Retrospective Radiographic Analysis of Peri-Implant Bone Loss in Mandibular Full-Arch Implant Rehabilitations

OBJECTIVES

Can the type of implant rehabilitation influence peri-implant bone loss in case of full-arch mandibular prosthesis? The purpose of the study was to assess, using orthopantomograms (OPGs), the bone loss around implants in different types of implant-supported prosthetic rehabilitations and identify potential risk factors, associated with the number and location of implants, that may have an association with bone defects.

METHODS

A radiographic study was conducted on 22,317 OPGs from 2010 to 2024. All OPGs with implant-supported prosthetic mandibular rehabilitations were included in the study.

RESULTS

A total of 155 OPGs were evaluated, with peri-implant bone loss identified in 64 (41.3%). Distal implants (furthest from the center) across various positioning patterns were most susceptible to bone loss, with positions 3.6 and 4.6 demonstrating the most frequent occurrence (25 and 26 cases, respectively). The χ2 test revealed significant associations between both the implant positioning pattern (p < 0.001) and number of implants (p < 0.001) with peri-implant bone loss. Also, by updating the sample of OPGs, increased susceptibility to bone resorption was found for implants placed distal to the mental foramen compared to mesial ones in full-arch-implant-supported fixed prostheses.

CONCLUSIONS

Prospective clinical studies will therefore be useful in investigating this finding further.

Effect Of Different Alkaline Treatments of Titanium Surface on Human Osteoblasts Metabolism

This investigation demonstrates the effect of alkali modification of titanium on the metabolism of human osteoblasts. Polished titanium discs were subjected to alkalinization protocols with NaOH (5M) at 60°C or 120°C. Surface topography and roughness were evaluated using scanning electron microscopy (SEM). Osteoblasts were seeded onto titanium discs, followed by cell adhesion and viability analysis, total protein and collagen production, and alkaline phosphatase (ALP) activity. Gene expression of tumor necrosis factor-alpha (TNF-α) and beta-defensin 3 (HBD3) was evaluated after inflammatory stimulus with lipopolysaccharides (LPS) of Porphyromonas gingivalis (1 μg/mL) for 4 h. Discs subjected to modification with NaOH showed major irregularities, especially for 120°C-protocol. Increased adhered cell number was observed for surfaces modified by NaOH. Osteoblasts cultured on modified surfaces showed higher cell viability, total protein and collagen synthesis, and ALP activity than that of cells cultured on the polished discs. Osteoblast response to LPS exposure showed increased TNF-α gene expression by these cells when cultured on the polished discs, while increased expression of HBD3 was detected for all groups in the presence of LPS. Modification of titanium discs by NaOH at 60°C or 120°C promoted an increase in adhesion and metabolism of osteoblasts and favored the response to inflammatory stimulus.

Effectiveness of Implant Therapy in Patients With and Without a History of Periodontitis: A Systematic Review With Meta-Analysis of Prospective Cohort Studies

AIM

This systematic review investigates the effectiveness of implant therapy in patients with and without a history of periodontitis in terms of implant loss, peri-implant marginal bone loss (MBL), and occurrence of peri-implant diseases.

METHODS

The protocol of the present meta-analysis was registered on PROSPERO (CRD42021264980). An electronic search was conducted up to April 2024. All prospective cohort studies reporting implant loss, MBL, and occurrence of peri-implant diseases in both patients with a history of periodontitis (HP) and patients with no history of periodontitis (NHP) after at least 36-month follow-up were included. The risk of bias was evaluated using the Newcastle-Ottawa Scale and the quality of the evidence was also assessed. A meta-analysis was performed on the selected outcomes at the available follow-up time points. Subgroup analyses were conducted based on follow-up time, rate of progression and severity of periodontitis, and implant surface characteristics. Publication bias was evaluated using the Funnel plot and Egger's test.

RESULTS

From 13 761 initial records, 14 studies (17 articles) were finally included. Eight studies had a low risk of bias level, and six had a medium risk of bias level. Meta-analysis showed that HP patients had a significantly greater risk for implant loss (HR: 1.75; 95% CI: 1.28-2.40; p = 0.0005; I2 = 0%), MBL (MD: 0.41 mm; 95% CI 0.19, 0.63; p = 0.0002; I2 = 54%), and peri-implantitis (3.24; 95% CI: 1.58-6.64; p = 0.001; I2 = 57%) compared to NHP, whereas no significant intergroup difference for peri-implant mucositis was found. Subgroup analyses revealed a particularly greater risk for implant loss for HP patients over a ≥ 10-year follow-up (HR: 2.02; 95% CI: 1.06-3.85; p = 0.03; I2 = 0%) and for patients with a history of grade C (formerly aggressive) periodontitis (HR: 6.16; 95% CI: 2.53-15.01; p < 0.0001; I2 = 0%). A greater risk for implant loss for stages III-IV (severe) periodontitis, and implants with rough surfaces was also found.

CONCLUSIONS

Within the limits of heterogeneous case definitions and methods of assessment, a history of periodontitis has been proved to significantly increase the risk for implant loss, particularly at long follow-up (≥ 10 years) and in case of rapidly progressive forms (grade C), and for MBL and peri-implantitis.

Multi-Scale Characterization of Conventional and Immediate Dental Implant Systems

We hypothesized that the different post-implantation healing stages between the conventional and immediate implantations produce different amounts and tissue composition of the peri-implant bone. Thus, the objective of the current study was to examine whether the stability of dental implant systems is associated with characteristics of the interfacial bone area at different post-implanation healing periods. Mandibular molars were extracted from each beagle dog. After 10 weeks post-extraction, a screw-type titanium dental implant was placed in the molar location following a conventional dental implant (Con) procedure. Simultaneously, mandibular premolars were extracted and the same type of dental implant was placed in the distal site of the extracted premolar root following an immediate dental implant (Imm) procedure. The implant stability quotient (ISQ) values were not significantly different between Con and Imm groups at 0-, 3-, and 6-weeks post-implantation. However, 3D micro-computed tomography and 2D histological images confirmed that the Imm system had more gaps between the bone and implant than the Con system. On the other hand, the nanoindentation modulus value at the bone-implant interface was significantly higher for the Imm group than the Con group at both 3 weeks and 6 weeks post-implantation. The current results from multi-scale characterization suggest that the higher interfacial bone quality of the Imm system, despite its earlier post-implantation stage, plays a crucial role in maintaining stability comparable to that of the Con system.

[Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery]

The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth and the corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, strategies for preventing and treating canalis sinuosus injuries need to be investigated. Preoperatively, CBCT is used to identify the canalis sinuosus and to virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, assessing bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT is used to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and the physiological functions in the anterior maxilla, and discusses strategies for avoiding canalis sinuosus injuries during implant surgery, thereby enhancing clinical awareness and providing references for clinical decision-making.

Correlation between marginal bone loss around dental implants and various systemic diseases: a cross-sectional study

PURPOSE

Diminished bone levels or the lack of osseointegration can lead to higher rates of failure of dental implants. The present study is aimed to evaluate the correlation between hypertension, diabetes mellitus and hyperlipidemia, on the marginal bone loss (MBL) surrounding dental implants among patients attending the University of Nevada, Las Vegas dental clinics.

METHODS

Clinical notes from patients at the University of Nevada, Las Vegas (UNLV) dental clinics were analyzed using AxiUm™ software. The study included patients with dental implants diagnosed with hypertension, diabetes mellitus, and hyperlipidemia who attended the UNLV School of Dental Medicine clinics from 2012 to 2022. Exclusions were made for patients with acquired immune deficiency syndrome and those with a limited number of radiographs. A search was conducted using keywords such as 'systemic disease,' 'marginal bone loss,' 'dental implant,' 'high cholesterol,' 'hypertension,' and 'diabetes' within the system.

RESULTS

Out of 1,310 potentially eligible patients, 57 fulfilled the inclusion criteria. The total number of evaluated implants was 165. 18% of the sample patients were 55 to 64 years of age, and 79% were 65 or above. 45.6% of patients reported having more than four systemic diseases and 67% of patients had four or more prescription medications. Patients diagnosed with hypertension (78.95%) or hyperlipidemia (73.68%) had the highest presence of marginal bone loss surrounding the dental implant(s) while those with diabetes (40.35%) had the least amount of MBL. Patients diagnosed with both hypertension and hyperlipidemia (29.82%) experienced the highest incidence of MBL around implants. The medications prescribed to combat these health issues, such as statins and antihypertensive, also showed the same trends and corresponded with a higher prevalence of MBL.

CONCLUSIONS

Within the limitations of the present investigation, patients diagnosed with hyperlipidemia and hypertension were more likely to exhibit MBL surrounding dental implants.

Squamous Cell Carcinoma Arising in a Squamous Odontogenic Tumor of the Maxilla: Case Report and Review of the Literature

Squamous odontogenic tumor (SOT) is an exceedingly rare, benign epithelial odontogenic tumor showing squamous differentiation. It is composed of variably sized and shaped islands of cytologically bland, mature squamous epithelium within a fibrous stroma. In this report, we present a rare transformation of a squamous odontogenic tumor (SOT) of the maxilla into a well-differentiated squamous cell carcinoma (SCC) with involvement of the pterygoid plates. To the best of our knowledge, only two cases of malignant transformation of SOT has been reported in the literature. Herein, we seek to report this extremely rare occurrence to raise awareness of oral and maxillofacial surgeons and pathologists of this unusual, but serious event and perform a literature review of squamous odontogenic tumors.

No association between periodontitis extent, severity, and progression rate with dental implant failure

OBJECTIVE

To analyze the relationship between extent, severity, and rate of progression of periodontitis with the implant outcome.

METHODS

Dental records of adult patients who had attended the dental clinics of the universities contributing data to the BigMouth network between 2011 and 2022 seeking implant therapy were evaluated. Patients' records were furthered examined for a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Patients were further categorized based on extent (generalized/localized), severity (stage I, II, III, IV), and rate of progression (grade A, B, C). Information including demographic characteristics, self-reported medical conditions, as well as the number of missing teeth were extracted from patients' electronic health records.

RESULTS

Records of 50,312 dental implants placed in 20,842 patients over a 12-year period were screened. Three hundred twenty-two records of implants were placed in patients with a recorded periodontitis diagnosis based on the 2017 periodontal classification. The mean age of the cohort was 57.53±12.95 years which consisted of 52.2 % males, 74.2 % non-Hispanic, 55.9 % white individuals, 9 % diabetics, 3.4 % tobacco users. The univariate analysis demonstrated that periodontitis extent, severity, and rate of progression were not significantly associated with the treatment outcome. The implant failure rate was estimated to be 5.6 %.

CONCLUSIONS

Within the limitations of this retrospective study that utilized records of dental implants placed in institutions in the United States contributing data to the BigMouth network, the implant failure rate was estimated to be 5.6 %. Periodontitis extent, severity, and rate of progression were not significantly associated with the implant treatment outcome.

Biomechanical evaluation of six zygomatic implants versus four zygomatic implants combined with dental implants in the treatment of different maxillary defects

BACKGROUND

This study aims to compare the biomechanics of six zygomatic implants (ZIs) and dental implants (DIs) combined with four ZIs with different maxilla defects.

METHODS

Three-dimensional constructs of the ZIs, DIs human skulls, and maxillary prostheses were created using SolidWorks Software (Version 2015, Dassault Systems SolidWorks Corporation, Waltham, MA, USA). Eight finite element models of the skull with four different alveolar defect types (0-4) were constructed. Type 0: No defect; Type 1: Bilateral posterior defects; Type 2: Right posterior defect; Type 3: Anterior and left posterior defects; Type 4: Bilateral posterior and anterior defects. In two models with the same defect type (for defect types 0-2), six ZIs or two DIs combined with four ZIs were inserted into the maxilla. Six ZIs were inserted in the maxilla models with defect types 3 and 4. Vertical (150 N) and masseteric (300 N) loads were simulated on the prosthesis. The maximum Von Mises stress in the implants/surrounding bone and bone deformation were evaluated.

RESULTS

The maximum Von Mises stresses in bone/implant were found highest in the defect type 2 model with four ZIs combined with two DIs. The lowest maximum Von Mises stress for bone was detected in the model with defect type 0 and with six ZIs.

CONCLUSION

Among the four types of defects, the posterior unilateral defect caused the highest stress value.

Protein profile at newly restored implants compared to contralateral teeth over 12-months: a pilot study

OBJECTIVES

To determine crevicular fluid alterations in protein expression of newly restored implants during their first year of function and associate them with those of contralateral teeth.

MATERIALS AND METHODS

In ten non-smokers, successfully treated for periodontitis, one newly restored implant (baseline-T0) and one corresponding tooth were followed for 12-months (T1). Oral hygiene was monitored during the study. Periodontal clinical indices and crevicular fluid were collected from an implant-site (PICF) and a tooth-site (GCF). Total proteomic profiles of PICF and GCF were investigated using label-free quantitative proteomics.

RESULTS

Clinical recordings remained stable at 12-months on the tooth-/implant-site basis. The comparative analysis of protein enrichment between teeth and implants at T0 revealed 664 human proteins, with 93 found only in teeth and 217 exclusively in implants. Among the 354 overlapping proteins, 46 were upregulated (log2FC > 1) in teeth, while 61 in implants. At T1, 569 human proteins were exclusively identified, with 67 found only in teeth and 193 exclusively in implants. Of the 309 overlapping proteins, 22 were upregulated in teeth, while 48 were in implants. The over-representation enrichment analysis identified "interferon-alpha response" and "allograft rejection" pathways, as significantly regulated categories at T0, with the latter being over-represented at T1.

CONCLUSIONS

Peri-implant tissue maturation was evident during the study. Proteins expressed in crevicular fluid reflected unique patterns between implants and teeth that are worth studying.

CLINICAL RELEVANCE

Different proteomic patterns were observed at the implant-site compared to the contralateral tooth-site towards inflammatory processes that prevail within otherwise clinically healthy peri-implant tissues.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID: NCT06379022.

Novel Insights into Non-Invasive Diagnostic Techniques for Cardiac Amyloidosis: A Critical Review

Cardiac amyloidosis (CA) is a cardiac storage disease caused by the progressive extracellular deposition of misfolded proteins in the myocardium. Despite the increasing interest in this pathology, it remains an underdiagnosed condition. Non-invasive diagnostic techniques play a central role in the suspicion and detection of CA, also thanks to the continuous scientific and technological advances in these tools. The 12-lead electrocardiography is an inexpensive and reproducible test with a diagnostic accuracy that, in some cases, exceeds that of imaging techniques, as recent studies have shown. Echocardiography is the first-line imaging modality, although none of its parameters are pathognomonic. According to the 2023 ESC Guidelines, a left ventricular wall thickness ≥ 12 mm is mandatory for the suspicion of CA, making this technique crucial. Cardiac magnetic resonance provides high-resolution images associated with tissue characterization. The use of contrast and non-contrast sequences enhances the diagnostic power of this imaging modality. Nuclear imaging techniques, including bone scintigraphy and positron emission tomography, allow the detection of amyloid deposition in the heart, and their role is also central in assessing the prognosis and response to therapy. The role of computed tomography was recently evaluated by several studies, above in population affected by aortic stenosis undergoing transcatheter aortic valve replacement, with promising results. Finally, machine learning and artificial intelligence-derived algorithms are gaining ground in this scenario and provide the basis for future research. Understanding the new insights into non-invasive diagnostic techniques is critical to better diagnose and manage patients with CA and improve their survival.

Palatal root endodontic microsurgery in maxillary molars using the palatal approach: a case study

BACKGROUND

In clinical practice, the buccal approach is typically the primary choice for endodontic microsurgery. Owing to the thickness of the buccal bone plate, the distance between the buccal bone plate and palatal lesion location, and soft tissue traction, the palatal approach may be more suitable for microsurgery for apical periodontitis of the palatal roots of the maxillary molars. However, the length of the palatal root, location of the greater palatine artery (GPA) and foramen (GPF), and surgical field of observation make palatal surgery challenging.

CASE PRESENTATION

With the aid of Cone-beam computed tomography imaging, the palatal approach was successfully applied in nine cases of endodontic microsurgery of the palatal root of a maxillary molar with a periapical lesion in Hangzhou Stomatology Hospital from January to December 2022.

CONCLUSIONS

Complete healing was assessed based on clinical symptoms and radiographic images at the 3- and 24-month follow-up visits in all nine cases. Several tips have been proposed including surgical positioning, incision design, palate flap modification, bone removal, and root-end resection.

Evaluation of the agreement of horizontal and vertical linear measurements obtained from digital models, printed models and direct measurements

INTRODUCTION

The use of arch models is essential in diagnosis and planning in orthodontics. The demand for digital and printed models has increased among professionals.

OBJECTIVE

The aim of the study was to assess the agreement of horizontal and vertical linear measurements obtained from digital models, printed models, and direct measurements.

MATERIALS AND METHODS

Intraoral scans of 30 individuals were obtained. Digital measurements were performed using the STL files. From printed models, the measurements were done using a digital caliper, and the real measurements were done directly to the mouth of respective patients.

RESULTS

The one-sample t test showed no discrepancy between the paired sets of measurements, with the value of 0 (p>0.05). The evaluation of the measurements was done using Bland-Altman analysis in pairs. The three methods showed agreement in horizontal and vertical measurements. Linear regression analyses showed no proportional bias in the data (p>0.05).

CONCLUSION

The horizontal and vertical measurements evaluated showed agreement when measured on digital models, printed models and directly in the individuals' mouths.

Medications Affecting Outcomes and Prognosis of Dental Treatment: Part 1

This article gives valuable insight into the effect of selected groups of medications on dental treatment outcome and prognosis. The review emphasizes the importance of thorough medical history, which may have an impact on the prognosis of dental treatment. We discuss drugs acting on the central nervous system, gastrointestinal tract, respiratory tract, endocrine system, and bone metabolism among others. Other pertinent drugs are discussed elsewhere in this special issue.

Implant survival rate and marginal bone loss of 174 implants with different variables associated over a minimum observational period of 20 years: A retrospective study

PURPOSE

To investigate the long-term implant survival rate and marginal bone loss (MBL) of implants with different variables associated over an observational period of at least 20 years.

MATERIALS AND METHODS

Patients with at least one implant placed prior to 2001 were recalled and visited. Data on implant macro-design, prosthetic aspects, site distribution, and patient-related factors were collected. MBL was evaluated on intraoral X-rays and peri-implant soft tissue parameters were recorded. The patients were asked to fill out a questionnaire to evaluate their satisfaction with the treatment received. Descriptive statistics indicators were estimated. Analysis of variance and analysis of covariance models were used to investigate any differences in the MBL and peri-implant probing depth (PPD) among the variables. A chi-square analysis was performed to investigate any association between different types of prosthetic implant-supported rehabilitations and survival/success outcomes.

RESULTS

Forty-one (41) patients and 174 implants were included with a mean observational period of 23.3 ± 2.8 years. The implant survival and success rates were 96.5% and 83.3% respectively, while 3.5% of early failures were detected. The lowest success rates were observed for implants supporting fixed full-arch rehabilitations (71.05%) and overdenture rehabilitations (86.11%). A mean MBL of 1.81 ± 0.71 mm and a mean PPD of 3.38 ± 1.62 mm were recorded. The interaction between the collected data with MBL and PPD did not reveal any statistically significant differences between the variables (p > 0.05). A statistically significant difference was recorded when analyzing the association between the different types of prosthetic implant-supported rehabilitations and success rates (p = 0.014), with fixed and removable full-arch rehabilitations presenting with lower success rates. Answers to the questionnaire showed a generally high level of satisfaction.

CONCLUSIONS

Within the limits of this retrospective study and based on the results, an implant survival rate higher than 96% was observed after a mean observational period of 23.3 ± 2.8 years. Both the implant survival rate and MBL seemed stable after a mean observational period of 23.3 ± 2.8 years. Implants supporting fixed and removable full-arch rehabilitations seemed to present lower success rates over time. Implant rehabilitation seemed to provide patients with optimal long-term outcomes in terms of functional and psychological aspects.

Five- and 18-Year Outcome of Two Cases with Full-Arch Rehabilitations Ad modum All-on-4 in the Presence of Challenging Conditions

Placing implants in fresh postextraction sites is a borderline rehabilitation procedure. The purpose of this report is to describe the pre-, per-, and postoperative procedures for maintaining long-term stability of two full-arch rehabilitations through the All-on-4 protocol, performed in the presence of challenging conditions. Two patients were referred for full-arch rehabilitation with immediate function, with both patients presenting infection in the jaws: patient 1 with an implant (position #45) inserted in a cystic cavity; patient 2 with one implant (position #24) inserted transsinus after the removal of a cyst on the base of the maxillary sinus and another implant (position #15) inserted with a dehiscence. Both patients received a preoperative dental hygiene appointment, a regenerative surgical protocol, and were enrolled in a postoperative maintenance protocol. After surgery a provisional prosthesis was provided ensuring immediate function, and 6 months after surgery, the final prosthesis was delivered. During the follow-up appointments (final follow-up at 5 and 18 years), the implants were stable, and no infection was observed for both patients. The present case report describes two full-arch rehabilitations in immediate function, supported by dental implants inserted in the presence of challenging conditions that do not represent the norm, rather are highly demanding for the clinical team, warranting caution in the interpretation of the results.

Successful Management of Cherubism Patient With Staged Bone Grafting and Fat Grafting

Cherubism is a rare hereditary dysplasia of the craniofacial skeleton with unpredictable course and controversial management. The authors report a case managed at the onset with limited mandibular resection and primary autogenous bone grafting, as well as staged secondary fat grafting for contour definition. Over 5 years, the patient demonstrated no recurrence of deformity except for mild hypoplasia, which was improved with fat grafting. The advantages of this early treatment were the ability to address the social stigma and anxiety at a young age versus conservative management strategies with minimal comorbidity.

Successful Management of an Emerging Distinct Gingival Lesion With a New Histopathological Identity

Gingival fibroma is a pathological condition that can manifest in pediatric and adult patients, often presenting diagnostic challenges due to shared histopathological characteristics among various lesions. It has been reported as a novel category with distinct histopathological features with new diagnostic criteria. A 40-year-old Saudi female patient with no significant medical history reported a 4×3 cm pedunculated, non-tender, firm, red gingival growth adjacent to the remaining root of tooth number 27 in the maxillary left side. Radiographic assessment yielded remarkable findings. An excisional biopsy was performed, and histopathology analysis confirmed the lesion to be a gingival fibroma. This case marks the first reported instance of gingival fibroma in Saudi Arabia. The recognition of such distinctive histopathological features contributes to improved diagnostic accuracy and highlights the need for vigilance in identifying emerging pathological entities within the gingival overgrowths. The recognition of gingival fibroma as a unique pathological entity is clinically significant, resolving diagnostic challenges in gingival growth cases. Specific diagnostic criteria enable accurate differentiation from similar lesions. The advancement improves patient care and refines the understanding of gingival overgrowth pathogenesis.

The effects of different lighting conditions on the accuracy of intraoral scanning

PURPOSE

This study aimed to investigate the extent to which intraoral scanning are affected by clinical conditions, and whether ambient lighting and different color temperatures have an impact on the accuracy of intraoral scanner, as well as to evaluate scanning time.

MATERIALS AND METHODS

Twelve different environments were created using various ambient lighting conditions (0, 500, 1000 and 1500 lux) and color temperatures (white, blue and yellow). A partially edentulous mandibular model with two implants and a three-unit bridge was scanned under each environment until 10 digital models were obtained, and scanning times were recorded using a virtual stopwatch. A 3D analysis was performed on the obtained digital models, and the data were analyzed using a software. The generalized linear model analysis and Tukey multiple comparison test were used to analyse the data (P < .05).

RESULTS

The effect of lux, color temperature, and scanning times on RMS data was found to be significant (P < .001). The mean RMS value was the highest in the 0 lux group and the lowest in the 500 lux group. Regarding the color temperature, the highest RMS value was in the white color group and the lowest in the yellow color group. Scanning times were similar among the 0, 500 and 1000 lux groups, with a significant increase in the 1500 lux group.

CONCLUSION

Different ambient lighting conditions and color temperatures have significant effect on the accuracy of intraoral scanning.

Deep learning to assess bone quality from panoramic radiographs: the feasibility of clinical application through comparison with an implant surgeon and cone-beam computed tomography

PURPOSE

Bone quality is one of the most important clinical factors for the primary stability and successful osseointegration of dental implants. This preliminary pilot study aimed to evaluate the clinical applicability of deep learning (DL) for assessing bone quality using panoramic (PA) radiographs compared with an implant surgeon's subjective tactile sense and cone-beam computed tomography (CBCT) values.

METHODS

In total, PA images of 2,270 edentulous sites for implant placement were selected, and the corresponding CBCT relative gray value measurements and bone quality classification were performed using 3-dimensional dental image analysis software. Based on the pre-trained and fine-tuned ResNet-50 architecture, the bone quality classification of PA images was classified into 4 levels, from D1 to D4, and Spearman correlation analyses were performed with the implant surgeon's tactile sense and CBCT values.

RESULTS

The classification accuracy of DL was evaluated using a test dataset comprising 454 cropped PA images, and it achieved an area under the receiving characteristic curve of 0.762 (95% confidence interval [CI], 0.714-0.810). Spearman correlation analysis of bone quality showed significant positive correlations with the CBCT classification (r=0.702; 95% CI, 0.651-0.747; P<0.001) and the surgeon's tactile sense (r=0.658; 95% CI, 0.600-0.708, P<0.001) versus the DL classification.

CONCLUSIONS

DL classification using PA images showed a significant and consistent correlation with CBCT classification and the surgeon's tactile sense in classifying the bone quality at the implant placement site. Further research based on high-quality quantitative datasets is essential to increase the reliability and validity of this method for actual clinical applications.

Preloading peri-implant crestal bone loss: A retrospective study of incidence and related factors

BACKGROUND

The aim of this study was to evaluate the incidence of preloading crestal bone loss (PLCBL) and to identify the patient-related and implant-related factors associated with PLCBL.

METHODS

This retrospective cohort examined the dental records of patients who received at least one dental implant. PLCBL was defined as a reduction ⩾0.5 mm and severe PLCBL (primary variable) as a reduction ⩾1.5 mm in mesial and/or distal bone level, measured from the day of implant placement to uncovering or abutment installation/crown delivery. The incidence of PLCBL and patient and implant variables were recorded. Bivariate analysis and binary logistic regression identified factors associated with PLCBL ⩾0.5 mm and ⩾1.5 mm.

RESULTS

A total of 746 dental implants placed in 361 patients from January 2011 to July 2021 was included in the analyses. Of the implants assessed, 24.4% (n = 182) exhibited PLCBL ⩾ 0.5 mm and 10.5% (n = 78) presented severe PLCBL (i.e., ⩾1.5 mm). Males (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.11-3.07), patients with diabetes (OR = 3.33, 95% CI = 1.73-6.42), and those allergic to penicillin (OR = 3.13, 95% CI = 1.57-6.22) were more likely to experience severe PLCBL (p < 0.05). Implants placed in the anterior area (OR = 2.08, 95% CI = 1.16-3.73), with bone-level platform-abutment connection (OR = 4.73, 95% CI = 1.94-11.49) and inserted supracrestally (OR = 3.77, 95% CI = 1.84-7.72), presented a greater risk of developing severe PLCBL (p < 0.05). Implants placed in a previously grafted area presented a lower likelihood of developing severe PLCBL (OR = 0.489, 95% CI = 0.28-0.84).

CONCLUSION

The incidence of PLCBL ⩾ 0.5 mm and ⩾1.5 mm was 24.4% and 10.5%, respectively. Male sex, diabetes, allergy to penicillin, anterior location, bone-level platform-abutment connection, and supracrestal implant placement are potential risk factors for severe PLCBL. A previously grafted area is a potential protective factor.

Systemic Factors Affecting Prognosis of Dental Implants

Clinicians who place and restore implants are always concerned about the success and longevity of the same. There are several local and systemic factors that affect osseointegration and the health of the peri-implant tissues. In this study, we review the systemic factors that can affect implant survival, osseointegration, and long-term success. The study highlights the importance of delineating, and taking into consideration these systemic factors from the planning phase to the restorative phase of dental implants. A thorough medical history, including prescription and over-the-counter medications, is vital, as there may be numerous factors that could directly or indirectly influence the prognosis of dental implants.

Inflammatory Paradental Cyst: A Case Report

Inflammatory paradental cysts (IPC) are frequently under-reported due to insufficient clinical details. Our case report describes a 45-year-old male with a complaint of discomfort in the right lower posterior region. Intra-oral examination revealed a partially erupted, mesioangularly impacted 48 without any dental caries. The radiograph revealed a well-circumscribed radiolucency around the distal root of the impacted mandibular third molar. Histopathology revealed odontogenic epithelium with an inflamed connective tissue wall. It was diagnosed as an IPC correlating the clinical and radiological findings. This case report describes the importance of clinical correlation to diagnose IPC.

Maxillary sinus lift augmentation: A randomized clinical trial with histological data comparing deproteinized bovine bone grafting vs graftless procedure with a 5-12-year follow-up

INTRODUCTION

Different protocols and procedures for sinus lift and implant placement are available, generally involving the use of grafts to increase the tissue volume and/or prevent the Schneiderian membrane from collapsing. Among xenografts, deproteinised bovine bone graft (DBBP) is frequently used in sinus lift procedures. Leaving an ungrafted space following membrane elevation has proven to have a bony regenerative potential as well. This study aimed to compare the clinical and histological features of sinus lift surgery performed with or without biomaterials.

METHODS

Patients with severe maxillary posterior atrophy (residual bone height 2-6 mm and residual crest thickness ≥4 mm), and in need of sinus lift surgery to allow the placement of three implants were enrolled and randomly divided into two groups. They underwent sinus lifts with DBBP (control) or with a graftless technique (test) and immediate placement of two implants (a mesial and distal one). After 6 months, a bone sample was retrieved from the area between the previously inserted fixtures, and a third, central implant was placed. The collected bone samples were analyzed morphologically and histomorphometrically. The patients were provided with prosthetic restorations after 6 months and followed up for 5-12 years.

RESULTS

Ten patients were enrolled in the test and nine in the control group. The 6-month follow-up showed in the control group an average augmentation of 10.31 mm (±2.12), while in the test group it was 8.5 mm (±1.41) and a success rate of 96.3% in the control and 86.7% in the test group (p > 0.05). The histological analysis evidenced the presence of new bone tissue surrounded by immature osteoid matrix in the test group, and a variable number of DBBP particles surrounded by an immature woven bone matrix in the control group.

CONCLUSION

The results of the present trial indicate that, with residual bone height of 2-6 mm and residual crest thickness ≥4 mm, sinus lift surgery with or without biomaterials followed by implant restoration, produces similar clinical and histological outcomes.

Success rate of all-ceramic FPDs depending on the time of restoration between 2011 and 2023

PURPOSE

Studies about success of FPDs (fixed partial dentures) mostly include restorations built by different clinicians. This results in limited comparability of the data. The aim of this study was to evaluate complications of all-ceramic FPDs built by 1 dentist between 2011 to 2023.

MATERIALS AND METHODS

342 all-ceramic FPDs were observed during follow-up care. 48 patients received 262 single crowns, 59 bridges and 21 veneers. Because of the different lengths of the bridges, units were defined as restored or replaced tooth. 465 units performed by the same dentist from Nov 2011 to Nov 2022 were included. Influencing factors "restoration", "construction", "abutment", "localization", "vitality" and "application period" were evaluated using Kaplan-Meier Analysis and Log-Rank Tests.

RESULTS

406 units (87.3 %) showed no complication. 7 correctable chippings (1.5 %) and 10 recementable decementations (2.1 %) occurred. Six decemented units got lost (1.3 %). 21 units failed due to fatal fracture (4.5 %). Crown margin complications, such as secondary caries, occurred in 15 units (3.2 %). Comparing the influencing factors resulted in higher complication rates of veneers (P < .001), of monolithic ceramics (P ≤ .050) and of molar-restorations (P = .047). The application period had no influence on the success and survival rate.

CONCLUSION

Overall, all-ceramic FPDs showed good clinical results. Although less complications were observed with modern restorations, these more often led to complete failure. To generate evidence-based recommendations, further studies are needed to evaluate the mid- and short-term success and survival of current all-ceramic restorations.

An Integrated Pathophysiological and Clinical Perspective of the Synergistic Effects of Obesity, Hypertension, and Hyperlipidemia on Cardiovascular Health: A Systematic Review

This review paper explores the synergistic effects of obesity, hypertension (HTN), and hyperlipidemia on cardiovascular health by integrating pathophysiological and clinical perspectives. Obesity, characterized by excessive body fat, HTN, defined by elevated blood pressure, and hyperlipidemia, indicated by high blood lipid levels, are globally prevalent conditions that significantly increase the risk of cardiovascular diseases (CVDs). The interplay between these conditions exacerbates cardiovascular risk through mechanisms such as chronic inflammation, insulin resistance, endothelial dysfunction, arterial stiffness, and atherogenesis. This review synthesizes epidemiological evidence and highlights the prevalence and co-occurrence of these conditions, with an emphasis on their combined impact on cardiovascular health. The literature search encompassed various databases, and data extraction included key study characteristics and outcomes. The findings underscore the importance of integrated management strategies, involving lifestyle interventions, pharmacological treatments, and regular monitoring, to mitigate the heightened cardiovascular risk posed by these conditions. In addition, the various public health implications are addressed, advocating for community-based interventions and policy changes. Future research directions may include exploring novel therapeutic approaches, personalized medicine strategies, and longitudinal studies to enhance the understanding and management of the synergistic effects of obesity, HTN, and hyperlipidemia on cardiovascular health.

Recurrence and Prognosticators of Recurrence in Odontogenic Keratocyst of the Jaws

Introduction

The incidence of recurrence of OKC varied from 2.5 to 62%. Studies have linked recurrence to treatment methods and also clinical and pathological features. The aim of this study was to evaluate the 5-year recurrence and the factors associated with recurrence in odontogenic keratocysts of the jaws.

Methods

A retrospective review of records was done from the Institute's Medical Records Directory from 2010 to 2021. The following data were obtained of the lesion; age at presentation, gender, site, subsite, radiographic presentation (locularity), radiographic borders, presence or absence of satellite cysts, inflammatory infiltrate, and treatment rendered presence or absence of cortical perforation and soft-tissue extension and presence or absence of recurrence. Kaplan Meir estimator was used to evaluate recurrence rate and log rank test was used to compare the survival amongst groups. Cox regression analysis was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval.

Results

In our study cohort, 27.2% of patients had recurrence. Posterior maxillary lesions, multilocular lesions, lesions with scalloped borders, presence of soft-tissue extension and cortical perforation, presence of satellite cysts and inflammatory infiltrate and enucleation with peripheral ostectomy were significantly associated with recurrence. However, soft-tissue extension, cortical perforation, multilocular lesions and presence of satellite cysts were independent risk factors.

Conclusion

There is still debate on the best treatment modality for the management of OKCs. More studies are required to quantify the results.

Xanthogranulomatous epithelial tumors/keratin-positive giant cell-rich tumors involving the head and neck: report of seven cases and review of the literature

Xanthogranulomatous epithelial tumor (XGET) and HMGA2::NCOR2 fusion keratin-positive giant cell-rich tumor (KPGCT) are recently described morphologically overlapping rare neoplastic entities characterized by HMGA2::NCOR2 fusions, low-grade biological behavior, and a strong predilection for young females. To date, 47 cases have been reported with only four occurring in head and neck anatomic locations. In this study, we describe the clinicopathologic, immunohistochemical, and molecular findings of seven XGET/KPGCTs occurring in the head and neck region. The patients were six females and one male, aged 3.5-59 years old (median, 25 years). The tumors involved the ear, vocal cord, skull, neck soft tissue, and sinonasal cavity. Tumor sizes ranged from 1.5 to 6.7 cm. Histologically, the tumors were characterized by xanthogranulomatous histiocytes, osteoclast-like giant cells, and keratin-positive epithelioid cells. The XGET/KPGCTs involving the ear was remarkable for more cytologic atypia than previously described. Four cases had the HMGA2::NCOR2 fusion identified by NGS and three had HMGA2 gene locus alterations by FISH. Follow-up information was available for 3 of 7 patients (range 6-46 months). The patient with a vocal cord XGET/KPGCTs developed a local recurrence treated with excision. This study illustrates that XGET/KPGCTs involves the head and neck region as well, where it may be unexpected and hence under-recognized, and expands the anatomic locations of involvement to include unreported sites (ear, vocal cord, and sinonasal tract).

Minimally invasive prosthodontics using the concept of prosthetically guided orthodontics

OBJECTIVE

This case report aims to present how digital technology can be employed to plan the orthodontic movement of teeth into their final positions for prosthodontic rehabilitation. An interdisciplinary approach to treatment planning and the result of prosthodontic treatment involves the cooperation of an orthodontist and a prosthodontist. When planned to achieve optimal results for a minimally invasive and functional prosthodontic treatment, orthodontic pretreatment provides superior esthetic results and favorable long-term success.

CLINICAL CONSIDERATIONS

The orthodontic movements of the teeth were planned so that the prosthodontist could reconstruct an optimally functional and esthetic occlusion while preserving the hard dental tissues. The orthodontic pretreatment minimized the need to prepare the teeth, avoiding any mucogingival surgery to improve the gingival architecture.

CONCLUSIONS

In complex clinical cases, it is essential to evaluate the advantages of an orthodontic pretreatment before starting a prosthodontic treatment. This pretreatment can help preserve dental tissues, reduce or eliminate the need for surgical intervention, and achieve long-term stability and esthetic results.

CLINICAL SIGNIFICANCE

This case clearly shows the benefits of orthodontic pretreatment for prosthodontic outcomes. With modern digital tools, such an orthodontic pretreatment should become standard clinical practice when planning a complex clinical case.

In vitro assessment of cementation of CAD/CAM fabricated prostheses over titanium bases. A systematic review

OBJECTIVES

The objective of this study is to investigate the outcomes of clinically relevant laboratory studies regarding the cementation of implant-supported restorations over ti-bases.

MATERIALS AND METHODS

The present study has been conducted according to PRISMA statement. An electronic search was performed, including publications up to March 2024, to identify studies investigating the parameters affecting the cementation between ti-bases and CAD/CAM prostheses. An assessment of the internal validity was performed, using a custom-made risk of bias tool (QUIN).

RESULTS

From the included studies, 40.1% were reported on luting systems, 25% on ti-base surface treatment, 25% on restoration surface, 21.8% on restoration material, and 18.7% on ti-base height. The majority of the included studies were associated with a medium risk of bias. In the absence of micro-retentive features, air-abrasion of ti-bases with a minimum height of 3.5 mm can be beneficial for restoration's retention. The bonding performance can vary not only between different bonding systems but also for different applications within the same system, based on a restoration's material and surface treatment as well as on ti-base height and surface treatment.

CONCLUSIONS

The height of the ti-base seems to be the prevailing factor as it constitutes the prerequisite for other modifications of the bonding surfaces to have an advantageous effect. Since the parameters that can affect bonding performance between ti-base and restoration can interact with each other, it is important for the clinician to focus on verified bonding protocols.

Systemic Factors Affecting Prognosis and Outcomes in Periodontal Disease

This review delves into the effects of autoimmune conditions like rheumatoid arthritis, inflammatory disorders such as irritable bowel syndrome, cardiovascular disease, diabetes, infectious ailments like human immunodeficiency virus, and their medications on periodontal therapy outcomes. It also explores the influence of hormones. Understanding these systemic factors is crucial for optimizing periodontal health and treatment efficacy. The review underscores the necessity of considering these variables in periodontal care. Other vital systemic factors are addressed elsewhere in this special edition.

Exploring Anatomical Variations in the Bony Architecture of the Greater Palatine Canal in Dry Bones

Introduction The greater palatine canal (GPC) holds significant clinical importance due to its role in providing access to the branches of the maxillary division of the trigeminal nerve. Anatomical variations within this posterior maxillary region can complicate the surgical anatomy, making the identification of vital structures challenging. Therefore, a thorough understanding of both normal anatomy and common anatomical variations of the GPC is essential to minimize perioperative complications during surgical procedures. This study aims to investigate the bony architecture of the GPC in dry bones to identify anatomical variations and address significant lacunae in our current understanding of this structure. Despite its impact on the management of various dental and surgical procedures, there remains a limited and sometimes inconsistent knowledge of the normal and variant anatomy of the GPC. Existing literature often lacks comprehensive detail regarding the range of anatomical variations and their implications for surgical approaches. By systematically documenting these variations, this study aims to bridge these gaps in knowledge, justify the need for continued research in this area, and highlight its potential clinical implications. Materials and methods In total, 30 dried and intact adult skull specimens were selected, consisting of 19 males (63.3%) and 11 females (36.7%). The selection criteria included an intact hard palate with fully erupted third molars and an intact lateral nasal wall on both sides. The presence of erupted third molars was used to assess the degree of bone resorption, ensuring that only specimens with minimal bone loss were included. The exclusion criteria ruled out specimens with major craniofacial deformities, excessive bone resorption, and signs of advanced age. The bony walls of the GPC were observed by passing a black wire made of rubber material with a consistent diameter (approximately 5 mm), allowing us to qualitatively assess the bore of the canal. Results In four out of 30 specimens (13.3%), significant variations were noted in the bony medial wall of the GPC. Of these, three specimens were male (75%) and one was female (25%). These variations have been categorized into four distinct types for clarity and analysis. Type 1, in a male specimen, showed a deficiency in the lower segment of the bony medial wall of the left GPC above the greater palatine foramen. Type 2, in a male specimen, had a small bar of bone in the left GPC midway between the foramen and the pterygopalatine fossa. Type 3, in a female specimen, exhibited a small bar of bone above the greater palatine foramen on the right side, with no wall above it. Type 4, in a male specimen, displayed a bar of bone above the greater palatine foramen on the right side, with the medial wall completely absent on the left side. Conclusion The study identified anatomical variations in the bony architecture of the GPC based on dry bone specimens. While these findings offer insights into potential variations that could affect surgical procedures, their clinical implications need validation through patient-based studies. Understanding these variations is crucial for improving preoperative planning and reducing surgical risks, but recommendations should be cautious given the limited sample size. Further research with larger samples and clinical validation is needed to fully understand the embryological basis and potential impact on surgical practice.

The impact of antiplatelet and anticoagulant medications on early implant failure following sinus floor augmentation: A retrospective cohort analysis

INTRODUCTION

The effect of antiplatelet and anticoagulant medications on the outcomes of sinus floor augmentation remains unclear.

METHODS

This retrospective cohort study analyzed data from electronic medical records of consecutive patients undergoing sinus floor augmentation at a single medical center. Patients were categorized into three categories: patients under antiplatelet medications, patients under anticoagulation medications, and healthy individuals. Data collected included tobacco smoking, residual alveolar bone height, timing of implant placement, materials used, vertical bone gain, early implant failure (EIF), and complications such as Schneiderian membrane perforation and postoperative bleeding. Multivariable analysis was performed to assess risk factors for EIF. Statistical significance was considered below 5%.

RESULTS

Among 110 patients with 305 implants, EIF occurred in 10% of patients and 4.65% of implants. No significant difference in postoperative bleeding or EIF was found between study groups. Univariate and multivariable analyses highlighted tobacco smoking (odds ratio [OR] = 7.92), lower residual alveolar ridge height (OR = 0.81), and staged implant placement (OR = 4.64) as significant EIF risk factors in this cohort.

CONCLUSIONS

Anticoagulant and antiplatelet therapies do not significantly elevate the risk of EIF or postoperative bleeding following sinus floor augmentation. Tobacco smoking, residual alveolar ridge height and staged sinus floor augmentation were risk factors for EIF in patients using antiplatelet or anticoagulation medications undergoing sinus floor augmentation.

Odontogenic Myxomas Harbor Recurrent Copy Number Alterations and a Distinct Methylation Signature

Odontogenic myxoma is a rare, benign, and locally aggressive tumor that develops in the tooth-bearing areas of the jaw. The molecular mechanisms underlying odontogenic myxomas are unknown and no diagnostic markers are available to date. The aim of this study was to analyze DNA methylation and copy number variations in odontogenic myxomas to identify new molecular signatures for diagnostic decision-making. We collected a cohort of 16 odontogenic myxomas from 2006 to 2021 located in the mandible (n = 10) and maxilla (n = 6) with available formalin-fixed paraffin-embedded or fresh frozen tumor tissue from a biopsy or resection material. Genome-wide DNA methylation and copy number variation data were generated from 12 odontogenic myxomas using the Illumina Infinium Methylation EPIC array, interrogating >850,000 CpG sites. Unsupervised clustering and dimensionality reduction (Uniform Manifold Approximation and Projection) revealed that odontogenic myxomas formed a distinct DNA methylation class. Copy number profiling showed recurrent whole-chromosome gains (trisomies) of chromosomes 5, 8, and 20 in all cases, and of chromosomes 10, 12, and 17 in all except one case. In conclusion, odontogenic myxomas harbor recurrent copy number patterns and a distinct DNA methylation profile, which can be used as an additional diagnostic tool in the appropriate clinical and radiologic context. Further research is needed to explain the genetic mechanisms caused by these alterations that drive these locally aggressive neoplasms.

BSP Implementation of prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline

OBJECTIVES

to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients.

SOURCES

This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri‑implant diseases and conditions [2].

METHODOLOGY

The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly.

RESULTS AND CONCLUSION

Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public.

CLINICAL SIGNIFICANCE

The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri‑implant diseases.

Assessment of bone density in edentulous maxillae using cone beam computed tomography (CBCT)

INTRODUCTION

In edentulous maxillae, the anterior maxilla is the region of interest for implant placement due to posterior bone resorption and sinus pneumatization. This study aimed to assess variations in bone density in different regions of the edentulous maxilla according to sex and age, using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

69 CBCT from edentulous maxilla were analyzed. Six virtual implants were planned between the maxillary sinuses at incisor, canine, and premolar sites. Bone densities (in Hounsfield units HU) were recorded at six points on the neck, body, and apex of the buccal and lingual areas of each virtual implant. We used the two-sample t-test to compare male and female bone densities, and the Spearman correlation coefficient to analyze the correlation between mean bone density and age. One-way analysis of variance with post hoc pairwise t-tests was used to analyze the differences in density between three sites of the edentulous maxilla and the differences in density between three parts of the implant. The significance level was set at 5%.

RESULTS

Mean bone density in males was significantly higher than in females. There was a significant correlation between mean bone density and age in females. Incisor sites showed the highest mean bone density, followed by canine and premolar sites. There was a significant decline in bone density from the neck to the apex.

CONCLUSIONS

Bone density varied within and among edentulous maxillae. Bone density of the edentulous maxilla seemed to be influenced by age in women and by sex.

Risk Factors for Implant Failure Following Transcrestal Sinus-Floor Elevation: A Case Report and Literature Review

Although transcrestal sinus floor elevation (TSFE) is widely used for cases of insufficient residual bone height in the posterior maxilla, few studies focus on the risk factors of early implant failure associated with TSFE procedures. This study aimed to identify and summarize the possible risk factors of implant failure associated with TSFE to ensure a more predictable implant survival rate using TSFE. We report the treatment of a patient with implant failure following TSFE and discuss this case's possible associated risk factors. A standard implant with a diameter of 4.8 mm and length of 10 mm was used after the TSFE procedure. Implant loosening was suddenly observed 6 weeks after the initial surgery. Factors that could result in early implant failure included patient-related risk factors, anatomical factors of the operational area, and operation- and implant-related factors. Within the current study's limitations, the graft material particles between the implant surface and socket could be considered a direct risk factor resulting in implant failure. Therefore, more attention should be paid to socket cleaning during the TSFE procedure, and loose particulate grafting materials should be discouraged. Another significant consideration for implant loss is the possibility of fractures in the buccal or palatal cortical plates during the site preparation and implant insertion. Thus, these factors should be studied further and receive more clinical attention.

Solitary ameloblastic fibroma with impacted teeth: A case report

This case report aimed to describe a rare benign mandibular tumour and assess the outcomes of the most recent reviews, between January 2017 and August 2023. Presenting a detailed clinical case, this study advances our understanding of the diagnostic and therapeutic aspects, ultimately improving the management of similar cases in clinical practice. Orthopantomogram (OPG) revealed a well-defined unilocular radiolucency extending from the midline of the ramus and teeth 47 and 48 were submerged at the base of the mandible. In the presented case, a PLANMECA ROMEXIS PROMAX® three-dimensional (3D) maximum (MAX) cone-beam computed tomography (CBCT) device was used for the 3D examination. An intraoral approach was preferred and the tumour was removed in toto by creating a bone window using a W&H® Dentalwerk Bürmoos GmbH Piezomed piezoelectric device, and the bone plates were fixed with 4 MEDARTIS® microplates, with a primary flap closure. A PANORAMIC 1000, 3DHISTECH Ltd® device was employed for the histological investigation. Odontogenic tumours are rare and typically asymptomatic, often discovered incidentally during routine radiographic examinations. Most of these benign lesions heal well after complete excision and require long-term follow-up. Once diagnosed, ameloblastic fibroma (AF) should be treated immediately to avoid malignant transformation.

Beyond bone volume: Understanding tissue-level quality in healing of maxillary vs. femoral defects

Currently, principles of tissue engineering and implantology are uniformly applied to all bone sites, disregarding inherent differences in collagen, mineral composition, and healing rates between craniofacial and long bones. These differences could potentially influence bone quality during the healing process. Evaluating bone quality during healing is crucial for understanding local mechanical properties in regeneration and implant osseointegration. However, site-specific changes in bone quality during healing remain poorly understood. In this study, we assessed newly formed bone quality in sub-critical defects in the maxilla and femur, while impairing collagen cross-linking using β-aminopropionitrile (BAPN). Our findings revealed that femoral healing bone exhibited a 73 % increase in bone volume but showed significantly greater viscoelastic and collagen changes compared to surrounding bone, leading to increased deformation during long-term loading and poorer bone quality in early healing. In contrast, the healing maxilla maintained equivalent hardness and viscoelastic constants compared to surrounding bone, with minimal new bone formation and consistent bone quality. However, BAPN-impaired collagen cross-linking induced viscoelastic changes in the healing maxilla, with no further changes observed in the femur. These results challenge the conventional belief that increased bone volume correlates with enhanced tissue-level bone quality, providing crucial insights for tissue engineering and site-specific implant strategies. The observed differences in bone quality between sites underscore the need for a nuanced approach in assessing the success of regeneration and implant designs and emphasize the importance of exploring site-specific tissue engineering interventions. STATEMENT OF SIGNIFICANCE: Accurate measurement of bone quality is crucial for tissue engineering and implant therapies. Bone quality varies between craniofacial and long bones, yet it's often overlooked in the healing process. Our study is the first to comprehensively analyze bone quality during healing in both the maxilla and femur. Surprisingly, despite significant volume increase, femur healing bone had poorer quality compared to the surrounding bone. Conversely, maxilla healing bone maintained consistent quality despite minimal bone formation. Impaired collagen diminished maxillary healing bone quality, but had no further effect on femur bone quality. These findings challenge the notion that more bone volume equals better quality, offering insights for improving tissue engineering and implant strategies for different bone sites.

Bilateral Primordial Odontogenic Tumour of Mandible: A Rare Case Report

Primordial odontogenic tumour is a recently categorised rare benign mixed epithelial and mesenchymal odontogenic tumour which occurs most frequently in first two decades of life. It is composed of cellular myxoid connective tissue lined by cuboidal to columnar odontogenic epithelium resembling inner enamel epithelium in early stages of tooth development. Here, we are presenting a unique case of bilateral primordial odontogenic tumour of mandible in a paediatric patient.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-023-02075-3.

The quality of reporting in randomized controlled trials investigating exercise for individuals with whiplash-associated disorders; a systematic review

BACKGROUND

Whiplash-associated disorders are a common sequela of road traffic accidents. Exercise therapy is considered an effective intervention, and it is recommended for the management of such condition. However, the application of research findings to everyday clinical practice is dependent on sufficient details being reported.

OBJECTIVES

To explore the quality of reporting in studies investigating the effectiveness of exercise for whiplash-associated disorders.

METHODS

A literature search was conducted to identify studies testing the effectiveness of exercise for whiplash-associated disorders. Two reporting checklists were used to evaluate reporting completeness. The median positive scores for each study and overall percentage of positive scores for each item were calculated. Percentage agreement and the Cohen's Kappa coefficient were calculated.

RESULTS

Twenty-one studies were included. According to the Template for Intervention Description and Replication checklist, items were reported appropriately with a median of 29% (range 0-95%, IQR 40.5). The median number of adequately reported items per study was 5 (range 1-10, IQR 3). For the Consensus on Exercise Reporting Template checklist, items were reported appropriately with a median of 29% (range 0-57%, IQR 29). The median number of adequately reported items per study was 4 (range 0-16, IQR 8). Percentage agreement ranged from 57% to 100% while Cohen's Kappa from -0.17 to 1.00.

CONCLUSIONS

The study reveals significant gaps in the quality of reporting in studies investigating exercise for whiplash-associated disorders as both checklists showed a median reporting adequacy of only 29%. Overall, the inter-rater agreement for both checklists was acceptable.

Positions of the Mandibular Foramen and Canal in Different Skeletal Classes and Implications for Bilateral Sagittal Split Osteotomy

Objectives

To evaluate the positions of the mandibular foramen (MF) and mandibular canal (MC) between different skeletal classes to highlight the implications for bilateral sagittal split osteotomy (BSSO).

Methods

A cross-sectional study was performed using cone-beam computed tomography on 90 patients classified into classes I, II and III. Linear measurements were performed on multiplanar reconstructions as follows: from the MF to the edge of the mandibular ramus (1), to the mandibular notch (2), to the ramus width (3) and to the occlusal plane (4); and from the MC to the alveolar crest (A), to the lower border of the mandible (B) and to the mandibular buccal cortical bone (C). Mandibular thickness (D), width (E) and height (F) of the MC were measured. Intra-class correlation coefficient (ICC) checked the reliability. Two-way ANOVA and Tukey's test were used to compare measurements and classes.

Results

Linear measurements 2 presented a statistically significant difference between classes I and II. There was no statistically significant difference between the classes and measurements B, C, D, E and F. Linear measurements A were shorter in class III than in class II.

Conclusions

Although most measurements suggest that the BSSO technique does not need to be modified for each skeletal class, measurements from the MF to the mandibular notch in class II and from the MC to the alveolar crest on distal of the second molars in class III could help surgeons to recognize critical regions.

Can Galanin Be Used as a Marker of Microvascular Dysfunction in Prehypertensives?

Objectives

Coronary microvascular dysfunction is present in large percentage of the population, and it has been shown to have a pathological and prognostic role in many conditions. Therefore, early detection of microvascular dysfunction is important, especially in selected populations. The aim of this study was to investigate the association of galanin with coronary flow reserve (CFR) in prehypertensive individuals to determine whether it can be used as a marker to detect microvascular dysfunction.

Methods

A total of 100 participants, 50 prehypertensive and 50 normotensive were included in this prospective study. Serum galanin levels were measured and CFR was calculated by detailed transthoracic echocardiography.

Results

CFR was significantly lower in the prehypertensive group (p<0.001). Also, galanin values were numerically lower in the prehypertensive group, but the difference between the groups did not reach statistical significance (p=0.062). There was no significant correlation between CFR and galanin (r=-0.161, p=0.11).

Conclusion

Lower CFR values in prehypertensives suggest that microvascular dysfunction starts above normotensive values even if hypertension does not develop. The reason why low galanin levels were not statistically significant in prehypertensives and no correlation was found between galanin and CFR may be due to the small study population. Relationship between galanin, prehypertension and microvascular dysfunction will become clearer if large-scale population studies are carried out.

The Effects of Smoking on Dental Implant Failure: A Current Literature Update

Background: This systematic review assesses the current literature (2020-2024) evaluating the impact of smoking on dental implant failure rates. Methods: A non-funded Pubmed database review was conducted according to PRISMA guidelines, and the results were tabulated to extract the study design, patient characteristics, follow-up time, comparison, outcome, and strengths and weaknesses, including risk of bias. This review included 33 studies with 29,519 implants placed in over 18,301 patients. We included prospective and retrospective clinical studies, randomized and non-randomized controlled trials, cohort studies, and observational studies that examined smoking's effects on implant failure rates. Studies had to classify individuals into two groups, smokers and non-smokers, with at least ten implants. Exclusions included reviews, case reports, experimental studies, guidelines, non-English publications, studies lacking comparative data on failure rates, those excluding smokers, and studies focusing on head and neck cancer patients or specialized implants. Results: Our findings indicate a significant correlation in 25 out of 33 studies between smoking and increased implant failure rates, affecting both early and late stages of implant integration and survival as well as revealing a dose-response relationship, with higher daily cigarette consumption significantly increasing the risk of implant failure. Conclusions: This review highlights the importance of smoking cessation efforts, patient education, and tailored patient care in dental implantology. Future research should explore the effects of smoking frequency and alternative tobacco products, such as e-cigarettes, aiming to improve success rates among smokers.

Peripheral calcifying odontogenic cyst in maxillary anterior gingiva: A case report

BACKGROUND

Calcifying odontogenic cysts (Gorlin cysts) most commonly present centrally and have only rarely been reported in peripheral locations. The purpose of this report is to describe a new case of peripheral calcifying odontogenic cyst (PCOC) occurring in the anterior maxillary gingiva and to review the management and differential diagnosis of such a lesion.

METHODS

A 37-year-old female presented with a long-standing submucosal nodule on the gingiva between the maxillary central incisors, with asymptomatic growth over the last three years. Following an initial incisional biopsy, a diagnosis of PCOC was established. To exclude the possibility of a central process, a corresponding small field of view cone beam CT scan was obtained and the patient returned for a 6 mm excisional biopsy to the depth of the periosteum.

RESULTS

Results of these additional assessments supported the original diagnosis of PCOC. Following uneventful healing of the second biopsy, no recurrence or other clinical findings were noted at 1-year follow-up.

CONCLUSION

While rare, the peripheral variant of calcifying odontogenic cyst, and other peripheral counterparts to recognized central cysts and tumors, should be considered in a differential diagnosis for a benign gingival nodule. Gingival tissue should be submitted for histologic evaluation to ensure a neoplastic process is not present.

KEY POINTS

Various lesions may present on the gingiva as a "bump"; these can represent common clinical entities, such as pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma, and fibroma, or more rare conditions that may not be adequately considered in the differential diagnosis. A rarely documented case of peripheral calcifying odontogenic cyst (PCOC; Gorlin cyst) on the maxillary anterior gingiva of an adult female is reported here and compared with the few other similar PCOC cases in the literature. A biopsy of gingival lesions is always necessary to establish the correct diagnosis and provide the appropriate treatment.

PLAIN LANGUAGE SUMMARY

Several different lesions can appear on the gingiva (gums). Some are quite common, and some are rare. This report documents the occurrence of a new case of calcifying odontogenic cyst (Gorlin cyst), a type of cyst that has been rarely found outside the jawbone, presenting as a "bump" on the gingiva between the maxillary central incisor teeth of an adult female. Because of the patient history, a peripheral calcifying odontogenic cyst (PCOC) was not initially suspected. Following a biopsy, a PCOC diagnosis was given. The possibility of a lesion within the bone was then excluded by an X-ray (cone beam CT) scan examination. A second, more extensive biopsy confirmed the diagnosis and the removal of the lesion. The patient had no complications or recurrence for the following 12 months. This case highlights the need to always biopsy lesions presenting on the gums to obtain a proper diagnosis and provide the correct treatment.

Comparative evaluation of salivary melatonin levels in patients with bruxism: a case-control study

Aim: To examine whether there is any difference in the levels of salivary melatonin between bruxism and nonbruxism groups and to compare the stress and anxiety levels between the two groups.Materials & methods: Patients meeting the probable bruxism criteria according to the International Consensus on the Assessment of Bruxism Criteria were included in the bruxism group. The salivary melatonin concentrations of both groups were measured using an ELISA kit. To determine the relationship between stress and bruxism, the State-Trait Anxiety Inventory (STAI) test was used.Results: The bruxism group had a significantly lower night-time salivary melatonin level than the control group (p < 0.05). No significant difference was determined between the bruxism group and the control group in respect of the STAI-T scores (p > 0.05).Conclusion: The study findings revealed a strong relationship between a low melatonin level and bruxism.

Investigation of Phase Transformation and Fracture Pattern as a Result of Long-Term Chewing Simulation and Static Loading of Reduced-Diameter Zirconia Implants

While zirconia implants exhibit osseointegration comparable to that of titanium, concerns arise regarding low-temperature degradation and its potential impact on fracture strength. This study investigated the phase transformation and fracture characteristics of zirconia dental implants after aging through chewing simulation and subsequent static loading. The experimental setup involved 48 one-piece monobloc zirconia implants with diameters of 3.0 mm and 3.7 mm that had straight or angled abutments, with crown restorations, which were divided into six groups based on intraoral regions. The specimens underwent chewing simulation equal to five years of oral service, which was followed by static loading. Statistical analyses were performed for the data obtained from the tests. After dynamic and static loadings, the fractured samples were investigated by Raman spectroscopy to analyze the phase composition and micro-CT to evaluate fracture surfaces and volume changes. According to the results, narrow-diameter zirconia implants have low mechanical durability. The fracture levels, fracture patterns, total porosity, and implant fracture volume values varied according to the implant diameter and phase transformation grade. It was concluded that phase transformation initially guides the propagation of microcracks in zirconia implants, enhancing fracture toughness up to a specific threshold; however, beyond that point, it leads to destructive consequences.

Assessment of different treatment alternatives for patients with total maxillectomy

PURPOSE

To assess the biomechanical advantages of combining zygoma and partial subperiosteal implants for maxillary reconstruction in severely atrophic maxillae, offering potential solutions to the challenges posed by traditional reconstruction methods.

MATERIAL AND METHODS

A finite element analysis used a craniofacial model simulating a totally resected maxilla. Four treatment scenarios (SCs) were evaluated: SC-1, the quad zygoma approach; SC-2, two zygoma implants (ZIs) and a one-piece subperiosteal implant (SI); SC-3, two ZI and a two-piece SI; and SC-4, four ZI and a one-piece SI. Stress distributions on bone, implants, abutments, and metal frameworks were compared under occlusal forces.

RESULTS

For the simulated bone regions under vertical and oblique forces, SC-4 values were higher than SC-1, while SC-2 and SC-3 values were comparable for pmax and pmin. In addition, SC-2 and SC-3 values were lower than those of SC-1 and SC-4. The most balanced von Mises stress values on the ZIsand were observed in SC-3 under vertical and oblique forces. Furthermore, lower von Mises stress values on the abutments were seen in SC-3 under oblique and vertical forces. Although the lower von Mises stress values on the metal frameworks at the lateral incisor and first premolar side were seen in SC-3, lower von Mises values were observed in SC-4 in the first molar region.

CONCLUSIONS

Overall, this study suggests that combining zygoma and partial subperiosteal implants may be a promising approach for reconstructing severely atrophic maxillae. These implants may offer improved biomechanical properties compared to ZIs alone.