Quantification of the apical palatal bone index for maxillary incisor immediate implant assessment: A retrospective cross-sectional study.

BACKGROUND: Apical palatal bone is important in immediate implant evaluation. Current consensus gives qualitative suggestions regarding it, limiting its clinical decision-making value. OBJECTIVES: To quantify the apical palatal bone dimension in maxillary incisors and reveal its quantitative correlation with other implant-related hard tissue indices to give practical advice for pre-immediate implant evaluation and design. MATERIAL AND METHODS: A retrospective analysis of immediate implant-related hard tissue indices in maxillary incisors obtained by cone beam computed tomography (CBCT) was conducted. Palatal bone thickness at the apex level (Apical-P) on the sagittal section was selected as a parameter reflecting the apical palatal bone. Its quantitative correlation with other immediate implant-related hard tissue indices was revealed. Clinical advice of pre-immediate implant assessment was given based on the quantitative classification of Apical-P and its other correlated immediate implant-related hard tissue indices. RESULTS: Apical-P positively correlated with cervical palatal bone, whole cervical buccal-palatal bone, sagittal root angle, and basal bone width indices. while negatively correlated with apical buccal bone, cervical buccal bone, and basal bone length indices. Six quantitative categories of Apical-P are proposed. Cases with Apical-P below 4 mm had an insufficient apical bone thickness to accommodate the implant placement, while Apical-P beyond 12 mm should be cautious about the severe implant inclination. Cases with Apical-P of 4-12 mm can generally achieve satisfying immediate implant outcomes via regulating the implant inclination. CONCLUSIONS: Quantification of the apical palatal bone index for maxillary incisor immediate implant assessment can be achieved, providing a quantitative guide for immediate implant placement in the maxillary incisor zone.

Clinical and radiographic assessment of cross-linked hyaluronic acid addition in demineralized bovine bone based alveolar ridge preservation: A human randomized split-mouth pilot study.

PURPOSE: To investigate clinically and radiographically at 4 months post-operatively the outcomes of mixing demineralized bovine bone material (DBBM) with cross-linked hyaluronic acid in alveolar ridge preservation. MATERIAL AND METHODS: Seven patients presenting bilateral hopeless teeth (14 teeth) were enrolled in the study, the test site contained demineralized bovine bone material (DBBM) mixed with cross-linked hyaluronic acid (xHyA) while the control site contained only DBBM. 4 months post-operatively prior to implant placement a Cone beam computed tomography (CBCT) scan was recorded and compared to the initial scan to assess the volumetric and linear bone resorption that occurred in both sites. Clinically, sites that needed further bone grafting at the implant placement stage were recorded. Differences in volumetric and linear bone resorption between both groups were assessed using Wilcoxon signed rank test. McNemar test was also used to evaluate difference in bone grafting need between both groups. RESULTS: All sites healed uneventfully, volumetric and linear resorption differences between the baseline and 4 months post-operatively were obtained for each site. The mean volumetric and linear bone resorption were respectively 36.56 ± 1.69%, 1.42 ± 0.16 mm in the controls sites and 26.96 ± 1.83%; 0.73 ± 0.052 mm in the tests sites. The values were significantly higher among controls sites (P=0.018). No significant differences were observed in the need for bone grafting between both groups. CONCLUSION: Cross-linked hyaluronic acid (xHyA) appears to limit the post-extractional alveolar bone resorption when mixed with DBBM.

Assessment of a Novel Alveolar Ridge Preservation Concept in Dehiscence Sockets: A Pilot Study.

In this prospective pilot study on ridge preservation (RP), a collagen sponge was placed to fill the bottom half of the socket, followed by a sequence of bone graft, collagen membrane, and a sponge placed on top. Twelve patients with 13 hopeless posterior teeth were included. Changes in bone dimension (including variations of horizontal ridge width [HRW] and bone height [BH]) between the time immediately postextraction (T0) and 6 months later (T6M) were evaluated through CBCT. The soft tissue was assessed using a wound healing index (WHI) at 2 weeks (T2W), 2 months (T2M), and 6 months (T6M) postsurgery. Measured at three parallel levels (1, 3, and 5 mm apical to the crest of the palatal plate), the mean HRW changes (T0 to T6M) ranged from 0.47 to 1.05 mm. Statistically significant negative correlations were observed between WHI (T6M) and midcrestal BH change. This proposed RP technique showed favorable outcomes regarding HRW and BH, even in periodontally compromised dehiscence sockets.

Simultaneous Assessment of Soft and Hard Tissue Behaviors After Alveolar Ridge Preservation Using Bone Substitutes.

This study aimed to simultaneously assess hard and soft tissues alterations and their proportions after alveolar ridge preservation (ARP). Participants (n = 65) who were previously enrolled in a clinical trial investigating ARP healing were selected. The CBCT DICOM (Digital Imaging and Communications in Medicine) and the cast STL (stereolithographic) files of each subject were imported, segmented, and superimposed. A cross-section view of the superimposed image presented the outlines from each DICOM and STL file. The center of preserved ridge was selected in the superimposed image and used to draw the reference lines to realize the measurements. Horizontal linear measurements determined ridge width (RW) and its respective hard/soft tissue proportion (H:S) at 1, 3, 5, and 7 mm below the buccal bone crest immediately after ARP and at the 4-month follow-up. At 1 mm, the baseline RW was 11.6 mm and reduced to 10 mm after 4 months. The baseline H:S was 65%:35% and was 43%:57% at the 4-month follow-up. Considering only the buccal half of the ridge, baseline H:S was 77%:23%, while after 4 months it shifted to 58%:42%. A similar pattern was observed at 3, 5, and 7 mm but with decreased resorption degree. The present study showed that hard tissue is mostly responsible for RW loss after healing, especially in the first 3 mm below the buccal bone crest. Soft tissue partially compensated for the hard tissue shrinkage, gaining thickness in the analyzed areas.

Volumetric assessment of changes in the alveolar ridge dimension following guided bone regeneration using a combination freeze-dried bone allograft with collagen membrane or novel resorbable scaffold: A prospective two-center clinical trial.

BACKGROUND: The aim of this study was to examine osseous changes following lateral bone augmentation using a novel scaffold (OV) alone and compare it to combination therapy using freeze-dried bone allograft (FDBA) and resorbable collagen membrane (FDBA/CM). METHODS: Thirty patients completed this 9-months prospective two-center cohort clinical trial. Before surgery and 9-months re-entry, linear measurements were performed, and impressions taken. Cone-beam computed tomography (CBCT) were done at baseline and 9 months. DICOM slice data were converted into volumetric images using 3D Slicer. Following 3D volumetric image construction, pre- and post-op Standard Triangle Language files were superimposed and volumetric data were extracted for a 10-mm region of interest. Linear measurements were compared similarly. RESULTS: Baseline clinical parameters were similar in both groups (4.22 and 4.53 mm for OV and FDBA/CM at -2 mm, respectively). Following treatment, vertical distance from the stent had changed minimally (-0.36 and -0.12 mm, respectively). Similarly, lateral bone gain ranged from 0 to 0.4 mm, for both groups. To the contrary, the CBCT measurements showed a significantly greater increase in horizontal width in the control at -2 mm (0.95 ± 0.2 mm) compared with -0.62 mm for the OV (P = 0.000). Similar changes were observed at -5 mm (0.63 and -0.41 mm, respectively, P = 0.01). Sites volume had increased from 266 ± 149 mm3 to 360 ± 138 mm3 (P = 0.001) for FDBA/CM with negligible changes for OV (from 334 to 335 mm3 , P = 0.952). these between-group changes being statistically significant (P = 0.023). CONCLUSION: FDBA/CM yielded better albeit moderate increase in the volume of the edentulous ridge, while OV scaffolds failed to produce similar results.

Evaluation of the CBCT imaging accuracy in the volumetric assessment of unilateral alveolar cleft.

INTRODUCTION: Appropriate radiographic evaluation is a fundamental step for determining the topography of the defect before the surgical intervention for alveolar bone grafting. Evaluation of cleft volume by CBCT has been done in dry skull samples in previous studies and it was recommended as an effective tool in the volumetric evaluation of the bone defect prior to the surgery. The purpose of this study was to evaluate the accuracy of preoperative clinical use of CBCT2 imaging in determining the alveolar cleft volume. MATERIAL AND METHODS: We performed a clinical study. 20 patients with unilateral alveolar cleft underwent preoperative radiographic evaluation using CBCT scan. Volumetric measurement was performed by an oral and maxillofacial radiologist using 0.5, 1, and 2 mm slices and an oral and maxillofacial surgeon using 2 mm slices. After the closure of the nasal floor and palatal mucosa, the alveolar defect was clinically measured with putty impression material. Descriptive and bivariate statistics were computed and the p-value was set at 0.05. RESULTS: This study showed that there is a statistically significant difference between CBCT-estimated and clinical volumes of the alveolar cleft (paired T-test, p-value < 0.05). CONCLUSION: Considering the significant difference between clinical and CBCT-estimated volumes of the alveolar cleft, CBCT imaging is not considered an accurate tool for pre-operative volumetric assessment of the alveolar cleft.

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 Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability.

OBJECTIVE: To analyze the effects of presurgical nasoalveolar molding (PNAM) in newborns with cleft lip and palate and evaluate its postsurgical stability at 1-year follow-up using a nasal stent. DESIGN: Prospective clinical trial. SETTING: Department of Orthodontics, Maulana Azad Institute of Dental Sciences, Delhi. PATIENTS: Patients with cleft lip and palate of 0 to 6 months. Sample size 25 recruited, 16 satisfactorily completed the procedure. INTERVENTIONS: Presurgical nasoalveolar molding done as indicated in all the patients. Postsurgical external nasal stents were given for 1 year to maintain the nasal correction. MAIN OUTCOME MEASURES: Changes in cleft defect and maxillary arch were recorded pre- and post-PNAM. Changes in nasal morphological parameters assessed pre- and post-PNAM and 1 year after surgical repair following the use of nasal stent. RESULTS: There was a significant reduction in cleft defect assessed both intraorally ( 4.16 mm) and extra orally ( 4.42 mm) at the end of PNAM therapy (average treatment time 4 months). The nasal morphology improved with an increase in columella height (1.5 mm) and reduction in columella width. Bialar width reduced (2.90 mm) with an increase in nostril height ( 2.10 mm). Better symmetry was achieved in all cases as the nostril height and width difference changed significantly pre- and post-nasoalveolar molding. The percentage increase in columella height was greater for infants less than 6 weeks. CONCLUSIONS: Presurgical nasoalveolar molding considerably reduces the cleft gap and improves arch form making surgical union easier along with improved nasal morphology which can be maintained at 1-year postsurgery by use of a postsurgical external nasal stent.

Objective computerised assessment of residual ridge resorption in the human maxilla and maxillary sinus pneumatisation.

OBJECTIVES: Atrophic resorption of the maxillary alveolar ridge is a complication that makes implantological rehabilitation critical. Our aim was to develop a novel computer aided procedure for the accurate quantitative assessment of maxillary residual ridge resorption including pneumatisation of the maxillary sinus that goes beyond previously described approaches and to apply it to a large dataset. MATERIALS AND METHODS: To develop and refine the method, we performed a retrospective analysis using computed tomography data from 405 patients to generate segmented, three-dimensional models of zygomaticomaxillary bones and maxillary sinuses. Using anatomical landmarks and orientation lines or planes, all models were aligned automatically to subsequently generate cross-sectional images (n = 2835), enabling the classification of atrophy as well as the quantification of volumes and caudal extensions of the maxillary sinuses. RESULTS: We developed and implemented an accurate and reproducible workflow for the semi-automated analysis of volumetric maxillary images. Comprehensive statistical analysis of the large quantitative dataset revealed various correlations of maxillary process heights and sinus volumes with atrophy class, age and region and identified conjectural trends over the patient group. CONCLUSIONS: The method was used successfully to process a large dataset to classify atrophy, to measure alveolar height parameters, and to quantify maxillary sinus volume, bottom volume and pneumatisation. CLINICAL RELEVANCE: Apart from the anthropometric value of the generated dataset, the method could be applied to provide additional and more accurate data to assess the necessity of bone augmentation in the context of three-dimensional planning before implantation.

Cone-beam CT assessment of implant-related anatomy landmarks of the anterior mandible in a Chinese population.

PURPOSE: To investigate the prevalence, location, and morphology of the mandibular lingual foramen (MLF), mandibular incisive canal (MIC), and anterior loop of the inferior alveolar canal (ALC) in a Chinese population using cone-beam CT (CBCT). MATERIALS AND METHODS: From 2014 to 2016, CBCT images from patients with various scanning purposes were obtained from the database of the Affiliated Stomatology Hospital of Kunming Medical University, China. Imaging analyses of the MLF, MIC, and ALC were performed via the NNT viewer software. The prevalence, location, length, classification of MLF, and its distances to the alveolar crest and the lower border of mandible were investigated, and the prevalence and length of MIC and the prevalence of ALC were also studied. RESULTS: This study examined 1008 subjects, 521 (51.7%) males, and 487 (48.3%) females. 916 (90.9%) subjects showed the medial lingual foramina (LF), a single medial LF with the supraspinous-type predominating. Lateral LF were observed in 547 (54.3%) subjects mostly located in the premolar areas. 876 (86.9%) subjects had the MIC on the left side, whereas 877 (87.0%) had the MIC on the right side. The ALC was present in 147 (14.6%) subjects. CONCLUSIONS: This study showed a high prevalence of LF and MIC in the Southwest Chinese population. Therefore, caution should be taken during the implant treatment at the anterior mandible region.

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%.

Decision Tree for Vertical Ridge Augmentation.

Vertical ridge augmentation (VRA) procedures before or during dental implant placement are technically challenging and often encounter procedure-related complications. To minimize complications and promote success, a literature search was conducted to validate procedures used for VRA. A decision tree based on the amount of additional ridge height needed (< 4, 4 to 6, or > 6 mm) was then developed to improve the procedure-selection process. At each junction, the clinician is urged to consider anatomical, clinical, and patient-related factors influencing treatment outcomes. This decision tree guides selection of the most appropriate treatment modality and sequence for safe, predictable management of the vertically deficient ridge in implant therapy.

A novel semi-automatic segmentation protocol for volumetric assessment of alveolar cleft grafting procedures.

A novel protocol for volumetric assessment of alveolar cleft grafting procedures is presented. Eleven cone-beam computed tomography (CBCT) datasets of patients who underwent secondary alveolar cleft reconstructive surgery for a unilateral alveolar cleft were evaluated by two investigators. Residual bone volumes 1 year after surgery were analysed using a semi-automated technique in which preoperative CBCT datasets were superimposed on the postoperative scans using voxel-based registration. To define the correct boundaries of the alveolar cleft defect in the preoperative CBCT dataset, a mirror image of the preoperative CBCT dataset was superimposed on the preoperative CBCT dataset. For the difference in residual bone volume between the two observers, an intraclass correlation of 0.98 and a Dice coefficient of 0.89 were found. This study describes a reliable segmentation protocol for volumetric analysis of the alveolar cleft defect in patients with a unilateral alveolar cleft.

Clinical and Histomorphometric Assessment of Lateral Alveolar Ridge Augmentation Using a Corticocancellous Freeze-Dried Allograft Bone Block.

Horizontal ridge augmentation with allografts has attracted notable attention because of its proper success rate and the lack of disadvantages of autografts. Corticocancellous block allografts have not been adequately studied in humans. Therefore, this study clinically and histomorphometrically evaluated the increase in ridge width after horizontal ridge augmentation using corticocancellous block allografts as well as implant success after 12 to 18 months after implantation. In 10 patients receiving implants (3 women, 7 men; mean age = 45 years), defective maxillary alveolar ridges were horizontally augmented using freeze-dried bone allograft blocks. Ridge widths were measured before augmentation, immediately after augmentation, and ∼6 months later in the reentry surgery for implantation. This was done at points 2 mm (A) and 5 mm (B) apically to the crest. Biopsy cores were acquired from the implantation site. Implant success was assessed 15.1 ± 2.7 months after implantation (range = 12-18 months). Data were analyzed using Friedman and Dunn tests (α = 0.05). At point A, ridge widths were 2.77 ± 0.37, 8.02 ± 0.87, and 6.40 ± 0.66 mm, respectively, before surgery, immediately after surgery, and before implantation. At point B, ridge widths were 3.40 ± 0.39, 9.35 ± 1.16, and 7.40 ± 1.10 mm, respectively, before surgery, immediately after surgery, and before implantation. The Friedman test showed significant increases in ridge widths, both at point A and point B (both P = .0000). Postaugmentation resorption was about 1.5-2 mm and was statistically significant at points A and B (P < .05, Dunn). The percentage of newly formed bone, residual graft material, and soft tissue were 33.0% ± 11.35% (95% confidence interval [CI] = 24.88%-41.12%), 37.50% ± 19.04% (95% CI = 23.88%-51.12%), and 29.5%, respectively. The inflammation was limited to grades 1 or zero. Twelve to 18 months after implantation, no implants caused pain or showed exudates or pockets. Radiographic bone loss was 2.0 ± 0.7 mm (range = 1-3). It can be concluded that lateral ridge augmentation with corticocancellous allograft blocks might be successful both clinically and histologically. Implants might have a proper clinical success after a minimum of 12 months.

Tomographic Assessment of Bone Formation After the Collares Technique of Gingivoperiosteoplasty in Patients With Cleft Lip and Palate.

OBJECTIVES: This cross-sectional study sought to assess bone formation and spontaneous tooth eruption in a cohort of 25 consecutive patients aged 6 to 11 years who underwent primary gingivoperiosteoplasty by the Collares technique. DESIGN: Cross-sectional study assessing bone formation in the cleft area using a within-group time series design. SETTING: Hospital de Clínicas de Porto Alegre (HCPA), a tertiary hospital in Brazil. PATIENTS: Twenty-five patients with nonsyndromic, complete unilateral cleft lip and palate, no comorbidities, and unerupted permanent canines. INTERVENTION: Cheiloplasty was performed by means of the Millard II technique, with the addition of a triangle at the mucocutaneous junction, vomer flap nasal floor closure, and wide subperiosteal elevation, followed by gingivoperiosteoplasty by the Collares technique. MAIN OUTCOME MEASURES: Cone-beam computed tomography was used to assess treatment effect. In a novel method, software was used to obtain two three-dimensional reconstructions, one each of the cleft and noncleft sides, enabling quantitative comparison of bone presence in the alveolar defect area. RESULTS: Of the 25 patients, 24 achieved bone bridge formation. The cleft side had 75.1% (67.9%-82.3%) of the bone volume, 70.5% (53.1%-87.9%) of the height, and 63.3% (44.1%-82.5%) of the width of the noncleft side. Bone formation was 17.28% lower in patients with lateral incisor agenesis. CONCLUSION: Collares gingivoperiosteoplasty performed well as a technique for alveolar repair in patients with cleft lip and palate, allowing spontaneous eruption of deciduous and permanent lateral incisors through the bone bridge created.

A novel semiautomatic technique for volumetric assessment of the alveolar bone defect using cone beam computed tomography.

OBJECTIVE: The aims of this study were (1) to determine the three-dimensional anatomical boundaries of the alveolar bone defect in cleft lip and palate (CLP) patients, (2) to precisely translate these anatomical boundaries into reliable cephalometric landmarks and planes that can be used for cone beam computed tomography (CBCT) analysis, (3) to standardize image acquisition and reconstruction parameters, and (4) to test the reproducibility of the proposed protocol for measuring the predefined alveolar bone defect, using a third-party software. METHODS: The alveolar bone defect volume of 10 randomly selected patients with unilateral CLP (UCLP) aged 8 years and 6 months to 11 years and 2 months was evaluated on preoperative and 1-year postoperative CBCT scans using a semiautomatic, standardized protocol. The alveolar bone graft outcome was calculated as a percentage of the bone fill using the formula (VOLpre - VOLpost)/VOLpre) × 100. Intra- and interobserver reliability was assessed. RESULTS: Intra- and interobserver reproducibility was excellent for volumes and bone fill as no statistically significant difference (P < .001) was seen between the different sets of measurements, and Pearson correlation coefficients were large (intraobserver: r > .9849, interobserver: r > .8784). The Bland-Altman plots indicated that the differences between the plots were not patterned. CONCLUSIONS: Volume determination using CBCT, third-party medical image processing software, and the presently defined image acquisition and reconstruction parameters, including anatomical boundaries, is a reproducible and practical method for assessing the volumetric outcome of secondary alveolar bone grafting in patients with UCLP.

Assessment of presurgical clefts and predicted surgical outcome in patients treated with and without nasoalveolar molding.

Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to the survey. For patients with UCLP, surgeons reported that, for NAM-prepared patients, 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM-prepared with non-NAM-prepared patients showed statistically significant differences (P < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared with patients not prepared with NAM.

Assessment of marginal bone loss using full thickness versus partial thickness flaps for alveolar ridge splitting and immediate implant placement in the anterior maxilla.

The aim of this study was to evaluate the effectiveness of maintaining the periosteal attachment of the facial and palatal cortical plates on crestal bone loss that occurs at the margin of dental implants placed immediately in split anterior maxillary alveolar ridges. This was a prospective randomized comparative clinical trial. The study population included 22 patients with edentulous anterior maxillary alveolar ridges who presented for treatment during the period March 2012 to September 2013. The selected patients were divided randomly into two equal groups. All patients underwent a maxillary ridge splitting technique; a total of 43 implants were placed immediately. A full thickness mucoperiosteal flap was performed in the control group patients, while a split thickness mucosal flap was done in the study group patients. Assessments included measurements of the linear changes in the marginal bone surrounding the implants immediately postoperative and after 6 months. Measurements were taken from cross-sectional and longitudinal cone beam computed tomography images using special software. The partial thickness flap used in the study group decreased the percentage of bone loss by 9.5% for the labial bone plate, 7.9% for the palatal bone plate, and 3.5% for the mesiodistal bone plate.

Patients', parents', and orthodontists' perceptions of the need for and costs of additional procedures to reduce treatment time.

INTRODUCTION: The purpose of this study was to evaluate patients', parents', and orthodontists' perspectives on orthodontic treatment duration and techniques for accelerating the rate of tooth movement. METHODS: Adolescent patients (n = 200) and their parents (n = 200), and adult patients (n = 50) from a multidoctor practice were personally surveyed regarding treatment duration and acceptance of appliances and techniques to enhance the speed of orthodontic treatment, and how much increase in fees they were willing to pay for these. Members of the American Association of Orthodontists were surveyed electronically regarding their willingness to use these techniques and appliances and the costs they were willing to pay for them. RESULTS: A total of 683 orthodontists replied to the electronic survey (7.5%). Approximately 70% of the orthodontists who replied to the survey were interested in adopting additional clinical procedures to reduce treatment time. No significant association was found between practice characteristics and interest in adopting clinical procedures to reduce treatment time. The invasiveness of the procedure was inversely related to its acceptance in all groups surveyed. Most orthodontists are willing to pay only up to 20% of their treatment fee to companies for the use of technologies that reduce treatment time, and most patients and parents were willing to pay only up to a 20% increase in fees for these approaches. Orthodontists thought that increases in the rate of tooth movement could pose a problem for fee collection. CONCLUSIONS: Orthodontists and patients alike are interested in techniques that can accelerate tooth movement. Similarities between all groups were found regarding the acceptance of different approaches to accelerate tooth movement and the percentage of the orthodontic fee that would be paid for these techniques. Less-invasive techniques had greater acceptability in all groups.

A radiographic assessment of the regeneration process in post-operative alveolar bone defects in patients with different IL-1B-511 genotypes.

BACKGROUND: IL-1 is the main regulator of inflammatory reactions. This cytokine also plays an important role in bone tissue remodeling processes. The IL-1α-coding gene and the IL-1ß-coding gene are located on the long arm of chromosome 2. These genes contain polymorphic sites. Polymorphic modifications in IL-1-coding genes determine the level of IL-1 release, which can affect bone tissue regeneration. OBJECTIVES: The objective of the present study was to assess the correlation between IL-1B-511 genetic polymorphism and the regeneration of the alveolar ridge bone. MATERIAL AND METHODS: The study was carried out at the Department of Oral Surgery in Bytom, Poland, which is part of the Silesian Medical University of Katowice. The study population comprised 92 patients with mandibular or maxillary alveolar bone defects which had developed following the surgical removal of tooth roots or the enucleation of impacted teeth or cysts. Genetic material was obtained from the epithelial cells of the inner buccal surface. The IL-1B-511 genotype was determined in each patient by means of the phenol-chloroform technique, in order to enable DNA isolation, as well as by the PCR-RFLP method. Once this had been achieved the patients could be classified into 3 groups according to the following genotypes: IL-1B-511 1/1, IL-1B-511 1/2 and IL-1B-511 2/2. Bone regeneration was assessed radiographically using Digora 2.5 software. A comparison was made over a 6-month follow-up period of post-operative bone loss regeneration observed in patients with different types of the IL-1B-511 gene (alleles 1/1, 1/2, 2/2). RESULTS: A careful analysis of the X-ray images showed that the average increase in the optical density of post-operative bone defects was statistically lower in patients with the IL-1B-511 2/2 genotype than in those possessing the IL-1B-511 1/1 or IL-1B-511 1/2 genotypes. The results indicate that alveolar bone regeneration proceeds more slowly in patients with the IL-1B-511 2/2 genotype compared to those with alleles 1/1 and 1/2.