[Rehabilitation after implant failure in the anterior maxilla: presentation of treatment options]. / Rehabilitation nach Implantatmisserfolg im Oberkiefer-Frontzahnbereich: Vorstellung möglicher Behandlungsvarianten.

The present article illustrates treatment options after implant removal (explantation) as a result of peri-implantitis in the anterior maxilla. After explantation of a dental implant in the anterior maxilla, the esthetical as well as functional rehabilitation is a demanding undertaking, especially, if removable prosthetic treatment options are undesirable. The present article illustrates that depending on individual patient's demands, different treatment options might be considered. However, in order to achieve aesthetically pleasing outcomes by means of fixed partial dentures (FDPs), the practitioner as well as the patient have to adapt oneself to a complex, time-consuming, and multiphasic therapy. Therefore, a comprehensive planning and systematic approach represent a mandatory prerequisite.

[The extrosseous/peripheral ameloblastoma in the aesthetic area of the maxilla: a presentation of a possible approach aiming an aesthetic satisfying rehabilitation. a case report]. / Das extraossäre/periphere Ameloblastom in der Oberkieferfrontzahnregion. Ein Therapievorschlag mit spezifischem Augenmerk auf eine ästhetisch vertretbare Rehabilitation. Ein Fallbericht.

Extraosseous/peripheral Ameloblastoma (EPA) is a rare, benign odontogenic soft tissue tumour with the same histological characteristics as the more common intraosseous subtypes. The EPA appears in the soft tissue of the gingiva and the mucosa of the alveolar process often as unspecified painless swelling. The present case report describes an EPA in the aesthetic area of the left anterior maxilla. Based on the clinical finding the suspected diagnosis of a gingival cyst was made. Firstly, this case should highlight the importance of a proper histopathologic evaluation whenever a biopsy is performed. Furthermore, this report should illustrate a step-by-step procedure from the surgical re-excision of the EPA with a safetymargin to the healing phase to the aesthetic satisfying rehabilitation by using periodontal plastic surgery.

Spontaneous reeruption after intrusive luxation of the permanent incisors by incomplete root formation. Two case reports (in German) / Spontandurchbruch nach Intrusionstrauma von bleibenden Inzisiven bei nicht abgeschlossenem Wurzelwachstum Zwei Fallberichte

In the context of tooth trauma mostly the maxillary central front teeth are involved, whereby their roots are in some cases in developing stage (immature). The intrusive luxation represents one of the most severe types of dental trauma because of the damage to the periodontal ligament, alveolar bone and pulp. Principally, three different treatment options are available: 1. Spontaneous reeruption, 2. orthodontic extrusion, 3. surgical repositioning. This report is aiming to illustrate, by two cases, that traumatic intruded teeth with incomplete root formation, treated without active repositioning (waiting for spontaneous reeruption), seem to be associated with the lowest risk of healing complications. Therefore, the decision of the treatment procedure should be based mainly on the stage of root development and only secondarily on the degree of intrusion.

The dentigerous cyst: two different treatment options illustrated by two cases / Die follikuläre Zyste: zwei unterschiedliche Behandlungsmöglichkeiten, präsentiert anhand zweier Fallbeispiele

The dentigerous cyst is the second most frequent odontogenic cyst after the radicular one. Typically, dentigerous cysts are asymptomatic and are commonly diagnosed incidentally. Due to the slow, expansive growth dentigerous cysts have the potential for dislocation of adjacent structures (neighbouring teeth, canalis retromolaris), root resorptions and in an extreme case could cause jaw fractures. A histological examination represents a sine qua non, because other more alarming pathologies (odontogenic keratocyst, unicystic ameloblastoma, myxoma, primordial odontogenic tumour etc.) can exhibit clinically and radiologically a similar appearance. This brief overview aims to illustrate, by two clinical cases, the examination, the diagnosis and decision-making for either a cystostomy or a cystectomy. The surgical procedure of both techniques is presented in a step-by-step manner.

Implant-Assisted Removable Partial Denture Prostheses: A Critical Review of Selected Literature.

PURPOSE: A critical review of selected relevant publications assessed clinical efficacy and effectiveness of implant-assisted removable partial dentures (IARPDs) with implant survival and failure rates, biologic and technical complications, and maintenance and patient satisfaction after rehabilitation as outcomes. MATERIALS AND METHODS: Screening of three databases (Medline [PubMed], Embase [OVID], and the Cochrane Library [CENTRAL]) and a manual search of related articles were performed. Reports on outcomes from human studies conducted between 1 January 1980 and 31 May 2016 were considered. A quality assessment of the identified full-text articles was performed to assess risk of bias and to evaluate heterogeneity. RESULTS: Only nine studies were included, and all nine demonstrated high risk of bias. The mean observation period ranged from 1 to 10 years, and only four studies included at least one control group. The studies reported implant survival rates of 91.7% to 100%, abutment tooth survival rates of 79.2% to 100%, and prosthesis survival rates of 90% to 100%. Approximal peri-implant crestal bone level changes (ΔCBL) ranged from -0.17 to -2.2 mm. IARPDs were associated with a higher frequency of technical complications and maintenance interventions than biologic complications. Only two question-based studies assessed patient satisfaction before and after treatment, and both reported marked improvement. A meta-analysis was not possible because of substantial heterogeneity in study design. CONCLUSION: Limited availability of robust publications related to the selected review topic precluded significant conclusions. Nonetheless, the preliminary assessment suggests that IARPDs are a simple and cost-effective approach to providing symmetric prosthesis support and stability, plus improved patient satisfaction.

Regenerative endodontics after front tooth trauma. A case report / Regenerative endodontische Therapie nach Frontzahntrauma. Ein Fallbericht

In the context of tooth trauma, mostly the maxillary central front teeth are involved, whereby their roots are in some cases still in the developing stage (immature). Depending on the type of trauma, a necrosis of the pulp is the consequence or at least foreseeable. In order to preserve such a tooth, an endodontic therapy is inevitable. The disadvantage of conventional endodontic therapy methods of immature teeth (apexification, apexogenesis) is the root growth stop. Alternatively, the regeneration/revascularisation of the dental pulp (RP) was suggested, that allows a further root growth. The aim of this case report is to present the procedure of a RP-therapy and to suggest a step-by-step manual.

The Impact of Brief Interventions for Tobacco Cessation on Patients' Awareness of Cigarette Smoking as a Risk Factor for Chronic Periodontitis.

PURPOSE: To evaluate the awareness of cigarette smoking as a risk factor for chronic periodontitis in patients either undergoing active periodontal treatment (APT) or enrolled in supportive periodontal therapy (SPT). MATERIALS AND METHODS: Comprehensive tobacco use history was collected with a questionnaire in 50 patients before and after APT (test) and in 50 patients (control) enrolled in SPT at the School of Dental Medicine, University of Bern. Carbon monoxide (CO) exhalation levels were measured in both APT and SPT patients. RESULTS: In the test group, 94% (n = 47) completed the study. Before APT, 48% of these (n = 24) knew about the association between smoking and periodontal disease, while 42% (n = 21) assumed a possible association and 10% (n = 5) did not. Following APT, 53% (n = 25) knew about the association, while 34% (n = 17) still assumed a possible association and 10% (n = 5) did not. In the control group, 60% (n = 30) of SPT patients knew about the association of smoking with periodontal disease, while 30% (n = 15) assumed an association and 10% (n = 5) were not aware of any association. In both APT and SPT patients, neither between-group nor baseline to follow-up differences were detected (p > 0.05). CONCLUSIONS: Brief interventions for tobacco cessation during APT or SPT failed to increase periodontal patients' awareness of smoking as a risk factor for chronic periodontitis. In order to both increase awareness and motivation to quit tobacco use, more counseling than conventional brief interventions may be needed. Key words: chronic periodontitis, exhaled carbon monoxide, patient education, risk factor, smoking, smoking cessation.

Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review.

OBJECTIVES: The aim was to compile the current knowledge about the efficacy of different soft tissue correction methods around osseointegrated, already uncovered and/or loaded (OU/L) implants with insufficient soft tissue conditions. Procedures to increase peri-implant keratinized mucosa (KM) width and/or soft tissue volume were considered. MATERIALS AND METHODS: Screening of two databases: MEDLINE (PubMed) and EMBASE (OVID), and manual search of articles were performed. Human studies reporting on soft tissue augmentation/correction methods around OU/L implants up to June 30, 2016, were considered. Quality assessment of selected full-text articles to weight risk of bias was performed using the Cochrane collaboration's tool. RESULTS: Overall, four randomized controlled trials (risk of bias = high/low) and five prospective studies (risk of bias = high) were included. Depending on the surgical techniques and graft materials, the enlargement of keratinized tissue (KT) ranged between 1.15 ± 0.81 and 2.57 ± 0.50 mm. The apically positioned partial thickness flap (APPTF), in combination with a free gingival graft (FGG), a subepithelial connective tissue graft (SCTG), or a xenogeneic graft material (XCM) were most effective. A coronally advanced flap (CAF) combined with SCTG in three, combined with allogenic graft materials (AMDA) in one, and a split thickness flap (STF) combined with SCTG in another study showed mean soft tissue recession coverage rates from 28 to 96.3 %. STF combined with XCM failed to improve peri-implant soft tissue coverage. CONCLUSIONS: The three APPTF-techniques combined with FGG, SCTG, or XCM achieved comparable enlargements of peri-implant KT. Further, both STF and CAF, both in combination with SCTG, are equivalent regarding recession coverage rates. STF + XCM and CAF + AMDA did not reach significant coverage. CLINICAL RELEVANCE: In case of soft tissue deficiency around OU/L dental implants, the selection of both an appropriate surgical technique and a suitable soft tissue graft material is of utmost clinical relevance.

Are there differences in the changes in oral-health-related quality of life (OHRQoL) depending on the type (rigidity) of prosthetic treatment?

OBJECTIVE: This prospective pilot study investigated differences in changes in oral-health-related quality of life (OHRQoL) depending on the prosthetic treatment type (rigidity). METHOD AND MATERIALS: Sixty participants seeking prosthetic treatment were included. The following data were collected before (T1) and 4 weeks after completion of prosthetic treatment (T2): OHRQoL (OHIP-G14) and dental status, categorized in terms of rigidity of the denture as fixed dental prosthesis (FDP, maximal rigidity), removable partial denture prosthesis (RPD, medium rigidity), or complete dentures (CDs, minimal rigidity). After prosthetic treatment, there were three groups of 20 participants: group 1, change in dental status to less rigid; group 2, equally rigid; group 3, more rigid restorations. Data were evaluated using nonparametric statistical test methods and power analysis. The minimally important difference (MID) of two OHIP-G14 units was determined to be clinically relevant. RESULTS: At T1, 20 participants had FDP, 18 RPD, and 22 CD; at T2, 10 had FDP, 37 RPD, and 13 CD. Overall, average OHIP-G14 values improved clinically relevantly and statistically significantly (P < .001) with treatment. OHRQoL improved more in group 3, with a median of 8 (IQR 14.75; P = .002), than in group 2, with 2.5 (IQR 9.5; P = .033), or group 1, with 4.5 (IQR 16.5; P = .116). Applying MID, all groups improved clinically significantly. Compared to groups 1 and 2, group 3 improved clinically more significantly. CONCLUSION: OHRQoL improved with prosthetic treatment. A patient-customized treatment regime seems as important as prosthesis type (rigidity).

[Benign odontogenic tumor in the lower jaw: A case report]. / Benigner odontogener Tumor im Unterkiefer. Ein Fallbericht.

Odontomas are classified within the group of odontogenic epithelial tumors with odontogenic ectomesenchyme with or without hard tissue formation. Together with ameloblastomas and keratocystic odontogenic tumors they are counted among the most common odontogenic tumors. Their growth is self-limiting and mostly, they are discovered accidentally as part of a x-ray examination. A common finding is that odontomas are associated with an unerupted permanent tooth. The aim of the present case report is to present the step-by-step procedure of a surgical odontoma removal in the lingual premolar/canine area of the lower jaw.

Surgical treatment option of the patent nasopalatine duct: a case report.

The nasopalatine duct (NPD) is a bilateral, epithelium-lined oronasal communication formed in the early fetal period. It connects the oral cavity with the nasal cavity within the primary palatal process. Mostly, the NPD obliterates during prenatal development and only epithelial remnants can be found after birth. A persistent NPD is therefore considered a developmental abnormality that often exists undetected without any clinical signs of discomfort. The presence of a persisting NPD, however, can be associated with pain sensation in the anterior maxilla. Differential diagnosis of the patent NPD is of importance, in order to prevent unnecessary therapy, such as endodontic treatment or tooth extractions. The present case report describes the diagnostic procedures, surgical treatment and follow-up of the patent NPD in a 53-year-old female patient suffering from maxillary pain caused by a patent NPD.

Soft tissue augmentation procedures at second-stage surgery: a systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the efficacy of different soft tissue augmentation/correction methods in terms of increasing the peri-implant width of keratinized mucosa (KM) and/or gain of soft tissue volume during second-stage surgery. MATERIALS AND METHODS: Screening of two databases, MEDLINE (PubMed) and EMBASE (OVID), and hand search of related articles, were performed. Human studies reporting on soft tissue augmentation/correction methods around submucosally osseointegrated implants during second-stage surgery up to July 31, 2015 were considered. Quality assessment of the selected full-text articles was performed according to the Cochrane collaboration's tool to assess the risk of bias. RESULTS: Overall, eight prospective studies (risk of bias: high) and two case series (risk of bias: high) were included. Depending on the surgical technique and graft material used, the enlargement of keratinized tissue (KT) ranged between -0.20 and 9.35 mm. An apically positioned partial-thickness flap/vestibuloplasty (APPTF/VP) in combination with a free gingival graft (FGG) or a xenogeneic graft material (XCM) was most effective. Applying a roll envelope flap (REF) or an APPTF in combination with a subepithelial connective tissue graft (SCTG), mean increases in soft tissue volumes of 2.41 and 3.10 mm, respectively, were achieved. Due to the heterogeneity of study designs, no meta-analysis could be performed. CONCLUSIONS: Within the limitations of this review, regarding the enlargement of peri-implant KT, the APPTF in the maxilla and the APPTF/VP in combination with FGG or XCM in the lower and upper jaw seem to provide acceptable outcomes. To augment peri-implant soft tissue volume REF in the maxilla or APPTF + SCTG in the lower and upper jaw appear to be reliable treatment options. CLINICAL RELEVANCE: The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.

[Tonsil calculi in the orthopantomography image]. / Tonsillolithen auf dem Orthopantomogramm.

Tonsilloliths are calcifications within the tonsillar crypts. Affected are especially the palatine tonsils. The prevalence is ranging between 16 and 46.1%. Tonsilloliths can be the reason for chronic halitosis, irritating cough, dysphagia, otalgia, foreign body sensation or foul taste in the mouth. They are often asymptomatic. Tonsilloliths can be discovered incidentally in orthopantomography (OPT) as singular or multiple radioopacities in the area of the ramus mandibulae. The aim of this case report is to present two cases with asymptomatic tonsilloliths detected based on an OPT and confirmed in a computed tomography (CT) or by magnetic resonance imaging (MRI).

The alveolar ridge splitting/expansion technique: a systematic review.

PURPOSE: The aim of this systematic review was to evaluate clinical, radiological and histological outcomes of the alveolar ridge splitting/expansion technique (ARST) with or without GBR. MATERIALS AND METHODS: A screening of two databases MEDLINE (PubMed) and EMBASE (OVID) and hand search of articles were performed. Human and animal studies reporting on dental implants placed with simultaneous ARST up to May 31st 2014 were considered. Quality assessment of selected full-text articles was performed according to the ARRIVE guidelines and the Cochrane collaboration's tool to assess risk of bias. RESULTS: Overall, 18 human and six animal studies (risk of bias: high/unclear) were included in this review. No randomized controlled trials were found. Due to the heterogeneity of study designs, definitions of success criteria, outcome variables, observation times and surgical procedures, no meta-analysis was performed. Reported survival (18 studies) and success (nine studies) rates ranged from 91.7 to 100% and 88.2 to 100%, respectively, with a mean follow-up of 1-10 years. Crestal bone level changes (∆CBL) in some studies indicate slightly higher bone loss before and after loading. Histologic and histomorphometric data from six animal studies confirm the crestal bone loss, particularly at buccal sites. CONCLUSIONS: Within the limitations of this review, ARST seems to be a well-functioning one-stage alternative to extended two-stage horizontal grafting procedures. Data indicate that during healing and first year of loading, increased ∆CBL particularly at buccal sites must be anticipated. Additional horizontal GBR can help to preserve buccal bone height and width.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial.

BACKGROUND: The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures. METHODS: The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement. RESULTS: Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr -0.60 ± 0.69 mm and Ti Grade IV -0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively. CONCLUSIONS: After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures. TRIAL REGISTRATION: Registered on www.clinicaltrials.gov: NCT01878331.

Intraorales Lipom am Zungengrund.

Lipomas represent a relatively rare finding in the oral cavity. They are classed with soft tissue mesenchymal neoplasms, are benign and normally show a painless slow-growing character. Important is the differential diagnosis toward the liposarcomas, which represent a malignant version of adipose neoplasia and as well show a painless slow-growing character. Therefore, in case of clinical suspicion of a lipoma, a histopathological examination of the excisional biopsy has to be exercised in order to confirm the clinical diagnosis. The aim of the present case report is to present the step-by-step procedure of a lipoma excision at the base of the tongue and to give an overview of the literature.

Die chirurgische Kronenverlängerung zur Verbesserung der biologischen Breite und Ästhetik.

The aims of surgical crown lengthening procedures are to improve prosthetic reconstructions at teeth with limited hard tissue, to prevent periodontal problems and/or to improve esthetics. When planning and performing surgical crown lengthening, it is important to consider not only periodontal and technical aspects but also the gingival profile of the neighbouring teeth. This paper presents the systematic approach starting with the diagnosis and indication to the performed treatments and the obtained results and gives clinical recommendations.

Distinct subcutaneous emphysema following surgical wisdom tooth extraction in a patient suffering from 'Gilles de la Tourette syndrome'.

Subcutaneous emphysema is a rare complication in oral surgery. In most cases, it resolves spontaneously. However, air might disperse into deeper facial spaces causing life-threatening complications such as compression of the tracheobronchial tree or the development of pneumomediastinum. Moreover, microorganisms might spread from the oral cavity into deeper spaces. Hence, rapid diagnosis of subcutaneous emphysema is important. Characteristic signs are both a shiftable swelling and crepitation. In this case report, a 30-year-old man, suffering from the Gilles de la Tourette Syndrome, with a distinct subcutaneous emphysema after bilateral surgical wisdom tooth extraction is presented. Induced by a specific motor tic, air accumulated from the periorbital through to the parapharyngeal region. Applying a 10-cm-long Redon drainage tube as air valve, 10 days after wisdom teeth extraction, the patient was asymptomatic with complete resolution of the emphysema.

Soft tissue grafting to improve the attached mucosa at dental implants: A review of the literature and proposal of a decision tree.

BACKGROUND: Scientific data and clinical observations appear to indicate that an adequate width of attached mucosa may facilitate oral hygiene procedures thus preventing peri-implant inflammation and tissue breakdown (eg, biologic complications). Consequently, in order to avoid biologic complications and improve long-term prognosis, soft tissue conditions should be carefully evaluated when implant therapy is planned. At present the necessity and time-point for soft tissue grafting (eg, prior to or during implant placement or after healing) is still controversially discussed while clinical recommendations are vague. OBJECTIVES: To provide a review of the literature on the role of attached mucosa to maintain periimplant health, and to propose a decision tree which may help the clinician to select the appropriate surgical technique for increasing the width of attached mucosa. RESULTS: The available data indicate that ideally, soft tissue conditions should be optimized by various grafting procedures either before or during implant placement or as part of stage-two surgery. In cases, where, despite insufficient peri-implant soft tissue condition (ie, lack of attached mucosa or movements caused by buccal frena), implants have been uncovered and/or loaded, or in cases where biologic complications are already present (eg, mucositis, peri-implantitis), the treatment appears to be more difficult and less predictable. CONCLUSION: Soft tissue grafting may be important to prevent peri-implant tissue breakdown and should be considered when dental implants are placed. The presented decision tree may help the clinician to select the appropriate grafting technique.

The patent nasopalatine duct: a potential cause of unclear pain in the anterior maxilla.

OBJECTIVE: The aim of this report is to describe symptoms that can suggest the presence of a patent nasopalatine duct and to illustrate three cases. SUMMARY: Patent nasopalatine ducts connecting the oral cavity with the nasal cavity are extremely rare. This malformation can be considered a developmental abnormality. Clinically, patent nasopalatine ducts appear as single or double spherical or oval apertures lateral or posterior to the incisive papilla. This type of anatomical malformation can be associated with an unclear pain sensation in the anterior maxillary region, which may be misinterpreted for example as toothache of endodontic origin. However, persisting nasopalatine ducts can also exist as an asymptomatic abnormality with no clinical sign of discomfort. Accordingly, understanding the differential diagnosis of a possible patent nasopalatine duct can prevent a general practitioner from performing unnecessary interventions, such as endodontic treatments, apical surgeries, or tooth extractions.