Implant surface modifications and their impact on osseointegration and peri-implant diseases through epigenetic changes: A scoping review

Dental implant surfaces and their unique properties can interact with the surrounding oral tissues through epigenetic cues. The present scoping review provides current perspectives on surface modifications of dental implants, their impact on the osseointegration process, and the interaction between implant surface properties and epigenetics, also in peri-implant diseases. Findings of this review demonstrate the impact of innovative surface treatments on the epigenetic mechanisms of cells, showing promising results in the early stages of osseointegration. Dental implant surfaces with properties of hydrophilicity, nanotexturization, multifunctional coatings, and incorporated drug-release systems have demonstrated favorable outcomes for early bone adhesion, increased antibacterial features, and improved osseointegration. The interaction between modified surface morphologies, different chemical surface energies, and/or release of molecules within the oral tissues has been shown to influence epigenetic mechanisms of the surrounding tissues caused by a physical-chemical interaction. Epigenetic changes around dental implants in the state of health and disease are different. In conclusion, emerging approaches in surface modifications for dental implants functionalized with epigenetics have great potential with a significant impact on modulating bone healing during osseointegration.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives.

Condyle head fracture management: A systematic review of outcomes

The management of Condylar Head fractures (CHFs) has historically been with closed treatments(CTR); however, contemporary studies suggest that Open Reduction and Internal Fixation(ORIF) may produce better clinical and radiographic results. Our primary aim was to review the literature on the clinical and radiological outcomes of open and closed management of CHFs. A systematic literature search was undertaken using EMBASE, MEDLINE and PubMed, using PRISMA guidelines, for all studies relating to outcomes following CHF. The inclusion criteria include 1) studies focused on CHF in adult patients that included at least 20 cases 2) published in English language. ROBINS-1 tool was used for risk assessment. Data extracted was analysed and compared using the relative risks. A total of 29 studies reporting on 1550 ORIF and 798 CTR were included. ORIF resulted in significantly less trismus (RR 9.5), chin deviation (RR 7.3), malocclusion (RR 6.5), TMJ clicking (RR 4.3) and pain(RR 12.6) than CTR. Due to the substantial heterogeneity of studies, firm conclusions are difficult but there does appear to be objective benefits in outcomes following ORIF than CTR. Satisfactory results may however be achieved with CTR. Further large studies using standardised outcome measurements will be required to help elucidate exactly which CHF are best served by ORIF.

Comparative Study of Implant Placement Techniques and Their Effect on Long-Term Success of Implant-Supported Restorations

Background

The long-term success of implant-supported restorations is influenced by various implant placement techniques.

Materials and Methods

This randomized controlled trial involved 120 patients requiring dental implants, divided into three equal groups based on the implant placement technique: Group A (conventional submerged), Group B (one-stage non-submerged), and Group C (guided surgery). All participants were followed for three years. The primary outcomes measured were implant stability (using implant stability quotient (ISQ) values) and marginal bone loss (using radiographic analysis). Secondary outcomes included patient satisfaction and prosthetic complications.

Results

The study results demonstrated significant differences among the implant placement techniques. Group C (guided surgery) exhibited the highest mean implant stability, with an ISQ value of 75.4, outperforming Group B (one-stage non-submerged) at 73.2 and Group A (conventional submerged) at 71.5. In terms of marginal bone loss, Group A demonstrated the greatest loss at 1.5 mm, whereas Group B and Group C experienced less bone loss, measuring 1.1 mm and 0.9 mm, respectively. Patient satisfaction scores were highest in Group C, with an average of 9.2 out of 10, followed by Group B at 8.7 and Group A at 8.3. Additionally, Group A recorded the highest incidence of prosthetic complications at 15%, compared to 10% in Group B and 5% in Group C, highlighting the superior performance of guided surgery in minimizing complications and enhancing overall outcomes.

Conclusion

Guided implant surgery demonstrated superior outcomes in terms of implant stability, reduced marginal bone loss, and higher patient satisfaction compared to conventional submerged and one-stage techniques.

Success Rates of Dental Implants in Patients With Diabetes: A Systematic Review

This systematic review evaluates the success rates of dental implants in patients with type 2 diabetes mellitus, focusing on outcomes such as implant survival, marginal bone loss, and peri-implant biomarkers. A comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane, Embase, Scopus, and Web of Science, to identify relevant systematic reviews and meta-analyses. Four studies were included, encompassing diverse populations and interventions. Findings indicate that diabetes, when well-managed (HbA1c < 8%), does not significantly compromise implant survival rates, with survival percentages ranging from 96.1% to 97.3% at one year and 87.3% to 96.1% at five years, comparable to non-diabetic populations. However, peri-implant health metrics, such as marginal bone loss (mean difference: -0.08 mm; 95% CI: -0.25 to 0.08) and probing depth, were adversely affected in poorly controlled diabetes (HbA1c > 8%), highlighting the critical role of glycemic control. Advanced statistical approaches, including dose-response relationships, revealed a progressive worsening of peri-implant outcomes as HbA1c levels increased. The review underscores the importance of interdisciplinary care and strict adherence to clinical protocols to optimize outcomes for diabetic patients receiving dental implants. Despite robust findings, limitations include heterogeneity among included studies and the need for long-term data to validate the observed trends. Future research should focus on standardized reporting and exploring the impact of advanced glycemic thresholds on implant success.

Antibiotic prophylaxis may effectively reduce early failures after beginner-conducted dental implant surgery

STUDY DESIGN

A randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE

To assess the impact of antibiotic prophylaxis on postoperative recovery and implant short-term survival in clinically healthy patients who underwent placement of 2-4 dental implants by inexperienced operators.

METHODS

The study adhered to the ethical guidelines of the Helsinki declaration, and followed the CONSORT protocol for randomized controlled trials (RCTs). Signed consent forms were provided by all patients. Included were healthy individuals aged over 18 years, with sufficient and fully healed alveolar ridge (undergone extraction at least 3 months prior), requiring placement of 2-4 dental implants, and were classified as ASA I or II. Exclusion criteria were: systemic diseases, hypersensitivity to penicillin, pregnancy or lactation, smoking, recent antibiotic usage, and history of periodontitis. Patients were randomly allocated into 2 groups: the antibiotic group received 1 g of amoxicillin one hour before surgery, while the placebo group was given starch-filled capsules that looked identical to the antibiotic. All implants were installed through 2-stage procedures by students of a specialization course in implant surgery, employing a standardized procedure and armamentarium. Each patient was evaluated preoperatively, and at 2 days and 7 days postoperatively, for the following parameters: mouth opening, experienced pain (using a visual analog scale), and signs of infection (fistula, wound ulceration, tissue necrosis, flap dehiscence, and purulent exudates). Implant survival was monitored for up to 90 days after implant surgery.

RESULTS

A total of 90 patients (224 implants) were included: 43 patients (108 implants) in the antibiotic group, and 47 patients (116 implants) in the placebo group. Overall, there were 58 women and 32 men, aged from 23 to 70 years old. In terms of mouth opening, pain, and infection parameters, no statistically significant differences were observed between the groups at any of the time points evaluated. Similarly, there was no statistically significant difference regarding antibiotic usage and implant loss at the patient level (p = 0.06). However, at the implant level, significantly higher implant loss rate was noted in the placebo group (14.9%) compared to the antibiotic group (2.3%) [p < 0.05].

CONCLUSION

Prophylactic antibiotic administration effectively reduced the occurrence of implant loss after implant surgery performed by inexperienced practitioners.

The Role of Occlusal Appliances in Reducing Masseter Electromyographic Activity in Bruxism

Background/Objectives: Bruxism is a masticatory muscle activity, phasic or tonic, with/without teeth contact, that appears in sleep or an awake state. An instrumental technique used to measure the surface electromyographic (sEMG) activity of the masseter muscle is used to diagnose bruxism activity during sleep and while awake. The objective of this study was to compare the variation in bruxism (sleep and awake) indices and masseter activity indices in low sleep bruxism and moderate sleep bruxism before and after wearing an occlusal appliance (OA) for 3 months each night. Methods: A clinical interventional study was designed in which subjects diagnosed with sleep bruxism were randomly selected to be included in the study. After the first sEMG recording, two groups were formed: a low sleep-bruxism group (number of sleep-bruxism events/h between 2 and 4) and a moderate sleep-bruxism group (number of sleep-bruxism events/h equal or higher than 4). All subjects received treatment with a 3D-printed occlusal appliance and wore it each night for 3 months, at which point the second sEMG recording was performed. For each participant of this study, a chart was created that included anamnestic data, clinical data, and sEMG data. The data were statistically analyzed with SPSS, using the Mann-Whitney U and Wilcoxon signed-rank tests. Results: A total of 21 participants were included in the final analysis, 18 women and 3 men, with a mean age of 24.5 ± 2.7 years. The OA lowered all bruxism indices in the whole group, but clusters analysis showed a significant reduction in sleep-bruxism indices in the moderate sleep-bruxism group, while in the low-bruxism group, the sleep and awake indices varied insignificantly, and the number of sleep-bruxism events/h remained constant. Conclusions: The 3D-printed occlusal appliances significantly lowered the sleep-bruxism indices and sleep masseter activity indices recorded with a portable sEMG device in the moderate sleep-bruxism group. The OA lowered the awake-bruxism indices and awake masseter activity indices in the moderate sleep-bruxism group.

A Comparative Analysis of Surgical and Conservative Management in Intra-Articular Condylar Fractures: A Retrospective Study

Background: Mandibular condylar fractures are among the most common fractures of the facial skeleton, and their surgical management remains a topic of considerable debate in maxillofacial trauma surgery. Numerous studies in the literature internationally have explored optimal treatment approaches, with a growing preference for open reduction and internal fixation (ORIF). While conservative treatment has traditionally been the standard for intra-articular fractures, recent research suggests that ORIF may also be appropriate for selected cases of these fractures. Methods: This study presents a 14-year review (2009–2023) of the authors’ experience in the surgical management of intra-articular condylar fractures. Data were collected on surgical techniques, early and late complications, clinical and radiological outcomes, and comparisons with conservative treatment. Results: The analysis included evaluations of both short-term and long-term outcomes following ORIF, identifying specific scenarios where ORIF demonstrated advantages over conservative management. Clinical and radiographic assessments provided valuable insights into patient recovery and functional outcomes, while complication rates were documented for both treatment methods. Conclusions: Findings indicate that ORIF can be a beneficial treatment option for intra-articular condylar fractures in select patient groups, offering improved outcomes in cases where conservative treatment may be insufficient. However, conservative management remains a valid approach when surgical risks exceed potential benefits. This study adds to the ongoing discussion, supporting a tailored approach that considers individual patient factors when choosing between ORIF and conservative treatment.

Interdisciplinary approach to prosthetic rehabilitation of a bilateral maxillectomy with a free fibula flap and zygomatic implants in a childhood cancer survivor: A clinical report

Rehabilitation of a bilateral maxillectomy defect is highly challenging. Reconstruction with a free-fibula flap provides optimal coverage and allows prosthetic rehabilitation with dental implant-retained prostheses. Deficient height of the fibula bone, especially in the pediatric population or in young adults, may complicate the rehabilitation process. This report describes an interdisciplinary approach to the rehabilitation of a bilateral maxillectomy defect in a childhood cancer survivor using an innovative modification of an existing protocol. Patient acceptance and the quality-of-life outcome were high after secondary placement of bilateral zygomatic and conventional implants in the fibula flap, providing excellent anchorage for a bar-LOCATOR overdenture prosthesis.

Reliability of the digital functionally generated path technique for assessing occlusal interferences and adjusting CAD-CAM zirconia crowns: an in vivo study

BACKGROUND

Designing the occlusal surface of a prosthesis to ensure optimal eccentric occlusion is challenging without precisely replicating the patient's mandibular movements. During the CAD-CAM prosthesis delivery process, clinicians often need to make adjustments to the prosthesis to avoid occlusal interferences that may occur during lateral excursions. Recently, there have been developments in the field of mandibular motion tracking using optical devices. These approaches seek to incorporate an individual's functional movement into the research field of occlusal morphology.

AIM

This study aimed to assess the accuracy of digitally replicating mandibular movements to identify and correct occlusal interferences in monolithic CAD-CAM zirconia crowns.

METHODS

An intraoral scanner (IOS) was used to capture complete arch maxillary and mandibular teeth and record buccal and lateral interocclusal records of maxillary first premolar abutment teeth of thirteen participants. For each patient, two monolithic zirconia crowns were fabricated following the standard digital workflow. The crowns were categorized based on the virtual method used for adjusting occlusal interferences into two groups: Group I, where occlusal interferences in CAD-CAM zirconia crowns were adjusted using buccal interocclusal records, and Group II, where adjustments were made using both buccal and lateral interocclusal records. After crown fabrication following the manufacturer's instructions, occlusion was analyzed using an electronic pressure analyzer. The mean, standard deviation and median values of the recorded data were measured. Paired t test and Wilcoxon Sign Rank test were executed for analyzing differences between groups (p value ≤ 0.05).

RESULTS

Group I recorded higher maximum pressure at lateral mandibular movement with mean ± standard deviation value of 26.00 ± 4.95% than Group II with 20.62 ± 3.38%. Regarding pressure recorded at maximum intercuspation (MI) Group I showed higher results; 8.08 ± 1.50% compared to Group II with 7.23 ± 1.59% mean ± standard deviation value. The average value of crown volume for Group I was (160.36 ± 15.94) mm3, while for Group II was (157.63 ± 14.45) mm3.

CONCLUSIONS

The digital functionally generated path technique allows for identifying occlusal interferences and modifying CAD-CAM zirconia crown designs.

Implant-supported fixed prostheses with cantilever: a systematic review and meta-analysis

PURPOSE

This systematic review (SR) aimed to investigate whether the presence of a cantilever affects the results of implant treatment for partial edentulism, including an analysis of the anterior and posterior regions of the dental arches.

METHODS

An electronic search was performed, and original articles published between 1995 and November 2023 were included. The outcomes were the implant survival rate, patient satisfaction, occurrence of mechanical complications, and marginal bone loss around the implants. Two SR members independently examined the validity of the studies, extracted evidence from the included studies, and performed risk of bias assessment, comprehensive evidence evaluation, and meta-analysis.

RESULTS

Nine studies met our inclusion criteria. Implant survival rate tended to be lower in the cantilever group, and marginal bone loss tended to be higher in the cantilever group; however, there was no significant difference. There was no significant difference in patient satisfaction based on the presence or absence of a cantilever. Moreover, the incidence of mechanical complications was significantly higher in the cantilever group. According to the analysis of anterior and posterior regions, implant survival rate tended to be lower in the cantilever group of the posterior region, and marginal bone loss around the implants tended to be higher in the cantilever group of the anterior region.

CONCLUSION

Implant-supported fixed prostheses with cantilevers did not negatively affect implant survival rate, marginal bone loss, or patient satisfaction. However, the incidence of mechanical complications significantly increased in the cantilever group.

Tapered Submerged Implants in an Augmented Posterior Maxilla After Oroantral Fistula Closure

Dental implantation in the posterior maxilla is challenging due to anatomic proximity to the sinuses, relative bone quality, and pre-existing sinus diseases. An oroantral fistula (OAF) acts as a pathologic pathway of bacteria and can cause sinus infections and complicate dental implant management. Bony augmentation between the sinus floor mucosa and the oral mucosa at the OAF closure site is another critical consideration. The purpose of this study was to elucidate the sequential patient management protocol from surgical closure of OAF and bone grafting to implant installation. The authors also aimed to evaluate the clinical effectiveness of dental implants in the augmented posterior maxilla. A retrospective study was designed for patients receiving the tapered bone-level dental implants in the posterior maxilla after OAF closure performed by a single surgeon at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, by applying specific inclusion criteria. Implant survival was determined by the presence of a functioning implant in the oral cavity at the time of assessment. In total, 13 implants were installed in 4 OAF patients with different etiologies. The method of OAF closure differed according to OAF cause and size. Three patients underwent concomitant modified endoscopic sinus surgery. Two patients underwent autogenous bone grafting from the ramus and symphysis, and 2 patients received sequential allogeneic onlay bone grafting. Implant survival was not affected by the type of graft material. The implant survival rate was 100%. An implant diameter of 4 mm (92.3%) and an implant length of 7 mm (69.23%) were most common. Careful separate sinus membrane and oral mucosa closure with sequential bone grafting between ensures stable and predictable outcomes for subsequent implantations. The tapered submerged implants, particularly the 7-mm length, can be reliably installed in the augmented posterior maxilla after OAF closure.

Internally Submerged, Tapered, Bone-level Dental Implants in the Anterior Esthetic Region

BACKGROUND

Aesthetics is a crucial consideration in the anterior region, alongside dental implant survival and marginal bone loss (MBL). Bone-level implants are advantageous in the esthetic zone as they create a natural emergence profile with the use of customized abutments. This study aimed to assess the esthetic outcomes of internally submerged, tapered, bone-level dental implants and to evaluate associated alveolar bone changes.

METHODS

Patients received Luna implants (Shinhung, Seoul, Korea) from 2012 to 2020. MBL was measured immediately after surgery and at 3-month, 6-month, and 1-year follow-ups. Pink and White Esthetic Scores (PES/WES) were evaluated after final restoration and at 6-month and 12-month follow-ups using standardized photographs.

RESULTS

Seventy-eight patients (37 males, 41 females) with a mean age of 73.42 years met the study's inclusion criteria. At the 1-year follow-up, the mean MBL was 0.39 ± 0.74 mm on the mesial aspect and -0.09 ± 0.97 mm on the distal aspect. A statistically significant difference in MBL on the mesial aspect was observed between immediate functional loading and the 12-month follow-up (P = 0.029). All implants achieved PES/WES scores of 6 or higher, meeting the threshold for clinical acceptance.

CONCLUSIONS

Within the study's limitations, Luna implants demonstrated satisfactory esthetic outcomes and stable bone levels. The results support their use as a viable option for implant placement in the anterior esthetic zone, ensuring both aesthetic and functional success.

An Umbrella Review of the Association Between Periodontal Disease and Diabetes Mellitus

AIM

To determine the clinical association between periodontal disease and diabetes mellitus through an umbrella review.

MATERIALS AND METHODS

A search for publications up to August 2023 was conducted using the following electronic databases: PubMed, Cochrane Database, Scopus, SciELO, Google Scholar, and OpenGrey. We included systematic reviews (SRs) with or without meta-analysis evaluating primary studies that investigated the association between periodontal disease and diabetes mellitus, and there were no time or language restrictions. Literature or narrative reviews, rapid reviews, intervention studies, observational studies, preclinical and basic research, abstracts, comments, case reports, protocols, personal opinions, letters, and posters were excluded. The AMSTAR-2 tool was used to determine the methodological quality of the included studies.

RESULTS

The preliminary search yielded a total of 577 articles, of which only 17 remained after discarding those that did not meet the selection criteria. Following their analysis, an association between periodontal disease and diabetes mellitus (type 1 and type 2 diabetes mellitus and gestational diabetes mellitus) was found.

CONCLUSIONS

The findings and conclusions of this umbrella review indicate with high confidence that periodontal disease is associated with the onset of type 1 and type 2 diabetes mellitus and gestational diabetes.

Ti6Al4V Implants with Dense-Trabecular Bilayer Morphology for Bone Ingrowth: Synergy of Green Net Shaping and Sacrificial Templating

Stress shielding in dental and orthopedic implants is a long-standing hurdle, and trabecular porous architecture to improve bone ingrowth is deemed to be a potential solution. Fabricating Ti6Al4V components with dense-porous bilayer structures is complicated with limited lab-scale and commercial success. Here, a green dough-forming technique with metal powders is successfully explored to develop heterogeneous structures with a monolith-like dense-porous interface. The porous region achieved 70% porosity with a 25 MPa compressive strength comparable to human cancellous bone. Due to its simplicity and versatility, this process is a promising solution for developing and mass-manufacturing customized designs for bone-related implants with improved bone ingrowth and osseointegration.

Management of Pediatric Mandibular Condyle Fractures: A Literature Review

This narrative review evaluates the literature on the management of mandibular condyle fractures in growing patients. It aims to illustrate some fundamental biological principles and to offer a series of considerations applicable to clinical practice. The discussion is based on 116 papers published in PubMed and two relevant textbooks. Condylar fractures may be overlooked, especially in pre-scholar children, where compliance is usually reduced. However, these injuries can have disabling sequelae such as ankyloses, facial deformities, malocclusion, and chronic pain in some patients if not diagnosed and managed correctly. Due to their significance, mandibular condyle fractures in children are a subject of considerable clinical interest. As of today, there is consensus about their treatment. Four management options are available: expectative (analgesia, soft food and follow-up), functional protocols (guiding elastics, orthodontic appliances and exercises), maxillomandibular fixation (MMF), and open reduction and internal fixation (ORIF). Nondisplaced and minimally displaced fractures should be treated expectantly; severely displaced non-comminuted fractures can be safely operated on if the expertise is available, even in patients with deciduous dentition. Moderately displaced fractures can be managed with functional protocols or operatively, depending on the background and know-how of the specialist. Functional protocols can achieve good outcomes, especially in patients with deciduous dentition. MMF should be foregone in children due to its many drawbacks.

The optional apex sites for quad zygomatic implant placement in edentulous patients with severe alveolar bone resorption: a CBCT anatomical analysis

OBJECTIVE

To investigate the difference in bone-implant contact (BIC) and the rate of infratemporal fossa intrusion among different apex sites for quad zygomatic implants (ZIs) design in edentulous patients with severe alveolar bone resorption.

METHODS

Patients with maxillary edentulism were evaluated. Alveolar bone resorption was assessed using the Cawood and Howell classification. Participants with Class IV or Class V/VI bone resorption were selected. The zygomatic bone was devided into upper, middle and lower thirds, with four potential implant apex locations identified in each third. Virtual planning for quad ZIs, along with measurements of BIC were performed. Additionally, the occurrence of ZIs intrusion into the infratemporal fossa was examined, and the distance between ZI and orbital cavity was measured.

RESULTS

A total of 28 CBCT scans of edentulous patients, encompassing 56 zygomas, were analyzed. Thirty-nine single lateral posterior edentulous jaws were classified into Class IV subgroup, while 17 into Class V/IV subgroup. Among all patients and patients in subgroups, the anterior and posterior ZI exhibited the highest BIC at points A3 and B2, respectively. The average zygomatic BIC at A3 apex point was 18.3 ± 3.9 mm, and that at the B2 apex point was 16.3 ± 5.3 mm. Quad ZIs risk intrusion into the infratemporal fossa when positioned at B2, B3, and at all apex points of the lower zygoma segment. Three anterior ZIs at A3 point show less than 1 mm distance to orbital cavity. Overall, A3 and B1 apex points showed high BIC and low infratemporal intrusion rate for quad ZIs, irrespective of patient's alveolar bone resorption status.

CONCLUSIONS

The optional apex point for anterior and posterior quad ZIs is A3 and B1, respectively, regardless of the patients's alveolar bone resorption level. Alveolar bone resorption does not affect the BIC for quad ZIs. Anterior ZI positioned at A3 point may present high risk for orbital penetration and may not be reccomended in a Quad ZI approach.

TRIAL REGISTRATION

The clinical research is registered under the number ChiCTR2100044472.

Effects of clindamycin and amoxycillin as prophylaxis against early implant failure: double-blinded randomized clinical trial

OBJECTIVE

The objective of this randomized controlled clinical trial (RCT) was to compare the frequency of early implant failure, postoperative infection, and pain/inflammation and the degree of implant stability between healthy non-penicillin-allergic individuals receiving a single prophylactic dose of 600 mg clindamycin versus 2 g amoxicillin at 1 h before implant surgery.

MATERIALS AND METHODS

A single-center double-blinded RCT study with parallel groups was undertaken. Eighty-two patients fulfilled study inclusion criteria and were randomly assigned to the amoxicillin (n = 41) or clindamycin (n = 41) group. The primary outcome variable was early implant failure. The presence of infection was evaluated immediately after surgery and on days 7, 14, 30, and 90, and postoperative pain/inflammation was assessed daily on days 1 to 7 post-surgery. Resonance frequency analysis was used to measure primary and secondary implant stability.

RESULTS

One early implant failure was observed (1/81), in a patient from the amoxicillin group. No statistically significant between-group differences were observed in early implant failure rate, postoperative infection rate up to 90 days, pain/inflammation scores during the first week post-surgery, or primary or secondary stability values.

CONCLUSIONS

A single dose of 600 mg clindamycin before implant surgery does not increase the risk of early implant failure or infection.

CLINICAL RELEVANCE

These findings suggest that a single dose of 600 mg clindamycin at 1 h before implant surgery is a safe antibiotic prophylactic approach; however, when a more prolonged antibiotic therapy is required, it appears advisable to prescribe an alternative antibiotic to avoid adverse effects.

Preclinical Experimental Study on New Cervical Implant Design to Improve Peri-Implant Tissue Healing

Objectives: In this preclinical study, we used an experimental rabbit model to investigate the effects of a new implant design that involves specific changes to the cervical portion, using a conventional implant design in the control group. Materials and Methods: We used 10 rabbits and 40 dental implants with two different macrogeometries. Two groups were formed (n = 20 per group): the Collo group, wherein implants with the new cervical design were used, which present a concavity (reduction in diameter) in the first 3.5 mm, the portion without surface treatment; the Control group, wherein conical implants with the conventional design were used, with surface treatment throughout the body. All implants were 4 mm in diameter and 10 mm in length. The initial implant stability quotient (ISQ) was measured immediately after the implant insertion (T1) and sample removal (T2 and T3). The animals (n = five animals/time) were euthanized at 3 weeks (T1) and 4 weeks (T2). Histological sections were prepared and the bone-implant contact (BIC%) and tissue area fraction occupancy (TAFO%) percentages were analyzed in the predetermined cervical area; namely, the first 4 mm from the implant platform. Results: The ISQ values showed no statistical differences at T1 and T2 (p = 0.9458 and p = 0.1103, respectively) between the groups. However, at T3, higher values were found for the Collo group (p = 0.0475) than those found for the Control group. The Collo samples presented higher BIC% values than those of the Control group, with statistical differences of p = 0.0009 at 3 weeks and p = 0.0007 at 4 weeks. There were statistical differences in the TAFO% (new bone, medullary spaces, and the collagen matrix) between the groups at each evaluation time (p < 0.001). Conclusions: Considering the limitations of the present preclinical study, the results demonstrate that the new implant design (the Collo group) had higher implant stability (ISQ) values in the samples after 4 weeks of implantation. Furthermore, the histomorphometric BIC% and TAFO% analyses showed that the Collo group had higher values at both measurement times than the Control group did. These findings indicate that changes made to the cervical design of the Collo group implants may benefit the maintenance of peri-implant tissue health.

Mechanical and biological complications of angled versus straight screw channel implant-supported prostheses: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Scientific evidence to determine the clinical performance of angled screw channel (ASC) versus straight screw channel (SC) implant-supported prostheses is lacking.

PURPOSE

This systematic review and meta-analysis investigated the mechanical and biological complications of ASC compared with those of SC implant-supported prostheses.

MATERIAL AND METHODS

A systematic search was conducted by following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline in the PubMed, Embase, and Web of Science databases and was supplemented with a manual search for clinical studies reporting the mechanical and biological complications of ASC compared with those of SC implant-supported prostheses. The search was focused on porcelain fracture, screw loosening or fracture, marginal bone loss (MBL), and pink esthetic score (PES). The data were extracted from selected articles and compounded to estimate the complications with a 95% confidence interval (CI) using a random effects meta-analysis. The publication bias was assessed using the Cochrane Risk of Bias and Newcastle-Ottawa Scale (α=.05).

RESULTS

A total of 4217 records were identified, and 14 studies were selected for quantitative synthesis of 629 participants with 658 ASC and 166 SC implant-supported prostheses. The meta-analyses of comparative studies showed no statistically significant difference in mechanical complications between ASC and SC prostheses, with odds ratio (OR) of 1.75 (95% CI=0.71-4.34, P=.224). Porcelain fracture and screw loosening were the most common complications with ASC prostheses. In addition, no statistically significant difference was found between ASC and SC prostheses in the MBL (mean difference=-0.07, 95% CI=-0.15-0.01, P=.077) and PES (mean difference=-0.19, 95% CI=-0.90-0.52, P=.593).

CONCLUSIONS

The clinical performance of ASC may be comparable with that of SC implant-supported prostheses in terms of mechanical and biological complications. However, the moderate level of evidence necessitates further research to validate these findings.

Comparison of conventional and digital impression approaches for edentulous maxilla: clinical study

BACKGROUND

The expectations for the clinical and laboratory phases of tissue-supported complete dentures (TSCDs) are changing. Currently, there is a trend towards fast, comfortable, reliable, and low-cost methods. In TSCD impressions, simplified impression and digital impression methods involving the use of an intraoral scanner (IOS) are becoming preferable. Given this situation, this study aims to compare different conventional and digital impression methods used in TSCDs.

METHODS

Patients with maxillary complete edentulism and healthy oral mucosa were included in this study. In the digital group, two different impressions were made using an IOS (Trios4) without (D1) and with (D2) artificial intelligence scanning (AI-Scan). In addition, a modified impression (D3) was made using the IOS in two steps, including the occlusal rim. In the conventional group, a two-step impression (C1) using an individual tray with zinc oxide eugenol and a one-step simplified impression (C2) using a stock tray with irreversible hydrocolloid were made. The comparison groups were determined to be C1-C2, C1-D1, D1-D2, and D1-D3. The best-fit algorithm was used to superimpose the impressions to be compared. The right and left vestibular areas, postdam area, palatal area, right and left matching area, entire surface, and borders were evaluated separately.

RESULTS

Fifteen patients were included in this study. In the C1-C2 group, the mean deviation at the borders was statistically significant (p = 0.01). No regions in the C1-D1 and D1-D3 groups exhibited significant differences in the mean amount of deviation (p > 0,05). In the D1-D2 group, the mean deviation in the palatal area was significant (p = 0,03).

CONCLUSION

In maxillary edentulism, digital impressions have shown comparable results to conventional impressions, suggesting promising implications for clinical applications.

TRIAL REGISTRATION

The clinical trial has been registered (ClinicalTrials.gov ID NCT06400277, registration date 06/05/2024, 'retrospectively registered').

Accuracy and efficiency of drilling trajectories with augmented reality versus conventional navigation randomized crossover trial

Conventional navigation systems (CNS) in surgery require strong spatial cognitive abilities and hand-eye coordination. Augmented Reality Navigation Systems (ARNS) provide 3D guidance and may overcome these challenges, but their accuracy and efficiency compared to CNS have not been systematically evaluated. In this randomized crossover study with 36 participants from different professional backgrounds (surgeons, students, engineers), drilling accuracy, time and perceived workload were evaluated using ARNS and CNS. For the first time, this study provides compelling evidence that ARNS and CNS have comparable accuracy in translational error. Differences in angle and depth error with ARNS were likely due to limited stereoscopic vision, hardware limitations, and design. Despite this, ARNS was preferred by most participants, including surgeons with prior navigation experience, and demonstrated a significantly better overall user experience. Depending on accuracy requirements, ARNS could serve as a viable alternative to CNS for guided drilling, with potential for future optimization.

Huge calcifying epithelial odontogenic tumor of the mandible and management with a teeth preserving surgical approach: a case report

BACKGROUND

Calcifying epithelial odontogenic tumor is a rare benign tumor that predominantly occurs in posterior sites of the mandible in adults.

CASE PRESENTATION

This case report describes a case of calcifying epithelial odontogenic tumor in a 37-year-old Iranian female with the chief complaint of swelling in the anterior region of the mandible and tooth displacement. This paper summarized the pathological findings, radiographical features and clinical management of the patient. Clinical examinations revealed a bony hard swelling ~ 3 cm × 4 cm in size with tenderness in the chin area. Radiography revealed an expansile mixed radiolucent and radiopaque lesion with cortical borders. A minimally aggressive surgical approach is used to remove the lesion.

CONCLUSION

This case report outlines the successful outcomes of this surgical approach and the positive outcome associated with the restoration of lost functions of displaced mobile teeth in an arranged and nonmobile way after treatment.

Mandibular Fractures in Edentulous Patients with Bone Atrophy and Osseointegrated Dental Implants: Therapeutic Management in a Case Series

Background and Objectives: This research describes the management of mandibular fractures in edentulous patients with atrophic mandibles and implant-retained overdentures, exploring etiologies and treatment options. Materials and Methods: A retrospective study (January 2010-December 2023) was conducted on six patients from two hospitals (Hospital Gregorio Marañón y Hospital La Paz, Madrid). The data collected included fracture etiology, treatment type, and complications. Results: All six patients were women, with a mean age of 76.33 years. The most common cause of fracture was peri-implantitis (50%). Surgical treatment (open reduction and internal fixation) was performed in five patients, with different surgical approaches and fixation methods. One patient, due to multiple comorbidities, received conservative treatment. Complications occurred in 50% of cases, including delayed healing and hypoesthesia. The average hospital stay was four days, with a mean follow-up of 34 months. Conclusions: Mandibular fractures in these patients are rare. Surgical treatment using rigid fixation plates is recommended. The rational use of bone grafting should be taken into account. Treatment depends on fracture type, patient condition, and surgeon experience.

Histone H3K9 Methylation Is Differentially Modified in Odontogenic Cyst and Tumors

OBJECTIVES

 Histone modification in odontogenic lesions is mostly unexplored. Trimethylation of histone H3 at lysine residue 9 (H3K9Me3) has been studied in various pathologic conditions and showed biological significance promising for future therapeutic application. This study aimed to investigate the level and clinical relevance of the H3K9Me3 histone modification in odontogenic cysts and tumors.

MATERIALS AND METHODS

 A total of 105 cases of odontogenic lesions, comprising 30 odontogenic keratocysts (OKCs), 30 adenomatoid odontogenic tumors (AOTs), 30 ameloblastomas, and 15 dental follicles, were included in the study. The paraffin-embedded tissues were immunohistochemically stained for H3K9Me3. Both the intensity and the distribution of staining were evaluated and calculated as H-score. The correlation between the H3K9Me3 expression and the clinical characteristics of each lesion was evaluated.

STATISTICAL ANALYSIS

 The Kruskal-Wallis test followed by Bonferroni's correction was performed to assess the differences in H-score among groups. In addition, Pearson's chi-squared test or Mann-Whitney U test was used to analyze potential factors that could affect protein expression.

RESULTS

 The reduced enamel epithelium of the dental follicle showed uniformly strong H3K9Me3 expression. All odontogenic cysts and tumors examined demonstrated a significantly reduced H3K9Me3 level compared with dental follicles. The AOT showed the lowest H3K9Me3 level, followed by OKC and ameloblastoma. Its immunoreactivity was mainly localized in the basal and parabasal cells of OKC and the whorled/duct-like structures of AOT. Ameloblastoma exhibited marked variation in the H3K9Me3 level among cases. Notably, the upregulated H3K9Me3 was related to multilocularity of OKC and ameloblastoma.

CONCLUSIONS

 Histone H3K9 methylation is differentially expressed in odontogenic cysts and tumors. This epigenetic modification may contribute to the pathogenesis and aggressive behavior of odontogenic lesions.

A Biomechanical Evaluation of Distal Tilting Implants in All-on-Four Rehabilitation with Mild Mandibular Resorption: A Finite Element Analysis Study

The geometry of implants plays a crucial role in the success of All-on-Four treatments for the lower jaw. This study builds upon prior research by evaluating the biomechanical performance of implant-supported prostheses in full-arch fixed dental restorations, specifically focusing on different implant lengths and connection types in cases of mild atrophic resorption of the mandible. Four groups were analyzed using finite element analysis (FEA): We utilized 13 or 18 mm posterior 17-degree tilting implants, each paired with two kinds of abutment connections. The external hexagon connection (EHC) group utilized 4 mm diameter implants, while the internal hexagon connection (IHC) group employed 4.3 mm diameter implants. A vertical force was applied to the cantilever region located at the distal side of the posterior implant. The maximum stress regions were observed in prosthetic screws and multi-unit abutments (MUAs) across all groups, with the lowest von Mises stress values noted in the bone. Stress peaks for implant screws and fixtures in the 13 mm group were 19.98% and 11.42% lower, respectively, compared to the IHC group. Similarly, in the 18 mm group, stress peaks were reduced by 33.16% and 39.70% for the EHC group compared to the IHC group. The stress levels on all components remained below the ultimate strength of the titanium alloy. For the same implant lengths, the stress in the prosthetic screw, MUAs, implant screw, and implant fixture positions was lower in the EHC group. When implant length was increased, a decrease in stress levels was observed in the implant screw and fixture of the EHC group and only in the implant screw of the IHC group. However, an increase in stress was noted in the prosthetic screw and MUAs for both groups.

Novel Subperiosteal Device Geometry and Investigation of Efficacy on Surrounding Bone Formation and Bone-Bonding Strength

To develop a safer bone-bonding device that promotes early osseointegration with cortical bone perforation, novel subperiosteal device geometries were proposed and evaluated for their ability to facilitate surrounding bone formation and enhance bone-bonding strength. This study used animal experiments and mechanical testing to assess the performance of these designs. The experimental device consisted of two main components: a rounded rectangular plate and a centrally positioned cylinder. To promote the recruitment of bone-marrow-derived factors, slits were incorporated into the cylinder, and a center hole was created directly above it. Four device variations, differing by the presence or absence of the slits and center hole, were fabricated and then subjected to tensile tests for mechanical property evaluation. In the animal experiments, the devices were bilaterally placed on rat tibiae, and after four weeks, bone-bonding strength tests were performed. Additionally, micro-computed tomography and histological analysis of undecalcified sections were conducted. All devices demonstrated early osseointegration, and geometric design differences, specifically the presence or absence of the slits and center hole, significantly affected the mechanical properties and bone induction. However, no significant differences in bone-bonding strength were detected. These findings suggest that the newly formed bone inside the slits and center hole contributes to the reinforcement of the device.

Anatomical study of pterygoid implants: artery and nerve passage through bone dehiscence of the greater palatine canal

PURPOSE

Pterygoid implants are an alternative approach to avoid sinus-lifting or other grafting procedures. During pterygoid implant placement, dental surgeons risk damaging the greater palatine canal (GPC). However, they do not have sufficient reasons to avoid GPC injury. This study performed a detailed morphological analysis of the GPC to determine susceptibility to damage during pterygoid implant surgery.

METHODS

To understand the detailed morphology of the GPC, gross anatomical analysis, histological analysis, and bone morphometry via micro-computed tomography were performed.

RESULTS

We found that the medial wall of the GPC communicated with the nasal cavity through the bone dehiscence. The dehiscence appeared near the inferior nasal concha in 72.4% of the cadavers. The nerve and artery passed from the GPC to the nasal mucous membrane through the dehiscence. Given that the greater palatine nerve passed medial to the descending palatine artery in the GPC, the descending palatine artery is damaged first rather than the greater palatine nerve during pterygoid implant surgery.

CONCLUSIONS

Dental surgeons who penetrate the GPC using an implant body may extend the bleeding to the nasal mucosa, which seems to spread the inflammation to the nasal cavity.

A retrospective epidemiological analysis of maxillofacial fractures at a tertiary referral hospital in istanbul: a seven-year study of 1,757 patients

BACKGROUND

The aim of the study was to evaluate the etiology, incidence, demographics, and characteristics of maxillofacial fractures treated at a university hospital over a seven-year period.

METHODS

We performed a retrospective analysis of 1,757 patients with maxillofacial fractures who were referred to our department between May 2012 and March 2019. The patients' demographic and clinical characteristics were noted, as well as the fracture type, location, and etiology. The treatment modalities were also analyzed.

RESULTS

A total of 2,173 maxillofacial fractures were seen in 1,757 patients. The male to female ratio was 3.9:1, and the mean patient age was 31.89 ± 17.70 years (range: 0-95 years). Maxillofacial injuries were most prevalent in the 19-28 years age group (23.9% of cases), with a general increase in injuries observed between 2013 and 2018 across all age groups. The most common etiological factor was assault (29.1%), followed by falls (26%). In male patients, assault was reported as the main cause, while in female patients, falls were identified as the main cause. The nasal bone was the most common site of fracture, followed by the maxilla. The average time from admission to surgery was 2.8 days, with local anesthesia being the most frequent surgical intervention. The average time from admission to surgery was 2.8 ± 2.5 days (range: 0-20 days), with surgeries performed under local anesthesia being more frequent than those carried out under general anesthesia. Among the surgical interventions, the most common general anesthesia technique for fracture reduction was open reduction and internal fixation with plates and screws. Plate exposure, wound-site infection, and temporomandibular joint ankylosis were the major complications encountered in the study population.

CONCLUSION

The study reveals significant variability in maxillofacial fractures based on gender, age, and etiology. Assault emerged as the leading cause of these fractures, followed by falls and road traffic accidents. Men were affected by maxillofacial trauma four times more often than women, with the highest incidence occurring in the 19-28 years age group. Nasal fractures were the most frequently observed (78.7%), while condylar-subcondylar process fractures were the most common type of mandibular fracture. Given these findings, a targeted, lifelong prevention strategy focused on high-risk groups could significantly reduce the burden of maxillofacial trauma.

Fracture rate and risk factors associated with the fracture of narrow diameter implants: A long-term retrospective analysis

OBJECTIVES

The objective of this long-term retrospective study was to evaluate the fracture rate and the risk factors associated with the fracture of 3.3 mm narrow diameter implants (NDIs).

MATERIALS AND METHODS

A total of 524 records of patients rehabilitated with 3.3 mm NDIs between 1997 and 2015 were assessed. Data on patients, implants, and prostheses were collected, and descriptive analysis of the variables was performed. NDIs were separated into 2 groups: "fractured" and "non-fractured", and a multilevel logistic regression model was applied to identify the risk factors associated with NDI fracture.

RESULTS

Eighty-four patients were removed from the analysis for interrupting follow-up or presenting failures other than fractures. Of the 440 patients included (64.66 ± 13.4 years), 272 were females (61.8%), and 168 males (38.2%), and mean follow-up time was 129 ± 47.1 months. Of the 1428 NDIs, 15 (1.05%) in 9 patients (2.04%) fractured during the studied period. Ten fractures (66.66%) happened in 6 patients (66.66%) showing signs of parafunction. NDI with modified sandblasted, large grit, acid-etched surface was the only implant variable to show a protective statistical significance (p = .0439).

CONCLUSIONS

NDI fracture was a rare event in the studied sample. NDIs manufactured with modified sandblasted, large grit, acid-etched surface may provide extra protection against NDI fracture. Patient-specific factors and implant characteristics should be carefully considered to limit the risk of fracture of 3.3 mm NDIs.

Osseointegrated dental implants that will undergo radiotherapy. Does risk of osteoradionecrosis exist? A scoping review

OBJECTIVE

Given the absence of a standardized action protocol for treating patients with dental implants (DIs) who are subjected to radiotherapy (RT), we have conducted an extensive review and analysis of published literature on this subject. Our objective is to gain a comprehensive understanding of the impact of RT on the bone surrounding osseointegrated implants during and after treatment.

STUDY DESIGN

We conducted a literature review using PubMed (MEDLINE) to identify studies describing the effects of RT on preexisting osseointegrated and/or loaded DIs. Articles published between January 1963 and December 2023 were considered for inclusion.

RESULTS

A total of 1,126 articles were retrieved, 64 full articles were reviewed, and only 13 articles were included in this review upon meeting the criteria. A total of 667 patients and 2,409 implants were included. Osteoradionecrosis (ORN) was observed in approximately 19 implants following antineoplastic treatment.

CONCLUSIONS

The interaction between DIs and RT is a complex and multifaceted issue that requires further research and clinical guidance. Although certain studies indicate a possible connection between DIs, radiation, and ORN risk, the precise relationship remains unclear. Factors such as radiation dosage, implant characteristics, material, and timing of placement significantly influence this association.

A Rare Case of Cementoblastoma of the Second Right Maxillary Premolar in a 30-Year-Old Man

Cementoblastoma is a benign odontogenic mesenchymal tumor characterized by cementum production. Cementoblastoma is considered a relatively rare neoplasm with a predilection to the posterior region of the mandible. The main clinical differential diagnoses include hypercementosis, cemento-osseous dysplasia, condensing osteitis, idiopathic osteosclerosis, osteoblastoma, odontoma, and osteosarcoma. Imaging findings may be pathognomonic when demonstrative. Although rather identical histologically, cementoblastoma exhibits unequivocal fusion to the root of the tooth, which distinguishes it from osteoblastoma. We present a case of a 30-year-old man with cementoblastoma arising in an unusual location: the root of the second right premolar of the maxilla.

Mesenchymal Tumors of the Head and Neck

The majority of neoplasms of the head and neck are of epithelial origin primarily including mucosal squamous cell neoplasms (papillomas; squamous cell carcinoma) as well as salivary gland neoplasms. However, the full spectrum of mesenchymal neoplasms (benign and malignant) typically arising in soft tissue sites may also develop in superficial layers of the upper aerodigestive tract. The diversity of mesenchymal neoplasms arising in the head and neck is beyond the scope of this article, and our focus will be on some of the more common and/or diagnostic problematic mesenchymal tumors occurring in the sinonasal tract, oral cavity/odontogenic, pharynx, larynx, and neck.

Evaluating the clinical behavior of veneered zirconia in comparison with monolithic zirconia complete arch implant-supported prostheses: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Because the use of zirconia in dentistry is relatively new, the number of published studies on the subject is scarce, even though material selection is an important factor in clinical performance. Therefore, a systematic assessment of the impact of the prosthetic material, framework design, veneering material, and manufacturing process is required.

PURPOSE

The purpose of this systematic review and meta-analysis was to investigate the survival and success rates of feldspathic porcelain veneered zirconia (VZir) in comparison with monolithic zirconia (MZir) complete arch implant-supported prostheses (CAISPs). A secondary objective was to assess the influence of the type of loading, the presence or absence of a cantilever, the type of zirconia used, the location, and the opposing arch on complications rates and patient satisfaction.

MATERIAL AND METHODS

An electronic search of the MEDLINE database (via PubMed), Scopus, Science Direct, Cochrane Library, and OpenGrey was carried out. The criteria described in the preferred reporting items for systematic reviews and meta-analyses statement were used. The search was restricted from January 2000 to January 2022.

RESULTS

The systematic search resulted in 20 articles that met the established criteria. In total, 751 patients (VZir=302; MZir=449) with 3038 CAISPs (VZir=368; MZir=2670) were analyzed. Higher prosthetic survival and success rates were found in MZir compared with VZir CAISPs (100% and 95.45%, respectively). The meta-analysis found significantly fewer complications related to MZir (9.4% [4.8%-14.1%]) compared with VZir (33.7% [17.5%-49.9%]).

CONCLUSIONS

Based on the findings of this systematic review, MZir CAISPs had higher survival and success rates than VZir CAISPs, with significantly fewer prosthetic complications. The influence of factors such as the type of functional loading, the presence of a cantilever, the material used in the prosthodontic workflow, the location of the CAISP, and the type of antagonist arch on the performance of Zir CAISPs remains unclear.

Odontogenic carcinosarcoma of the mandible: A case report

Key Clinical Message

Odontogenic carcinosarcoma, a rare and challenging diagnosis, was identified in a 60-year-old male through histopathology, revealing a biphasic neoplasm with malignant epithelial and mesenchymal components. Surgical resection is crucial for management, highlighting the importance of vigilant postoperative follow-up to ensure early detection of any recurrence.

Abstract

One rare mixed malignant odontogenic tumor is odontogenic carcinosarcoma, which comprises malignant epithelial and mesenchymal components. Diagnosing odontogenic carcinosarcoma is challenging due to its rarity and atypical clinical presentation. This study reports a 60-year-old male patient who presented with a painless swelling on the right side of his face and experienced facial asymmetry for 6 months, ultimately diagnosed with odontogenic carcinosarcoma. A biphasic neoplasm with malignant alterations in both epithelial and mesenchymal components was identified upon histopathological examination. MRI imaging showed an expansile multilobulated lytic lesion with cortical erosion and extraosseous extension in the posterior region of the right mandibular body and ramus. Following contrast administration, homogeneous lesion enhancement was observed, with a few small non-enhancing necrotic areas in central parts. The patient subsequently underwent a right hemi-mandibulectomy with resection of adjacent soft tissues and neck dissection due to lymph node involvement. The resulting defect was reconstructed using a pectoralis major flap. No recurrence or metastasis was reported during the 6-month follow-up, reinforcing the positive results. This case highlights the importance of recognizing odontogenic carcinosarcoma and underscores the challenges in diagnosing and managing this rare tumor. Early identification and aggressive treatment can lead to positive outcomes, as evidenced by the absence of recurrence or metastasis in this patient during the follow-up period.

Microvascular reconstruction of midface osteoradionecrosis

BACKGROUND

Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population.

METHODS

Retrospective multi-institutional review of FF reconstruction for midface ORN (2005-2022; n = 54).

RESULTS

The FF survival rate was 87% (n = 54). Patients were less likely to be tolerating a regular diet at 3 months postoperative if they had a preoperative history of prior head and surgery (80% vs. 95%; p = 0.02), a pathologic fracture (50% vs. 90%; p = 0.04), exposed bone intraorally (43% vs. 94%; p = 0.002), or a fistula (67% vs. 96%; p = 0.03). Mean albumin was higher in patients whose FF survived (3.6 ± 0.5 vs. 2.7 ± 1.4; p = 0.03). Patients with low prealbumin were more likely to undergo a hematoma evacuation (27% vs. 0%; p = 0.02).

CONCLUSION

In this series of midface ORN requiring FF reconstruction preoperative nutritional status impacted postoperative complications. Preoperative occurrence of a fistula, pathologic fracture, and intraoral bone exposure correlated with decreased tolerance of a regular diet following reconstruction.

Fretting-corrosion at the Implant-Abutment Interface Simulating Clinically Relevant Conditions

OBJECTIVE

Implant treatment is provided to individuals with normal, idealized masticatory forces and also to patients with parafunctional habits such as grinding, clenching, and bruxing. Dental erosion is a common increasing condition and is reported to affect 32 % of adults, increasing with age. This oral environment is conducive to tribocorrosion and the potential loss of materials from the implant surfaces and interfaces with prosthetic components. Although several fretting-corrosion studies have been reported, until now, no study has simulated clinically relevant micromotion. Therefore, our aim is to investigate fretting-corrosion using our new micro-fretting corrosion system, simulating clinical conditions with 5 µm motion at the implant-abutment interface under various occlusal loads and acidic exposures.

METHODS

We simulated four conditions in an oral environment by varying the contact load (83 N and 233 N) and pH levels (3 and 6.5). The commonly used dental implant material, Grade IV titanium, and abutment material Zirconia (ZrO2)/ Grade IV titanium were selected as testing couple materials. Artificial saliva was employed to represent an oral environment. In addition, a standard tribocorrosion protocol was followed, and the pin was controlled to oscillate on the disk with an amplitude of 5 μm during the mastication stage. After the testing, 3D profilometry and scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) were utilized to analyze the worn surfaces. Inductively coupled plasma mass spectrometry (ICP-MS) was also used to measure the metal ion release.

RESULTS

Energy ratios were below 0.2, indicating a fretting regime of partial slip for all groups. Open-circuit potential (OCP) and electrochemical impedance spectroscopy (EIS) were analyzed to compare the electrochemical behavior among groups. As a result, corrosive damage was observed to be more in the Ti4- Ti4 groups than in Zr-Ti4 ones, whereas more mechanical damage was found in the Zr-Ti4 groups than in the Ti4-Ti4 groups. Possible mechanisms were proposed in the discussion to explain these findings.

SIGNIFICANCE

The results observed from this study might be helpful to clinicians with implant selection. For example, for patients with bruxism, a titanium implant paired with a titanium abutment may be preferable, while patients with GERD may benefit more from a titanium implant paired with a zirconia abutment.

Bone complications of cancer treatment

With the advancements in conventional treatment modalities such as radiation, chemotherapy, and surgery, as well as the emergence of immunotherapy, the overall cure rate for solid tumor malignancies has experienced a significant increase. However, it is unfortunate that exposure to cancer treatments can have detrimental effects on the function of osteoblasts and osteoclasts, disturbing bone metabolic homeostasis in patients, as well as causing damage to bone marrow cells and other bone tissues. Consequently, certain tumor treatment options may pose a risk for subsequent bone diseases. Common bone disorders associated with cancer treatment include osteonecrosis, bone loss, and secondary bone tumors. (1)Cancer treatment-related osteonecrosis is primarily linked to the use of radiation therapy and certain chemicals, such as bisphosphonates, denosumab, antiangiogenic agents, and immunomodulators. It has been observed that high-dose radiation therapy is more likely to result in osteonecrosis. (2)Chemicals and hormones, particularly sex hormones, glucocorticoids, and thyroid hormones or thyrotropic hormones, are among the factors that can contribute to cancer treatment-related bone loss. (3)Secondary bone tumors differ from metastases originating from primary tumors, and radiotherapy plays a significant role in their development, while chemotherapy may also exert some influence. Radiogenic secondary bone tumors are predominantly malignant, with osteosarcoma being the most common type. Chemotherapy may be a risk factor for the relatively rare occurrence of secondary Ewing sarcoma of the bone. These treatment-related bone disorders have a considerable adverse impact on the prognosis of cancer patients. Hence, it is imperative to prioritize the bone health of patients undergoing cancer treatment and give it further attention.

Fracture Resistance of Endodontically Treated Teeth Prepared With Biologically Oriented Preparation Technique Versus Horizontal Finish Lines: An In Vitro Study

INTRODUCTION

The biologically oriented preparation technique (BOPT) is a conservative tooth preparation method with no defined finish lines. Studies comparing the fracture resistance of endodontically treated teeth (ETT) prepared using BOPT or horizontal finish lines are lacking. The primary objective of this study was to compare the fracture resistance of ETT prepared using BOPT, chamfer finish line, or shoulder finish line and restored with monolithic zirconia (MZ) crowns. The secondary objective was to determine the modes of fracture of ETT with different finish lines.

METHODS

Forty-five maxillary premolar teeth were endodontically treated and randomly allotted to three tooth preparation methods: Group 1, BOPT; Group 2, chamfer finish line; and Group 3, shoulder finish line. MZ crowns were milled and cemented on their respective tooth preparations. The fracture resistance was tested using a universal testing machine. Maximum fracture load was recorded in Newtons (N). The fracture modes were classified using Burkey's codes and a newly proposed fracture grading.

RESULTS

The highest fracture resistance was seen in samples from Group 1, followed by Group 2, and the least in Group 3. Tukey's post hoc test showed a significant difference between Group 1 and Group 3 (p<0.05) and between Group 2 and Group 3 (p<0.05). No significant differences were found between Group 1 and Group 2 (p>0.05). Code V and Grade 3B fractures were highest in Group 3 samples.

CONCLUSIONS

Within the limitations of the present study, it can be concluded that ETT prepared with BOPT and chamfer finish lines had the greatest fracture resistance compared to shoulder finish lines. Teeth prepared with shoulder finish lines had more non-restorable fractures compared to BOPT or chamfer preparations.

Multi-modal investigation of the bone micro- and ultrastructure, and elemental distribution in the presence of Mg-xGd screws at mid-term healing stages

Magnesium (Mg) - based alloys are becoming attractive materials for medical applications as temporary bone implants for support of fracture healing, e.g. as a suture anchor. Due to their mechanical properties and biocompatibility, they may replace titanium or stainless-steel implants, commonly used in orthopedic field. Nevertheless, patient safety has to be assured by finding a long-term balance between metal degradation, osseointegration, bone ultrastructure adaptation and element distribution in organs. In order to determine the implant behavior and its influence on bone and tissues, we investigated two Mg alloys with gadolinium contents of 5 and 10 wt percent in comparison to permanent materials titanium and polyether ether ketone. The implants were present in rat tibia for 10, 20 and 32 weeks before sacrifice of the animal. Synchrotron radiation-based micro computed tomography enables the distinction of features like residual metal, degradation layer and bone structure. Additionally, X-ray diffraction and X-ray fluorescence yield information on parameters describing the bone ultrastructure and elemental composition at the bone-to-implant interface. Finally, with element specific mass spectrometry, the elements and their accumulation in the main organs and tissues are traced. The results show that Mg-xGd implants degrade in vivo under the formation of a stable degradation layer with bone remodeling similar to that of Ti after 10 weeks. No accumulation of Mg and Gd was observed in selected organs, except for the interfacial bone after 8 months of healing. Thus, we confirm that Mg-5Gd and Mg-10Gd are suitable material choices for bone implants.

Evaluation of efficacy of digital or virtual bite registration over conventional techniques- A systematic review

Background

Bite registration procedures have been transformed by the digital revolution in dentistry, thus it is now necessary to compare the accuracy of digital or virtual techniques to conventional ones.

Aim

To assess the accuracy of digital or virtual bite registration systems in comparison to conventional methods to clarify any potential advantages or disadvantages.

Methodology

A thorough search in numerous databases, including PubMed, Embase, the Cochrane Library, Scopus, and Web of Science, was carried out in accordance with PRISMA criteria. The review focused on the accuracy of digital or virtual bite registration and covered a variety of study formats, including randomized controlled trials, clinical studies, and in-vitro investigations. For each of the included 7 studies, a thorough assessment of bias was conducted using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. As there would be expected variability in study designs, data synthesis required both a narrative explanation of the results and a qualitative synthesis.

Results

This systematic review compared 7 studies on traditional bite registration methods versus digital/virtual techniques. Digital techniques highlighted improved efficiency and innovation with increased speed, accuracy, and integration advantages. Evaluations performed with the Newcastle-Ottawa Scale and ROBINS-I tool showed little bias in cross-sectional studies. Nevertheless, in vitro studies have identified biases in participant selection and result reporting, indicating a need for better study rigor and reporting standards. A study received a noteworthy 8 out of 9 score on the Newcastle-Ottawa Scale, indicating strong methodology with careful sample selection, solid comparability, and comprehensive outcome evaluation, enhancing its credibility in assessing bite registration techniques.

Conclusion

The benefits of digital/virtual bite registration methods over traditional ones are demonstrated in this systematic review, which also shows how these methods improve speed, accuracy, and integration. Although some studies have shown biases, overall results support the validity and efficiency of digital techniques in improving dental practice.

Epidemiological analysis of the facial fractures pattern in relation to motorcycle helmet type: A retrospective study on 282 patients

Most maxillofacial traumas are caused by road traffic collisions and, in particular, by motorcycle accidents. Helmets represent an efficient protective tool in these traumas but they do not provide complete protection. The aim of this study was to perform an epidemiological analysis of facial fractures pattern in relation to the helmet type worn during the accident. The study was a retrospective analysis of 282 patients with a diagnosis of maxillofacial fracture caused by a motorcycle accident. The patients were divided in three groups based on helmet type (Group A: full-face helmet; Group B: modular [half-face] helmet; Group C: open-face helmet). For each group, fractures type and trauma severity, using the Comprehensive Facial Injury (CFI) scale, were recorded. Results showed that isolated midface fractures were strongly related to full-face helmet wearing (p < 0.001), while mandibular fractures and panfacial trauma/combined fractures were negatively correlated (p < 0.001). Mandibular fractures (p < 0.001) and panfacial trauma/combined fractures (p < 0.001) were strongly related to open helmet. Moreover, severe trauma (CFI 8.16) was recorded for open-face helmet wearing. In conclusion, full-face helmet wearing reduced the risk of facial fracture, in particular panfacial trauma/combined fractures, while open-face helmet wearing increased the risk of these fractures.

Factors affecting radiographic marginal bone resorption at dental implants in function for at least 5 years: A multicenter retrospective study

OBJECTIVE

To evaluate the influence of patient and implant-related factors on the changes of marginal bone levels (MBL) at implants with a follow-up ≥5 years.

MATERIALS AND METHODS

At baseline (within 6 months from prosthetic insertion) and long-term (≥5 years after implant placement) visits, interproximal (mesial and distal) MBL were radiographically evaluated. To analyze factors predicting MBL change, the site (either mesial or distal) showing the highest MBL change (hChMBL site) was identified for each implant. Multilevel regression models were built to explain MBL change as well as the probability for a bone loss ≥2 mm at long-term.

RESULTS

942 implants in 312 patients with a mean follow-up of 8.02 ± 2.5 years were analyzed. MBL change was significantly predicted by baseline MBL, oral bisphosphonate (BP) intake, history of periodontitis, diabetes, and super-hydrophilic implant surface. Higher risk for a bone loss ≥2 mm was observed in patients with history of periodontitis (OR = 9.52, 95% CI 0.72-3.79) and taking BP (OR = 6.84, 95% CI 0.21-3.63). Mandibular implants had higher odds for bone loss ≥2 mm compared to maxillary implants (OR = 3, 95% CI 0.39-1.87).

CONCLUSIONS

The findings of the present study contribute to the identification of specific clinical scenarios at higher risk for implant-supporting bone loss that need to be strictly monitored during maintenance.

Bruxism, temporomandibular disorders, and headache: a narrative review of correlations and causalities

ABSTRACT

The co-occurrence of bruxism, temporomandibular disorders (TMDs), and headache is common in patients. However, there is conflicting evidence regarding whether this association is simply a result of their high prevalence or whether there are indeed causal relationships. This review provides an overview of the current state of research while taking into account the controversies surrounding research methods, particularly in definitions and diagnostic standards. Bruxism-defined as repetitive jaw muscle activity during sleep or wakefulness-is not a painful disorder but may-particularly in co-occurrence with TMD-worsen pre-existing headache. It seems important to differentiate between sleep and awake bruxism because of different impact on pathophysiological processes in different primary headache disorders such as migraine and tension-type headache. Temporomandibular disorder is a heterogenous entity with both myofascial and arthrogenous types of pain in addition to nonpainful disorders. Research suggests a correlation between TMD pain and migraine, as well as between awake bruxism and tension-type headache. However, psychosocial factors may act as confounders in these relationships. Determining causality is challenging because of the limited number of experimental and clinical studies conducted on this topic. The main finding is an apparent lack of consensus on the definition and assessment criteria for bruxism. Treatment wise, it is important to differentiate all 3 conditions because treatment of one condition may have an effect on the other 2 without proving causality. For future research, it is crucial to establish greater consistency and applicability in diagnostic procedures and definitions. In addition, more experimental and clinical studies investigating the question of causality are needed.

Maxillary Cystic Ameloblastic Fibroma in a Dalmatian Mix

A 6-month-old intact male Dalmatian mix puppy was presented for the evaluation of left maxillary swelling due to a suspected cyst and an unerupted left maxillary canine tooth. Removal of the unerupted left maxillary canine tooth (204) and enucleation of the cyst was performed, followed by histological analysis, which identified the maxillary swelling to be a cystic ameloblastic fibroma. Ameloblastic fibromas are rare in companion animals, and to the best of the authors' knowledge, this is the first cystic variant reported in dogs. The clinical, radiographic, cone beam computed tomography, and histological findings of this case are discussed and compared with the findings of previously documented human and domestic animal cases.

Assessment of Early and Late Management of Submental Gunshot Wounds

Background: Management of submental gunshot wounds is becoming more common and requires complex surgical decisions. Objective: Compare outcomes of early and definitive reconstructive techniques following submental gunshot wounds. Methods: Retrospective chart review evaluated subjects who sustained a self-inflicted submental gunshot. The incidence of complications requiring unplanned operations was compared for early management techniques of skin/soft tissue, bone, and mucosal lining and definitive reconstructive techniques using Fisher's or Pearson Chi-square exact test with p ≤ 0.05 considered statistically significant. Results: The total of 27 patients were included. Early techniques included skin = primary soft tissue closure (n = 19) versus wound vacuum-assisted closure (n = 8); mandible = open reduction internal fixation (ORIF) (n = 19) versus external fixation (n = 8); and oral mucosal lining = primary mucosal closure (n = 20) versus dermal substitute (n = 7). Definitive management included ORIF (n = 10, 37%), ORIF with bone grafting (n = 8, 30%), and microvascular free-flap (n = 9, 33%). The incidence of complications requiring unplanned operation when using dermal substitutes for mucosal lining management was statistically higher than primary closure (p < 0.001); otherwise the complication rates of surgical techniques were equivalent. Conclusion: Several surgical decisions and techniques can be utilized at the time of early and definitive management of submental gunshot wounds. Only the use of dermal substitutes for mucosal lining is associated with a significantly higher rate of unplanned operation.

Mandibular Condylar Head Regeneration Owing to Remodeling of the Costochondral Graft After Condylectomy for Odontogenic Myxoma

Odontogenic myxoma of the mandibular condyle is a rare tumor that requires complete surgical resection because of the tendency for recurrence. The right mandibular condyle was resected to remove the myxoma. The author performed immediate condylar reconstruction using a costochondral graft (CCG), and stable temporomandibular joint (TMJ) function and occlusion were achieved. During follow-up, the grafted CCG healed well, and a favorable bony union with the mandibular ramus was observed. Furthermore, unexpected bony remodeling was observed in the CCG; growth of the cartilaginous part resulted in the formation of a structure similar to the condylar head, and the body of the rib bone thickened similar to the mandibular subcondylar region. In conclusion, the author reported the successful removal of an odontogenic myxoma from the right mandibular condyle via condylectomy, condylar reconstruction using a CCG, and condylar head regeneration owing to CCG remodeling.

Proximal tibia for alveolar augmentation and augmentative rhinoplasty-a suitable option? A retrospective clinical study on donor and recipient site morbidity

BACKGROUND

Autologous bone grafts are essential in reconstructive oral and maxillofacial surgery, and depending on the donor site, they can be associated with specific harvesting morbidities. One of the most commonly applied bone grafts is the iliac crest bone graft, irrespective of other grafts, which might be associated with an easier surgical procedure or the possibility of harvesting them under local anaesthesia. Objective of the study is the clinical evaluation of proximal tibia bone grafts regarding their eligibility for maxillofacial bone grafting.

METHODS

In this retrospective study, proximal tibia bone grafts were examined with regard to associated donor and recipient site morbidity and their suitability for alveolar ridge augmentation and rhinoplasty.

RESULTS

In total, 21 tibia grafts were included. Fifty-seven percent of the bone grafts were used for alveolar ridge reconstruction, and 43% were used for augmentative rhinoplasty. No significant complications occurred during or after harvesting, but in 14.3% of the patients, minor wound healing disorders were recorded at the donor site, and in 19% of the patients, they were recorded at the recipient site. Statistically, patient sex, age, nicotine and alcohol abuse and metabolic diseases had no significant influence on the complication rate. Graft harvesting under local anaesthesia and at summer temperatures was associated with significantly more complications at the harvesting site (p < 0.05). In cases of dental implant insertion into augmented sites, the implants (n = 31) were followed up for a median period of 40.5 months, during this time 86.7% of the implants survived.

CONCLUSION

The proximal tibia is a suitable donor site for harvesting autologous bone grafts for alveolar ridge augmentation or rhinoplasty because the donor site morbidity is low, and in contrast to iliac crest bone grafts, they can be harvested under local anaesthesia, which might be advantageous for outpatient surgeries.