Assessment of bone gain and neurosensory affection with the sandwich osteotomy technique for vertically deficient posterior mandible using a full digital workflow versus conventional protocol: A randomized split mouth study.

BACKGROUND: Using the sandwich osteotomy technique in the posterior mandible is delicate. This study aimed to assess the safety and the amount of bone gain using a full digital workflow versus the conventional procedure. PATIENTS AND METHODS: This split mouth study included 10 patients with bilateral vertically deficient posterior mandible. One side received conventional sandwich interpositional bone grafting (control group), while the other side received the same protocol using two patient-specific guides. The first guide (cutting guide) was used to place the osteotomies safely and accurately according to the predetermined dimensions and locations, and the second guide was used to fix the mobilized bony segment, leaving the desired gap to be filled with a particulate xenogenic bone graft. RESULTS: Full neurosensory recovery was documented at 2 months postoperative for all patients and bilaterally. After 4 months, there was a statistically significant difference in vertical bone gain between both groups (p = 0.001), measuring an average of 3.76 ± 0.72 mm in the study group and 2.69 ± 0.37 mm in the control group. No statistically significant difference was found between the planned vertical augmentation (3.85 ± 0.58 mm) and the obtained vertical bone gain (3.76 ± 0.72 mm) in the study group (p = 0.765) proving the accuracy of the guided procedure. CONCLUSION: Computer-guided sandwich interpositional grafting is predictable regarding the execution of the osteotomies and the accuracy of fixation of the transport segment.

Assessment of absorbable gelatin sponge for maxillary sinus floor elevation versus anorganic bovine bone minerals: a randomized clinical trial.

PURPOSE: The present study compared the absorbable gelatin sponge as a space-filling material versus anorganic bone bovine mineral (ABBM) in maxillary sinus augmentation with simultaneous endosseous dental implant placement. METHODS: Eighteen maxillary sinus floor elevation cases were randomly allocated into two groups. The first group received ABBM, while the second group received an absorbable gelatin sponge as a space-filling material. For both groups, CBCT scans were obtained immediately postoperatively and six months later to calculate the difference in sinus floor bone gain. Osstell readings were recorded both at the time of implant placement and implant exposure with a total of twenty-three dental implant placements in relation to the eighteen elevated sinus floors. RESULTS: The mean radiographic sinus floor gain in the ABBM group was 10.2 mm (± 2.5), while in the absorbable gelatin sponge group was 5.4 mm (± 2.0), with a mean difference of 4.8, which was statistically significant (p < 0.001). The mean implant stability for the ABBM was 77.3 (± 4.9), while in the absorbable gelatin sponge group was 74.2 (± 3.0), with a mean difference of 3.1, which was statistically insignificant (p = 0.1610). CONCLUSION: The ABBM showed superior results regarding the amount of radiographic sinus floor bone gain. However, the implant stability was invariable between both groups.

Assessment of bone quality using buccal and palatal autogenous cortical shells harvested from two different mandibular donor sites for maxillary alveolar ridge augmentation: a histomorphometric randomized clinical trial.

PURPOSE: This study aims to compare the quality of free autogenous bone grafts harvested from two different mandibular donor sites, used as onlay shells to augment horizontally and vertically deficient anterior maxillary alveolar ridges. METHODS: Fourteen patients with edentulous and atrophic anterior maxillae are randomly allocated into two groups. Seven symphyseal chin (group I) and seven retromolar (group II) mandibular bone grafts were harvested and fashioned to construct buccal and palatal frameworks, fixed in place with mini-screws, followed by compacting the inter-positional gaps with an equal particulate mix of xenograft and autogenous cancellous particulates. Six months later, 42 core biopsies, three from each patient, 21 for each study group, were retrieved before the implants' insertion and subjected to histomorphometric bone area percent analysis. RESULTS: The bone area percent of the newly formed bone augmented with the chin shells was 52.53 ± 1.68% versus 47.97 ± 1.83% for the retromolar grafts. The mean area percent difference between both groups was statistically significant (p = 0.0004). CONCLUSION: A higher bone quality and more volumetric stability were associated with the symphyseal cortical shells. CLINICAL TRIAL REGISTRATION: The study was registered on www.clinicaltrials.gov (#: NCT03607006) in July 2018 by Ola Alaa El Morsy.

Assessment of patient-specific titanium onlay versus autogenous inlay eminoplasty technique for treatment of recurrent temporomandibular joint dislocation: a randomized clinical trial.

PURPOSE: Various procedures have been adopted for eminence augmentation for treatment of recurrent temporomandibular joint dislocation. The aim of this study is to assess maximal incisal opening (MIO) using a custom-made titanium implant versus inlay autogenous augmentation from the patient's chin for more stable condylar movements. METHODS: Ten patients were treated in this study (20 joints) five patients with bilateral patient-specific titanium onlay implant and five for autogenous inlay grafting technique; each implant in the study group was virtually designed using a specific software and milled from titanium grade V blocks, then fixed with mini screws at the lateral aspect of the zygomatic arch while in the control group, autogenous corticocancellous bone block was harvested from the chin and wedged at the created defect of the eminence to increase its height. RESULTS: The follow-up period ranged from 6 months to 1 year to access the maximal incisal opening (MIO). The mean preoperative maximal incisal opening was 47.8 mm and that of the postoperative was 33.2 mm in the study group and 35.4 mm in the control group, respectively. One patient reported postoperative slight unilateral edema and pain that gradually diminishes after 1 month postoperative. CONCLUSION: No statistical difference between both groups p value 0.3.

Assessment of 3-dimensional bone augmentation of severely atrophied maxillary alveolar ridges using patient-specific poly ether-ether ketone (PEEK) sheets.

BACKGROUND: This study aimed to analyze the effectiveness of virtually designed polyether-ether ketone (PEEK) sheets to delineate and maintains the three-dimensional patient's maxillary alveolar ridge. MATERIALS AND METHODS: Fourteen patients (34 implants) with severely atrophied anterior maxillary alveolar ridges underwent rehabilitation using custom-made CAD/CAM PEEK sheets acting as a containment system for interpositional mix of particulate autogenous and xenogeneic bone graft, fixed by mono-cortical screws. Radiographic Assessment included measurements of linear changes in the vertical and horizontal dimensions on cross-sectional cuts of computed tomography (CBCT) using special software. RESULTS: Wound healing was uneventful for all the patients except one patient that showed wound break down 2 weeks postoperatively, which did not affect the outcome of the procedure. CBCT scans were interpreted to compare the quantity of both vertical and horizontal bone preoperatively and 6 months postoperatively. Statistical analyses demonstrated a significant difference between the results of both time intervals, with a mean vertical and horizontal bone gain was 3.47 mm(±1.46) and 3.42 (±1.1) with a P-value of (.0001). The customized sheets were removed 6 months postoperative with the successful placement of dental implants. CONCLUSION: The virtual planning of three-dimensional maxillary alveolar ridge augmentation utilizing patient-specific PEEK sheets deemed successful to restore the deficient ridge and to accommodate suitable size dental implants.

Assessment of vertical ridge augmentation and marginal bone loss using autogenous onlay vs inlay grafting techniques with simultaneous implant placement in the anterior maxillary esthetic zone: A randomized clinical trial.

BACKGROUND: Bony reconstruction and dental rehabilitation of patients with posttraumatic anterior maxillary alveolar defects is a very complicated procedure. The aim of this study is the assessment of vertical ridge augmentation using autogenous onlay vs inlay bone grafting techniques in the anterior maxilla. MATERIALS AND METHODS: Sixteen patients (40 implants) with vertically deficient anterior maxillary alveolar ridges were equally allocated into two groups; Autogenous block bone graft was harvested from the chin with simultaneous implant placement was done either onlay (control) or inlay (study). Radiographic assessment was performed preoperatively, 1 week and 6 months postoperatively. Assessment included measurements of linear changes in the vertical height on cross sectional cuts of cone beam computed tomography (CBCT) using special software. Finally, the amount of vertical gain and marginal bone loss in each group was compared to that of the other. RESULTS: Wound healing was uneventful for all cases except three cases of the onlay group showed wound breakdown and graft loss. The mean vertical bone gain in the control group was -0.02 mm while in the study was 3.34 mm. While the mean of the crestal bone loss of the control group was 4.77 mm and that of the study group was 1.65 mm. CONCLUSION: The final vertical bone gain was statistically significant in the study group, so the inlay bone grafting technique with immediate implant placement could be used successfully for vertical alveolar ridge augmentation in the esthetic zone.

Assessment of three dimensional bone augmentation of severely atrophied maxillary alveolar ridges using prebent titanium mesh vs customized poly-ether-ether-ketone (PEEK) mesh: A randomized clinical trial.

BACKGROUND: Alveolar bone grafting techniques and dental rehabilitation of patients with maxillary alveolar defects is a very challenging and costly procedure. Various methods have been described to reconstruct these defects in order to facilitate the placement of dental implants. The aim of this study was to assess three dimensional (3D) maxillary ridge augmentation using two innovative, accurate, and time saving protocols. MATERIALS AND METHODS: Sixteen patients (32 implants) with vertically and horizontally deficient maxillary alveolar ridges, were equally allocated into 2 groups; a mix of particulate autogenous and xenogenic bone grafts loaded in a prebent titanium mesh (Control group) vs patient specific poly-ether-ether ketone meshes (Study group). Radiographic assessment was performed preoperatively, 1 week and 6 months postoperatively. Assessment included measurements of linear changes in the vertical and horizontal dimensions on cross sectional cuts of cone beam computed tomography using special software. Finally; the percentage of 3D bone gain in each group was compared to that of the other. RESULTS: Wound healing was uneventful for all cases except one patient in each group were the meshes were exposed 2 weeks' postsurgery. There was no statistical significance between both groups (P value = 0.2). CONCLUSION: Within the limitations of the sample size of this study, both techniques could be used as a successful method of ridge augmentation with no statistical significance between them.

Assessment of vertical ridge augmentation and labial prominence using buccal versus palatal approaches for maxillary segmental sandwich osteotomy (inlay technique): A randomized clinical trial.

BACKGROUND: The aim of this study was to evaluate the final vertical gain at the deficient anterior maxillary alveolar ridges using buccal versus palatal approaches for maxillary segmental sandwich osteotomy (inlay technique). This is a single-institutional randomized comparative clinical trial. MATERIAL AND METHODS: The study population was 16 patients with edentulous anterior maxillary alveolar ridges (40 implant sites). Patients were randomly divided into two equal groups. Both groups received sandwich osteotomy with down fracture of the deficient anterior maxillary alveolar ridge, using buccal approach (control group) and palatal approach (study group) with interpositional alloplastic bone blocks fixed with miniplates. Assessment included the mean percentage of vertical gain at the proposed implant sites after 4 months, taken from cross-sectional cuts of a cone beam computed tomography. RESULTS: All cases showed uneventful wound healing and a total of 40 delayed implant placement were done. Results showed that there was no statistical significance between the 2 groups in terms of bone height (P = .43) and labial prominence (P = .5) CONCLUSION: Both techniques were successful where the mean percentage of 4 months postoperative vertical bone gain of the control group was 79.9% and that of the study group was 76.5%.

An assessment of the current treatment landscape for rheumatology patients in Qatar: Recognising unmet needs and moving towards solutions.

Objective This study assessed the mode of application (oral, intravenous or subcutaneous (SC)) currently employed in the treatment of rheumatoid arthritis (RA) in patients from Qatar in comparison with patients' individual preferences for the mode of application of their treatment. Methods This study included 294 RA patients visiting three clinics at the main referral hospital in Qatar who were interviewed using a standard questionnaire to determine their preference of mode of application for their disease-modifying antirheumatic drug (DMARD) treatment in relation to their currently employed mode of application. Results The majority of patients were female (76%), and 93% of male patients and 61% of female patients in the study clinics were of a nationality other than Qatari. The highest patient preference recorded was for an oral therapy (69%), compared with injection (23%) and intravenous (8%) therapy. In total, 85% of patients expressed a preference to remain on oral therapy compared with 63% and 58% of intravenous and SC injection patients indicating a preference to remain on their current method of administration. Conclusions This high preference for oral therapies highlights the considerable need for incorporation of new oral targeted synthetic DMARD therapies into clinical practice within the region.