Elevoplasty®: An Innovative, Minimally Invasive Procedure for the Treatment of Snoring.

For non-obstructive sleep apnea diagnosed patients with predominantly palatal snoring, Elevoplasty® is an efficient, minimally invasive treatment option. Aimed at reducing snoring severity, the innovative procedure involves the placement of three to four small resorbable polydioxanone barbed sutures, which are buried in the tissues of the soft palate. After placement, the sutures are "activated" by a gentle pull, which provides a "lift" of the soft palatal tissues and uvula. The soft palate, thus, is moved off of the posterior pharyngeal tissues at the back of the throat, providing an increased opening of the posterior pharyngeal airway and a reduction in snoring severity. This article provides an overview of this procedure along with other treatments for snoring.

Is a Fully Digital Dental Implant Treatment Solution a Real Possibility in 2020?

Digital implant workflows are facilitating new and more accurate methods of implant treatment planning when compared to conventional analog techniques. The placement of implants using guided surgery presents multiple benefits for immediately restoring a patient functionally and esthetically with a provisional restoration. Although digital technology enables efficiency and enhanced accuracy for dental implant treatments, some cases may require the use of a hybrid workflow that employs both conventional and digital procedures, as some limitations to a fully digital approach exist depending on the clinical situation. This article presents several different implant treatment scenarios and discusses whether a fully digital workflow is possible and/or beneficial in each situation. The scenarios describe the full-treatment sequence for immediately loaded implants, allowing a direct comparison of various restorative and surgical implant workflows.

Computer-Guided Dental Implant Treatment of Complete Arch Restoration of Edentulous and Terminal Dentition Patients.

The treatment of completely edentulous or soon-to-be completely edentulous dental arches with complete-arch fixed denture restorations, supported by dental implants, are some of the more complicated patient cases in oral and maxillofacial surgery and prosthodontics. This article discusses the use of digital technologies, computerized tomographic (CT) guided planning software applications, and surgical guides in treating these complex dental implant patient cases. A discussion of the nuances and workflows of different types of treatments are provided. The importance of experience and a multi-disciplinary team approach is emphasized.

Ten Myths of Guided Implant Surgery.

Since their introduction, guided dental implant planning and surgery procedures, like most new techniques in medicine and dentistry, have undergone many modifications and advances. While some practitioners were early adopters, most dental surgeons have been cautious regarding this methodology. Despite more than a decade of literature, podium presentations, advances in instrumentation and technique, and successful cases, questions remain within the dental surgical community. This article attempts to address some of these by outlining common but erroneous beliefs about this technology and procedure.

What's Hindering Dentistry From the Widespread Adoption of CT-Guided Surgery?

Although computed tomography (CT)-guided technology has been shown to increase implant placement accuracy, decrease surgical complications, and improve the predictability of implant case outcome, many in the dental implant community continue to resist using it for three main reasons: time, money, and fear. While it is true that there are additional preparatory steps necessary in patient case planning and the practitioner must invest in unfamiliar technologies and overcome a learning curve, increased efficiency, improved restorative outcomes, and clear benefits to both patients and practitioners make a strong case for adopting this approach.

Cumulative survival rate of implants placed "fully guided" using CT-guided surgery: a 7-year retrospective study.

PURPOSE: To evaluate the cumulative survival rates (CSRs) of dental implants placed "fully guided" using computed tomography (CT)-guided surgery, including cone beam CT (CBCT). MATERIALS AND METHODS: Records, mountings, wax-ups, and scanning appliances were made for patients to wear during CT/CBCT scans following established manufacturer-guided surgery protocols. Virtual planning was performed using either the NobelProcera/NobelClinician or the SimPlant/Facilitate softwares. Manufacturer-produced stereolithographic guides and implant-specific instrumentation were used to place implants fully guided to planned depths and angulations. Included in the study were 177 patients, who had 796 implants placed fully guided, using 212 surgical guides. RESULTS: Among 796 implants placed, there were 24 failures, for a 96.98% CSR. System CSRs were: NobelActive, 95.87%; Astra OsseoSpeed, 96.72%; NobelReplace Select Tapered, 97.02%; and NobelReplace Select Straight, 100% (P less than 0.05). Maxillary CSR was 97.62%; mandibular CSR was 95.88% (P less than 0.05). CSR for standard implants (10 mm to 13 mm) was 97.3%; short implants (less than or equal to 9 mm) was 95.1% (P less than 0.05), and long implants greater than 13 mm) was 95.2%. Implant diameter CSR was not significant (P greater than 0.05) for any diameter implant. Full-arch immediately loaded CSR (97.18%) was not different compared to full-arch unloaded (97.20%) (P less than 0.05). CONCLUSIONS: 1) Fully guided implant CSR was 96.98%, which is comparable to "freehand" placement; 2) CSRs varied between implant systems; 3) fully guided short and long implants had lower CSRs than standard implants; 4) the diameter of fully guided implants did not affect CSR; 5) fully guided implants in the anterior maxilla and posterior mandible had reduced CSRs; 6) extraction/immediate placement using fully guided surgery had reduced CSRs; and 7) immediate loading fully guided implants did not affect CSRs.

Cavernous sinus thrombosis as a result of a fungal infection: a case report.

Cavernous sinus thrombosis (CST) is a rare disease with the potential for significant morbidity and even death. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. The cause may be aseptic or infectious. When the cause is infectious in nature, it is most commonly from a bacterial origin. However, we present the case of a 57-year-old man with a fungally related CST that ultimately led to his death.

Comparison of the accuracy of cone beam computed tomography and medical computed tomography: implications for clinical diagnostics with guided surgery.

PURPOSE: This study compared the accuracy of cone beam computed tomography (CBCT) and medical-grade CT in the context of evaluating the diagnostic value and accuracy of fiducial marker localization for reference marker-based guided surgery systems. MATERIALS AND METHODS: Cadaver mandibles with attached radiopaque gutta-percha markers, as well as glass balls and composite cylinders of known dimensions, were measured manually with a highly accurate digital caliper. The objects were then scanned using a medical-grade CT scanner (Philips Brilliance 64) and five different CBCT scanners (Sirona Galileos, Morita 3D Accuitomo 80, Vatech PaX-Reve3D, 3M Imtech Iluma, and Planmeca ProMax 3D). The data were then imported into commercially available software, and measurements were made of the scanned markers and objects. CT and CBCT measurements were compared to each other and to the caliper measurements. RESULTS: The difference between the CBCT measurements and the caliper measurements was larger than the difference between the CT measurements and the caliper measurements. Measurements of the cadaver mandible and the geometric reference markers were highly accurate with CT. The average absolute errors of the human mandible measurements were 0.03 mm for CT and 0.23 mm for CBCT. The measurement errors of the geometric objects based on CT ranged between 0.00 and 0.12 mm, compared to an error range between 0.00 and 2.17 mm with the CBCT scanners. CONCLUSIONS: CT provided the most accurate images in this study, closely followed by one CBCT of the five tested. Although there were differences in the distance measurements of the hard tissue of the human mandible between CT and CBCT, these differences may not be of clinical significance for most diagnostic purposes. The fiducial marker localization error caused by some CBCT scanners may be a problem for guided surgery systems.

Combining All-on-4 treatment with CT-guided technology: technique and report of three cases.

No longer merely a concept for the future, the use of digital technologies in dentistry has become common practice today. Computed tomography (CT)-guided dental implant surgery has greatly expanded over the past decade as concepts and techniques have become increasingly refined and more implant manufacturers have adapted their implant systems to these new technologies. The All-on-4® technique for dental implant placement and restoration, while developed some two decades ago, has recently generated increased interest as a highly functional, esthetic, cost-effective alternative for a large group of patients who could benefit from a full-arch, implant-supported fixed restoration. The authors ask, "Are these two technologies a marriage made in heaven?" This article describes the All-on-4 CT-guided surgery technique and reports on the treatment findings on three patients, each with different prosthodontic management.

Application and success of two stereolithographic surgical guide systems for implant placement with immediate loading.

PURPOSE: Two different stereolithographic surgical guide systems, NobelGuide (Nobel Biocare) and SimPlant (Materialise), were compared clinically, and the survival rates of the planned immediately loaded dental implants with prefabricated provisional restorations were evaluated. MATERIALS AND METHODS: Patients were treated with implants using either the Materialise SimPlant system or the Nobel Biocare system. All implants were planned on cone beam computed tomography (CBCT) or CT-derived images. Mucosa-, bone-, or tooth-supported stereolithographic guides were produced using the two commercial systems. A provisional was placed immediately after implant insertion in all cases. RESULTS: Fourteen patients were enrolled. Seventy-five implants were placed (34 with Materialise, 41 with Nobel Biocare) using stereolithographic surgical guides. All but one implant were loaded immediately with prefabricated provisionals. In all cases, implants were in place for a minimum of 12 months. No complications related to associated anatomy occurred. One implant failed, leading to a combined cumulative survival rate of 98.7%. There were no other intraoperative or postoperative complications. Implants placed by bone-supported guides had increased patient symptoms of postoperative swelling and discomfort. All provisionals were successful. CONCLUSIONS: Both types of stereolithographic surgical templates were sufficiently accurate in transferring the planned implant positions to the surgical field, allowing the placement of prefabricated provisionals. These technologies are most beneficial in patients in whom the simultaneous placement of multiple implants in combination with complex restorations is planned.

Computer-guided implant surgery: indications and guidelines for use.

The introduction of medical-grade computed tomography (CT) technologies and the ballooning use of cone beam CT (CBCT) in dental offices, in combination with the use of proprietary dental implant software, has revolutionized the planning and placement of dental implants. These technologies facilitate a team approach in a truly restoratively driven treatment plan based on the accurate planning and placement of dental implants. Using this approach, the planned restoration for an implant site is first created; then the dental team, in effect, works backwards to virtually plan the ideal implant position for the site based on the anatomy, vital structures in the area, surrounding and opposing teeth and restorations, and the restoration planned. Although an argument could be made for using these technologies in most implant patients, their cost/time/benefit precludes their use in every situation. This article presents an overview of the guidelines and indications for use of computer-guided technologies in dental implant treatment.

An open system approach for surgical guide production.

PURPOSE: Surgical guides for oral implantology were made with a new open system independent of implant planning software based on a universal computed tomography/cone beam computed tomography (CBCT) scan plate for fiducial markers. MATERIALS & METHODS: For this in vitro study, CBCT scans were taken of 18 models based on a universal computed tomography/CBCT scan plate (Bego Medical, Bremen, Germany) for fiducial markers. The models were made from radiopaque composite with several integrated radiopaque gutta-percha points used as a reference. The coDiagnostiX (Institut Straumann, Basel, Switzerland) and implant 3D (med3D, Heidelberg, Germany) software programs were used for virtual implant planning. Coupling devices on the scan plate allowed for the precise connection to a special transfer plate (Bego Medical), which transfers the implant position to the drill guide. The horizontal distance of the final implant position to the gutta-percha markers was compared with the implant planning values. RESULTS: Planning of 18 implants was performed with the Institut Straumann system and 18 with the med3D system. The horizontal deviation of the final implant placement compared with the implant planning made with the med3D system showed a mean error of 0.33 mm for implants 1 and 2. The difference between the CBCT measurements of the Institut Straumann models was larger than that of the med3D measurements. The mean error for implant 1 was 0.65 mm and 1.13 mm for implant 2. CONCLUSION: The reduction in the dental laboratory costs, the freedom to use different implant planning software programs, and the easy handling might facilitate the distribution of guided surgery and provide significant benefits for the clinician and the dental laboratory.

Guided surgery for implant therapy.

New three-dimensional diagnostic and treatment planning technologies in implant dentistry have expanded on concepts of a team approach to the planning and placement of dental implants. The accurate and predictable placement of implants according to a computer-generated virtual treatment plan is now a reality, taking the virtual plan from the computer to the patient clinically. Recent advances in three-dimensional imaging in dentistry, in combination with the introduction of third-party proprietary implant planning software and associated surgical instrumentation, have revolutionized dental implant diagnosis and treatment and created an interdisciplinary environment in which communication leads to better patient care and outcomes.

The use of 3-dimensional imaging in dentoalveolar surgery.

In the past decade, many different cone-beam volumetric tomography (CBVT/CBCT) machines have been introduced to the dental market with varying features. While medical-grade CT is still considered the "gold standard" for CT accuracy and diagnosis, CBCT, because of its convenience, lower radiation, and smaller machine footprints, has become more commonplace in dental surgical offices. This article discusses the use of CBCT technologies along with proprietary implant software programs in dentoalveolar surgery.