Comparison of the success rate and marginal bone loss of implants placed simultaneously with either bone expansion or ridge splitting in maxillary sites: a prospective non-randomized study.

This study was performed to compare the amount of marginal bone loss (MBL) and the success rate of implants placed following maxillary ridge expansion with two surgical techniques. A non-randomized prospective study was designed. The patients underwent either bone expansion or ridge splitting, and simultaneous implant placement. The implants were loaded according to the delayed loading protocol with single crowns. Each study group included 35 implants placed in 31 patients. One year after loading, the implant success rate was 100 % in both groups. The median MBL was 1.00 mm in both groups (interquartile range 0.10 mm in the bone expansion group and 0.30 mm in the ridge splitting group) (no significant difference, P = 0.749). The median MBL around implants placed in sites with D2, D3, and D4 density bone was 1.40 mm, 1.00 mm, and 0.80 mm in the expansion group and 1.50 mm, 1.00 mm, and 0.85 mm in the splitting group, respectively. There was a significant difference in MBL between the different bone density types within both groups (P < 0.001). In conclusion, no significant difference in the amount of MBL or the success rate was observed between implants placed simultaneously with ridge splitting and those placed simultaneously with bone expansion, in the maxilla.

Osseous genioplasty versus chin implants: early complications and patient satisfaction.

Osseous genioplasty and chin augmentation with implants are the two main treatment options for retrognathia. This retrospective cohort study was performed to compare the prevalence of complications and patient satisfaction following osseous genioplasty and chin augmentation by implant. Eighty patients were included: 38 underwent advancement osseous genioplasty and 42 received chin implants (alloplastic, either Medpor or Silastic) intraorally or extraorally. The patients were assessed for complications 12 months after surgery, including neurosensory disturbances, infection or extrusion, wound dehiscence, and the need for reoperation. Patient satisfaction was evaluated using a visual analogue scale. The infection rate was significantly higher in the chin implant group than in the genioplasty group (P = 0.028). Moreover, dehiscence and the need for reoperation appeared to be more common following chin augmentation with implants. However, there was no significant difference in the prevalence of neurosensory disturbances between the two groups (P = 0.137). In the chin implants group, the extraoral approach resulted in a lower dehiscence rate than the intraoral approach. Patients in the genioplasty group had significantly higher satisfaction scores than those in the chin implant group (P = 0.001). Overall, the rates of the complications assessed were lower and patient satisfaction was higher after osseous genioplasty when compared to chin augmentation with implants.

Effect of transcutaneous electrical nerve stimulation on pain, edema, and trismus after surgical removal of impacted third molars: a split-mouth randomized clinical trial.

BACKGROUND: The transcutaneous electrical nerve stimulation (TENS) stimulus inhibits the activity of nociceptive neurons of the central nervous system. Pain relief is achieved by increasing the pulse amplitude of TENS to induce a non-painful paranesthesia beneath the electrodes. This study aimed to assess the effect of TENS on acute pain, edema, and trismus after surgical removal of impacted third molars. MATERIAL AND METHODS: This randomized, double blind, split-mouth clinical trial was conducted on 37 patients with bilaterally impacted mandibular third molars. The angle and body of mandible at the site of surgery in one randomly selected quadrant underwent TENS immediately after surgery (50 Hz, 100-µs short pulse, 15 minutes for 6 days). The TENS stimulator device was used in off mode for the placebo quadrant. The pain score (primary outcome) was measured for 7 days postoperatively, and edema and trismus (secondary outcomes) were assessed at 2, 4 and 7 days, postoperatively. The results were analyzed by repeated measures ANOVA using R software (alpha=0.05). RESULTS: The overall mean pain score was significantly lower in the TENS than the placebo group (P<0.05). The number of taken analgesics in the first 3 days was significantly lower in the TENS group (P<0.001). Postoperative edema in the TENS group was lower than the placebo group but only the difference was not statistically significant (P>.05). The inter-incisal distance, as an index to assess trismus, was not significantly different between the two group at day 2, but it was significantly higher in the TENS group after the second day (P<0.001). CONCLUSIONS: TENS effectively decreased pain and trismus following impacted third molar surgery, and may be recommended as a non-pharmaceutical method to relieve postoperative symptoms.

Does the serum level of vitamin D affect marginal bone loss around dental implants?

Vitamin D is effective in bone healing. The aim of this study was to assess marginal bone loss (MBL) around dental implants in patients with sufficient and insufficient serum levels of vitamin D. This was a prospective cohort study with a pre-protocol population. Patients who underwent dental implantation in the first or second molar region and had a long-cone peri-apical digital radiograph taken at the time of loading and 12 months later were studied. Patients were assigned to one of three groups based on their serum vitamin D level: group 1, the serum level of vitamin D was deficient, group 2 insufficient, and group 3 sufficient. The marginal bone level change from immediately after loading to 12 months later was considered as MBL. Analysis of variance (ANOVA) was applied to compare MBL between the three groups. Ninety patients were included (30 in each group). The mean MBL was 1.38 ± 0.33 mm in group 1, 0.89 ± 0.16 mm in group 2, and 0.78 ± 0.12 mm in group 3. Analysis of the data demonstrated a significant difference in the mean MBL among the three groups (P < 0.001). There was a correlation between MBL and vitamin D serum levels (P < 0.001). It appears that a low serum level of vitamin D may be associated with increased MBL.

Does maxillary advancement alter vocal acoustic parameters in class III skeletal patients?

Any change in the maxillary position can affect the length of the vocal tract. This cross-sectional study aimed to assess the vocal acoustic parameters in 24 class III skeletal patients who underwent Le Fort I osteotomy for maxillary advancement. The vocal acoustic parameters (fundamental frequency, and jitter and shimmer perturbation indexes) were studied before, and at three, seven, and 10 months after maxillary advancement. The age and gender of the patients were the variables of the study. The amount of maxillary advancement was the predictive factor, and the changes in vocal acoustic parameters the study outcomes. Repeated-measures ANOVA were used to analyse the vocal acoustic parameters at different time points. Mean (SD) maxillary advancement was 3.5 (0.59) mm (range 3 - 6 mm). Data analysis did not demonstrate any significant correlation between the mean amount of maxillary advancement and changes in vocal acoustic parameters except for frequency of the 'i' sound. The results did not show a substantial change in the vocal acoustic parameters at 10 months after orthognathic surgery compared with baseline. These changed at three and seven months, but had returned to their baseline preoperative state 10 months after surgery.

Comparison of Single Photon Emission Computed Tomography (SPECT) and implantable Doppler in the monitoring of a vascularised fibular free flap for reconstruction of the mandible.

Monitoring of microvascular free flaps is an influencing factor in the success or failure of the treatment. In this study, we aim to compare the accuracy of implantable Doppler and scintigraphy in the monitoring of a vascularised buried fibular graft for reconstruction of the mandible. In a prospective cohort study, an implantable Doppler was placed intraoperatively, and Single Photon Emission Computed Tomography (SPECT) was taken in patients when abnormal blood flow was detected via the implantable Doppler or 48 hours after operations in patients with normal signals on the Doppler. The flaps were explored if patients did not have regular signals via implantable Doppler or if SPECT revealed impaired perfusion. The number of true- and false-positive cases and true- and false-negative cases were documented. Positive predictive value (PPV) and negative predictive value (NPV) were calculated. Eighteen (29%) of 62 patients underwent explorative surgery. The sensitivity of SPECT was 38.88%, and specificity was 97.72%. In SPECT, PPV was 87.50% and NPV 79.62%. The sensitivity of the implantable Doppler was 72.22%, and specificity was 93.08%. In assessment with the implantable Doppler, PPV was 81.25% and NPV 93.18%. It seems that SPECT and the implantable Doppler had sufficient specificity in the monitoring of a buried fibular graft. However, SPECT had a lower sensitivity than the implantable Doppler.

Does osteoporosis increase marginal bone loss around dental implants in the posterior of the maxilla?

Osteoporosis is caused by an imbalance in bone remodelling. The aim of this study was to compare the marginal bone loss (MBL) around dental implants placed in the posterior maxilla between osteoporotic and non-osteoporotic female patients. This was a prospective cohort study. Female patients needing a dental implant restoration in the posterior maxilla were included. Dual-energy X-ray absorptiometry was performed and the T-score recorded. MBL was measured at 12 months after loading. The patients were assigned to one of two groups: group 1, osteoporotic (T-score ≥2.5); group 2, non-osteoporotic (T-score <2.5). In this study, osteoporosis was the primary predictor variable and MBL was the outcome variable. The mean MBL was compared between the two groups using an independent t-test. Pearson's correlation test was applied to identify any correlation between the T-score and MBL. Ninety female patients were studied, 44 in group 1 and 46 in group 2. The mean MBL was 1.20±0.29mm in group 1 and 0.87±0.15 in group 2; this difference in mean MBL was statistically significant (P=0.001). There was a correlation between T-score and MBL (P=0.001). Despite the correlation between T-score and MBL, this study did not provide enough evidence to prove any causal relationship between MBL and osteoporosis.

Assessment of compression and strength of divergent screws mounted on miniplates and dynamic compression plate in fixation of mandibular body fractures: an in vitro study.

Achieving compression in the fracture line gap by open reduction and internal fixation leads to more primary bone healing and therefore hastens the healing process and patient's rehabilitation. We aimed to evaluate the application of compression by a modification in screw insertion in miniplates to improve the efficiency of the previous relevant methods. In this in vitro experimental study 20 sheep hemimandibles were prepared. Following intentional fracturing of the hemimandibular bodies, the specimens were divided into two: the control and study groups (n=10 each). The control group was fixed with straight four-hole dynamic compression plate (DCP) without a bar and with parallel screws. The study group was fixed with a straight four-hole miniplate without a bar. Screws were divergently inserted into the bone with an angle of 45°. The differences in the fracture line gap were measured before and after fixation considering the indicators of compression. The strength of the fixation was also assessed with a universal testing machine. The control group provided more compression than the study group (p=0.4). There was no difference in the strength of fixation between the two groups. It is concluded that the application of the miniplates with divergent screws instead of DCP could encompass the advantages of both perspectives such as intraoral incisions and compressive force and prevent the disadvantages of compression plates such as hard adaptation.

Effect of fixation method on intergonial width stability after mandibular setback via bilateral sagittal split osteotomy.

Q4: Horizontal changes occur following bilateral sagittal split osteotomy (BSSO) in skeletal class III patients. The aim of this study was to assess the ostoperative changes in intergonial (IG) width and compare them between the positional screw and miniplate fixation methods in BSSO. This study evaluated patients who had mandibular prognathism and underwent BSSO for mandibular setback. Internal fixation was performed bilaterally, either with positional screws in the lateral ramus or with a miniplate. Postero-anterior cephalograms were obtained preoperatively (T1), at 1 month postoperative (T2), and at 6 months postoperative (T3). The IG widths and the alterations in IG width postoperative (T2-T1, T3-T2) were measured. No correlations were observed between the amount of setback and changes at T2 -T1 or T3-T2. The IG width values decreased after mandibular setback and internal fixation with both methods. Statistical analyses showed a significant difference between T3 and T1 in the miniplate group (P=0.045). No significant difference in the postoperative change in IG width (T2-T1 and T3-T2) was found between the two fixation groups. The magnitude of this change was smaller for positional screws when compared to miniplates for fixation. The amount of mandibular setback showed no correlation with postoperative changes in IG width..

Does maxillary superior repositioning affect nasal airway function?

This study aimed to assess nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity in patients who have had maxillary superior repositioning (MSR). This is a cross-sectional study, and nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity were evaluated by rhinometry and acoustic rhinometry techniques in patients who had had MSR. Thirty-two patients were studied, and the mean (SD) MSR was 5.03 (1.61) (range 3-8) mm. There was a significant correlation between the mean MSR and the mean change in nasal airflow and nasal resistance (p=0.001 and p=0.005, respectively). There was also a correlation between MSR and the change in the cross-sectional area of the inferior concha (p=0.001), but there was no correlation between the mean MSR and the change in cross-sectional area of the isthmus (p=0.07). Nasal airflow increases when the mean MSR is less than 6.5mm, and when maxillary impaction is 6.5mm or more, nasal airflow decreases. It seems, therefore, that MSR of less than 6.5mm was associated with an improvement in nasal airflow. When maxillary impaction was more than 6.5mm, nasal airflow and the cross-sectional area of the nasal cavity decreased, and nasal resistance increased.

Does preservation of the socket decrease marginal bone loss in the mandible after extraction of first molars?

The quality of the bone plays an important part in marginal bone loss (MBL) around dental implants. The aim of this study was to compare MBL around implants the sockets of which had been preserved with the bone around healed sites in the mandible after extraction of first molars. It was a prospective, cohort study in which subjects were divided into three groups (n=30 in each): dental implants were placed six months after preservation of the socket in the first group, eight weeks after tooth extraction in the second, and six months after tooth extraction in the third. The changes between the marginal bone level after loading of the implant and 12, 24, and 36 months later were considered to be the MBL. Age and sex were the variables studied, the condition of the bone (healed socket or preservation) was a predictive factor, and MBL was the outcome. Analysis of variance was used to compare MBL and age among groups. There were no differences in the mean MBL among the three groups 12, 24, and 36 months after loading (p=0.55, p=0.22, p=0.38, respectively). Preservation of the socket did not seem to affect MBL of the first molar of the mandible.

Polyglactin 910 suture compared with polyglactin 910 coated with triclosan in dental implant surgery: randomized clinical trial.

Antibacterial coating of surgical sutures is a suggested approach to prevent surgical site infections. The aim of this study was to compare the incidence of surgical site infection following the use of polyglactin 910 (Vicryl) and polyglactin 910 coated with triclosan (Vicryl Plus) sutures in dental implant surgery. This single-blind, randomized clinical trial evaluated patients who received three implants in the posterior mandible. Patients were randomly divided into two groups to receive either Vicryl Plus sutures (group 1) or Vicryl sutures (group 2). A total of 320 patients were included in the study (n=160 in each group). Twelve patients (7.5%) in group 1 and 11 patients (6.9%) in group 2 had a surgical site infection. Analysis of the data did not demonstrate any significant difference in the incidence of surgical site infection between the two groups (P=0.5). The incidence of surgical site infection in fresh socket implant placement was higher than that in delayed implant placement, irrespective of the type of suture used (P=0.001). Triclosan-coated Vicryl sutures did not decrease the incidence of surgical site infection in dental implant surgery.

Can platelet-rich fibrin accelerate neurosensory recovery following sagittal split osteotomy? A double-blind, split-mouth, randomized clinical trial.

Neurosensory disturbance (NSD) is common following sagittal split osteotomy (SSO) surgery. The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) on neurosensory recovery following SSO. This double-blind, split-mouth, randomized clinical trial was performed on patients undergoing bilateral SSO. PRF was applied to one side (selected using computer randomization) after the osteotomy and before fixation. The other side served as the control. The two-point discrimination test and a brush directional stroke test were used to assess NSD at 6 and 12 months postoperative. Self-reported paresthesia was documented using a 10-point visual analogue scale (VAS). Twenty-one patients were included in the study. The results of the two-point discrimination test and the number of subjects who reported a true direction in the brush directional stroke test differed significantly between the treatment and control sides (P=0.001). The recovery of NSD (self-reported paresthesia) was better on the treatment side than on the control side (P=0.001). PRF may enhance the recovery of paresthesia following SSO.

Does platelet-rich fibrin increase the stability of implants in the posterior of the maxilla? A split-mouth randomized clinical trial.

The effect of platelet-rich fibrin (PRF) on bone healing around dental implants in areas of poor bone quality has not been studied. The aim of this study was to evaluate the stability of implants placed in the posterior maxilla, with or without the use of PRF, during the healing period. A split-mouth randomized clinical trial was performed. Twenty patients with missing teeth in the molar region of the maxilla, requiring bilateral implants, were included. PRF was used on one side (group 1); no PRF was used on the other (group 2). Implant stability was assessed by resonance frequency analysis (RFA) at 2, 4, and 6 weeks after placement. At 2 weeks, the mean ISQ was 60.60±3.42 in group 1 and 58.25±3.64 in group 2; at 4 weeks it was 70.30±3.36 in group 1 and 67.15±4.33 in group 2; at 6 weeks it was 78.45±3.36 in group 1 and 76.15±2.94 in group 2. Significant differences in RFA were found between the groups at 2 weeks (P=0.04), 4 weeks (P=0.014), and 6 weeks (P=0.027) after placement. The study results suggest that the use of PRF may enhance the post-insertion stability of dental implants placed in the posterior maxilla during the healing period.

Do antiplatelet drugs increase the risk of bleeding after tooth extraction? A case-crossover study.

The aim of this study was to assess the risk of bleeding after tooth extraction in patients taking aspirin or clopidogrel. This case-crossover study evaluated patients taking aspirin (80mg/day) or clopidogrel (75mg/day) and undergoing tooth extraction. In the first session, extraction was performed without discontinuing aspirin (group 1) or clopidogrel (group 2). In the second session, patients ceased using antiplatelet drugs 5days prior to tooth extraction. Bleeding was evaluated using a visual analogue scale (VAS) for 72h after tooth extraction. The platelet function assay (PFA) was performed for group 1 and flow cytometry assessment of vasodilator-stimulated phosphoprotein (VASP) was performed for group 2, in both sessions. Thirty-eight patients were studied: 20 in group 1 and 18 in group 2. Analysis of the data did not demonstrate any difference in bleeding severity between sessions 1 and 2 in either group (P>0.05). There was a significant difference between sessions 1 and 2 in group 1 for the mean collagen/epinephrine membrane closure time (PFA) (P=0.001). A significant difference in platelet reactivity index (flow cytometry for VASP) was noted between sessions 1 and 2 in group 2 (P=0.001). According to this case-crossover study, dental extraction can be performed safely without withdrawal of aspirin or clopidogrel.

Reduced-intensity and non-myeloablative allogeneic stem cell transplantation from alternative HLA-mismatched donors for Hodgkin lymphoma: a study by the French Society of Bone Marrow Transplantation and Cellular Therapy.

Allogeneic stem cell transplantation (allo-SCT) following a non-myeloablative (NMA) or reduced-intensity conditioning (RIC) is considered a valid approach to treat patients with refractory/relapsed Hodgkin lymphoma (HL). When an HLA-matched donor is lacking a graft from a familial haploidentical (HAPLO) donor, a mismatched unrelated donor (MMUD) or cord blood (CB) might be considered. In this retrospective study, we compared the outcome of patients with HL undergoing a RIC or NMA allo-SCT from HAPLO, MMUD or CB. Ninety-eight patients were included. Median follow-up was 31 months for the whole cohort. All patients in the HAPLO group (N=34) received a T-cell replete allo-SCT after a NMA (FLU-CY-TBI, N=31, 91%) or a RIC (N=3, 9%) followed by post-transplant cyclophosphamide. After adjustment for significant covariates, MMUD and CB were associated with significantly lower GvHD-free relapse-free survival (GRFS; hazard ratio (HR)=2.02, P=0.03 and HR=2.43, P=0.009, respectively) compared with HAPLO donors. In conclusion, higher GRFS was observed in Hodgkin lymphoma patients receiving a RIC or NMA allo-SCT with post-transplant cyclophosphamide from HAPLO donors. Our findings suggest they should be favoured over MMUD and CB in this setting.

Allogeneic hematopoietic cell transplantation for multiple myeloma in Europe: trends and outcomes over 25 years. A study by the EBMT Chronic Malignancies Working Party.

We describe the use and outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for multiple myeloma (MM) in Europe between January 1990 and December 2012. We identified 7333 patients, median age at allo-HSCT was 51 years (range: 18-78), of whom 4539 (62%) were males. We distinguished three groups: (1) allo-HSCT upfront (n=1924), (2) tandem auto-allo-HSCT (n=2004) and (3) allo-HSCT as a second line treatment and beyond (n=3405). Overall, there is a steady increase in numbers of allo-HSCT over the years. Upfront allo-HSCT use increased up to year 2000, followed by a decrease thereafter and represented 12% of allo-HSCTs performed in 2012. Tandem auto-allo-HSCT peaked around year 2004 and contributed to 19% of allo-HSCTs in 2012. Allo-HSCT as salvage after one or two or three autografts was steadily increasing over the last years and represented 69% of allo-HSCTs in 2012. Remarkable heterogeneity in using allo-HSCT was observed among the different European countries. The 5-year survival probabilities from time of allo-HSCT for the three groups after year 2004 were 42%, 54% and 32%, respectively. These results show that the use of allo-HSCT is increasing in Europe, especially as second line treatment and beyond. There is an unmet need for well-designed prospective studies investigating allo-HSCT as salvage therapy for MM.