A strip free gingival graft and a xenogeneic collagen matrix to increase keratinized tissue after vertical bone augmentation.

PURPOSE: After vertical bone augmentation (VBA) surgery, loss of both keratinized tissue (KT) and vestibule depth (VD) take place. This article evaluated KT gain, patient satisfaction, and aesthetic outcomes after a modified apically repositioned flap (ARF) in combination with a strip-free gingival graft (FGG) harvested from the palate and a xenogeneic collagen matrix (XCM) to correct mucogingival distortion (MGD) after VBA. This technique minimizes patient morbidity by reducing the need for extensive masticatory mucosa grafts. MATERIALS: The study included 12 patients with ≤3 mm KT after vertical augmentation procedures. KT gain and tissue thickness were measured. Patient morbidity and aesthetic outcomes were also evaluated. RESULTS: Twenty-four months after surgery, significant VD gain was observed, obtaining a vertical KT augmentation of 5.38 ± 2.06 mm, although tissue thickness increase was only 0.42 ± 0.42mm. Regarding patient satisfaction, aesthetic results evaluating tissue color and texture were satisfactory; the pain was slight, obtaining a score of 2.10 ± 1.13 out of 10, measured using a Visual Analogue Scale (VAS). CONCLUSION: The present retrospective case series study shows that using an apically repositioned flap combined with a strip FGG and an XCM might offer a valid means of achieving KT gain.

An unusual presentation of peripheral ameloblastoma in the maxilla.

Peripheral ameloblastoma (PA) is believed to be the rarest variant of ameloblastoma and only has been described in isolated case reports. PA is usually confined to the soft tissues surrounding the supporting tissues of the teeth. Although it manifests nonaggressive behavior and can be treated with complete removal by local surgical excision, long term follow up is mandatory to prevent future recurrence and possible malignant transformation.

Accuracy of Digital Dental Implants Impression Taking with Intraoral Scanners Compared with Conventional Impression Techniques: A Systematic Review of In Vitro Studies.

The aim of this systematic review was to evaluate the in vitro accuracy of dental implants impressions taken with intraoral scanner compared with impressions taken with conventional techniques. Two independent reviewers conducted a systematic electronic search in the PubMed, Web of Science and Scopus databases. Some of the employed key terms, combined with the help of Boolean operators, were: "dental implants", "impression accuracy", "digital impression" and "conventional impression". Publication dates ranged from the earliest article available until 31 July 2021. A total of 26 articles fulfilled the inclusion criteria: 14 studies simulated complete edentation (CE), nine partial edentation (PE) and only two simulated a single implant (SI); One study simulated both CE and SI. In cases of PE and SI, most of the studies analyzed found greater accuracy with conventional impression (CI), although digital impression (DI) was also considered adequate. For CE the findings were inconclusive as six studies found greater accuracy with DI, five found better accuracy with CI and four found no differences. According to the results of this systematic review, DI is a valid alternative to CI for implants in PE and SI, although CI appear to be more accurate. For CE the findings were inconclusive, so more studies are needed before DI can be recommended for all implant-supported restorations.

Digital Impression Taking for Maxillary Full-Arch Restoration With Immediate Loading: A Case Report.

The aim of this clinical report is to describe a maxillary full-arch implant supported restoration with immediate loading performed by means of an entirely digital work flow with photogrammetric system and intraoral scanning. A female patient with an edentulous maxillary arch attended the dental clinic seeking a maxillary fixed restoration. After treatment planning, 6 implants were placed using a surgical splint fabricated digitally by intraoral scanning of her previous removable prosthesis. Multiunit abutments were fitted, and 2 digital impressions were taken, one with a photogrammetric system for determining implant positions and the other with an intraoral scanner for soft tissue registration. The acrylic resin structure of the immediate prosthesis was milled and placed within 8 hours of implant surgery. This provisional structure fitted correctly and provided adequate esthetics and function. Radiographic and clinical follow-up after 24 months observed adequate implant evolution.

Diagnostic challenge and management of intraosseous mandibular hemangiomas: a case report and literature review.

Hemangioma is a benign tumor characterized by the proliferation of blood vessels. Although it often appears in soft tissues, its occurrence in bone tissue, particularly the mandible, is extremely rare. A 32-year-old female sought attention at the dental clinic complaining of a painless swelling in the posterior region of the left side of the mandible. A panoramic radiograph and computed axial tomography scan were taken, showing honeycomb and sunburst images, respectively, in the affected area. The patient underwent a biopsy, which led to the diagnosis of intraosseous hemangioma. Having assessed the characteristics of the lesion, it was decided to perform complete excision including safety margins, followed by an iliac crest bone graft to reconstruct the mandible. Awareness of the possible clinical and radiographic presentations of intraosseous hemangioma is considered important, as non-diagnosis could have severe consequences given its possible relation to dental structures.

Clinical performance of alveolar ridge augmentation with xenogeneic bone block grafts versus autogenous bone block grafts. A systematic review.

INTRODUCTION: This systematic literature review aimed to evaluate the feasibility of xenogeneic bone blocks for ridge augmentation compared with autogenous blocks by analyzing block survival rates, block resorption, subsequent implant survival rate, post-surgical complications, and histomorphometric findings. MATERIALS AND METHODS: Electronic searches were conducted in the Medline (PubMed), Web of Science and Cochrane databases, complimented by a manual search in specialist journals, for relevant articles published up to March 2020. Inclusion criteria were human studies in which the outcomes of xenogeneic bone block grafts were evaluated by means of their survival rates and subsequent implant survival rates. RESULTS: Sixteen articles fulfilled the inclusion criteria and were analyzed. 333 patients were recruited with a total of 337 xenogeneic bone blocks and 82 autogenous bone blocks, showing block failure rates of 6.82% and 6.1%, respectively. Bone gain, in both height and width, was similar among xenogeneic and autogenous bone blocks, but autogenous bone blocks suffered greater resorption. Implant survival rates were slightly lower for xenogeneic bone blocks. Histological and histomorphometric analysis observed more bone formation and less residual bone substitute with autogenous bone blocks than xenogeneic bone blocks. CONCLUSIONS: Atrophic alveolar crest reconstruction with xenogeneic bone block grafts would appear to offer a viable alternative to autogenous bone block grafts, obtaining similar block graft failure rate, fewer sensitive postoperative complications but a slightly lower implant survival rate. Further investigations generating long term data are needed to confirm the feasibility of xenogeneic bone blocks in different clinical scenarios.

Effectiveness of the bone ring technique and simultaneous implant placement for vertical ridge augmentation: a systematic review.

BACKGROUND: Dimensional changes after dental extraction frequently lead to situations in which bone augmentation procedures are required prior to dental implant placement. Bone ring technique (BRT) has been described as a one-stage approach to restore vertical alveolar ridge defects, in which an autogenous or allogeneic cortico-cancellous bone block graft is stabilized with a dental implant inserted simultaneously. The objective of this systematic review was to evaluate the clinical performance of BRT. MATERIALS AND METHODS: This review was conducted according to PRISMA guidelines. An electronic search was conducted in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. RESULTS: Sixteen studies with a total of 186 patients treated with 219 bone rings bocks were included in the review. The studies showed a mean bone gain of 4.94 mm, mean bone resorption of 0.83 mm, and mean marginal bone loss of 0.57 mm after a mean follow-up period of 13.35 months. A mean bone ring survival rate of 97.26% and implant survival rate of 94.97% were recorded. CONCLUSIONS: BRT would appear to be an adequate alternative technique for restoring single vertical alveolar ridge defects with simultaneous dental implant placement. However, further studies comparing this technique with other vertical ridge augmentation procedures in different clinical scenarios are needed to confirm the present results.

Placing Dental Implants through Impacted Teeth to Support a Fixed Partial Denture in a Geriatric Patient as an Alternative to Invasive Extraction Surgeries.

Multiple dental impactions not associated with craniofacial syndromes are a rare condition and present the dentist with a therapeutic challenge when it comes to performing surgical/restorative treatments in adult patients. This case report describes a geriatric patient with multiple impacted teeth restored by means of two different protocols. In the second quadrant, an impacted tooth was extracted followed by regeneration and placement of an implant. In the third quadrant, implants were placed though impacted teeth for restoration with a fixed partial prosthesis. Placing dental implants through impacted teeth may offer a possible therapeutic option for implant-supported restorations in middle-aged or elderly patients, for whom surgery and orthodontic traction are not possible, and/or patients who refuse to undergo more invasive extraction surgery.

Epidemiological Features and Clinical Repercussions of Supernumerary Teeth in a Multicenter Study: A Review of 518 Patients with Hyperdontia in Spanish Population.

OBJECTIVES: The aim of this study was to establish the prevalence of supernumerary teeth (ST) in a sector of the population of Madrid, as well as possible complications associated with the presence of these teeth. MATERIALS AND METHODS: The study investigated patients (n = 28,114) who sought dental care at the Oral Surgery Service of three different centers between May 2005 and April 2018. Cases that did not present this numeric dental developmental variation were discarded, registering only those presenting ST. STATISTICAL ANALYSIS: Statistical analysis consisted of univariate analysis (mean, standard deviation, median, etc.), bivariate analysis applying the chi-squared test, whereby statistical significance was established with a confidence interval (CI) of 95% (p < 0.05), and multivariate analysis by means of classification and decision trees. RESULTS: The study found ST in 518 patients, representing a prevalence of 1.84%. The 518 patients presented a total of 726 ST. Distomolars were the most common, representing 37.7% of the sample, followed by premolars (20.1%). About 70.5% of the sample were located in the maxilla and 78% of ST were impacted. Radiographs revealed that 39.7% of STs were associated with disorders. Supplementary morphology appeared in 52.1% of the sample. CONCLUSIONS: Although mesiodens is considered the most common ST, the present study found distomolars and supernumerary premolars to be the most frequently occurring. Pathology was associated with 39.7% of the ST sample. Early diagnosis allows optimal patient management and treatment planning, with intervention at an appropriate time to prevent complications in development and so reduce later treatment need.

Pre-operative measurement of the volume of bone graft in sinus lifts using CompuDent.

OBJECTIVE: The aim of this study was to calculate the volume of graft necessary for rehabilitation using varying lengths of implants, and to evaluate the usefulness of the planning dental software in determining the pre-operative volume of bone graft in maxillary sinus floor lifts. MATERIAL AND METHODS: Using the CompuDent program, we calculated the volume of graft necessary for 62 sinus lifts. This volume was measured to raise the floor of each sinus to 13.4 and 15 mm in height. RESULTS: The average volume of graft to achieve a lift of 13.4 mm was 2.61 ± 0.69 cm³ for the right maxillary sinus, with the range of 1.38-4.1 cm³, and 2.68 ± 0.81 cm³ for the left maxillary sinus, with the range of 1.1-4.25 cm³. The average volume of graft to achieve a lift of 15 mm was 3.13 ± 0.75 cm³ for the right maxillary sinus, with the range of 1.59-4.81 cm³, and 3.29 ± 1.02 cm³ for the left maxillary sinus, with the range of 1.48-5.11 cm³. The statistical results showed a significant inversely proportional correlation between the average of the heights and the volume of graft in the right sinus. CONCLUSIONS: The planning dental software is an effective tool in determining the volume of bone graft given the tool's simplicity, rapidness and possibility of standardization in all pre-surgical procedures.

Glossopharyngeal neuralgia: a presentation of 14 cases.

OBJECTIVE: The aim of this study was to present a series of clinical cases on glossopharyngeal neuralgia as well as the therapeutic approach used. PATIENTS AND METHODS: This observational, descriptive, and retrospective study was carried out on 14 patients who were diagnosed with glossopharyngeal neuralgia between the years 1997 and 2007 at the Oral-Facial and Implant Surgery Department and at the Otorhinolaryngology, Neurology, and Neurosurgery Departments of the Madrid University Hospital. RESULTS: The study consisted of 8 women and 6 men. The neuralgia was found predominantly on the left side, and considering the 4 areas of topographical distribution into which the distribution of the ninth nerve is divided, the results of our study showed that the maximum of the areas affected was 3, with 2 areas being the most common. Accompanying symptoms were only recorded in 4 of the cases. In 12 of the cases, initial treatment was with prescription drugs consisting of different doses of carbamazepine. In the remaining cases, or once the other course of treatment was proven to be unsuccessful, surgical treatment was used, applying different techniques and obtaining a high rate of success with them. CONCLUSIONS: Glossopharyngeal neuralgia is an uncommon pathology that is treated with medicine or surgery, with carbamazepine and vascular microdecompression being the treatments of choice.

A clinical epidemiologic analysis of a sample of 73 supernumerary premolars.

BACKGROUND: The authors conducted a retrospective study to determine the prevalence of supernumerary premolars in sample of patients from Madrid, as well as the possible complications associated with the presence of such supernumerary premolars. METHODS: The study included a data assessment of all patients seeking dental care at a hospital's department of oral surgery across four years. The authors studied data from patients who had supernumerary premolars. RESULTS: The authors identified supernumerary premolars in the records of 43 patients (0.32 percent) of the total population studied. These patients had 73 hyperdontic premolars (65 mandibular premolars [89 percent] and eight maxillary premolars [11 percent]). CONCLUSIONS: Supernumerary premolars usually are diagnosed as a coincidental radiographic finding without an associated pathology. However, the authors found a higher percentage of comorbidity than they initially expected. CLINICAL IMPLICATIONS: Mechanical or obstructive pathology was associated with 2.7 percent of the premolars, and enlargement of the follicular sac of more than 3 millimeters was present in 26.0 percent of the sample.