The profile of chronic hyperplastic candidiasis: a clinico-pathological study

The aims of this study were investigation of clinical presentation, systemic factors, and long-term malignant transformation rate in chronic hyperplastic candidiasis versus leukoplakia. This is a retrospective case-controlled study of cases with chronic hyperplastic candidiasis and leukoplakia without dysplasia, diagnosed between 2000 and 2013. A database was created, and all additional biopsies from the same cases were searched up to 2022, for records of oral malignant transformation. Associations between microscopic diagnoses and clinical features of lesions and clinical outcomes of patients were performed. A study database included 116 patients, allocated to the group diagnosed with chronic hyperplastic candidiasis (CHC-group, 62) and to the group of leukoplakia without dysplasia (LKP-group, 54). Tongue and buccal mucosa were most frequently recorded in both groups. In CHC-group, significantly fewer cases presented as white lesions compared to LKP-group (P < 0.001); more were ulcerated or exophytic (P = 0.006 and P = 0.003, respectively). History of head and neck malignancy was significantly more frequent in CHC-group (P = 0.005), as were chemotherapy, (P = 0.019) radiotherapy (P = 0.0265), and immune-related conditions (P = 0.03). Within the follow-up period (2000-2022), in CHC-group, two cases (3.2%) had malignant transformation at the site of original biopsy, one was recurrence of previous carcinoma. In LKP-group, two cases (3.7%) had newly diagnosed carcinoma and one at the site of original biopsy; no significant differences were found between groups. In conclusion, medical background of immune-related conditions, head and neck malignancy, radiotherapy, and chemotherapy may play a role in predisposing for chronic hyperplastic candidiasis. Malignant transformation rate within CHC-group was low, and similar to that within LKP-group, representing a lower transformation rate than expected.

Towards Genetic Dissection of Skeletal Class III Malocclusion: A Review of Genetic Variations Underlying the Phenotype in Humans and Future Directions

INTRODUCTION

Skeletal abnormalities and malocclusions have varied features that impact populations globally, impairing aesthetics and lowering life quality. The prevalence of the Skeletal Class III disease is the lowest among all angle malocclusions, with varied prevalence across nations. Environmental, genetic, and societal factors play a role in its numerous etiologies. In this study, we conducted a thorough search across the published data relating to quantitative trait loci (QTL) and the genes associated with Class III progression in humans, discussed these findings and their limitations, and proposed future directions and strategies for studying this phenotype.

METHODS

An inclusive search of published papers in the PubMed and Google Scholar search engines using the following terms: 1. Human skeletal Class III; 2. Genetics of Human skeletal Class III; 3. QTL mapping and gene associated with human skeletal Class III; 4. enriched skeletal Class-III-malocclusion-associated pathways.

RESULTS

Our search has found 53 genes linked with skeletal Class III malocclusion reported in humans, genes associated with epigenetics and phenomena, and the top 20 enriched pathways associated with skeletal Class III malocclusion.

CONCLUSIONS

The human investigations yielded some contentious conclusions. We conducted a genome-wide association study (GWAS), an epigenetics-wide association study (EWAS), RNA-seq analysis, integrating GWAS and expression quantitative trait loci (eQTL), micro- and small-RNA, and long non-coding RNA analysis in tissues connected to skeletal Class III malocclusion phenotype in tissues connected with the skeletal phenotype. Finally, we invite regional, national, and international orthodontists and surgeons to join this effort by contributing human samples with skeletal Class III malocclusion following the accepted Helsinki ethical protocol to challenge these phenomena jointly.

The Use of Cancellous Block Allografts for Reconstruction and Following Implant Failure Associated with Severe Bone Loss: A Prospective Survival and Histomorphometric Study

A failed implant site is prone to reduced alveolar bone volume, both horizontally and vertically. The present study assessed the outcome of using cancellous bone block allografts for ridge reconstruction following the removal of failed implants associated with severe bone loss. Individuals presenting with failed implants and massive bone loss were included. Cancellous bone block allografts were used for reconstruction of the atrophic alveolar ridge. Radiographic evaluation at 6 months postgrafting revealed favorable bone healing, allowing implant placement. Bone biopsy samples were taken during implant placement. Twenty-four blocks and 58 implants were placed in 16 patients. Over a mean follow-up time of 40 ± 15 months, the mean bone gain was 5 ± 0.5 mm horizontally and 7 ± 0.5 mm vertically. Block and implant survival rates were 96% (1 block failed) and 95% (3 implants failed), respectively. Histomorphometrically, the mean percentage of newly formed bone was 40%, with 20% residual cancellous block allograft and 40% marrow and connective tissue. Cancellous bone block allograft is a viable treatment alternative for reconstructing the alveolar ridge to achieve a successful second reimplantation, even in the presence of initial severe bone loss.

Anatomical Features of the Parotid Duct in Sialography as an Aid to Endoscopy—A Retrospective Study

Sialography is used for diagnosis of obstructive salivary gland diseases and prior to sialendoscopy. Three-dimensional cone beam computerized tomography (CBCT) sialography allows imaging and measurement of salivary duct structures. Salivary gland endoscopy has a long learning curve. The aim of this retrospective study is to create an anatomical quantitative guide of different distances and angles significant for endoscopy. Twenty-six CBCT sialographies of healthy parotid ducts were included. Outcome parameters included diameters, distances, angles and number of minor tributaries. Results show the average distance from the papilla to the curvature of the gland was 41.5 mm (Q1 36.97 mm–Q3 45.32 mm), with an angle of 126.9° (Q1 107.58°–Q3 135.6°) of the curvature and a distance of 35.25 mm (±7.81 mm) between the curvature and the hilus. The mean width of the duct was 0.8 mm (Q1 0.7 mm–Q3 1.15 mm) at its narrowest and 2 mm (Q1 1.4 mm–Q3 2.2 mm) at its widest. This is the first anatomical quantitative study of the parotid duct in relation to sialendoscopy.

Trends in the Incidence and Severity of Injuries Sustained by Riders of Electric Bikes and Powered Scooters: A Retrospective Cross-Sectional Study

Background and Objectives: The worldwide increase in electric bike (E-bike) and powered scooter (P-scooter) use in recent years has been accompanied by an increase in associated injuries to riders. The aim of this study was to evaluate trends in the incidence and types of E-bikes and P-scooter-related injuries in riders evacuated to a tertiary ED. Materials and Methods: A retrospective cross-sectional design was used. The cohort included 1234 patients referred to the emergency department (ED) of a tertiary medical center in 2014–2020 for injuries sustained while riding an E-bike or P-scooter. Demographic, clinical, and injury data were collected from the medical files, and injury rates were evaluated over time. Results: The results showed that the annual number of ED visits by injured E-bike and P-scooter riders increased steadily over the study period concomitant with an increase in ED referrals for hospitalization, indicating severe injury. The upper and lower extremities were the most frequent anatomic sites of injury in every year of the study, with variations among the different age groups. Conclusions: Our findings suggest a need for safety regulations for riders who operate two-wheel powered vehicles, such as licensing requirements and mandatory protective gear, especially for anatomic sites most at risk.

Impact of Comorbidities on Hospitalization for Injuries in Riders of Electric Bikes and Powered Scooters: A Retrospective Cross-Sectional Study

Background and Objectives: Injuries associated with electric bikes (E-bikes) and powered scooters (P-scooters) have increased yearly worldwide. We aimed to evaluate the impact of pre-existing comorbidities on the probability of hospitalization for injuries in riders of E-bikes and P-scooters. Materials and Methods: A retrospective cross-sectional study design was used. The cohort included patients referred to the emergency department (ED) of a tertiary medical center in 2014–2020 for injuries sustained while riding an E-bike or P-scooter. Data were collected from the medical files on demographics, clinical characteristics including pre-existing comorbidities and permanent use of medications, and injury characteristics. Findings were compared between patients referred for hospitalization from the ED and patients discharged home. Results: Of the 1234 patients who met the inclusion criteria, 202 (16.4%) had a prior medical condition and 167 (13.5%) were taking medication on a permanent basis. A significant relationship was found between hospitalization and having a medical condition (𝜒²(1) = 9.20, p = 0.002) or taking medication on a permanent basis (𝜒²(1) = 6.24, p = 0.01). Hospitalization for injuries was more likely in patients with a comorbidity (27.8%) than those without a comorbidity (15.5%), and in patients who were on permanent drug therapy (22.2%) than in patients who were not (12.9%). Surprisingly, anticoagulant intake specifically had no effect on the probability of hospital admission. Conclusions: Patients with comorbidities have a higher incidence of hospitalization for E-bike- and P-scooter-associated injuries. Therefore, physicians may take into account comorbidities for the effective management of this patient group’s injuries.

The Use of Bone Block Allografts for Vertical Augmentation of the Extremely Atrophic Mandible

PURPOSE

Treatment alternatives based on implant-supported prostheses (ISPs) may be almost impossible in cases with extremely atrophic mandibles. Vertical bone augmentation is then the only possibility to achieve an ISP.

MATERIALS AND METHODS

The consequences of vertical augmentation in extremely atrophic mandibles (≤ 10-mm bone height) of edentulous patients using allogeneic block grafts via a submental approach were assessed. The recorded parameters were sex, age, physical status, hospitalization duration, postoperative complications, implant characteristics (length, diameter), early and late implant failure (yes/no; primary outcome variable). Bone height was measured at three points using the pre-grafting and pre-implant placement CBCT imaging. The difference between the measurements was defined as bone gain (primary outcome variable).

RESULTS

Sixteen patients (2 men, 14 women) were included. The preoperative bone height ranged from 4 to 10 mm. A mean of 5.3 ± 1 months was allowed for graft consolidation. The average bone height gain was 11.2 ± 3.1 mm. Two to six dental implants were placed in the grafted bone. Early implant failure occurred in 4 out of 73 (5.5%). Follow-up ranged from 12 to 92 (mean: 48 ± 30) months. All patients were followed for more than a year, and two additional late implant failures were recorded, rendering a 92% cumulative survival rate.

CONCLUSION

Bone grafting using allogeneic bone blocks via a submental approach seems to be a promising solution for reconstruction of the extremely atrophic mandible.

Esthetic Assessment Succeeding Anterior Atrophic Maxilla Augmentation with Cancellous Bone-Block Allograft and Late Restoration Loading

Background: Various conditions may lead to bony deficiency in the anterior maxilla. The present study evaluated esthetic (PES—pink esthetic score and WES—white esthetic score) results after augmentation of the anterior atrophic maxilla using cancellous bone-block allograft followed by implant placement and late (conventional) loading. Methods: Cohort study that included 33 patients with missing teeth in the upper anterior region characterized by extensive bone loss. Allogeneic cancellous bone-blocks were used for augmentation. Six months later, a dental implant was inserted. After a waiting time of an additional six-months, implant exposure and reconstruction were performed. The mean follow-up period was 62.93 ± 17.37 months (range 19–82 months). Results: The mean value of PES/WES was 17.8 ± 2.78. All patients had a PES/WES value above 12 (threshold value defined as clinically acceptable esthetics). The mean value of PES was 9.0 ± 1.79 and the mean value of WES was 8.8 ±1.84. Conclusions: Bone augmentation of the anterior atrophic maxilla using cancellous block-allograft and late loading supports achievement of a predictable esthetic result with long-term stability of soft and hard tissues around implant-supported reconstructions.

Sinus Augmentation-Expect the Unexpected: Diagnostic Anatomical Study

“Big-nose variant” is an anatomical phenomenon defined as the pneumatization of inferior third of the nasal cavity within the alveolar ridge while simultaneously displacing the maxillary sinus laterally. The purpose of the present study was to assess the prevalence of the big-nose variant phenomenon and suggest a morphology classification system. Diagnostic anatomical evaluation was performed in a tertiary medical center on 321 randomly selected maxillary cone beam computerized tomography scans of patients who presented at an oral and maxillofacial department. Two anatomical categories were defined for anatomical identification: classes for horizontal mesiodistal distribution, and divisions for vertical distribution. Class 2, defined as location of the nasal/sinus border between the distal edge of the canine up to the distal edge of second premolar, was found to be the most prevalent (64.6%). Class 3, defined as location of the nasal/sinus border distal to mesial edge of the first molar, was found in 17.9% of cases. Regarding the divisions category, in 96% and 58.2% of teeth examined, nasal cavity alone was found to be superior to the canine and first premolar, respectively, defined as Division A. In 46.9% and 85.6% of teeth examined, maxillary sinus alone was located above the second premolar and first molar, respectively, defined as Division C. Identifying Class 3 on the paraxial reconstruction is the first step in identifying big-nose variant, with further assurance gained from each determining division. The use of the classes and divisions may enable better maxillary treatment planning, alert surgeons for the unexpected, and avoid complications.

The Development of Large Radicular Cysts in Endodontically Versus Non-Endodontically Treated Maxillary Teeth

Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect of previous root canal treatment on the clinical presentation of large maxillary radicular cysts. Materials and Methods: All cases of radicular cysts treated at the Oral and Maxillofacial Surgery Department of a tertiary public hospital over a period of six years (2012–2018) were evaluated. Histologically confirmed radicular cysts of the maxilla with a maximal dimension of over 15 mm were included. Demographic data of the patients, clinical presentation and radiographic features of the lesions were analyzed. Results: A total of 211 inflammatory cysts were treated in the study period, of these 54 histologically diagnosed radicular cysts in the maxilla were found to have a maximal dimension of over 15 mm. The mean age of patients with large maxillary radicular cysts was 43.3 years, 57.6% of which were male and 42.4% female. The lateral incisor was the most common tooth affected (46.3%). The mean size of the large radicular cysts was 25 mm. Then, 83.8% of the cysts were observed in teeth with previous endodontic treatment. Teeth without endodontic treatment presented clinically with significantly fewer acute symptoms in comparison to teeth with previous endodontic treatment. Conclusions: the vast majority (83.8%) of large maxillary radicular cysts were associated with endodontically treated teeth. Previous endodontic treatment was correlated to increased frequency of clinical symptoms.

The impact of helmet use on oral and maxillofacial injuries associated with electric-powered bikes or powered scooter: a retrospective cross-sectional study

BACKGROUND

Electric bikes (E-bikes) and powered scooters (P-scooters) have become increasingly popular modes of public transportation, but they have been associated with injuries of all kinds, including dental trauma. Helmet use is promoted as a means of reducing injuries in accidents involving motorized and unmotorized vehicles. The aim of the study was to evaluate the impact of helmet use on the number and severity of oral and maxillofacial injuries caused by E-bikes and P-scooters.

METHODS

A retrospective cross-sectional study design was used. The cohort included all patients referred to the emergency department of a tertiary medical center in 2014-2020 with oral and maxillofacial injuries involving E-bikes or P-scooters. Data were collected from the medical files on demographics, types of injuries, circumstances of occurrence, work-up, treatment, and outcome. Use of a helmet was recorded in each case.

RESULTS

Of the total 1417 patients referred to the emergency department for E-bike and P-scooter-related trauma, 62 had oral and maxillofacial injuries, including 57 riders and 5 pedestrians. All had hard- or soft-tissue injuries; 20 (32.2%) had head injuries and 22 (35.5%) had dentoalveolar injuries. Eleven riders had worn a helmet at the time of injury (17.7%). Helmet use was associated with time of injury (weekday/weekend, daytime/night-time), type of motorized vehicle (E-bike or P-scooter), head injury, and number of bone fractures. Head injuries occurred more often on the weekend (57.9%) than during the week (20.9%) and were more likely to occur in riders who were not protected by a helmet (37.3% vs 18.2%). Patients who used helmets also had a lower rate of fractured bones (18.2%) and dentoalveolar injuries (23.7%) than patients who did not (68.8 and 37.3%, respectively). Interestingly, helmet use had no protective effect on soft-tissue injuries.

CONCLUSIONS

Helmet use by E-bike and P-scooter riders decreased the probability of head injury and of hard tissue and dentoalveolar injuries. These results may provide guidance for effective legislation and regulation of helmet use and improved treatment protocols for general and dental physicians.

Potential Circumferential Bone Engagement following Tooth Extraction in the Posterior Mandible: Computed Tomography Assessment

Background and Objectives: Immediate implant placement (IIP) is a popular surgical procedure with a 94.9–98.4% survival rate and 97.8–100% success rate. In the posterior mandible, it poses a risk of injury to adjacent anatomical structures if the implant engages apical bone. This study sought to assess the implant dimensions that allow for circumferential bone engagement at each position in the posterior mandible without additional apical drilling. Materials and Methods: An observational, cross-sectional study design was used. The pre-extraction cone beam computed tomography scans of 100 candidates for IIP were analyzed. Measurements of each root of the posterior mandibular second premolar, first molar, and second molar were taken from three aspects: buccolingual, mesiodistal, and vertical. Two-sided p values < 0.05 were considered statistically significant. Results: A total of 478 mandibular teeth and 781 roots were assessed. Based on Straumann^® BLX/BLT implant-drilling protocols, predicted rates of radiological circumferential engagement (RCE) were 96% for implants 5 mm in diameter in the second premolar root position; 94% for implants 4.0–4.2 mm in diameter in the first molar root position; and 99% for implants 4.5–4.8 mm in diameter in the second molar root position. Corresponding rates of achieving an available implant length (AIL) of 10 mm were 99%, 90%, and 86%. Patients <40 years old were at higher risk of lower RCE and lower AIL (p < 0.005) than older patients for all roots measured. Conclusions: The high primary stability prediction rates based on the calculation of RCE and AIL support the use of IIPs without further apical drilling in the posterior mandible in most cases.

Micro-CT Analysis of Microgap at a Novel Two-Piece Dental Implant Comprising a Replaceable Sleeve In Vitro

PURPOSE

Microcomputed tomography (micro-CT) is a relatively new modality to investigate mechanical deformations. The purpose of this study was to assess the microgap at the implant-sleeve connection of a new two-piece dental implant with a replaceable sleeve.

MATERIALS AND METHODS

Implants were assembled with 25-degree angulated abutments. Micro-CT was used to assess implant-sleeve connection gaps under the following mechanical conditions: (1) unloading; (2) compressive 10,000 cyclic loading with 400 N; (3) static compressive load of 200 N or 400 N for 24 hours.

RESULTS

The mean gap in the unloaded sample was 2.9 ± 0.9 μm. The mean gap difference after cyclic compressive load was 0.3 ± 0.15 μm, demonstrating a negligible effect for the cyclic loading. Under static compressive load, there was no increase in microgap size at 200 N. At 400 N, a significant (P < .05) increase was noted. While the mean values increased by 1.9 μm, the most pronounced significant increase in mean microgap was noted in the direction of force application (5.1 ± 2.14 μm), while a significant decrease in mean microgap (1.2 ± 1.47 μm) was noted on the opposite side.

CONCLUSION

The mechanical behavior of the implant-sleeve connection under static and dynamic loads was found to be within the previously reported range of implant dentistry.

Is the Risk to Develop Osteoradionecrosis of the Jaws Following IMRT for Head and Neck Cancer Related to Co-Factors?

Background and Objectives: Determine the contribution of coexisting factors to the risk to develop Osteoradionecrosis (ORN) of the jaws among patients who have received radiotherapy by intensity modulated radiation therapy (IMRT) for head and neck cancer (HNC) between 2013 and 2016, in a single medical center. Materials and Methods: The records of all patients treated with IMRT for HNC between 2013 and 2016 in The Davidoff Center for the treatment and Research of Cancer in Rabin Medical Center—Beilinson hospital, Petah-Tikva, Israel were screened. Patients who have received a minimum mean dose of 40 Gy to the oral cavity entered the research and their medical records were retrospectively reviewed. Collected background data included: age, gender, smoking, diabetes mellitus (DM), ASA score, mean and maximal radiation doses (Gy), and diseases characteristics including histological diagnosis, primary tumor site, and disease stage. Results: A total of 1232 patients were surveyed. Out of all screened patients, 93 received a minimum mean dose of 40 Gy to the oral cavity. Out of the 93 patients, 7 (7.52%) developed ORN (ORN+) and 86 did not develop ORN (ORN−). Tumor type in all seven patients in the ORN+ group was Squamous Cell Carcinoma (SCC). In three out of those seven patients (42.9%), the tumor was located in the mandible. Conclusions: within the limits of the relatively small cohort in the current study, we suggest that the development of ORN due to Radiation therapy (RT) with IMRT is related significantly only to the location of a tumor in the mandible. Other co-factors do not significantly increase the risk to develop ORN when RT is delivered via IMRT.

Age-Related Palatal Wound Healing: An Experimental In Vivo Study

We assessed age-related excisional palatal mucoperiosteal wound closure in rats. A 4.2 mm diameter punch was used to create a secondary healing defect in the palate of Wistar rats. Study group-21, 18-month-old vs. control 21, 2-month-old males. The 2-dimensional area, maximum length and width of the soft tissue defect served as clinical outcome parameters. The dynamics of the initial three healing weeks were assessed. Semi-quantitative histomorphometric analysis of inflammation and myofibroblasts served for the evaluation of the inflammatory and proliferative wound healing phases. Complete wound closure was faster in the old rats. A dimensional related wound closure was observed in the young rats versus a symmetrical wound closure in the old rats. Inflammatory response was significantly delayed and of lower intensity in the old rats. Myofibroblastic response, representing the proliferative stage, was delayed and of lower intensity in the old rats, albeit not statistically significant. Reduced initial tissue damage due to decreased and delayed inflammatory response in the old rats ultimately led to faster clinical wound healing compared to the young rats, despite a statistically non-significant lower proliferative response in the old rats.

Computed Tomography for the Assessment of the Potential Risk After Implant Placement in Fresh Extraction Sites in the Posterior Mandible

Immediate implant placement (IIP) is considered a reliable procedure, with survival rates of 94.9%-98.4%. Nevertheless, in the posterior mandible, it poses a high risk of damage to anatomic structures. The aim of this study was to determine the risk of anatomic structures injury associated with IIP in the posterior mandible based on apical primary stability, respecting a safe distance from the inferior alveolar nerve and lingual plate, and to evaluate the influence of different factors on those risks. Pre-extraction cone beam computed tomography scans of 100 patients were retrospectively analyzed. Measurements were taken from tooth apices to lingual plate and to mandibular canal. Values of <4 mm of the former and <6 mm of the latter were categorized as considerable risk. Values of <2 mm at both measurements were considered high risk. Two-sided P < .05 was considered statistically significant. Mean root-to-alveolar canal distance was 7.6 ± 2.7 mm in the first molar, 6.5 ± 3mm in the second premolar, and 5.4 ± 3 mm in the second molar (P < .005). The mean distance to the outer lingual cortex was 3.9 ± 2.1 mm in the first molar and 3.2 ± 0.1 mm in the second molar. Thus, second molars were at higher risk of inferior alveolar nerve injury and lingual plate perforation during IIP. Background factors associated with higher IIP risk were female sex and age < 40 years. In the mandible, the anatomic risk posed by IIP is greatest for second molars and lowest for first molars. Several background factors affect the distances between root apices and the mandibular canal.

Fatigue Evaluation of a New Two-Piece Dental Implant, Having a Replaceable Titanium Sleeve

A new two-piece dental implant, having a replaceable thin titanium sleeve in its 5 mm crestal part was designed. The use of a sleeve of near 0.2 mm thickness reduces implant diameter by 0.4 mm. Narrower diameter implants may increase the likelihood of component fracture in dental implant systems. 14 two-piece dental implants, with 25 deg abutment angle were subjected to a dynamic fatigue test according to DIN EN ISO 14801. The highest load at which a runout (nonfailure) occurred at 5 × 106 cycles, amounted to 575 N. This load level was confirmed with n = 3 samples. The Wöhler curve was determined. Accordingly, the runout at 106 cycles can be anticipated as 625 N. The new two-piece Implant B™ design using a 0.2 mm sleeve is compatible with the DIN EN ISO 14801 standards for dimensions of 4.2 mm diameter and 13 mm length. It withstands dynamic fatigue test at least as good as any other standard endosseous implant.

Clinical and radiological characteristics of oro-antral communications/fistulae due to implant dentistry procedures: A cross-sectional retrospective study

OBJECTIVES

Assess the unique clinical and radiological sequelae following oro-antral communications/fistulae (OAC/OAF) due to implant dentistry vs other etiologies.

MATERIALS AND METHODS

A structured form served to collect data from medical records. All consecutive patients who underwent surgical closure of OACs/OAFs between 2003 and 2020, at a single center were included. Demographic, radiological, clinical, operative and postoperative characteristics were collected. The differences between groups (cases with implant dentistry etiology [IDE] vs cases with other etiologies) were assessed statistically.

RESULTS

Data were gathered from 121 cases. The findings show that IDE cases were more likely to be of older age (OR = 1.07, CI [1.02, 1.13] P = .02); to have a foreign body in the maxillary sinus (OR = 21.04, CI [4.34, 114.92] P < .01); to have fluid passage (OR = 11.40, CI [1.87, 118.73] P = .02) and purulent discharge through the fistula (OR = 3.52, CI [0.86, 16.34] P = .09).

CONCLUSIONS

Clinical and radiological sequelae due to OACs/OAFs secondary to implant dentistry procedures are more severe compared to other etiologies. The suggested pathogenesis is foreign body reaction. Early and accurate diagnosis of the foreign body location, followed by its early removal is recommended.

Evaluation of wound healing following surgical extractions using the IPR Scale

OBJECTIVE

To monitor wound healing following surgical extraction of wisdom teeth using the novel Inflammatory Proliferative Remodeling (IPR) Scale.

METHODS

A prospective study design was used. Participants included 94 otherwise healthy adult patients undergoing surgical extraction of a wisdom tooth at a tertiary medical centre from June 2018 to June 2019. The IPR Scale was completed by two resident surgeons in oral and maxillofacial surgery at three time points after the procedure, corresponding to the three phases of wound healing. Mean subscale and total scores were calculated. Patients graded their preoperative anxiety, intraoperative pain, and pain during follow-up on a 10 cm visual analog scale, and the findings were correlated with the IPR Scale scores.

RESULTS

Mean IPR total score (range 0-16) was excellent (14.43 ± 1.45). Mean scores by healing phase were as follows: inflammatory 6.35 ± 1.34 (range 0-8); proliferation, 4.56 ± 0.8 (range 0-5); remodeling, 2.83 ± 0.51 (range 0-3). There was a positive correlation between mean preoperative anxiety level (5.9 ± 3.6) and intraoperative pain perception (2.4 ± 2.4; P = 0.65) and a negative correlation between mean preoperative anxiety level and IPR Scale scores for each healing phase. Two cases were complicated by abscesses which resolved with treatment.

CONCLUSION

The IPR Scale is a promising tool for the effective evaluation of the wound healing process following wisdom tooth extractions. Relaxation methods and behavioural adaptation might help to lower patient anxiety and thereby improve oral wound healing.

Sinus augmentation - autograft vs. fresh frozen allograft: Bone density dynamics and implant stability

OBJECTIVES

Compare bone density changes and initial implant stability following sinus augmentation with autogenous bone (AB) vs. fresh frozen bone (FFB).

MATERIALS AND METHODS

Randomized, prospective, split mouth study. Sinus augmentation executed using either AB or FFB. Dental implants were inserted after 6 months of healing. Implant dimensions and insertion torques were recorded. Prostheses were delivered 6 months thereafter. All patients had computerized tomography (CT) scans 1 week (T1) and 6 months (T2) after initial bone grafting. Third CT (T3) was taken 12 months after prosthesis delivery. Data from CT scans was used to analyze bone density at each period.

RESULTS

A total of 15 patients (8 males, 7 females) following bilateral sinus augmentation procedures, were included. Mean age was 54 ± 5 years (range 48-60 years). All patients had 3 CT examinations. The initial augmented AB density was higher than the initial FFB density. Nevertheless, density differences between the two groups were not statistically significant at any time frame. At T2 density of both grafts showed a statistically significant increase. A significant increase from T2 to T3 was noted only for the FFB group. Implant insertion torque was significantly higher in the FFB group. Insertion torque ≥32 N/cm was achieved in significantly more patients in the FFB group.

CONCLUSION

The use of FFB for sinus augmentation is a reliable option of graft material. The newly formed bone quality performance, evaluated by CBCT density, is as good as AB, allowing predictable initial implant stability and osseointegration. Unnecessary morbidity associated with AB harvesting is thus avoided.

Is inferior meatal antrostomy still relevant? A 12-year analysis of 93 oroantral fistulae closure with concomitant Caldwell-Luc operations

OBJECTIVE

The aim of this study was to retrospectively evaluate clinical outcomes after closure of oroantral fistulae with concomitant Caldwell-Luc operations (OFCLOs) with or without inferior meatal antrostomy (IMA).

STUDY DESIGN

Records from consecutive OFCLOs carried out over a 12-year period at the oral and maxillofacial surgery department at a single medical center were reviewed. Background data included age, sex, medical status, indications, and etiologies. Outcome data included operative time, hospitalization time, and postoperative use of analgesics and complications.

RESULTS

From 2002 to 2013, 54 male patients (58%), 39 female patients (42%) (mean age 50 years; range 12-84 years) underwent OFCLOs. IMA was carried out in 66 cases (70%). All patients had minimal complications. We found statistically significant shorter operating times (72 vs 84 minutes), shorter postoperative hospitalization times (4.1 vs 5.6 days), lower need of analgesics (1.44 vs 2.88 per day), and fewer complications (11% vs 38%) when IMA was not used.

CONCLUSIONS

IMA during OFCLOs carries increased morbidity without apparent benefits. Its routine use should, therefore, be discontinued.

Effects of peri-implant infection on serum biochemical analysis

BACKGROUND

Peri-implant disease (PID) has not been directly linked to pathological organ changes. The present study assessed the dynamics of serum biochemical parameters in a model of experimental peri-implantitis in dogs, followed by open flap debridement.

METHODS

Seven male beagle dogs comprised the study group. Procedures were performed as follows-extractions of two premolars and one molar on each mandibular quadrant (Day 0); bone healing time (week14); placement of four rough-surface endoosseous implants, two on each mandibular side; implant uncovering (week 28); induction of experimental peri-implantitis by the use of three ligatures (weeks 31, 34, 37) followed by open flap debridement (week 42). Serum biochemical analysis following each procedure was compared to baseline. Biochemical parameters were assigned into four subsets of variables-inflammation, renal function, liver function, and blood glucose. Wilcoxon paired tests were conducted in order to identify statistically significant differences between baseline data and values obtained after each procedure RESULTS: Following experimental peri-implantitis, the dynamics of renal parameters and blood glucose were minimal whereas statistically significant (P < 0.05) increases were noted for inflammatory (total protein and albumin concentrations) and hepatic (ALT, AST) parameters. A statistically significant (P < 0.05) decrease was only noted for total bilirubin. After open flap debridement, inflammatory (total protein and albumin concentrations) and hepatic (AST) parameters returned to baseline.

CONCLUSIONS

Within their limits, the present results indicate that: (a) PID affects inflammatory and hepatic serum biochemical parameters, and (b) following open flap debridement most of the values returned to baseline.

Sialolithiasis-Do Early Diagnosis and Removal Minimize Post-Operative Morbidity?

Background and objectives: Sialolithiasis is an inflammation of a salivary gland due to obstruction of salivary flow by a sialolith. We aim to assess potential factors that may predict lower morbidity following endoscopically assisted per-oral sialolith removal. Materials and Methods: Retrospective cohort study. Retrospective review of 100 records of patients with sialolithiasis, following surgical sialolith removal. A single medical center (Department of oral and maxillofacial surgery-Rabin Medical Center, Beilinson & Hasharon-Israel) survey. Data were gleaned from the patient files based on a structured questionnaire. Factors that may predict morbidity were evaluated using linear regression equation. Results: 59 of the subjects were men and 41 were women. The mean age of the patients in the study was 50 ± 17.5 years. Sialolith volume and past antibiotic treatment were positively associated while age was negatively associated with hospitalization duration. Conclusion: Early sialolith diagnosis and removal may lower postoperative morbidity.

Evaluation of Surgical Treatment of Oroantral Fistulae in Smokers Versus Non-Smokers

Background and Objectives: Smoking has been found to interfere with wound healing processes. Therefore, the purpose of this study was to compare surgical treatment of oroantral fistulae (OAFs) in smokers and non-smokers. Materials and Methods: Medical records of all consecutive patients who underwent surgical closure of OAFs between 2003 and 2016 at the oral and maxillofacial surgery department, Rabin Medical Center, Israel were reviewed. Patients' demographic data, preoperative signs and symptoms, surgical method of repair, and postoperative complications were recorded. Results: The cohort consisted of 38 smokers and 59 non-smokers. Age and gender distributions were similar in both groups. The main etiology in both groups was tooth extraction, followed by pre-prosthetic surgery in smokers and odontogenic infection in non-smokers (p = 0.02). Preoperative conditions were not significantly different between smokers and non-smokers in terms of size of soft tissue fistula and bony defect, chronic sinusitis and foreign bodies inside the sinus. OAFs were repaired by local soft tissue flaps without consideration of smoking status. Smokers experienced more moderate-severe postoperative pain (p = 0.05) and requested more weak opioids (p = 0.06). Postoperative complications included infection, delayed wound healing, residual OAF, pain, sensory disturbances and sino nasal symptoms. These were mostly minor and tended to be more frequent in smokers (p = 0.35). Successful closure of OAFs was obtained in all patients except one smoker who required revision surgery. Conclusions: Smokers may be more susceptible to OAFs secondary to preprosthetic surgery. In this cohort, there was no statistically significant difference in outcome between smokers and non-smokers in terms of failure. However, smokers tended to have more severe postoperative pain and discomfort and to experience more postoperative complications. Further studies with larger sample sizes should be conducted to validate these results.

Angiolipoma in the Head and Neck: Imaging, Diagnosis and Management

Angiolipoma, distinguishable from other lipomas by its excessive degree of vascular vessels, are rare in the head and neck and require unique management. A slow growing mass, located underneath the inferior border of the right mandibular angle of a 51-year-old female, was excised under general anesthesia. Unexpected excessive bleeding during the excision was observed and the histological specimen was diagnosed as angiolipoma. As shown in this case report, pre-operative imaging modalities have a crucial influence and are sufficient to diagnose and manage angiolipomas. The “Gold standard” treatment is excision with clear margins and bleeding management should be taken into account according to appropriate differential diagnosis.

Sclerotherapy of Vascular Malformations in the Oral Cavity-Minimizing Postoperative Morbidity

Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. Special attention was given to factors that may contribute to minimizing postoperative morbidity. Data from 25 patients (32 lesions) with oral VMs submitted to sclerotherapy with monoethanolamine oleate (EAO) were included. A structured form was used to collect data. An arbitrary score was determined to evaluate postoperative morbidity. Each of the following signs or symptoms received one point: pain, swelling, hematoma, ulceration, erythema, transient numbness, and transient itching. Pain and swelling were further divided into mild to moderate (1 point) and severe (2 points). Theoretically, the score was in the range of 0–9. Calculated scores ranged 0–4. The patients were further divided into two groups with scores of 0–1 denoting minimal morbidity (MIN) and 2–4 denoting significant morbidity (SIG). The number of lesions in each morbidity-score group were comparable (MIN 17and SIG 15). There were no statistically significant differences between the groups regarding age, number of applications, or average injection volume per mm lesion. Statistically significant differences were noted regarding gender (p = 0.05), lesion diameter (p = 0.030), total volume of first (p = 0.007) and second application (p = 0.05), and total injected volume (p = 0.03). Factors contributing to the risk for significant morbidity included being male, lesion diameter > 5 mm, volume > 0.3 mL per application, and total injected volume > 0.3 mL. A waiting time of 12 weeks prior to additional EAO application was required in 12 out of 29 lesions for clinical observation of complete regression. It was concluded that sclerotherapy with EAO as monotherapy is easy to apply, safe, and effective within a small number of sessions. Application of <0.3 mL EAO per session, and a waiting time of 12 weeks prior to the second application, would significantly minimize morbidity.

Peri-implant disease affects systemic complete blood count values-an experimental in vivo study

OBJECTIVES

To assess complete blood count (CBC) dynamics following ligature removal and open flap debridement in experimental peri-implantitis in dogs.

MATERIALS AND METHODS

Seven male beagle dogs were included in the study. Four rough-surface implants were placed pair-wise in both sides of the mandible 14 weeks after tooth extraction. Second stage surgery was performed after 14 weeks. Experimental peri-implantitis was initiated 3 weeks later by ligature placement around the healing caps thus facilitating plaque accumulation and inducing inflammation and destruction of peri-implant tissues. Ligature removal and open flap debridement were performed 11 weeks later. The CBC values were compared with baseline after each procedure. Wilcoxon paired tests were conducted in order to identify statistically significant differences between baseline data and values obtained after each procedure.

RESULTS

Following experimental peri-implantitis, statistically significant (p < 0.05) increases were noted for white blood cells-WBC (9.62 ± 4.34 vs. 6.48 ± 1.34 cells per microliter of blood × 1000), hemoglobin-Hb (15.25 ± 0.94 vs. 13.52 ± 1.46, grams per deciliter), red blood cells-RBC (7.26 ± 0.79 vs. 5.9 ± 0.61 cells per microliter of blood × 1000), mean corpuscular hemoglobin-MCH (23.64 ± 0.96 vs. 23.16 ± 0.83 picograms/cell), platelets-PLT (349.86 ± 51.05 vs. 277.57 ± 66 cells per microliter of blood × 1000), and mean corpuscular hemoglobin concentration-MCHC (35.83 ± 0.27 vs. 31.04 ± 0.48 grams per deciliter). A statistically significant (p < 0.05) decrease in values was noted only for after ligature removal and open flap debridement. Mean corpuscular volume-MCV values were significantly lower (65.99 ± 2.31 vs. 74.65 ± 2.85 femtoliter) following 1^st ligature. Values returned to baseline after open flap debridement.

CONCLUSIONS

Within its limits, the present data suggest that experimentally induced peri-implantitis affects CBC values. Following surgical treatment, CBC values returned to normal. Clinical relevance This is the first study suggesting possible relationships between peri-implantitis and CBC values. Future studies, confirming such correlation, may provide an insight into the importance of peri-implant maintenance and treatment to minimize supporting tissues disease and reduce systemic effects.

The dynamics of closure following excisional mid-palatal mucoperiosteal wound in a rat model

OBJECTIVES

The aim of the present study was to assess macroscopically the time-related dimensional pattern of excisional palatal mucoperiosteal wound closure in rats, concomitantly with microscopic analysis of the density of inflammatory infiltrate and myofibroblasts.

MATERIALS AND METHODS

Excisional palatal wounds, 4.2 mm in diameter, were made in twenty-one 2-month-old male Wistar rats. The total area and anteroposterior/laterolateral dimensions of the wounds were measured macroscopically at 1, 2, and 3 weeks post-operatively. In addition, histomorphometry was used for assessment of the intensity of inflammation and density of myofibroblasts in the wound area.

RESULTS

A significant decrease was found in the total area and anteroposterior but not the laterolateral dimension of the wounds during the 2nd week. These changes were less prominent in the 3rd week. Three weeks post-operatively, the density of inflammatory infiltrate remained high in the central part of the wound concomitant with a significant increase in the number of myofibroblasts.

CONCLUSIONS

We concluded that the second week was the most significant in wound closure, with wound contraction first occurring in an anteroposterior plane followed by the laterolateral plane. The increased inflammatory reaction and changes in the density of myofibroblasts may explain the macroscopic decrease in wound dimensions in a time-related manner.

CLINICAL RELEVANCE

These findings emphasize the importance of the amount of soft tissue left at surgery, and suggest that the most appropriate time for the use of healing promoters would be the second post-operative week.

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6–9 months of healing time. Mean follow-up was 17.5 months, range 12–36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

Palatal Erythema with Histological Psoriasiform Pattern: An Enigmatic Oral Finding Shared by a Range of Conditions

Long standing, asymptomatic, well-demarcated erythema of the hard palate with a histopathological psoriasiform pattern comprises a challenging diagnosis. We present a series of patients with such clinical and histological findings and discuss the possible diagnoses. We collected all patients with palatal erythematous lesions that had well-documented clinical examination. Excluded were patients with definitive diagnosis of oral infections (e.g. candidiasis), neoplastic/pre-neoplastic lesions, auto-immune diseases, reactive lesions, blood disorders and vascular malformations. Thirteen patients (six females, seven males, age range 11-56 years) were included. Histopathologically, a psoriasiform pattern was observed in all biopsied lesions. One patient was diagnosed with hereditary mucoepithelial dysplasia (HMD) and four with cutaneous psoriasis. The remaining eight patients were otherwise healthy. A combination of persistent, asymptomatic palatal erythematous lesion with psoriasis-like histopathology may represent an oral manifestation of HMD or psoriasis, concomitant to extra-oral features. In lack of any known medical background, the term "oral psoriasiform mucositis" is suggested.

Anterior atrophic mandible restoration using cancellous bone block allograft

BACKGROUND

Bone block grafting may be required to restore the alveolar process prior to implant placement in Kennedy Class IV partial edentulism of the anterior mandible.

PURPOSE

Evaluate the application of allograft cancellous bone blocks for the augmentation of the anterior atrophic mandible.

MATERIALS AND METHODS

Fourteen consecutive patients underwent augmentation with cancellous bone block allografts in the anterior mandible. A bony deficiency of at least 3 mm horizontally and up to 3 mm vertically according to computerized tomography para-axial reconstruction served as inclusion criteria. Following 6 months, 26 implants were placed and a cylindrical sample core was collected. All specimens were prepared for histological and histomorphometrical examination. The rehabilitation scheme was two dental implants, placed in the lateral incisor area, supporting a 4-unit implant-supported prosthesis.

RESULTS

Twenty-four blocks were placed in 14 patients. Mean follow-up was 26 ± 17 months. Mean bone gain was 5 ± 0.5 mm horizontally, and 2 ± 0.5 mm vertically. Twenty-six implants were used. Marginal bone loss at last follow up did not extend beyond the first thread. Block and implant survival rates were 91.6% and 100%, respectively. All patients but one received a fixed implant-supported prosthesis. Histomorphometrically, the mean fraction of the newly formed bone was 42%, that of the residual cancellous block-allograft 17%, and of the marrow and connective tissue 41%.

CONCLUSIONS

The potential of cancellous bone block allografts for reconstruction of Kennedy Class IV partial edentulism in the anterior mandible seems promising but still has to be evaluated scientifically in long-term observations.

The Feasibility of Flapless Approach to Sinus Augmentation Using an Implant Device Designed According to Residual Alveolar Ridge Height

Hydraulic sinus lift and augmentation may be successfully performed using a dedicated implant device designed according to residual bone height (RBH). The aim of this study was to evaluate whether a flapless surgical approach might negatively influence the outcome. A total of 40 consecutive patients (16 men and 24 women) were included in the study, 20 in each group (minimal flap/control versus flapless/study). Inclusion criteria were ≥ 3 mm RBH, ≥ 6 mm width of the residual alveolar ridge according to preoperative cone beam computerized tomography, and ≥ 8 mm buccopalatal keratinized gingiva for the flapless group. Primary outcome parameters included intraoperative membrane perforation. Secondary outcome parameters included postoperative infection, soft tissue healing, bone gain, and short-term dental implant survival. Mean RBH was 4.6 mm. No intraoperative membrane perforations and no postoperative infections were observed. Mean bone gain height was similar for both groups, at 11 mm. Soft tissue healing was observed within 2 months. In all cases, second-stage surgery allowed generation of at least 2 mm of keratinized gingiva buccally. All implants were osseointegrated at second-stage surgery. The use of a flapless approach to maxillary sinus augmentation using an implant device based on RBH yields predictable results.

Age-related new bone formation following the use of cancellous bone-block allografts for reconstruction of atrophic alveolar ridges

BACKGROUND

An age-related decrease in the number of osteogenic progenitor cells may compromise bone augmentation.

PURPOSE

Histomorphometrical assessment of age-related new bone formation, following atrophic alveolar ridge reconstruction, using cancellous bone-block allografts.

MATERIAL AND METHODS

Ninety-three consecutive patients (58 females and 35 males) were referred for implant-supported restoration of 122 severe atrophic alveolar ridges. Alveolar ridge deficiency locations were classified as anterior maxilla (n = 58), posterior maxilla (n= 32), and posterior mandible (n = 32). A bony deficiency of at least 3 mm horizontally and up to 3 mm vertically according to computerized tomography (CT) in the posterior mandible and anterior maxilla, served as inclusion criteria. In the posterior maxilla, a residual alveolar ridge up to 4 mm vertically according to CT served as inclusion criteria. Augmentation was performed by the use of cancellous bone-block allografts. Bone biopsies (9-month posterior maxilla, 4 months anterior maxilla and posterior mandible) of young (≤40 years) versus older (>40 years) patients were histomorphometrically evaluated.

RESULTS

In the posterior maxilla, no statistically significant histomorphometric differences were noted. While at the anterior maxilla and posterior mandible, statistically significant more newly formed bone was found in young versus older individuals, respectively (38.6% vs 19.8%, P = 0.04 and 69% vs 31%, P = .05).

CONCLUSION

New bone formation following residual alveolar ridge bone grafting is age-related. Longer bone consolidation and healing time may be recommended for older individuals.

Volumetric Stability of Fresh Frozen Bone Blocks in Atrophic Posterior Mandible Augmentation

Fresh frozen bone allografts (FFB) have become an alternative for bone augmentation in the past decades, especially because of the absence of recent reports of disease transmission or immunologic reactions when it is used. The aim of this prospective controlled study is to evaluate volumetric changes of newly created bone following reconstruction of the atrophic posterior mandible. Twenty consecutive patients presenting for reconstruction of posterior mandibular alveolar bone ridge width ≤6.0 mm and/or height ≤6.0 who met all inclusion and exclusion criteria were included. FFB blocks were used. The main outcome variable investigated was bone volume dynamics. Vertical, horizontal, and 3-dimensional bone gain data were measured from computerized tomography scans. The main predictor variable was time evaluated at 3 points: immediately after surgery (T1), at implant placement (T2), and 1 year after functional loading (T3). Secondary outcome parameters evaluated were implant survival, histologic findings, and microtomographic morphometry. The study included 28 hemi-mandibles, 50 FFB bone blocks, and 15 female and 5 male patients (mean age, 51.8 years). Block and implant survival rates were 100% and 96%, respectively, after 31.75 months of follow-up. Vertical and horizontal bone gain at T2 was 5.15 and 6.42 mm, respectively. Volumetric resorption was 31% at T2, followed by an additional 10% reduction at T3. Histologic evaluation showed newly formed vital bone in intimate contact with the remaining FFB. Microtomography revealed 31.8% newly formed bone, 14.5% remaining grafted bone, and 53.7% connective tissue and bone marrow. Thus, FFB blocks may lead to new bone formation and consolidation, with satisfactory volumetric bone maintenance, allowing implant-supported rehabilitation with high success rates.

Can Differences in Vascularity Serve as a Diagnostic Aid in Fibro-Osseous Lesions of the Jaws?

PURPOSE

Different lesions in the fibro-osseous group share microscopic features; thus, establishing a definitive diagnosis based on microscopic features alone can be a challenge. There is a need for additional microscopic tools to aid in differentiating these lesions. This study compared parameters related to vascularity among 3 lesions in the fibro-osseous group: fibrous dysplasia (FD), central ossifying fibroma (COF), and cemento-osseous dysplasia (COD).

MATERIALS AND METHODS

This study was a cross-sectional analysis of biopsied lesions retrieved from 3 medical centers over a 14-year period. The primary predictor variables were the vascularity parameters (number, perimeter, and area). The outcome variables were diagnoses of FD, COF, and COD. Diagnosis was based on clinical, microscopic, and radiologic correlations. From each histopathologic slide, 5 representative fields were captured with a computerized digital camera. The number of blood vessels was counted, and the surface area and vascular perimeter were measured by tracing the perimeter of each vessel. Data were statistically analyzed using analysis of variance with logarithmic transformation and a Tukey adjustment.

RESULTS

Sixty-six cases were included in the study (26 in FD group, 26 in COF group, and 14 in COD group). The mean number of vessels showed only a tendency to be larger in the FD group compared with the COF and COD groups (5.4 ± 2.6, 3.7 ± 2.3, and 3.6 ± 1.7, respectively), but the results did not reach the threshold for significance. The mean vascular perimeter was 1,385.8 ± 859.2 pixels in the FD group and 742.6 ± 661.8 in COF group after logarithmic transformation (P = .012). The perimeter in the COD group was smaller (941.1 ± 502) compared with that in the FD group, but the difference did not reach the threshold for significance. The mean area was 25,061 ± 24,875.6 in the FD group and 11,773.8 ± 21,734.4 in the COF group after logarithmic transformation (P = .004). The perimeter in the COD group was smaller (13,011.1 ± 8,338.3) compared with the FD group, but the difference did not reach the threshold for significance.

CONCLUSION

The vascular content of the FD group was markedly higher than of the COF group. These vascular changes can aid in differentiating these lesions microscopically.

[Bone augmentation of the extremely atrophic anterior mandible, using allogeneic block grafts, via submental approach]

Edentulous patients with advanced resorption of the mandible (atrophic mandible) suffer major discomfort when using dentures. Furthermore, placing dental implants is impossible due to lack of sufficient bone volume. In the past, several methods of bone grafting to the anterior mandible have been proposed. Most of them were unpredictable in either the short or long-term. In 2002 a technique for bone grafting of the anterior mandible via a submental approach was published. A wide reflection of the soft tissue was followed by implant placement. Autogenous particulate posterior iliac crest bone graft was used. The presence of the implants did not allow for contraction of the soft tissue and bone resorption. The addition of bone volume to the chin improved the facial aesthetics of the patients due to a fuller appearance of the chin and tightening of the skin of the neck. The submental approach changes the spatial orientation of the surgeon and placement of implants in the correct location and angle become challenging. Placement of the implants too far buccally was a prosthetic problem. A major disadvantage of autogenous bone grafting is the necessity to operate a donor site. The increasing experience in use of allogenic bone grafts with resorbable collagen membranes, allowed us to modify the submental approach for bone grafting of the anterior atrophic mandible, avoiding a donor site surgery. We chose to perform the bone graft as a first stage surgery, in which, via a submental approach allogenic bone blocks were adapted and fixated to the anterior mandible with titanium screws, xenograft and resorbable collagen membranes were used. A few months (>4) were allowed for graft consolidation and then a second stage surgery was performed, via an intraoral approach dental implants were placed. In this way we avoided loss of orientation and had a familiar setting for implant location and angulation. Five patients with atrophic mandibles were treated using this surgical protocol. Based on cone beam CT imaging, average bone height in the anterior mandible prior to treatment was 5.52 mm. After bone graft, the average gain in bone height was 12.74 mm. No major post-operative complications were noted. After bone graft consolidation, 4 or 5 dental implants were placed, most of the implants used were longer than 11.5 mm. 22 implants were placed, out of which 21 integrated (95.5%). Some of the patients were rehabilitated with overdentures and locators and some with PFM bridges. All patients were followed up for more than a year and no implant failure was recorded. Bone grafting to the anterior mandible using allogenic blocks with collagen membranes via a submental approach with second stage implant placement seems to be a viable solution for rehabilitation of the atrophic mandible.

Effects of the subcranial approach on facial growth and development

OBJECTIVE: To analyze the long-term effects of subcranial surgery for anterior skull base tumors on facial growth.

STUDY DESIGN AND SETTING: Retrospective study (1994 to 2004) in a university-affiliated hospital. Of 108 patients who underwent a subcranial surgical approach for anterior skull base tumors, six adolescents and five young adults fulfilled study entry criteria for age and follow-up data availability (mean, 3.2 ± 2 years). Cephalometric x-ray films monitored postoperative facial growth. Anteriorly and posteriorly measured horizontal and vertical maxillary growth were compared with normal values.

RESULTS: All subjects had superiorly positioned maxillae (shorter in patients with long-standing pathologies). The upper incisor teeth were proclined relative to the cranial base reference planes. All cephalometric changes were within a 10 percent deviation of normal values.

CONCLUSIONS: Subcranial surgery for these tumors minimally affects vertical facial skeleton growth. Early surgery is essential for unaffected horizontal growth.

SIGNIFICANCE: Guidelines for anterior skull base tumor surgery in adolescents and young adults.

© 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

Maxillary Sinus Grafting with Autograft Versus Fresh-Frozen Allograft: A Split-Mouth Evaluation of Bone Volume Dynamics

PURPOSE

To compare volumetric changes after sinus augmentation of completely edentulous maxillae with either autogenous or allogeneic fresh-frozen bone particles.

MATERIALS AND METHODS

This split-mouth study in patients who required bilateral sinus grafting used autograft particles for one sinus and allograft particles for the contralateral sinus. The grafted sinuses were left to heal for 6 months prior to implant insertion. All patients underwent four computed tomography scans: prior to augmentation and 1 week, 6 months, and 12 months after grafting. Computer software was used to analyze bone graft volume in each scan.

RESULTS

Fifteen patients (8 men, 7 women) with a mean age of 54 ± 5 years (range, 48 to 60 years) took part and underwent 30 sinus augmentation procedures. Mean autograft and allograft volumes were not statistically significantly different at each time point (1 week: 2.01 ± 0.43 cm³ vs 2.46 ± 0.79 cm³; 6 months: 1.53 ± 0.49 cm³ vs 1.75 ± 0.64 cm³; and 12 months: 1.38 ± 0.43 cm³ vs 1.59 ± 0.56 cm³, respectively). Mean volumetric reductions of 31.35% and 35.36% (23.9% and 29.9% in the 6 months prior to implant insertion, followed by an additional 9% and 9% in the following 6 months), relative to 1 week postgrafting, were noted for the autograft and allograft groups, respectively, after 12 months.

CONCLUSION

On the basis of this split-mouth study of 15 patients, there was no statistically significant volumetric difference after 12 months between the use of autograft or allografts for sinus augmentation. Fresh-frozen bone allograft may serve as an alternative that avoids the morbidity associated with autograft harvesting.

Reliability of retrievable cemented implant-supported prostheses

STATEMENT OF PROBLEM

One of the disadvantages of a cemented implant restoration is the potential difficulty of retrieving it. The restoration may be destroyed during removal.

PURPOSE

The purpose of this retrospective clinical study was to assess the long-term survival rates of cemented posterior metal ceramic implant-supported prostheses (ISPs) with a metal screw access hole.

MATERIAL AND METHODS

During a 12-year period, 274 cemented ISPs with an abutment screw access hole in the metal framework were assessed and served as the study group, and 119 conventional cemented ISPs (without access hole) served as the control group. Participants were followed every 6 months in the first year and once a year subsequently. Ceramic fracture, screw loosening, and refabrication were the prosthetic outcome parameters evaluated at the recall. The Pearson Chi square and Fisher exact test were used to compare the outcome parameters between the control and study groups.

RESULTS

A total of 1005 implants and 393 ISPs were evaluated. Ceramic fracture occurred in 6.6% of the ISPs (6.2% test and 7.6% control). Screw loosening occurred in 3.28% of the test group and 3.36% of the control group. Refabrication of ISPs was done in 2.79% of all restorations, (1.45% test and 6.72% control [P=.012]).

CONCLUSIONS

Within the limits of this study, preparing cemented ISPs with a screw access hole in the metal framework improves ISP survival rates over time and lowers the cost of maintenance without increasing the risk for porcelain fracture or screw loosening.