Cellular Midpalatal Suture Changes after Rapid Maxillary Expansion in Growing Subjects: A Case Report.

The present case report aimed to investigate immediate histologic changes in midpalatal suture in humans following rapid maxillary expansion compared to control. Three patients (mean age 8.3 +/- 0.9 years) were enrolled in the case report and underwent midpalatal suture biopsy. Two patients underwent treatment before biopsy. The third patient did not show transversal maxillary deficiency and was enrolled as a control. Biopsy samples of midpalatal suture at 7 (subject 1) and 30 days (subject 2) after maxillary expansion as well as of one control (subject 3) were collected and processed for histology. In the control (subject 3) inter-digitations at the palatal suture gap were observed. At 7 days (subject 1) mature bone with small marrow spaces and trabecular bone with the peculiar storiform appearance inside the soft tissue and collagen fibers running parallel only in the central part were present. At 30 days (subject 2), a greater number of newly-formed bone trabeculae with a perpendicular orientation to the long axis of the suture could be seen. At 30 days the fibrous component of bone tissue was less represented compared to the sample at 7 days. Data from the preliminary histological results showed that bone formation was observed in the gap after rapid maxillary expansion, although the healing process was still ongoing.

Immediate, non-submerged, root-analogue direct laser metal sintering (DLMS) implants: a 1-year prospective study on 15 patients.

This study evaluated the 1-year survival and success rate of root-analogue direct laser metal sintering (DLMS) implants, placed into the extraction sockets of 15 patients. DLMS is a technology which allows solids with complex geometry to be fabricated by annealing metal powder microparticles in a focused laser beam, according to a computer-generated three-dimensional (3D) model; the fabrication process involves the laser-induced fusion of titanium microparticles, in order to build, layer-by-layer, the desired object. Cone-beam computed tomography (CBCT) acquisition and 3D image conversion, combined with the DLMS process, allow the fabrication of custom-made, root-analogue implants (RAIs). CBCT images of 15 non-restorable premolars (eight maxilla; seven mandible) were acquired and transformed into 3D models: from these, custom-made, root-analogue DLMS implants with integral abutment were fabricated. Immediately after tooth extraction, the RAIs were placed in the sockets and restored with a single crown. One year after implant placement, clinical and radiographic parameters were assessed: success criteria included absence of pain, suppuration, and exudation; absence of implant mobility and absence of continuous peri-implant radiolucency; distance between the implant shoulder and the first visible bone-to-implant contact <1.5 mm from initial surgery; and absence of prosthetic complications. At the 1-year follow-up, no implants were lost, for a survival rate of 100 %. All implants were stable, with no signs of infection. The good conditions of the peri-implant tissues were confirmed by the radiographic examination, with a mean DIB of 0.7 mm (±0.2). The possibility of fabricating custom-made, RAI DLMS implants opens new interesting horizons for immediate placement of dental implants.

Esthetic evaluation of implants placed after orthodontic treatment in patients with congenitally missing lateral incisors.

OBJECTIVE: The aim of this retrospective study was to evaluate the esthetic outcome of single tooth Morse taper connection implants used to replace congenitally missing lateral incisors after orthodontic treatment by means of the pink esthetic score (PES) and white esthetic score (WES) index. MATERIALS AND METHODS: Twenty consecutive patients who were treated with a single tooth Morse taper connection implants (Leone Implant System®, Florence, Italy) were enrolled in this study. An independent calibrated examiner applied the PES/WES index to 20 implant-supported restorations 3 months and 3 years after implant placement. RESULTS: No implants were lost. All 20 implants fulfilled the established success criteria for dental implants with regard to osseointegration and prosthetic complications, with an overall implant-crown success of 100.0%. At the 3 year examination, the mean distance between the implant shoulder and the first visible bone-implant contact was of 0.49 ± 0.18 mm (95% confidence interval 0.41-0.57); the mean PES was 8.15 ± 1.69, and the mean WES was 8.70 ± 0.92. CONCLUSIONS: The placement of single-tooth Morse taper connection implants for rehabilitation of congenitally missing lateral incisors after orthodontic treatment represents a successful procedure in the medium term. Further studies are necessary in order to assess the long-term esthetic score. CLINICAL SIGNIFICANCE: This paper evaluates the esthetic outcome of Morse taper connection implants placed to restore congenitally missing lateral incisors after orthodontic treatment.

Maxillary ridge augmentation with custom-made CAD/CAM scaffolds. A 1-year prospective study on 10 patients.

Several procedures have been proposed to achieve maxillary ridge augmentation. These require bone replacement materials to be manually cut, shaped, and formed at the time of implantation, resulting in an expensive and time-consuming process. In the present study, we describe a technique for the design and fabrication of custom-made scaffolds for maxillary ridge augmentation, using three-dimensional computerized tomography (3D CT) and computer-aided design/computer-aided manufacturing (CAD/CAM). CT images of the atrophic maxillary ridge of 10 patients were acquired and modified into 3D reconstruction models. These models were transferred as stereolithographic files to a CAD program, where a virtual 3D reconstruction of the alveolar ridge was generated, producing anatomically shaped, custom-made scaffolds. CAM software generated a set of tool-paths for manufacture by a computer-numerical-control milling machine into the exact shape of the reconstruction, starting from porous hydroxyapatite blocks. The custom-made scaffolds were of satisfactory size, shape, and appearance; they matched the defect area, suited the surgeon's requirements, and were easily implanted during surgery. This helped reduce the time for surgery and contributed to the good healing of the defects.

Survival and complication rates of fixed restorations supported by locking-taper implants: a prospective study with 1 to 10 years of follow-up.

PURPOSE: The aim of this 10-year follow-up study was to evaluate the implant survival and complication rates of fixed restorations supported by locking-taper implants. MATERIALS AND METHODS: Over a 10-year period (January 2002 to December 2011) all patients referred to a single private practice for treatment with fixed restorations (single crowns, SCs; fixed partial prostheses, FPPs; fixed full arches, FFAs) supported by dental implants were considered for inclusion in the study. At each annual follow-up session, clinical, radiographic, and prosthetic parameters were assessed. The surviving implant-supported restorations were defined as "complication free" in the absence of any biological or prosthetic (mechanical or technical) complication. The cumulative implant survival and the "complication-free" survival of fixed implant-supported restorations were identified using the Kaplan-Meier method. The Log-rank test was used to identify correlations between the study variables. RESULTS: In total, 1494 locking-taper implants (727 maxilla, 767 mandible) were placed in 642 patients (356 males, 286 females). Nineteen implants (12 maxilla, 7 mandible) failed. Implant failures were attributed to lack of osseointegration (14 implants), peri-implantitis (4 implants), and mechanical overloading (1 implant). An overall 10-year cumulative implant survival rate of 98.7% (98.3% maxilla, 99.1% mandible) was found. The implant survival rates did not significantly differ with respect to implant location, position, bone type, implant length and diameter, and type of restorations. Among the surviving implant-supported restorations (478 SC, 242 FPP, 19 FFA), a few biological (11/739: 1.4%) and prosthetic (27/739: 3.6%) complications were reported. The incidence of mechanical complications was low (3/739: 0.4%), with three loosened abutments in three SCs (3/478: 0.6%), and no abutment fractures; technical complications were more frequent (24/739: 3.2%), with an incidence of decementation of 2.0% (SC 2.0%, FPP 1.6%, FFA 5.2%) and ceramic/veneer chipping/fracture of 1.2% (SC 0.0%, FPP 2.8%, FFA 10.5%). A 10-year cumulative "complication-free" survival of restorations of 88.6% (SC 91.7%, FPP 83.1%, FFA 73.8%) was reported. The complication rates differ significantly with respect to the type of restoration (p < 0.05). CONCLUSIONS: Fixed restorations on locking-taper implants seem to be a successful procedure for the rehabilitation of partially and completely edentulous arches.

Vertical ridge augmentation of the atrophic posterior mandible with custom-made, computer-aided design/computer-aided manufacturing porous hydroxyapatite scaffolds.

The present study describes a new protocol for the manufacturing of custom-made hydroxyapatite scaffolds using computer-aided design/computer-aided manufacturing (CAD/CAM), to augment posterior mandibular bone and minimize surgery when severe atrophy is present. Computed tomographic images of an atrophic posterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model. This model was transferred as a stereolithographic file to a CAD program, where virtual 3D reconstructions of the alveolar ridge were performed, drawing 2 anatomically shaped, custom-made scaffolds. Computer-aided-manufacturing software generated a set of tool-paths for manufacture on a computer-numerical-control milling machine into the exact shape of the 3D projects. Clinically sized, anatomically shaped scaffolds were generated from commercially available porous hydroxyapatite blocks. The custom-made scaffolds well matched the shape of the bone defects and could be easily implanted during surgery. This matching of the shape helped to reduce the time for the operation and contributed to the good healing of the defects. At the 6-month recall, a newly formed and well-integrated bone was observed, completely filling the mandibular posterior defects, and implants were placed, with good primary stability. At the 1-year follow-up examination, the implant-supported restorations showed a good functional and esthetic integration. Although this is an interim report, this study demonstrates that anatomically shaped custom-made scaffolds can be fabricated by combining computed tomographic scans and CAD/CAM techniques. Further studies are needed to confirm these results.

Prospective clinical evaluation of 201 direct laser metal forming implants: results from a 1-year multicenter study.

This prospective clinical study evaluated the survival rate and the implant-crown success of 201 direct laser metal forming (DLMF) implants in different clinical applications, after short-term follow-up of functional loading. At the 1-year scheduled follow-up examination, several clinical, radiographic, and prosthetic parameters were assessed. Success criteria included absence of pain, sensitivity, suppuration, exudation; absence of implant mobility; absence of continuous peri-implant radiolucency, DIB <1.5 mm; absence of prosthetic complications at the implant-abutment interface. A total of 201 implants (106 maxilla, 95 mandible) were inserted in 62 patients (39 males, 23 females; aged between 26 and 65 years) in eight different clinical centers. The sites included anterior (n = 79) and posterior (n = 122) implants. The overall implant survival rate was 99.5%, with one implant loss (maxilla: 99.0%, 1 implant failure; mandible: 100.0%, no implant failures). The mean DIB was 0.4 ± 0.2 mm. Among the survived implants (200), five did not fulfill the success criteria, giving an implant-crown success of 97.5%. This 1-year follow-up prospective clinical study gives evidence of very high survival (99.5%) and success (97.5%) rates using DLMF implants.

Full-Digital Workflow for Fabricating a Custom-Made Direct Metal Laser Sintering (DMLS) Mandibular Implant: A Case Report.

Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top of the other, until the desired object is generated. With DMLS, it is now possible to fabricate custom-made titanium implants for oral and maxillofacial applications. We present the case of a 67-year-old woman diagnosed with a squamous cell carcinoma of the mandible. The patient underwent subtotal mandibular resection; conventional reconstruction procedures failed to rehabilitate the function of the mandible. A prosthesis replacing the resected mandible was designed and fabricated using a digital workflow. The extensive bone defect was rehabilitated with a prosthesis replacing the mandibular bone and supporting a morse-taper dental prosthesis. The masticatory function was reestablished.

Digital Dynamic 3D Monitoring of Lower Incisors Intrusion in Lingual Orthodontics.

OBJECTIVE: The aim of the present study is to propose a 3-dimensional evaluation of lower intrusion obtained with lingual orthodontics considering not only the crowns but also dental roots. METHODS: 9 adult patients underwent fixed lingual orthodontic treatment with i-TTя lingual brackets system for the correction of crowding in the lower arch associated with a deep overbite. Initial records, consisting of photos, CBCTs and intraoral scans were collected. Threshold segmentation of the CBCT was performed to generate a three-dimensional virtual model of each the teeth of the lower arch, superimposed with the crown of the same teeth obtained by intraoral scan models to generate a complete set of digital composite lower arch The same procedure was performed to monitor one key step of the i-TTЯ technique consisting in lower incisors intrusion (T2). T1-T2 three-dimensional superimposition and color displacement maps were generated to measure and evaluate the movements obtained at the lower arch. RESULTS: The root displacement of the incisors during their intrusion in the early stage was totally "bone-safe" in the 88.9% (8 of 9) of the cases observed. No significant extrusion of the premolars used as anchorage unit was measured. CONCLUSION: This method has proved to be an accurate and reliable approach to dynamically visualize the 3-dimensional positions of the teeth, including their roots, with no additional radiation for in-progress treatment monitoring. The 3-dimensional evaluation showed that the employed lingual appliance allowed to obtain significant lower incisors intrusion with negligible undesired extrusion of premolars employed as anchorage teeth.

Three-dimensional digital modeling and setup.

Obtaining accurate images of the craniofacial region is critical when developing an orthodontic diagnosis and treatment plan. The purpose of this article is to describe a new imaging method that provides complete 3-dimensional views of the maxilla and the mandible, and the model setup with individual anatomic roots. The method uses computed tomography technology and laser scanning; it offers high-resolution images with relatively low radiation exposure. Technical aspects of the new procedure and its possible uses for orthodontic diagnosis and treatment planning are discussed.

Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients.

Purpose. To present a computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) technique for the design, fabrication, and clinical application of custom-made synthetic scaffolds, for alveolar ridge augmentation. Methods. The CAD/CAM procedure consisted of (1) virtual planning/design of the custom-made scaffold; (2) milling of the scaffold into the exact size/shape from a preformed synthetic bone block; (3) reconstructive surgery. The main clinical/radiographic outcomes were vertical/horizontal bone gain, any biological complication, and implant survival. Results. Fifteen patients were selected who had been treated with a custom-made synthetic scaffold for ridge augmentation. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. A few patients experienced biological complications, such as pain/swelling (2/15: 13.3%) and exposure of the scaffold (3/15: 20.0%); one of these had infection and complete graft loss. In all other patients, 8 months after reconstruction, a well-integrated newly formed bone was clinically available, and the radiographic evaluation revealed a mean vertical and horizontal bone gain of 2.1 ± 0.9 mm and 3.0 ± 1.0 mm, respectively. Fourteen implants were placed and restored with single crowns. The implant survival rate was 100%. Conclusions. Although positive outcomes have been found with custom-made synthetic scaffolds in alveolar ridge augmentation, further studies are needed to validate this technique.

Correlation Assessment between Three-Dimensional Facial Soft Tissue Scan and Lateral Cephalometric Radiography in Orthodontic Diagnosis.

Purpose. The aim of the present prospective study was to investigate correlations between 3D facial soft tissue scan and lateral cephalometric radiography measurements. Materials and Methods. The study sample comprised 312 subjects of Caucasian ethnic origin. Exclusion criteria were all the craniofacial anomalies, noticeable asymmetries, and previous or current orthodontic treatment. A cephalometric analysis was developed employing 11 soft tissue landmarks and 14 sagittal and 14 vertical angular measurements corresponding to skeletal cephalometric variables. Cephalometric analyses on lateral cephalometric radiographies were performed for all subjects. The measurements were analysed in terms of their reliability and gender-age specific differences. Then, the soft tissue values were analysed for any correlations with lateral cephalometric radiography variables using Pearson correlation coefficient analysis. Results. Low, medium, and high correlations were found for sagittal and vertical measurements. Sagittal measurements seemed to be more reliable in providing a soft tissue diagnosis than vertical measurements. Conclusions. Sagittal parameters seemed to be more reliable in providing a soft tissue diagnosis similar to lateral cephalometric radiography. Vertical soft tissue measurements meanwhile showed a little less correlation with the corresponding cephalometric values perhaps due to the low reproducibility of cranial base and mandibular landmarks.

Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge.

This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results.

Maxillary sinus augmentation with adult mesenchymal stem cells: a review of the current literature.

PURPOSE: Mesenchymal stem cells (MSCs) have been applied in maxillary sinus augmentation (MSA) with clinically successful results. The purpose of this article was to evaluate the systematically acquired evidence for the effectiveness of cell-based approaches in MSA with various scaffolds, and to narratively assess evidence from additional articles that report effectiveness of cell-based approaches in MSA. MATERIALS AND METHODS: Electronic database searches were performed. Inclusion criteria were studies of cell-based approaches in MSA with various scaffolds, in humans, with at least 3 to 4 months of follow-up. Meta-analysis was performed for randomized controlled trials (RCTs) with histologic/histomorphometric evaluation. RESULTS: Fifteen studies (4 RCTs) were considered to be eligible for inclusion in the review. The meta-analysis suggested a marginal, nonstatistically significant positive effect of MSCs on the bone regrowth. CONCLUSIONS: A number of studies have demonstrated the potential for cell-based approaches in MSA; further RCTs that clearly demonstrate benefits of cell-based approach are needed.

Tissue response during self-ligating treatment.

INTRODUCTION: Orthodontic tooth movement is characterized by tissue reactions, which consist in an inflammatory response in periodontal ligament, depending on the forces applied. Self-ligating brackets are able to minimize the sliding resistance and to reduce the forces necessary to move a tooth, with a better tissue response. OBJECTIVES: The purpose of this study was to evaluate the activity of the lactate dehydrogenase (LDH) in gingival crevicular fluid (GCF) during orthodontic tooth movement using self-ligating brackets. MATERIALS AND METHODS: Forty patients were selected and treated with two kinds of self-ligating brackets, Quick 2.0 and Smart Clip, and superelastic or thermoactive archwires. Patients' lower arches were bonded and GCF was collected at one side for each tooth at baseline, one hour after bonding and on the 7(th), 28(th) and 42(nd) day. Test teeth were 4.1, 4.3 and 4.5. Control teeth were 1.1, 1.3 and 1.5. Samples were analyzed with a specific assay for LDH activity. RESULTS: The statistical analysis showed no significant differences in the LDH activity between test and control teeth in the selected groups. CONCLUSIONS: There are no significant differences, in terms of tissue response, between superelastic and thermoactive archwires.

Condiciones de salud oral en ancianos del club geriátrico “Abue-Club” en Paraguay / Oral health conditions in elderly of the geriatric club “Abue-Club” in Paraguay

El objetivo del estudio fue describir las condiciones de salud oral en personas mayores de 60 años del club geriátrico “Abue-Club”, Parroquia Virgen de Fátima-Barcequillo-San Lorenzo–Paraguay. Estudio descriptivo de corte transversal en adultos mayores de 60 años, que incluyó la exploración bucodental, evaluación de saliva post-estímulo y una encuesta para evaluar dieta, hábitos de higiene y acceso a los servicios de salud. El 63,9% de los evaluados era del sexo femenino con una mediana de edad de 72,6 años y en varones 68,8 años. El Índice CPOD total fue 23,4, con una prevalencia de caries activa del 75%. El 33,3% presentó edentulismo total (39,1% en mujeres y 23,1% en hombres). El 83,3% tenía más de la mitad de sus dientes ausentes, con mayor frecuencia en mujeres (86,9%). El 69,4% utilizaba prótesis, de los cuales el 56% usaba prótesis total. La prevalencia de enfermedad periodontal por el Índice de Russel fue de 66,7%; 70,8% con lesiones destructivas óseas y/ó bolsas periodontales. El 89% de la población presentó saliva fluida y 75% en cantidad normal (>1 ml). El 56% de los participantes acudió a un servicio odontológico un año o menos antes del estudio, siendo más frecuente en mujeres (69,5%). El grupo de estudio presentó marcado deterioro de salud oral, caracterizado por el edentulismo parcial y total, con alta frecuencia de uso de prótesis total; por tanto urge la necesidad de promoción de salud, con énfasis en la prevención de pérdidas dentarias y alternativas de rehabilitación protésica.

The objective of the study was to describe the oral health conditions of people over 60years from the geriatric grandparents club, Virgen de Fatima Parish-San LorenzoBarcequillo-Paraguay.It was a cross-sectional study carried out in adults over 60 years,which included oral examination, evaluation of post-stimulus saliva and a survey to assessdiet, oral hygiene and access to health services. Sixty three point nine percent (63.9%) ofthose tested were women with a median age of 72.6 years and 68.8 years for men. Theoverall DMFT index was 23.4, with a prevalence of 75% active caries. Thirty three pointthree (33.3%) were edentulous (39.1% women and 23.1% men) and 83.3% had more thanhalf his teeth missing, which was observed more frequently in women: 86.9%. A prosthesiswas used by 69.4% and 56% had full dentures. The prevalence of periodontal disease byRussel Index was 66.7%, 70.8% with destructive bone lesions and/or periodontal pockets.Eighty nine percent of the population had fluid saliva and 75% normal amount (>1 ml).Fifty six percent (56%) went to dental services one year or less before the study and thiswas more frequent in women (69.5%). The study group showed marked deterioration oftheir oral health, characterized by partial and total edentulism, with high frequency of theuse of a total prosthesis. Therefore, there is an urgent need for health promotion, withemphasis on the prevention of tooth loss and alternatives prosthetic rehabilitation.