Microbiological assessment of the implant-abutment interface in different connections: cross-sectional study after 5 years of functional loading.

OBJECTIVE: To evaluate the bacterial microflora present inside the implant connection and in the peri-implant sulcus fluid of healthy implants, and to analyze the relationships between these harboring sites for four different implant systems after at least 5 years of functional loading. MATERIALS AND METHODS: A cross-sectional study was performed involving 40 patients treated with metal-ceramic cemented bridges supported by at least two healthy implants functionally loaded for 5 years. Four different implant-abutment connections were studied: external hexagon (control group), double internal hexagon (test group 1), internal hexagon with external collar (test group 2), and conical connection (test group 3). Samples for microbiological analysis were obtained from three types of sites: peri-implant sulci, connections' inside and abutments surface and, as control, gingival sulci of neighboring teeth. Quantitative real-time PCR was carried out for Total Bacterial Count and for 10 microorganisms: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens, and Candida albicans. The response variables were percentage of positive sites and absolute bacterial load. The relations of the response variables with the type of connection and of sampling site were assessed using generalized estimating equations. RESULTS: Regarding the analysis of positivity to bacteria in the peri-implant sulcus no significant differences were observed. Analyzing the connection's inside, none of the connection designs had the capacity to prevent microbiological leakage through the implant/abutment microgap. Test group 3 presented the lowest mean values for red complex bacteria and control group the highest, although differences were non-significant. Statistical significance was only reached for Treponema denticola in the bacterial load analysis inside the connection. Test groups 1 and 2 yielded lower values for orange complex bacteria but only for Peptostreptococos micros the differences resulted significant. Test groups 2 and 3 had significantly lower total bacterial counts in the peri-implant sulcus and inside the connection. CONCLUSIONS: Outcomes suggested that all the analyzed connections resulted contaminated after 5 years of functional loading. However, the connection design might influence bacterial activity levels qualitatively and quantitatively, especially inside the implant connection.

Application of mesenchymal stem cells in bone regenerative procedures in oral implantology. A literature review.

OBJECTIVE: The aim of this work was to review de literature about the role of mesenchymal stem cells in bone regenerative procedures in oral implantology, specifically, in the time require to promote bone regeneration. STUDY DESIGN: [corrected] A bibliographic search was carried out in PUBMED with a combination of different key words. Animal and human studies that assessed histomorphometrically the influence of mesenchymal stem cells on bone regeneration procedures in oral implantology surgeries were examined. Reults: - Alveolar regeneration: Different controlled histomorphometric animal studies showed that bone regeneration is faster using stem cells seeded in scaffolds than using scaffolds or platelet rich plasma alone. Human studies revealed that stem cells increase bone regeneration. - Maxillary sinus lift: Controlled studies in animals and in humans showed higher bone regeneration applying stem cells compared with controls. - Periimplantary bone regeneration and alveolar distraction: Studies in animals showed higher regeneration when stem cells are used. In humans, no evidence of applying mesenchymal stem cells in these regeneration procedures was found. CONCLUSION: Stem cells may promote bone regeneration and be useful in bone regenerative procedures in oral implantology, but no firm conclusions can be drawn from the rather limited clinical studies so far performed. Key words:Mesenchymal stem cells, bone regeneration, dental implants, oral surgery, tissue engineering.

Impression of multiple implants using photogrammetry: description of technique and case presentation.

AIM: To describe a technique for registering the positions of multiple dental implants using a system based on photogrammetry. A case is presented in which a prosthetic treatment was performed using this technique. STUDY DESIGN: Three Euroteknika® dental implants were placed to rehabilitate a 55-year-old male patient with right posterior maxillary edentulism. Three months later, the positions of the implants were registered using a photogrammetry-based stereo-camera (PICcamera®). After processing patient and implant data, special abutments (PICabutment®) were screwed onto each implant. The PICcamera® was then used to capture images of the implant positions, automatically taking 150 images in less than 60 seconds. From this information a file was obtained describing the relative positions - angles and distances - of each implant in vector form. Information regarding the soft tissues was obtained from an alginate impression that was cast in plaster and scanned. A Cr-Co structure was obtained using CAD/CAM, and its passive fit was verified in the patient's mouth using the Sheffield test and the screw resistance test. RESULTS AND CONCLUSIONS: Twelve months after loading, peri-implant tissues were healthy and no marginal bone loss was observed. The clinical application of this new system using photogrammetry to record the position of multiple dental implants facilitated the rehabilitation of a patient with posterior maxillary edentulism by means of a prosthesis with optimal fit. The prosthetic process was accurate, fast, simple to apply and comfortable for the patient.

Implants placed in the nasopalatine canal to rehabilitate severely atrophic maxillae: a retrospective study with long follow-up.

To assess the survival rate of implants placed in the nasopalatine canal for the rehabilitation of patients with atrophic maxillae and the level of satisfaction of these patients. A retrospective study was performed between 2000 and 2009 of patients with severe atrophy of edentulous maxillae (Cawood and Howell's class V) rehabilitated with implant-supported prostheses with 1 implant placed in the nasopalatine canal. A preoperative computed tomography scan was obtained of all patients and all surgeries were performed by the same surgeon. The following parameters were assessed: neurosensory status of the anterior palate (using the pointed/blunt discrimination method); implant success rate according to criteria described by Albrektsson et al; patient satisfaction with the prosthetic treatment (using visual analogue scales). Thirteen patients with a mean age of 54.8 years were treated, 5 men and 8 women. Seventy-eight implants were placed: 13 in the nasopalatine canal, 6 in the zygomatic bone, 12 in the pterygomaxillary region, 2 in the frontomaxillary buttress and 45 in other locations. Six patients reported a slight decrease in sensitivity in the anterior palate after surgery, which disappeared in all cases within a few weeks. Two early failures (before prosthetic loading) and no late failures (after prosthetic loading) of nasopalatine implants were recorded, yielding a success rate for these implants of 84.6% after a mean follow-up of 70 months (range 24 to 132 months. High patient satisfaction with the prosthetic restoration was generally achieved in terms of comfort, stability, function, esthetics, and ease of cleaning. Residual bone is associated with the nasopalatine canal, even in patients with severe maxillary atrophy. This canal may be considered a possible location for an anterior implant when rehabilitating atrophic patients using implant-supported prostheses.

Conventional radiofrequency treatment in five patients with trigeminal neuralgia.

INTRODUCTION: In trigeminal neuralgia, when drug treatment proves ineffective, other management options must be considered. In this context, conventional radiofrequency of Gasser's ganglion is a safe and effective alternative. MATERIAL AND METHODS: We describe 5 patients with long-evolving trigeminal neuralgia subjected to conventional radiofrequency according to the Sweet technique, with a follow-up of two years. RESULTS: Pain relief was complete after two months in all cases. One patient suffered an unexpected episode of nausea, vomiting and foul odor sensation that subsided after three days of rest and drug treatment. Three patients described non-painful hypoesthesia in the region of the treated nerve branch that subsided within three months. The patients remained free of symptoms over long-term follow-up. In one case the same radiofrequency technique had to be repeated after 21 months because of the reappearance of symptoms in the same zone, followed by immediate pain relief. CONCLUSIONS: In our series of patients trigeminal neuralgia was not controlled by drug treatment, and conventional radiofrequency targeted to Gasser's ganglion proved very effective, with no major complications.

Radiofrequency treatment of cervicogenic headache.

OBJECTIVES: In the clinical management of facial pain, a possible cervical origin must be considered. A clinical exploration is therefore essential. The disorder originates in the intimate connections between the cranial portion of the spinal cord and the trigeminal system. Although solid evidence supporting the use of radiofrequency (RF) treatment is lacking, it remains one of the management options to be taken into account. The present study evaluates the efficacy of RF in application to cervicogenic headache. STUDY DESIGN: We present three cases of severe facial pain arising from different cervical structures. RESULTS: In two cases the pain originated in cervical roots C2 and C3, while in the third patient the trigger point was located at the level of the atlantoaxial joint. Pulsed RF was applied for 4 minutes at the dorsal ganglion of C2 and C3 in the first two cases, and for 8 minutes at intraarticular level in the third patient. The pain gradually subsided during the first month in all cases. The first two patients reported 70% improvement after one month, 60% improvement after 6 months, and 30-50% after one year, versus baseline. The third patient reported complete pain resolution lasting approximately 5 months, after which the pain reappeared with the same intensity as before. CONCLUSIONS: Radiofrequency is a satisfactory treatment option, affording adequate analgesia, though the effects are sometimes temporary.

Guided implant surgery with modification of the technique involving the raising of a semicircular miniflap: a preliminary study.

OBJECTIVE: An evaluation is made of pain, swelling and peri-implant attached mucosal width after implant-based rehabilitation involving guided surgery and a modification of the technique with the raising of a semicircular miniflap, in single and partial replacements. STUDY DESIGN: A case-control study was carried out. The study group consisted of 12 patients with the placement of 19 implants using a guided surgery and miniflap technique. The control group consisted of 12 patients with the placement of 22 implants using the conventional technique. Each patient scored postoperative swelling and pain by means of a visual analog scale (VAS). Attached vestibular mucosa width was evaluated 12 weeks after implant placement. RESULTS: Twelve operations were carried out in each group. Immediate aesthetics were established for all implants of the study group. One implant failed in each group. Maximum pain was recorded after 6 hours in both groups (mean VAS score 4 and 4.9 in the study and control group, respectively). Maximum swelling was recorded after 24 hours (mean VAS score 2.5) in the study group and on the second day (mean VAS score 3.4) in the control group. The mean attached vestibular mucosa width was 2.9 mm in the study group and 3.2 mm in the control group. CONCLUSION: In this preliminary study, guided implant surgery with a semicircular miniflap in single and partial replacements resulted in slightly less postoperative pain and swelling than with the conventional implant technique. The attached vestibular mucosa width was greater in the control group, though the differences were very small.

Indirect osteotome maxillary sinus floor elevation: an update.

The objective was to review publications on indirect osteotome maxillary sinus floor elevation (OMSFE) procedures. Studies published between 1999 and 2010 on patients with a minimum of 1 year of follow-up were analyzed. Fourteen studies were included. Indirect OMSFE is indicated for a bone height of 6-8 mm. More bone height was gained when graft material was used. Schneiderian membrane perforation was the most frequent complication. Survival rates varied between 93.5% and 100%. Osteotome sinus membrane elevation is a predictable and effective procedure for placing implants in areas of the posterior maxilla with low bone height.

Bilateral vertical ridge augmentation with block grafts and guided bone regeneration in the posterior mandible: a case report.

The aim is to describe bilateral vertical ridge augmentation with intraoral block grafts and guided bone regeneration in the posterior mandible in preparation for implant placement. A 61-year-old woman, edentulous in the posterior mandible, presented for implant rehabilitation. The radiographic study showed 3 to 6 mm of bone height from the ridge to the mandibular canal. Autogenous bone block grafts from the chin and the mandibular ramus, harvested with ultrasonics, were used to augment the alveolar ridge. To reduce resorption, the grafts were covered with particulate alloplastic material and a collagen membrane. Delayed implants were placed 6 months after vertical augmentation, and 3 months later implants were loaded with a fixed prosthesis. A temporary sensory complication occurred, but 12 months after implant loading, there were no failures. In this case report block bone grafting was a feasible option to vertically augment the alveolar ridge in the posterior mandible.

Rehabilitation of the atrophic posterior maxilla with pterygoid implants: a review.

The purpose of this article is to review the literature published and to assess the success of treatment of patients with atrophic posterior maxilla with pterygoid implants. Studies from 1992 to 2009 on patients with atrophic posterior maxilla rehabilitated with pterygoid implants were reviewed. Those reporting clinical series of at least 5 patients with atrophic posterior maxilla (Class IV and V of Cawood and Howell), rehabilitated with pterygoid implants and fixed prosthesis, and with 12 months minimum follow-up were included. In each study the following were assessed: number of patients, number of implants, surgical technique, prosthetic rehabilitation, success rate, bone loss, complications and patient satisfaction. Thirteen articles were included, reporting a total of 1053 pterygoid implants in 676 patients. The weighted average success of pterygoid implants was 90.7%; bone loss evaluated radiographically ranged between 0 and 4.5 mm. No additional complications compared with conventional implants were found, and patient satisfaction level with the prosthesis was high. Pterygoid implants have high success rates, similar bone loss levels to those of conventional implants, minimal complications and good acceptance by patients, being therefore an alternative to treat patients with atrophic posterior maxilla. Two anatomical locations in which implants are placed in the retromolar area can be distinguished: the pterygoid process and the pterygomaxillary region. Implant lengths and angulations vary between these two techniques.

Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia: a preliminary study.

OBJECTIVE: To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. DESIGN: A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. RESULTS: The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia--the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia--the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. CONCLUSIONS: The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia.

Symptoms before periapical surgery related to histologic diagnosis and postoperative healing at 12 months for 178 periapical lesions.

PURPOSE: To compare the preoperative signs and symptoms with the histologic diagnosis and postoperative healing at 12 months for 178 periapical lesions. MATERIALS AND METHODS: A total of 152 patients who had undergone periapical surgery from 2005 to 2008 were studied. The study included patients presenting with signs and symptoms before periapical surgery with a sufficient tissue sample (periapical lesion) for histologic analysis and a minimal follow-up of 12 months. The signs and symptoms present in the soft tissues at the initial examination were recorded. The histologic analysis established the diagnosis as granuloma, cyst, or scar tissue. The postoperative healing at 12 months was evaluated according to the criteria of von Arx and Kurt. RESULTS: Of the 152 patients, 147, with 178 periapical lesions, were included in the present study. No significant relationship was found between the preoperative signs and symptoms, lesion type, and evolution. However, scar tissues were asymptomatic in 78.1%, and 36.4% of granulomas were painful. Of the 8 cysts, 50% were asymptomatic and 50% caused pain. Fibrous scars created no soft tissue alterations in 68.7%. Granulomas had fistulized in 31.7%, and 75% of cysts had produced no alterations. The lesions with swelling had worse healing, and those with no soft tissue alterations had better postoperative healing. CONCLUSIONS: Chronic periapical lesions (granuloma, cyst, and scar tissue) are usually asymptomatic and do not create soft tissue alterations. However, they can deteriorate, producing pain and fistulization. Worse postoperative healing was observed for lesions with swelling, although the difference was not significant.

Satisfaction of patients fitted with implant-retained overdentures.

OBJECTIVE: to evaluate patient satisfaction with implant-retained overdentures, and its relationship with age, sex, period of follow-up, the rehabilitated jaw (maxilla, mandible or both), number of implants, splinting, type of attachment and the antagonist. MATERIAL AND METHODS: the study comprised patients with overdentures fitted between January 1996 and June 2007, and with a minimum follow-up of one year. Data regarding patients and prostheses were collected. The patients indicated their overall satisfaction on a visual analogue scale (VAS) from 0 to 10, as well as satisfaction for individual items such as aesthetics, speech, mastication, prosthetic stability and self-esteem. These data were collected one month after fitting the prostheses, at 12 months and at a final examination. Statistical analyses were made using the SPSS version 15, statistical significance was considered for p<0.05. RESULTS: the study included 95 patients, 43 men and 52 women, with a mean age of 55.9 years; 76 edentulous mandibles and 31 edentulous maxillae were rehabilitated with 107 overdentures. One hundred and thirty-seven implants were placed in the maxilla, and 224 in the mandible. The mean level of overall satisfaction was 9 at one month of fitting the prosthesis, 8.8 at 12 months and 8.7 at the final control (mean 71 months). CONCLUSIONS: the patients fitted with implant-retained overdentures expressed a high level of overall satisfaction, independently of age, sex, length of follow-up, rehabilitated jaw, number of implants per overdenture, whether splinted or non-splinted, and type of attachment. Men were more satisfied with mastication and stability.

Maximum use of the anterior maxillary buttress in severe maxillary atrophy with tilted, palatally positioned implants: a preliminary study.

PURPOSE: To evaluate an alternative treatment for rehabilitation of the atrophic maxilla with palatal and tilted implants and to assess patient satisfaction with the results. MATERIALS AND METHODS: A retrospective case study was made of completely edentulous subjects with tilted, palatally positioned implants in the anterior maxillary buttress placed and loaded between January 2005 and January 2007. Patients with severely resorbed edentulous maxillae (Class V according to Cawood and Howell) who requested overdentures and were followed for 12 months after implant loading were included. Mesial and distal implant bone loss was measured on panoramic radiographs. Subjects indicated satisfaction with the new prosthesis after 12 months on a visual analog scale. RESULTS: Twelve patients treated with tilted and palatal implants in the anterior maxillary buttress were included in the study; 48 implants were placed (4 implants in each patient) to support 12 overdentures with bars. One implant failed, resulting in a survival rate of 97.9%. The mean peri-implant bone loss of implants with palatal anchorage after 1 year of loading was 0.78 ± 0.5 mm. All patients had stable prostheses at the end of the observation period. Patients were satisfied with comfort and stability, ability to speak, ease of cleaning, esthetics, and function of the prosthesis. CONCLUSION: Placement of implants slightly to the palatal and tilted in the anterior maxillary buttress to support an overdenture with bars may be a viable treatment alternative for the rehabilitation of the atrophic maxilla, providing a high level of satisfaction with the prosthesis and reducing patient morbidity and costs.

Dental implants placed simultaneously with bone grafts in horizontal defects: a clinical retrospective study with 37 patients.

PURPOSE: The aim of this study was to evaluate the 1-year success rate and marginal bone loss for dental implants placed simultaneously with bone grafts. MATERIALS AND METHODS: The study sample comprised 37 patients treated with dental implants placed simultaneous with intraoral block bone grafts. The block grafts were harvested from the chin, retromolar area, or maxillary tuberosity. Complications with the bone grafts were categorized as minor or major and, for the graft success rate, the Barone and Covani criteria were used. The definition of implant success was based on the clinical and radiographic criteria of Albrektsson et al. Peri-implant bone loss was measured after 1 year of prosthetic loading. RESULTS: The study involved 39 bone grafts (17 maxillary and 22 mandibular) and 129 implants (73 implants in grafted areas) in 37 patients. No complications were observed at the donor sites. A part of the onlay bone graft was exposed in eight sites; six sites showed spontaneous reepithelialization following chlorhexidine application, but two grafts became infected and had to be removed. Three implants were lost in the grafted areas; the success rate for implants with simultaneous bone grafting was therefore 95.9%. No complications were found at 12 months after prosthesis placement. The mean overall bone loss after 1 year of loading was 0.64 mm. CONCLUSION: In patients meeting the inclusion criteria, simultaneous placement of bone grafts and implants shortens treatment time without increasing complications or reducing the success rate.

Influence of oral hygiene and smoking on pain and swelling after surgical extraction of impacted mandibular third molars.

PURPOSE: To assess the pain and swelling during the first week after surgical extraction of impacted mandibular third molars and the relationship with oral hygiene and smoking before surgery and during the postoperative period. MATERIALS AND METHODS: A prospective study was performed on patients undergoing surgical extractions of impacted mandibular third molars. Pain was recorded on a visual analog scale from 1 to 10 and swelling on a 4-point descriptive scale at 2, 6, and 12 hours after surgery and daily during the first postoperative week. Oral hygiene and smoking before surgery and during the postoperative period were recorded. Statistical analysis was performed of all the variables. A P value less than .05 was considered statistically significant. RESULTS: A total of 50 patients (27 men and 23 women) with a mean age of 26.3 years (range 18 to 39) underwent surgical extraction of an impacted third molar. The maximum pain occurred during the first day and the maximum swelling at 24 hours after surgery. The patients with a lower brushing frequency before surgery reported greater pain. Likewise, the patients who smoked more after surgery experienced greater pain at 24 hours postoperatively. The hygiene after surgery and smoking before the surgical intervention had no statistically significant relationship to the occurrence of pain (P > .05). Swelling had no relationship with the variables studied (P > .05). CONCLUSIONS: Surgical extraction of an impacted third molar caused moderate pain and swelling during the first 24 hours after surgery. A lower brushing frequency before surgery and during the first postoperative week as well as smoking after surgery were related to greater pain scores.

Immunohistochemical study of Langerhans cells in periapical lesions: correlation with inflammatory cell infiltration and epithelial cell proliferation.

AIM: The aim of this study is to determine the presence and distribution of Langerhans cells in periapical lesions, and correlate this with inflammatory cell infiltration and epithelial cell proliferation. MATERIAL AND METHODS: Seventy chronic dental periradicular lesions, obtained during periapical surgery from 70 patients, were included in this study, including: 46 granulomas, 18 scar tissue and 6 periradicular cysts. Immunohistochemical staining was performed using the following markers: CD3 to analyze the inflammatory infiltrate, CD1a to determine the presence of Langerhans cells and Ki67 to analyze the epithelial cell proliferation. The CD1a immunostaining density was established following Cincura (2007) criteria, being classified ranging from intense (3), moderate (2), discrete (1) or no (0) immunostaining. CD3 and Ki67 staining was evaluated following the Liapatas et al. scale, as: 0) no cells stained; 1) weak stain or few cells stained (11-25%); 2) moderate staining or some cells stained (26-75%); 3) intense staining or many cells stained (more than 76%). RESULTS: Langerhans cells were found in 32.8% of the periapical lesions being more intense in the epithelialized lesions. CD3 immunohistochemical staining was found in all lesions, but with different values in relation to histological subtypes. Ki67 was positive in all epithelialized lesions, although with a moderate staining. CONCLUSIONS: Langerhans cells appeared to be associated with T-lymphocyte infiltration and the proliferative potential of the epithelial tissue in periapical lesions.

Retrospective study of 68 implants placed in the pterygomaxillary region using drills and osteotomes.

PURPOSE: The aim of this study was to evaluate the success rate of implants placed in the pterygomaxillary region using drills and osteotomes with a minimum of 12 months' follow-up. Bone loss after 1 year of loading and patient satisfaction with the prosthesis were evaluated. MATERIAL AND METHODS: A retrospective case study was made. The sample was composed of patients rehabilitated with pterygoid implants between January 2000 and January 2006. The inclusion criteria were patients in good general health with severe atrophy of the posterior maxilla who had been rehabilitated with one or two pterygoid implants inserted using drills and osteotomes and had been followed for 12 months after implant loading. Implant success was defined according to the criteria of Albrektsson et al. Bone loss was measured on panoramic radiographs on the mesial and distal of each implant, and the largest value (whether mesial or distal) was selected as the bone loss for the implant in question. Subjects indicated satisfaction with the new prosthesis on a visual analogue scale. RESULTS: Forty-five patients were treated with 268 implants (200 anterior and 68 pterygoid). The success rate of pterygoid implants was 97.05%. The mean bone loss around implants in the pterygomaxillary region after 1 year of loading was 0.71 mm (range, 0 to 3.20). All prostheses were stable at the end of the observation period. Patients were satisfied with comfort and stability, ability to speak, ease of cleaning, and esthetics and functionality of the prosthesis. CONCLUSION: Placement of implants in the posterior pterygomaxillary region using drills and osteotomes is a viable alternative treatment modality for rehabilitation of atrophic posterior maxilla. Patients were satisfied with a prosthesis supported by pterygoid implants.

Idiopathic trigeminal neuropathies: a presentation of 15 cases.

PURPOSE: The aim of this study is to present a clinical series of patients with trigeminal neuropathy and their treatment. PATIENTS AND METHODS: We present a retrospective study of 15 cases of idiopathic trigeminal neuropathies, with unilateral involvement of 1 or more divisions of the trigeminal nerve. The clinical, radiologic, and laboratory data of the patients, in addition to the treatment and clinical evolution, were reviewed. The patients were followed up for a mean of 34.4 months (range, 12-120 months). RESULTS: The study consisted of 11 women and 4 men. The numbness was predominantly located in the innervated mental area and extended in some cases to the first and second trigeminal divisions. Seven patients had slight continuous discomfort in association with the numbness, one of whom had added bouts of typical neurogenic pain. Of the 15 cases, 8 (53%) had acute idiopathic trigeminal neuropathies and fully recovered within 3 months and 7 (47%) were chronic cases, without full recovery after 3 months. Mild pain was felt by 57% of the chronic patients and 37% of the acute patients; treatment with amitriptyline achieved complete or partial improvement in over half of these patients. CONCLUSION: Of the idiopathic trigeminal neuropathies, half were acute and half were chronic. Mild pain presented more frequently in the chronic patients and was relieved with amitriptyline.

Palatal positioning of implants in severely resorbed edentulous maxillae.

PURPOSE: The aim of this study was to evaluate implant-supported restorations supported by palatally positioned implants as an alternative treatment for rehabilitation of the atrophic maxilla and to assess the satisfaction of patients with the results. MATERIALS AND METHODS: A retrospective case study was conducted on completely edentulous subjects who received palatally positioned implants (placed and loaded) between January 2000 and January 2004. Inclusion criteria were patients with severely resorbed edentulous maxillae (Class IV or V maxillary atrophy, according to the Cawood and Howell classification) who requested implant-supported restorations and had a follow-up period of at least 24 months after implant loading. Panoramic radiographs and maxillary computerized tomograms had been made for all patients prior to treatment. Mesial and distal implant bone loss was measured on panoramic radiographs, and the largest value was designated as the bone loss for the implant in question. Subjects indicated their degree of satisfaction with the new prosthesis after 12 months on a visual analogue scale. RESULTS: Sixty-nine patients with severely resorbed edentulous maxillae were included in the study. Four hundred and ninety implants (six to eight in each patient) were placed to support 69 fixed prostheses; 330 were in palatal positions and 160 were in molar positions (84 over the crest in the first molar position and 76 in anatomic buttresses). The success rate of palatally positioned implants was 97.8% (323/330). The mean bone loss of implants with palatal anchorage after 2 years of loading was 0.61 mm (range, 0 to 3.10 mm). All patients had stable prostheses at the end of the observation period. Patients were satisfied with comfort and stability, ability to speak, ease of cleaning, esthetics, and function of the prosthesis. CONCLUSION: Implants placed in a palatal position may be a viable alternative for rehabilitation of the atrophied maxilla.