Periodontitis and non-communicable diseases in a Brazilian population, a cross-sectional study, Vila Velha-ES, Brazil.

BACKGROUND: The objective of this study was to examine the hypothesis that periodontal disease is associated with chronic non-communicable diseases. METHODS: In this cross-sectional study, we evaluated the periodontal health condition of the population, based on the community periodontal index, as well as the number of missing teeth and the presence of systemic health conditions. We quantified the association between oral health and the presence of chronic diseases using simple logistic regression, adjusting for confounding factors including age, smoking, and overweight. RESULTS: The study population consisted of 334 volunteers, aged between 19 and 81 years. In patients over 45 years old, periodontal disease was found to be significantly associated with hypertension and diabetes. Furthermore, in female patients, periodontal disease was significantly associated with hypertension, diabetes, and cancer. CONCLUSION: Our findings indicate that periodontal disease is positively and significantly associated with both arterial hypertension and diabetes, independent of potential confounding factors.

Accuracy of open-sleeved vs. closed-sleeved static computer-assisted implant systems in immediate maxillary molar implant placement: An in vitro study.

OBJECTIVES: The objective of this study is (1) to compare the accuracy of an open-sleeved static computer-assisted implant system (sCAIS) with a closed-sleeve sCAIS and free-hand approach in immediate implant placement (IIP) of maxillary molar sites and (2) to investigate the influence of socket morphology on these approaches. MATERIALS AND METHODS: Ninety partially edentulous duplicated maxillary models simulating three different molar sockets (type A, B, and C based on Smith and Tarnow's classification) were investigated. Three modalities, including sCAIS with open-sleeves, sCAIS with closed-sleeves, and free-hand approach, were applied separately to 30 models with 120 sockets. A customized Python script automatically measured the deviations between the virtual and actual implant positions for all 360 implants. RESULTS: The 3D deviations of sCAIS were significantly influenced by the socket and sleeve types. Both guided groups exhibited significantly less deviation than the free-hand approach. Type A and C sockets resulted in better implant positions than type B socket sites. In type B sockets, the open-sleeve group achieved significantly less deviation compared to the closed-sleeve group, with respect to apical global (1.34 ± 0.53 vs. 1.84 ± 0.59 mm), coronal horizontal (0.68 ± 0.36 vs. 0.93 ± 0.34 mm), apical horizontal (1.21 ± 0.59 vs. 1.74 ± 0.63 mm), and angular (3.30 ± 1.41 vs. 4.41 ± 1.96°) deviations. CONCLUSIONS: Guided implant surgery significantly reduces deviations during molar IIP compared to free-hand procedures. Furthermore, the use of open-sleeve sCAIS appears to be more effective in minimizing deviations in type B sockets when compared with the closed-sleeve guided system.

The Scalloped Surgical Guide as an Alternative to Flat Bone Reduction Guide in Full-Arch Implant Restoration.

The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3-dimensional (3D)-printed guide according to the future gingival margin of the planned dentition. A 61-year-old woman with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of recontouring of the alveolar ridge and gingiva and placement of 6 implants and an FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully digitally guided surgery was planned. This consisted of using 3 surgical guides, starting with the fixation pin guide, continuing with the scalloped hard- and soft-tissue reduction guide, and finally the implant placement template. Following the surgery, the patient received a temporary restoration, and on the 4-month follow-up, a new polymethyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the article. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.

Influence of fabrication method on the marginal fit of temporary restorations

Abstract Computer-aided manufacturing (CAM) technology allows the use of different manufacturing techniques. This in vitro study aimed to evaluate the marginal fit of temporary restorations manufactured using conventional chairside methods, milling, and three-dimensional printing. Fifteen 3-element temporary restorations specimens were produced and categorized into three groups: non-digital, obtained using the conventional chairside method (GC); milled (GM); and three-dimensionally printed (GP). Marginal fit was assessed using scanning electron microscopy (SEM) performed under two conditions: one with only the central screw tightened, and the other with all three screws tightened. Horizontal misfit values were categorized as over-, equal-, and under-extended and qualitatively analyzed. Statistical analysis was performed using the Tukey-Kramer test (α=0.05). In the vertical assessment, three-dimensionally printed restorations demonstrated greater misfit than restorations obtained by milling and the conventional chairside method (P<0.05). In the horizontal assessment, the misfit in the GP group was significantly higher than that in the GM and GC groups. Restorations obtained using the conventional chairside method and milled provisional restorations showed more favorable results than three-dimensionally printed restorations.

Digitally Guided Lateral Sinus Floor Elevation With Simultaneous Implant Placement: 3 Case Reports With Technical Considerations.

A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla. Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon designs and locates the window after the flap is reflected based on the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardships in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring an LSFE simultaneous to implant placement, a maxillary sinus surgical guide has been tested and reported to be the amiable method to be utilized as a conjunct to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated based on 3D software. During surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. This technique makes the sinus window opening procedure simple and predictable, reduces surgical time and the risk of complications, and allows the placement of the implant in the ideal 3D position.

Volumetric Outcomes of Peri-implant Soft Tissue Augmentation with a Xenogeneic Cross-Linked Collagen Scaffold: A Comparative Clinical Study.

Performing soft tissue augmentation (STA) at implant sites to improve esthetics, patient satisfaction, and peri-implant health is common. Several soft tissue grafting materials can be used to increase soft tissue thickness at the second-stage surgery, including human dermal matrices and xenogeneic collagen scaffolds. This study assessed and compared the volumetric outcomes, from second-stage surgery to crown delivery, around implants that received STA with a xenogeneic cross-linked collagen scaffold (XCCS) vs nonaugmented implant sites. Thirty-one patients (31 implant sites) completed the study. Intraoral digital scans were taken at the second stage and prior to crown delivery, and the STL files were imported in an image-analysis software to assess volumetric changes. XCCS-augmented implants showed significantly greater volumetric changes compared to control sites, which showed volume loss. The mean thickness of the XCCS-augmented area was 0.73 mm. There was no difference in patient-reported esthetic evaluations between groups. STA with XCCS provided significantly greater volumetric outcomes compared to nonaugmented sites. Further studies are needed to evaluate the long-term behavior of the augmented peri-implant mucosa and the effects of STA on peri-implant health.

Sleeveless guided implant placement compared to conventional approaches: An in vitro study at healed sites and fresh extraction sockets.

PURPOSE: To investigate the accuracy of a novel sleeveless implant surgical guide by comparing it with a conventional closed-sleeve guide and a freehand approach. MATERIALS AND METHODS: Custom resin maxillary casts with corticocancellous compartments were used (n = 30). Seven implant sites were present per maxillary cast, corresponding to healed (right and left first premolars, left second premolar and first molar) and extraction sites (right canine and central incisors). The casts were assigned into three groups: freehand (FH), conventional closed-sleeve guide (CG) and surgical guide (SG) groups. Each group comprised 10 casts and 70 implant sites (30 extraction sites and 40 healed sites). Digital planning was used to design 3D printed conventional and surgical guide templates. The primary study outcome was implant deviation. RESULTS: At extraction sites, the largest difference between groups occurred in angular deviation, where the SG group (3.80 ± 1.67 degrees) exhibited ~1.6 times smaller deviation relative to the FH group (6.02 ± 3.44 degrees; P = 0.004). The CG group (0.69 ± 0.40 mm) exhibited smaller coronal horizontal deviation compared to the SG group (1.08 ± 0.54 mm; P = 0.005). For healed sites, the largest difference occurred for angular deviation, where the SG group (2.31 ± 1.30 degrees) exhibited 1.9 times smaller deviation relative to the CG group (4.42 ± 1.51 degrees; P < 0.001), and 1.7 times smaller deviation relative to the FH group (3.84 ± 2.14 degrees). Significant differences were found for all parameters except depth and coronal horizontal deviation. For the guided groups, there were fewer significant differences between healed and immediate sites compared to the FH group. CONCLUSION: The novel sleeveless surgical guide showed similar accuracy to the conventional closed-sleeve guide.

Digital planning for two-implant-supported overdenture and bone reduction guide using cone-beam computed tomography: Simple features for predictable outcomes.

The two-implant-supported mandibular overdenture is considered a reliable treatment option to restore masticatory function. Digital planning has been shown to improve the precision and accuracy of the surgical procedure. The outcomes are indeed pertinent to the ideal three-dimentional positioning of the implant placement. Recently, the uses of cone-beam computed tomography (CBCT) and intraoral scan have improved greatly the workflow of digital planning; however, the sophisticated technology caused confusion among clinicians. The purpose of this case series was to exhibit the efficacy of a bone-supported guide in applying simultaneous implant placement and bone reduction, solely based on CBCT data. The bone reduction can therefore be determined accordingly, by adding windows to the guide, allowing the clinician to decide the amount of bone reduction as well as the location for implant placement. This novel surgical guide would not only fit properly on the bone but also provide the benefits of less-invasive surgery and the opportunity to place implants parallel. The  digital workflow described not only simplifies the fabrication process but also yields predictable surgical outcomes.

Accuracy of partially and fully guided surgical techniques for immediate implant placement: An in vitro assessment.

STATEMENT OF PROBLEM: Optimal implant positioning is essential to achieving predictable results. Computer-guided surgery has been reported to be an accurate technique for implant placement in healed sites, but the accuracy of guided techniques for immediate implant placement into fresh sockets is still unclear. PURPOSE: The purpose of this experimental randomized split-mouth study in pig jaws was to determine the accuracy of partially and fully guided surgical techniques for immediate implant placement into fresh sockets and to compare 2 different methods of implant position deviations analysis. MATERIAL AND METHODS: Twenty implants were installed in 10 pig jaws using 2 different techniques: partially guided (n=10) and fully guided (n=10). Cone beam computed tomography and digital scanning were performed before and after the surgical procedure to plan the virtual implant position and fabricate the surgical guide, as well as to determine implant position deviations. Two methods were used to evaluate implant deviations: tomographic and digital scanning. The Shapiro-Wilk test of normality was used. Deviation comparisons were carried out by using paired t tests (α=.05), and intraclass correlation coefficient (ICC) was computed to assess the agreement between the 2 methods of implant deviation analysis. RESULTS: In the tomographic analysis, the partially guided technique resulted in significantly higher global apical and lateral coronal deviations (2.25 ±0.59 mm; 0.96 ±0.55 mm) than fully guided (1.52 ±0.89 mm; 0.75 ±0.52 mm) (P<.01 and P<.05, respectively). The analysis performed using digital scanning showed significantly higher angular, global apical, and lateral apical deviations in the partially guided (6 ±3.28 degrees; 2.49 ±1.03 mm; 2.16 ±1.07 mm) technique than in the fully guided (3.32 ±1.84 degrees; 1.5 ±0.58 mm; 0.98 ±0.67 mm) (P<.05). An ICC of 0.522 between the 2 methods of implant deviation analysis was obtained. CONCLUSIONS: The partially guided technique was less accurate than the fully guided technique for immediate implant placement into fresh sockets. A moderate concordance was observed between cone beam computed tomography and digital scanning analyses, suggesting that more studies are required to validate and to define the most reliable method of measuring implant deviation.

Assessment of Deviations of Implants Installed with Prototyped Surgical Guide and Conventional Guide: In Vitro Study.

OBJECTIVE: The study aimed to assess the angular and linear deviations of implants installed in mannequins aided by surgical guides produced with the techniques of dual tomography (DT), model-based tomography (MT), and nonprototyped guide. MATERIALS AND METHODS: Implants were installed in mannequins of a partially edentulous maxilla and divided into three groups: Group C (n = 20), implants installed using the conventional technique with flap opening and conventional guide; Group DT (n = 20), implants installed using guided surgery with the dual tomography technique; and Group MT (n = 20), implants installed using the model-based tomography technique. After implant installation, the mannequin was subjected to a computed tomography (CT) to measure the linear and angular deviations of implant positioning relative to the initial planning on both sides. RESULTS: There was a higher mean angular deviation in group C (4.61 ± 1.21, p ≤ 0.001) than in groups DT (2.13 ± 0.62) and MT (1.87 ± 0.94), which were statistically similar between each other. Similarly, the linear deviations showed group C with the greatest discrepancy in relation to the other groups in the crown (2.17 ± 0.82, p = 0.007), central (2.2 ± 0.77, p = 0.004), and apical (2.34 ± 0.8, p = 0.001) regions. CONCLUSION: The techniques of DT and MT presented smaller angular and linear deviations than the conventional technique with the nonprototyped guide. There was no difference between the two-guided surgery techniques.

Does guided level (fully or partially) influence implant placement accuracy at post-extraction sockets and healed sites? An in vitro study.

OBJECTIVES: The aim of this study is to evaluate the effect of guide level on the accuracy of static computer-aided implant surgery (sCAIS) at post-extraction sockets and healed sites. MATERIALS AND METHODS: A total of 30 duplicate dental models, with 300 potential implant sites, were used. All the models were equally randomized into three groups: fully guided (FG, n = 100), partially guided (PG, n = 100), and free handed (FH, n = 100) surgeries. After implant placement, the mean global, horizontal, depth, and angular deviations between the virtually planned and actual implant positions were measured automatically by a Python script within software Blender. RESULTS: Both FG and PG surgeries showed significantly higher accuracy than FH surgery at post-extraction sockets and healed sites. In both sCAIS groups, there were nearly 50% more deviations from implants placed at sockets than those from delayed placement. For the immediate implant placement, the accuracy of sCAIS was significantly affected by the level of guidance. The FG group exhibited lower deviations than the PG group, with a significant difference in coronal global and horizontal deviations (p < .05). For the healed sites, two guided groups exhibited similar outcomes (p > .05). CONCLUSIONS: sCAISs provide more accuracy than the free-handed approach in position transferring from planning to a model simulation. Full guidance can significantly increase the accuracy, especially at post-extraction sites. CLINICAL RELEVANCE: Guided protocols showed significantly higher accuracy than free-handed surgery regardless of implantation timing, but both had nearly 50% more deviations in immediate implant placement.

Open-sleeve templates for computer-assisted implant surgery at healed or extraction sockets: An in vitro comparison to closed-sleeve guided system and free-hand approach.

OBJECTIVE: A buccal opening guide provides better view and better irrigation. The aim of this study was to investigate the accuracy of this open-sleeve system. MATERIAL AND METHODS: Thirty duplicated maxillary models, each with six extraction sockets and four healed sites, were used. Based on the same digital plan, three modalities, sCAIS with open-sleeves, closed-sleeves, and free-hand approach, were used to place implants. The global, horizontal, depth, and angular deviations between the virtual and actual implant positions were measured. RESULTS: Both sCAIS groups exhibited better accuracy than the free-hand group in two clinical scenarios. At healed sites, the closed-sleeve group showed a significantly fewer error than the open-sleeve group in global apical (0.68 ± 0.33 vs. 0.96 ± 0.49 mm), horizontal coronal (0.28 ± 0.15 vs. 0.44 ± 0.25 mm), horizontal apical (0.64 ± 0.32 vs. 0.94 ± 0.48 mm), and angular deviations (1.83 ± 0.95 vs. 2.86 ± 1.46°). For extraction sockets, the open-sleeve group exhibited fewer deviations than the closed-sleeve group in terms of global (coronal: 0.77 ± 0.29 vs. 0.91 ± 0.22 mm; apical: 1.08 ± 0.49 vs. 1.37 ± 0.52 mm) and horizontal (coronal: 0.60 ± 0.24 vs. 0.86 ± 0.20 mm; apical: 0.95 ± 0.50 vs. 1.32 ± 0.51 mm) deviations. However, the closed-sleeve group was more accurate in the depth control (0.26 ± 0.20 vs. 0.40 ± 0.31 mm). CONCLUSION: In this in vitro investigation, open-sleeve sCAIS proved better accuracy than free-hand surgery for both delayed and immediate implant placement. Compared with a closed-sleeve sCAIS system, open sleeve have the potential of providing better outcomes in extraction sockets but not in healed sites.

Presence and predominance of histological grade 3 define cT1HG bladder cancer prognostic groups.

PURPOSE: Current World Health Organization/International Society of Urological Pathology (2004 WHO/ISUP) grading of bladder urothelial carcinoma relies on the highest pathologic grade of the specimen and does not reflect the inherent qualitative and quantitative heterogeneity of disease. MATERIALS AND METHODS: We retrospectively studied consecutive urothelial high-grade cT1 (cT1HG) carcinomas submitted to adjuvant bacille Calmette-Guérin between 2008 and 2015 to evaluate the prognostic potential of grade 3 (presence or predominance) according to the 1973 WHO system concerning disease progression and cancer-specific death. RESULTS: Among 253 patients, grading distribution was 34.4% 1+2, 7.5% 2+1, 20.2% 2+2, 19.0% 2+3, 5.1% 3+2, and 13.8% 3+3. Recurrence was diagnosed in 115 (45.5%), progression in 83 (32.8%), and cancer-specific death in 50 patients (19.8%). Mean time to recurrence, progression, and death from disease were 35.9±31.7, 47.6±44.5, and 51.2±50.4 months, respectively. Grade 3 presence (2+3, 3+2, or 3+3) occurred in 96 (37.9%) and independently predicted time to progression (p<0.001; hazard ratio [HR], 3.11; 95% confidence interval [CI], 1.88-5.14). Grade 3 predominance (3+2 or 3+3) occurred in 48 (18.9%) and independently predicted time to disease-specific death. CONCLUSIONS: Grade 3 presence and predominance are independent predictors of progression and disease-specific death and occur in about 40% and 20% of cT1HG, respectively. Describing qualitative and quantitative heterogeneity in urothelial carcinoma grading might improve the stratification of patients. This gives three prognostic high-grade groups based on WHO/ISUP 1973: prognostic grade group I (grade 3 absence), prognostic grade group II (grade 3 presence), and prognostic grade group III (grade 3 predominance).

The Impact of Surgical Guide Fixation and Implant Location on Accuracy of Static Computer-Assisted Implant Surgery.

PURPOSE: To evaluate the accuracy of static computer-assisted implant surgery (sCAIS) for tooth-supported free-end dental implantation with the aid/and without the aid of fixation pins to secure the surgical template through comparison between planned, 3D printed guide position and placement implant position. MATERIALS AND METHODS: Thirty-two duplicated maxillary resin models were used in the present in vitro study. Digital planning was performed and fabrication of a surgical template that allowed implant placement on the distal extension edentulous site of the model (maxillary left side). A first optical scan was performed after fitting the surgical template on the model to assess the deviation at the surgical guide level. After placing implants in the model using the surgical guide, scan bodies were attached to the implants, and a second scan was performed to record the position of placed implants. The digital representations were later superimposed to the pre-operative scan and measurements of implant deviations were performed. Global (coronal and apical), horizontal (coronal and apical), depth and angular deviations were recorded between planned implant position, guide position, and placement implant position. Three-way ANOVA was used to compare implant location (#13, 14, and 15), fixation pin (with or without pin), and guide comparison (planned, guided, and placement). RESULTS: Final implant placement based on the digital plan and based on the 3D printed guide were very similar except for depth deviation. Use of fixation pin had a statistically significant effect on the depth and angular deviation. Overall, without fixation pins and based on guide versus placement, mean global coronal (0.88 ± 0.36 mm), horizontal coronal (0.55 ± 0.32 mm), and apical (1.44 ± 0.75 mm), and angular deviations (4.28 ± 2.01°) were similar to deviations with fixation pins: mean global coronal (0.88 ± 0.36 mm); horizontal coronal (0.67 ± 0.22 mm) and apical (1.60 ± 0.69 mm); and angular deviations (4.53 ± 2.04°). Horizontal apical without pins (1.63 ± 0.69 mm) and with fixation pins (1.72 ± 0.70 mm) was statistically significant (p = 0.044). Depth deviation without pins (-0.5 ± 0.5 mm) and with fixation pins (-0.16 ± 0.62 mm) was also statistically significant (p = 0.005). Further analysis demonstrated that the final sleeve position on the 3D printed guide was on average 0.5 mm more coronal than the digital plan. CONCLUSIONS: The use of surgical guides with or without fixation pins can provide clinically acceptable outcomes in terms of accuracy in implant position. There was a statistically significant difference in the accuracy of implant position when utilizing fixation pins only for horizontal apical and depth deviation. Additionally, a statistically significant difference between the planned and the 3D printed surgical guide when considering the sleeve position was detected.

Implant Placement with Palatal Access Flap (PAF) for Facial Tissue Preservation in the Esthetic Zone: A Retrospective Case Series.

Conventional crestal and intrasulcular incisions followed by full-thickness flap reflection may inevitably induce surgical trauma, resulting in facial contour reduction, mucosal recession, and interdental papilla loss. Flapless implant surgery is the most conservative approach; however, it might create undetectable bone fenestration/dehiscence and subsequent complications. The present clinical study introduces a modified and minimally invasive approach, the palatal access flap (PAF), for placing implants in the esthetic zone. Preliminary data of 15 consecutive cases demonstrated clinically negligible soft tissue contour changes when pre- and postoperative 3D model scans were compared. The PAF technique could be a surgical solution, especially for patients with a high esthetic risk, to maintain facial and interproximal tissue contours for the implant site and adjacent teeth.

Flapless Guided Implant Surgeries Compared with Conventional Surgeries Performed by Nonexperienced Individuals: Randomized and Controlled Split-Mouth Clinical Trial.

PURPOSE: The study aimed to evaluate the outcomes of flapless guided surgery related to surgery, patient, operator, assistant, and advisor, comparing it with conventional surgery performed by undergraduate students who had never placed implants in patients. MATERIALS AND METHODS: A randomized controlled split-mouth clinical trial was carried out. Ten patients with bilateral mandibular posterior tooth loss received an implant on each side with conventional flap surgery or flapless guided surgery that was performed by undergraduate students. Surgery time, pain, patient satisfaction, quantity of consumed medications, time of procedure, ease of procedure, anxiety, and stress were assessed. RESULTS: Conventional surgery showed statistically significantly inferior results compared with flapless guided surgery in terms of procedure time (56 minutes, 36 seconds ± 8 minutes, 38 seconds vs 30 minutes, 1 second ± 6 minutes, 2 seconds), consumption of analgesic medications (49 tablets vs 15 tablets), intraoperative (1.75 ± 1.56 vs 0.65 ± 0.64) and postoperative pain (4.62 ± 2.17 vs 1.17 ± 0.72), and operator anxiety (4.76 ± 1.66 vs 3.47 ± 1.50), respectively. CONCLUSION: Flapless guided implant surgeries performed by individuals with no previous clinical experience showed reduced surgery time and delivered better patient-reported outcomes both in the intraoperative and postoperative periods; reduced medication consumption; and showed better results in the operator and assistant perspectives.

Denture scanning technique for computer-guided implant-supported restoration treatment of edentulous patients.

The traditional protocol for guided surgery in a completely edentulous patient is time-consuming, requiring the fabrication of a radiographic guide and a dual cone beam computed tomography (CBCT) scan. Using intraoral scanners to scan the edentulous ridge and the existing denture has been advocated to simplify the process. This technique offers a versatile, precise, and predictable method for the digital planning workflow in edentulous patients for either a fixed or removable restoration. In addition, this approach can help improve the quality of the guide produced by reducing CBCT artifacts associated with the existing denture, as well as capture the soft-tissue contour to further improve the fit of the surgical guide.

Creating a virtual patient for completely edentulous computer-aided implant surgery: A dental technique.

A fully digital workflow for generating a virtual patient for completely edentulous computer-aided implant surgery is described. Existing dentures are temporarily relined with a radiopaque dental silicone material, and a cone beam computed tomography scan is made with the relined denture inserted. Then, scans of the relined denture are made with an intraoral scanner. The radiopaque silicone material increases the stability of the dentures and allows the a cone beam computed tomography images and the scans of the dentures to be superimposed to create a virtual patient. This technique may reduce laboratory work steps, clinical chairside time, and treatment costs.

Digital Immediate Complete Denture for a Patient with Rhabdomyosarcoma: A Clinical Report.

Fabricating an immediate complete denture can be very challenging in some clinical situations. This clinical report describes a digital workflow to fabricate a printed maxillary immediate complete denture for a patient with a severely compromised maxilla. Digital data obtained by using an intraoral scanner was utilized to reconstruct the three-dimensional (3D) image of the jaws at the desirable vertical dimension of occlusion. After performing the virtual teeth extraction and alveoloplasty, the denture base and teeth were designed. The resulting data were exported to a 3D printer for denture fabrication and the 3D printed (additively manufactured) denture was successfully inserted immediately after the surgery. After initial healing and confirmation of good retention and function, a new printed denture was fabricated by digitally duplicating the relined denture maintaining the same teeth positions but adjusting the base to a new intraoral scan of the healed ridge.

Electrical stimulation enhances early palatal wound healing in mice.

BACKGROUND/OBJECTIVE: Electrical stimulation (ES) has been used to treat chronic wound and other clinical applications, showing favorable results in wound closure. It was hypothesized that ES can present a positive effect on oral mucosa healing. The aim of this study was to investigate the effects of ES during the palatal mucosa early healing process in Swiss mice. METHODS: Ninety animals were divided into two groups: Control (C; n = 45), which received Sham ES applications, and Test (ES; n = 45), which received ES (100 µA; 9 kHz; 660 mVpp) once a day for 3 days. A full thickness wound was performed with a 1.5 mm diameter biopsy punch in the hard palate. Histologically, the following parameters were evaluated: palatal wound closure and epithelial and connective wound edge distance (EED and CED). Furthermore, IL-1ß, IL-6, IL-10 TNF-α, and VEGF cytokine levels were evaluated by multiplex assay. The percentage of collagen fibers was assessed using the polarization method and the Smad proteins using the immunofluorescence method. RESULTS: Palatal wound closure presented a significant reduction on day 5 in the ES group (p = 0.01). Additionally, both EED and CED were shorter for all time points in the ES group (p < 0.05), and the inflammatory markers IL-6, IL-10, TNF-α, and VEGF were reduced (p < 0.05). There were no differences in collagen fibers and phospho-Smad2 between the groups. CONCLUSION: ES had a positive effect on early palatal wound closure outcomes, as well as on inflammatory markers.