, and incorporating fiber posts.

CONCLUSIONS

The use of fiber posts and labial positioning of the endodontic access cavity could positively influence the success rate of porcelain veneers on endodontically treated teeth. The effect of immediate dentin sealing on the survival rate of endodontically treated veneered teeth is still unclear and further research is needed.

The Immune System, An Arrow into the Heart. Principles of Cardioimmunology, An Emerging Branch in Medicine

Cardioimmunology is an emerging branch of medicine whose development has been facilitated by more sophisticated diagnostic procedures. Recent studies have mainly focused on the immune response during myocardial infarction (MI), and there is evidence that both resident and external immune cells participate in acute inflammatory disease, as well as tissue remodeling. Following MI, macrophages, dendritic cells (DCs) and mast cells (MCs) are the main players in the heart. Under steady-state conditions, cardiac resident macrophages (CRMs) protect the heart against stress and infectious events, being involved in cell and matrix turnover, as well as phagocytosis of apoptotic cells. Moreover, CRMs contribute to the resolution of inflammation via release of interleukin (IL)-10, and efferocytosis of dying cells. Conversely, CCR2+ monocytederived macrophages promote inflammation in the acute phase of myocardial damage, with the release of pro-inflammatory cytokines. Conventional (c) DCs possess enhanced capacity to present antigens to T lymphocytes. In MI patient autopsies, massive infiltration of T helper (Th) cells and CDs has been detected in the myocardium. Cardiac MCs play a dual role during MI, with the production of cytokines for early inflammatory response, and the release of anti-inflammatory cytokines, IL10 and IL-13 during the resolution phase. In experimental coronary artery ligation, the myocardium is infiltrated with Th1, Th2, Th17, and T regulatory (TREG) cells, which participate in the acute inflammation. In cardiac repair, T cell reparative response is mediated by TREG cells, with improved ventricular remodeling and function post-ischemia. In this review, emphasis will be placed on the innate and adaptive immune response during and post-MI. At the same time, immunotherapy- based cardiac failure following chimeric antigen receptor T-cell and immune checkpoint inhibitory therapy will be pointed out.

Unilateral Surgical Treatment of Severe Deviated Condylar Base Fracture in Pediatric Bilateral Condylar Fracture: 12-Year Follow-Up

Pediatric condylar fractures are commonly managed conservatively, as the condyle typically exhibits spontaneous remodeling. However, should conservative treatment be administered for severe deviated condylar processes? In a case involving a 7-year-5-month-old girl who fell from a height of 3 m, she sustained a mandibular parasymphysis fracture and bilateral condylar fractures, including a condylar base fracture with 60-degree medial deviation on the right side and a condylar head fracture, Neff type A, on the left side. To address the fractures, internal fixation was performed on the right condyle via a classical retromandibular approach, and a mini-plate was removed four months postsurgery. At a follow-up 12 years and 7 months later, the patient showed normal occlusion, TMJ function, and no visible scars. In addition, there was no facial deviation, although the surgical site condyle was larger than the nonsurgical site, suggesting that the surgical site facilitated normal growth while the nonsurgical site impeded it.

Malformations vs. Neoplasia in the Oral Cavity: Special Emphasis on Mixed Odontogenic Tumors

BACKGROUND

The terminology surrounding developmental lesions in the oral cavity is widely applied, often leading to confusion in differentiating between developmental malformations and neoplasia. Odontogenic tumor classification includes both true neoplasms and malformations which make it very complex and dynamic.

METHOD AND CONCLUSION

In this brief report, we will first discuss the concepts of malformations and neoplasia and then focusing on their relevance to odontogenic tumors, which impacts their classification and treatment, particularly mixed odontogenic lesions.

Cluster behavior in dental implant failure - A scoping review

PURPOSE

To provide an overview of cluster behavior in dental implant failure including the reported prevalence in modern roughened surface implants as well as the risk factors associated with cluster failures.

MATERIAL AND METHODS

An electronic search for articles in the English language literature published from January 1, 2000, to March 8, 2023, was performed using PubMed, Embase, Dentistry and Oral Sciences, ProQuest, and Central search engines. Using a standardized systematic search process and predetermined inclusion and exclusion criteria in three stages, the final list of selected articles reporting on cluster behavior in dental implant failure was obtained. Cluster behavior was defined as the failure of two or more implants in the same patient within a 2-year period irrespective of the site. Data from the selected articles were reviewed, critically analyzed, interpreted, and reported.

RESULTS

The initial electronic search resulted in 948 titles. After applying inclusion and exclusion criteria, the systematic search process resulted in five clinical studies reporting data on cluster behavior of dental implant failure with modern roughened surfaces. These five studies reported on a total of 9986 implants with 858 reported failures (early and late) over varying periods. Out of the 858 implant failures, 217 implants (25.2%) exhibited cluster behavior. The overall prevalence of cluster behavior of modern roughened surface implant failure was 2.1%.  The most common location risk factors reported were posterior maxilla, history of previous implant failures, poor bone quality, and occlusal overload.

CONCLUSIONS

Cluster behavior occurs in 25% of modern roughened surface implant failures which is significantly less than machined surface cluster implant failures. Nevertheless, the overall prevalence of cluster pattern of implant failure of modern roughened surface implants is reasonably low at 2%.

Analysis of Germline and Somatic Mutation in Patients With Developmental Odontogenic Cysts Using Targeted Gene Panel

BACKGROUND

Odontogenic keratocyst (OKC) is a partial manifestation of Gorlin syndrome (GS), resulting from the abnormal activation of the hedgehog signaling pathway. OKC predominantly occurs in young adults and is mostly asymptomatic at the time of initial diagnosis. As OKC is asymptomatic, GS can be challenging to diagnose in certain instances. In this study, we attempted to identify asymptomatic GS from sporadic OKC cases using a previously developed gene panel for GS.

METHODS

Genomic DNA was extracted from patient samples. These DNA samples were analyzed using the AmpliSeq Custom DNA Panel (Illumina), which was specifically designed to target four previously established genes (PTCH1, PTCH2, SMO, and SUFU). Mutations from patients were predicted using tools, such as MutationTaster, CADD, and Polyphen-2.

RESULTS

Thirty-one patients with OKC were included: 22 sporadic, 9 syndromic, 14 cases with dentigerous cysts, and 3 patients with orthokeratinized odontogenic cysts. One patient with sporadic OKC carried 50% genetic mutation in the cyst and blood, indicative of GS. PTCH1 mutations were found in one of the 14 patients with dentigerous cysts, 3 of the 17 first-time sporadic cases, and all four recurrent cases. Resected OKC tissues revealed a PTCH1 mutation.

CONCLUSIONS

We found one patient with GS from those diagnosed with sporadic OKC. Our findings suggest that PTCH1 mutations are associated with postoperative recurrence of OKC, implying that hedgehog-related gene variations may contribute to jaw cyst development and improve the prognosis of OKC.

Combined static and dynamic computer-guided surgery for prosthetically driven zygomatic implant placement

OBJECTIVES

To propose and validate a minimally invasive combined static and dynamic computer assisted implant surgery (CAIS) workflow for zygomatic implant (ZI) placement.

METHODS

A combined approach leveraging static CAIS for initial positioning, complemented by dynamic CAIS for real-time control of the angle, depth and width was proposed. Fourteen consecutive patients (age: 60.3±9.8 years; 8 females) seeking ZI-supported restoration were enrolled. A single anatomically and prosthetically driven ZI on either the unilateral zygoma or bilateral zygomata was planned and placed using the proposed approach. The zygomatic anatomy-guided approach (ZAGA) type and the ZI length were recorded. The angular, coronal global, and apical global deviation between the planned and placed positions were measured by overlapping post- and pre-operative cone beam computer tomography. Comparisons were made between the left and right sides across the ZAGA type and ZI length. Statistical significance was set at P<0.05.

RESULTS

22 ZIs were placed using the combined approach and 13 immediate loading prostheses were delivered, with one patient restored 6 months after surgery. The angular deviations and coronal global deviations were 1.99±0.17° and 1.21±0.45 mm, respectively. The median apical global deviation was 1.67 mm (interquartile range [IQR]: 1.11-1.93 mm). No significant differences were found between the left and right sides across the ZAGA type or ZI length. All ZIs remained stable over a median follow-up of 14.5 months (IQR: 7-20 months).

CONCLUSIONS

The proposed combination of static and dynamic CAIS is safe, reliable, accurate, and robust for ZI placement.

CLINICAL SIGNIFICANCE

This pilot study proposed a minimally invasive ZI placement method that combined static and dynamic computer-guided surgery. The implant positioning accuracy achieved using this approach validated its safety, reliability, accuracy, and robustness. The combined approach may reduce the technique sensitivity of ZI placement, facilitating future rehabilitation of severely atrophic or defective maxillae.

Modified Conservative Technique of Odontogenic Keratocyst Treatment With Long-Term Follow-Up: A Case Report

An odontogenic keratocyst is a benign developmental cyst that affects the jawbone and has aggressive characteristics. Compared to other odontogenic cysts, it has a high recurrence rate. Standardized treatment protocols for this cyst remain a topic of debate. This case report describes a 42-year-old Saudi male patient with a recurrent odontogenic keratocyst involving a mandibular right angle. The patient underwent conservative treatment involving a modified technique utilizing a specially designed, custom-made soft tray to keep the surgical site open for potential re-curettage, aimed at reducing the chances of recurrence. The cystic lesion was effectively and successfully treated with no recurrence observed throughout the six-year follow-up period, emphasizing the importance of close monitoring and follow-up in managing odontogenic keratocysts.

Molecular Mechanisms Underlying the Therapeutic Potential of Plant-Based α-Amylase Inhibitors for Hyperglycemic Control in Diabetes

BACKGROUND

Diabetes mellitus (DM), arising from pancreatic β-cell dysfunction and disrupted alpha-amylase secretion, manifests as hyperglycemia. Synthetic inhibitors of alphaamylase like acarbose manage glucose but pose adverse effects, prompting interest in plantderived alternatives rich in antioxidants and anti-inflammatory properties.

OBJECTIVE

The current review investigates plant-based alpha-amylase inhibitors, exploring their potential therapeutic roles in managing DM. Focusing on their ability to modulate postprandial hyperglycemia by regulating alpha-amylase secretion, it assesses their efficacy, health benefits, and implications for diabetes treatment.

METHODS

This review examines plant-derived alpha-amylase inhibitors as prospective diabetic mellitus treatments using PubMed, Google Scholar, and Scopus data.

RESULTS

Plant-derived inhibitors, including A. deliciosa, B. egyptiaca, and N. nucifera, exhibit anti-inflammatory and antioxidant properties, effectively reducing alpha-amylase levels in diabetic conditions. Such alpha-amylase inhibitors showed promising alternative treatment in managing diabetes with reduced adverse effects.

CONCLUSION

The current literature concludes that plant-derived alpha-amylase inhibitors present viable therapeutic avenues for diabetes management by modulating alpha-amylase secretion by regulating inflammatory, oxidative stress, and apoptotic mechanisms involved in the pathogenesis of diabetes. Further investigation into their formulations and clinical efficacy may reveal their more comprehensive diabetes therapeutic significance, emphasizing their potential impact on glucose regulation and overall health.

Giant odontoma: A systematic scoping review and case report

INTRODUCTION AND IMPORTANCE

The most common type of odontogenic tumor is odontoma. Cases with at least one dimension (sagittal, axial, or coronal) ≥30 mm were categorized as giant odontomas. This study aimed to provide a scoping review of giant odontoma and present a case report.

CASE PRESENTATION

A 6 years-old boy attended for a routine dental examination without any symptoms. A slight swelling of the right buccal cortex of the posterior maxilla was detected. Radiography views revealed a mixed radiolucent-radiopaque lesion with multiple tooth-like structures. The lesion caused displacement teeth and elevated the floor of the maxillary sinus. The tumor was thoroughly enucleated and the dimensions of the tumor were measured as 32.4 mm × 22.2 mm × 15.3 mm. The specimen was histopathologically examined and was diagnosed as a giant compound odontoma.

CLINICAL DISCUSSION

This scoping review indicated that the mean age of patients diagnosed with giant odontomas was 18.73 years, with no difference between the sexes. The posterior jaws were the most prevalent regions of incidence. The most common clinical manifestations are swelling, pain, and a sensation of hardness on palpation. Giant odontomas are usually diagnosed with panoramic radiography, cone-beam computed tomography, and histopathological examinations. Surgical enucleation is the treatment approach for this tumor.

CONCLUSION

The distinction between giant odontoma and non-giant odontoma is solely based on tumor size. Although giant odontomas are benign, their large size necessitates specific precautions for diagnosis and management. Proper treatment involves critical decisions concerning surgical settings, bone grafting techniques, and jaw stabilization methods.

Patient-Reported Outcomes of Dental Implants in Type 2 Diabetes: A Cross-Sectional Study on Quality of Life and Satisfaction

INTRODUCTION

Dental implants provide a durable solution for missing teeth and improve mastication, speech, and quality of life (QoL). However, systemic conditions, such as type 2 diabetes mellitus (T2DM), may affect implant success. This study evaluated patient satisfaction (PS) and QoL as patient-reported outcome measures (PROMs) following dental implant therapy in T2DM patients.

MATERIALS AND METHODS

A cross-sectional study was conducted in the Department of Prosthodontics on 90 T2DM patients who had undergone single-unit dental implant therapy at least one year prior to the study. Data were collected using validated PROMs tools, including the Oral Health Impact Profile-14 (OHIP-14) questionnaire for QoL and a nine-item PS questionnaire. Statistical analyses, including regression and mediation, were performed to identify predictors and relationships among the variables.

RESULTS

The study reported moderate QoL scores (mean: 2.71 ± 0.61) and high PS scores (mean: 2.96 ± 0.44). Significant predictors of QoL included sex, implant duration, and implant survival, with successful implants showing a substantial positive association. Implant survival had the strongest direct impact on satisfaction, with ceramic crowns and anterior tooth positions being associated with higher scores. Mediation analysis revealed that factors such as crown type, duration of diabetes, and tooth loss period indirectly influenced outcomes. Implant survival remains the key determinant of both QoL and PS.

CONCLUSION

T2DM patients undergoing dental implant therapy exhibit moderate QoL and high PS, with implant survival being the most critical predictor of outcomes. Additional factors such as prosthetic choice, tooth position, and systemic health also play significant roles. These findings underscore the importance of glycemic control, individualized care, and robust implant planning to optimize outcomes in T2DM patients.

Cardiovascular Considerations After Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations

Cancer survivors, particularly those treated with anthracyclines and chest radiation, face an elevated risk of cancer therapy-related cardiovascular toxicity. These complications affect not only physical health, but also life expectancy. Risk factors for cancer therapy-related cardiovascular toxicity include age at which cancer treatment was received, the use of (potentially) cardiotoxic cancer therapies, and the presence of concomitant cardiovascular risk factors. Current guidelines provide recommendations for cardiovascular surveillance after cancer therapy, including type and frequency. All cancer survivors are advised to undergo annual clinical screenings and optimization of cardiovascular risk factors. Those at higher risk should undergo additional cardiovascular testing. This document aims to summarize the available evidence, present practical recommendations, and outline existent gaps in the current literature regarding cardiovascular care after cancer therapies.

Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren's Syndrome: A Five-Year Prospective Clinical Study

BACKGROUND

Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren's syndrome.

AIM/HYPOTHESIS

We hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration.

MATERIAL AND METHODS

Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020. The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment.

RESULTS

We included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group. All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026).

CONCLUSION

Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.

Risk Factors for Postoperative Complications Following Mandibular Fracture Repair

Complications following mandibular fracture repair (MFR) may carry significant morbidity to patients. The purpose of our study is to determine the risk factors for postoperative complications following MFR. The authors conducted a retrospective cohort study of trauma patients who underwent MFR in 2018 and 2019. Excluded were patients below 18 years old and those with postoperative follow-up <2 weeks. The primary outcome was the incidence of major and minor postoperative complications following MFR. Of n=275 patients included, mean (SD) age was 35 (14) years and median (IQR) follow up was 49 (26-117) days. Most patients [n=208 (76%)] underwent both maxillomandibular/intermaxillary fixation (MMF/IMF) and open reduction and internal fixation (ORIF). The incidence of major postoperative complications was 19% (n=51) including malunion [n=8 (2.9%)], malocclusion [n=21 (7.6%)], and unplanned reoperation [n=26 (9.5%)]. The incidence of minor postoperative complications was 61% (n=167). Alcohol use at the time of surgery and greater MISS score were associated with greater odds of major complications [adjusted odds ratio (aOR) 95% CI: 3.4 (1.2-9.0), 1.09 (1.02-1.160), respectively]. Smoking at the time of surgery and moderately (>2 mm) and severely displaced fractures (>4 mm) were associated with greater odds of minor complications [aOR (95% CI): 2.1 (1.04-4.2), 2.7 (1.2-6.4), 2.7 (1.1-6.6), respectively]. Alcohol use, smoking, greater MISS score, and displaced fractures >2 mm were significant risk factors for postoperative complications following MFR. Our findings can help guide informed decision making and surgical planning in patients with mandibular fractures.

Impact of smoking on dental implant: A review

Dental implants are the most innovative strategy for substituting a missing tooth. Smoking has been identified as a significant risk factor impacting the success rates of dental implants. This study explores the correlation between tobacco use and implant failure focusing on the physiological mechanisms involved. Smoking impairs osseointegration, the critical process where the implant integrates with the alveolar bone due to reduced blood flow oxygenation and angiogenesis caused by nicotine and carbon monoxide. Smokers exhibit higher rates of implant failure compared to non-smokers with compromised bone quality and delayed wound healing as contributing factors. Studies suggest that smoking adversely affects implant stability, particularly during the critical early healing phase. This review highlights the biological mechanisms and clinical implications of smoking on dental implant outcomes.