Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level.

AIM: The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment. MATERIALS AND METHODS: A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading. RESULTS: Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years. CONCLUSION: The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level. CLINICAL SIGNIFICANCE: Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.

Comparing the osteogenic potential of schneiderian membrane and dental pulp mesenchymal stem cells: an in vitro study.

Mesenchymal stem cells, being characterized by high self-renewal capacity and multi-lineage differentiation potential, are widely used in regenerative medicine especially for repair of bone defects in patients with poor bone regenerative capacity. In this study, we aimed to compare the osteogenic potential of human maxillary schneiderian sinus membrane (hMSSM)-derived stem cells versus permanent teeth dental pulp stem cells (DPSCs). Both cells types were cultivated in osteogenic and non-osteogenic inductive media. Alkaline phosphatase (ALP) activity assay and quantitative real-time PCR analysis were carried out to assess osteogenic differentiation. We showed that ALP activity and osteoblastic markers transcription levels were more striking in hMSSM-derived stem cells than DPSCs. Our results highlight hMSSM-derived stem cells as a recommended stem cell type for usage during bone tissue regenerative therapy.

Alveolar Ridge Preservation in the Esthetic Maxillary Zone: Tuberosity Punch Technique of Gingiva and Bone: A Pilot Study.

AIM: This paper aims to present an alveolar ridge preservation technique, using an autologous punch formed of hard and soft tissues harvested from the tuberosity area. MATERIALS AND METHODS: Ten residual sockets in the anterior maxilla were filled with a punch of hard and soft tissues harvested from the tuberosity area. Clinical and radiographical data were collected at the surgical extraction time 0 (T0) and 5 months during implant placement (T1), from clinical and radiological measurements using cone-beam computed tomography scans and periapical radiographs. Core biopsy was harvested during implant placement for histological and histomorphometrical analysis. RESULTS: Clinically, the alveolar ridge presented a mean width of 10.3 mm before extraction which decreased to 8.85 mm at T1, where the mean horizontal loss is 1.45 mm (standard deviation [SD] 1.03 mm). The initial ridge mean height was 11.25 mm and increased to 12.85 mm after 5 months, where the mean vertical gain is 1.6 mm (SD 0.65 mm). The radiological evaluation shows a reduction in the horizontal dimension with a mean of 1 mm; however, the sockets show stability in the vertical dimensions. Histology showed a new lamellar bone formation with some areas of woven bone. Histomorphometric analysis showed that the percentage of new bone formed was 42.44 ± 5.54% and 48.62 ± 8.66% of the connective tissue and 8.94 ± 5.28% of the residual autogenous bone. CONCLUSION: At T1, the extraction sockets showed significantly lower vertical and horizontal bone changes, compared to T0. The described preservation punch technique resulted in greater stability in the horizontal and vertical dimensions after 5 months. CLINICAL SIGNIFICANCE: Clinical and radiological results show that the punch of hard and soft tissue graft reduces hard and soft tissue dimensional alteration after tooth extraction. In addition, using autogenous bone showed histological new bone formation.

An update on human periapical cyst-mesenchymal stem cells and their potential applications in regenerative medicine.

The broad clinical applications of Mesenchymal Stem Cells (MSCs) in the regenerative medicine field is attributed to their ability to self-renew and differentiate into multiple cellular lineages. Nowadays, MSCs can be derived from a variety of adult and fetal tissues including bone marrow, adipose tissue, umbilical cord and placenta. The difficulties associated with the isolation of MSCs from certain tissues such as bone marrow promoted the search for alternative tissues which are easily accessible. Oral derived MSCs include dental pulp stem cells (DPSCs), dental follicle progenitor cells (DFPC), and periodontal ligament stem cells (PDLSC). Being abundant and easily accessible, oral derived MSCs represent an interesting alternative MSC type to be employed in regenerative medicine. Human periapical cyst-mesenchymal stem cells (hPCy-MSCs) correspond to a newly discovered and characterized MSC subtype. Interestingly, hPCy-MSCs are collected from periapical cysts, which are a biological waste, without any influence on the other healthy tissues in oral cavity. hPCy-MSCs exhibit cell surface marker profile similar to that of other oral derived MSCs, show high proliferative potency, and possess the potential to differentiate into different cell types such as osteoblasts, adipocytes and neurons-like cells. hPCy-MSCs, therefore, represent a novel promising MSCs type to be applied in regenerative medicine domain. In this review, we will compare the different types of dental derived MSCs, we will highlight the isolation technique, the characteristics, and the therapeutic potential of hPCy-MSCs.

Effect of Simulated Mastication on the Retention of Locator Attachments for Implant-Supported Overdentures: An In Vitro Pilot Study.

PURPOSE: Limited information is currently available relative to the effect of masticatory loads on the retentive properties of Locator attachments. The aims of this in vitro study were to assess and compare the effect of simulated mastication on the retention of white, pink, and blue Locator inserts for overdentures retained by 2 implants. MATERIALS AND METHODS: Thirty specimens simulating a nonanatomic edentulous flat ridge with two implants and an overdenture were divided into 3 groups according to the color of the fitted insert: transparent clear group (n = 10), pink group (n = 10), and blue group (n = 10). Retention forces were measured in an axial direction initially and after 100,000 cycles of simulated masticatory loads. One-way ANOVA followed by Tukey's post hoc tests were used to compare retention values and percentage retention loss between the 3 groups with significance set at p = 0.05. RESULTS: The 3 groups presented significant differences in retention at baseline (9.95 ± 1.91 N, 15.43 ± 4.08 N, and 41.73 ± 9.29 N for the blue, pink, and clear groups, respectively) and after simulated mastication (6.37 ± 2.64 N, 14.00 ± 3.89 N, 38.20 ± 5.11 N for the blue, pink, and clear groups, respectively). Within the same group, cyclic loading did not significantly affect retention in the clear and pink groups, while the blue inserts showed a significant retention loss (-37%) after loading. CONCLUSIONS: The results suggest that short-term simulated mastication affects the extra-light blue inserts but not the more-retentive inserts.

In Vitro Effect of Mastication on the Retention and Wear of Locator Attachments in a Flat Mandibular Ridge Model.

PURPOSE: The effect of masticatory loads on the retention of overdenture attachments is poorly documented. The aim of this in vitro study is to assess the effect of simulated mastication on the retentive properties and dimensions of Locator inserts. MATERIALS AND METHODS: 30 specimens simulating nonanatomic edentulous flat ridges with two implant replicas each were fabricated. Overdenture units were connected to the implants with Locator attachments and 3 types of inserts: transparent (Group T; n = 10 pairs), pink (Group P; n = 10 pairs), and blue (Group B; n = 10 pairs). The overdenture units were subjected to simulated bi-axial masticatory loads of 68.6 N. Locator retention was assessed using axial dislodging forces at baseline (T0) and following 100,000 (T1) and 200,000 (T2) masticatory cycles. The inner diameter of the insert (XY) and the diameter of the central core (AB) were measured under stereomicroscope at T0 and T2. Retention changes and dimensional variations of the inserts were statistically analyzed. RESULTS: The 3 groups showed significantly different retentions with the highest values recorded for group T followed by group P, and finally group B at T0, T1, and T2. Groups T and P were not affected by loading while group B showed a significant mean retention loss from T0 to T1. XY and AB were significantly different between the 3 color-coded inserts at baseline and at T2. No correlation could be established between retention changes and dimensional variations of the 3 types of inserts. CONCLUSIONS: Within the limitations of this in vitro study, simulated mastication seems to significantly affect the extra-light blue Locator inserts but not the more-retentive ones. The transparent and pink inserts may require less frequent replacements and could therefore be recommended under clinical conditions.

Mesenchymal stem cells with osteogenic potential in human maxillary sinus membrane: an in vitro study.

OBJECTIVES: The aim of our study is to prove and validate the existence of an osteogenic progenitor cell population within the human maxillary Schneiderian sinus membrane (hMSSM) and to demonstrate their potential for bone formation. MATERIALS AND METHODS: Ten hMSSM samples of approximately 2 × 2 cm were obtained during a surgical nasal approach for treatment of chronic rhinosinusitis and were retained for this study. The derived cells were isolated, cultured, and assayed at passage 3 for their osteogenic potential using the expression of Alkaline phosphatase, alizarin red and Von Kossa staining, flow cytometry, and quantitative real-time polymerase chain reaction. RESULTS: hMSSM-derived cells were isolated, showed homogenous spindle-shaped fibroblast-like morphology, characteristic of mesenchymal progenitor cells (MPCs), and demonstrated very high expression of MPC markers such as STRO-1, CD44, CD90, CD105, and CD73 in all tested passages. In addition, von Kossa and Alizarin red staining showed significant mineralization, a typical feature of osteoblasts. Moreover, alkaline phosphatase (ALP) activity was significantly increased at days 7, 14, 21, and 28 of culture in hMSSM-derived cells grown in osteogenic medium, in comparison to controls. Furthermore, osteogenic differentiation significantly upregulated the transcriptional expression of osteogenic markers such as ALP, Runt-related transcription factor 2 (Runx-2), bone morphogenetic protein (BMP)-2, osteocalcin (OCN), osteonectin (ON), and osteopontin (OPN), confirming that hMSSM-derived cells are of osteoprogenitor origin. Finally, hMSSM-derived cells were also capable of producing OPN proteins upon culturing in an osteogenic medium. CONCLUSION: Our data showed that hMSSM holds mesenchymal osteoprogenitor cells capable of differentiating to the osteogenic lineage. CLINICAL RELEVANCE: hMSSM contains potentially multipotent postnatal stem cells providing a promising clinical application in preimplant and implant therapy.

Sinus Floor Augmentation With Ambient Blood and an Absorbable Collagen Sponge: A Prospective Pilot Clinical Study.

PURPOSE: The aim of this study was to clinically, radiologically, and histologically evaluate a sinus augmentation technique using a resorbable collagen sponge to maintain space between the Schneiderian membrane and the residual crestal bone. MATERIALS AND METHODS: Patients with partially edentulous maxillae were clinically and radiographically evaluated for implant placement. A total of 10 consecutive patients with the bone height for implant placement (<4.0 mm) were enrolled in the study. The lateral maxillary wall was surgically exposed and the Schneiderian membrane was carefully elevated. A collagen wound dressing was placed in the antral area between the sinus floor and the raised membrane. The vertical sinus floor height was calculated using cone-beam computed tomography before the surgical procedure (baseline) and at 6 months postoperative. Immediately after the second scan, a core biopsy was removed for histological evaluation. The biopsy site was then further prepared for implant placement in the same location. RESULTS: Biopsies showed mature cancellous bone with a predominantly lamellar structure. Well-vascularized intertrabecular spaces were filled with connective tissue and bone marrow. Analysis of bone height changes showed significant mean (SD) differences before and after procedures in anterior (2.67 ± 0.62 mm and 11.15 ± 1.1 mm), medial (2.98 ± 0.55 mm and 10.96 ± 0.77 mm), and posterior (3.17 ± 0.91 mm and 10.63 ± 0.51 mm) maxillary jaw locations (P = 0.005). CONCLUSION: The collagen sponge provided an effective substrate for osseous regeneration of the sinus floor.

Subantral Augmentation With Mineralized Cortical Bone Allograft Material: Clinical, Histological, and Histomorphometric Analyses and Graft Volume Assessments.

PURPOSE: The aim of this study was to clinically and histologically evaluate the effect of using mineralized cortical bone allograft in sinus lift augmentation and to 3-dimensionally quantify volumetric changes in maxillary sinuses augmented over a 2-year period. MATERIALS AND METHODS: Eleven patients affected with less than 3 mm of residual ridge were enrolled in the study. After sinus grafting with a mineralized bone allograft, the site was covered with a collagen wound dressing. During implant placement 4 months later, a biopsy was obtained for histological and histomorphometry evaluations. Bone volume changes were also evaluated. RESULTS: Biopsies showed mature cancellous bone with a predominantly lamellar structure. The well-vascularized intertrabecular spaces were filled with connective tissue and bone marrow. Histomorphometry evaluations revealed a mean 43.76 ± 1.47% of bone marrow, 40.16 ± 1.35% of mineralized bone and 16.59 ± 0.55% of woven bone. The mean of residual particles was 0.47 ± 0.01%. Volumetric measurements showed a mean volume of grafted material 16.24 ± 1.55 cm at T0, 14.48 ± 1.48 cm at T1, and 13.06 ± 1.39 cm at T2. The mean volume retraction was 10.83% of the initial total volume at (T0-T1) and 9.8% at (T1-T2). CONCLUSIONS: The clinical and histological results indicated that mineralized cortical bone allograft promoted de novo bone formation and can be used for sinus lift procedure.

Marginal Bone Remodeling around healing Abutment vs Final Abutment Placement at Second Stage Implant Surgery: A 12-month Randomized Clinical Trial.

BACKGROUND: The periimplant bone level has been used as one of the criteria to assess the success of dental implants. It has been documented that the bone supporting two-piece implants undergoes resorption first following the second-stage surgery and later on further to abutment connection and delivery of the final prosthesis. OBJECTIVE: The aim of this multicentric randomized clinical trial was to evaluate the crestal bone resorption around internal connection dental implants using a new surgical protocol that aims to respect the biological distance, relying on the benefit of a friction fit connection abutment (test group) compared with implants receiving conventional healing abutments at second-stage surgery (control group). MATERIALS AND METHODS: A total of partially edentulous patients were consecutively treated at two private clinics, with two adjacent two-stage implants. Three months after the first surgery, one of the implants was randomly allocated to the control group and was uncovered using a healing abutment, while the other implant received a standard final abutment and was seated and tightened to 30 Ncm. At each step of the prosthetic try-in, the abutment in the test group was removed and then retightened to 30 Ncm. Horizontal bone changes were assessed using periapical radiographs immediately after implant placement and at 3 (second-stage surgery), 6, 9 and 12 months follow-up examinations. RESULTS: At 12 months follow-up, no implant failure was reported in both groups. In the control group, the mean periimplant bone resorption was 0.249 ± 0.362 at M3, 0.773 ± 0.413 at M6, 0.904 ± 0.36 at M9 and 1.047 ± 0.395 at M12. The test group revealed a statistically significant lower marginal bone loss of 20.88% at M3 (0.197 ± 0.262), 22.25% at M6 (0.601 ± 0.386), 24.23% at M9 (0.685 ± 0.341) and 19.2% at M9 (0.846 ± 0.454). The results revealed that bone loss increased over time, with the greatest change in bone loss occurring between 3 and 6 months. Alveolar bone loss was significantly greater in the control condition than the test condition. CONCLUSION: The results of this prospective study demonstrated the benefit of placing a prosthetic component with a stable connection at second-stage surgery, in terms of reduced marginal bone remodeling when compared with conventional procedure. CLINICAL SIGNIFICANCE: The use of a stable connection in a healing component during try-in stages prior to final restoration placement leads to less periimplant marginal bone loss.

Micromovement Evaluation of Original and Compatible Abutments at the Implant-abutment Interface.

INTRODUCTION: Use of compatible abutments may increase micromovements between the abutments, and the inner part of the implant may increase the stress on marginal bone level. Also micromovement will change the volume of the inner space of the implant-abutment complex. The resulting pumping effect can transport even initially immobile microorganisms from the exterior to the interior and vice versa. OBJECTIVES: The purpose of the study was to evaluate the mechanical comportment of OsseoSpeed™ Tx implants connected with original and compatible abutments in vitro under simulated clinical loading conditions. MATERIALS AND METHODS: A total of 15 OsseoSpeed™ TX implants (4 × 11 mm) were used and divided into three groups (n = 5). Three types of abutments were used in the study; group I: Five original Ti Design™ abutments, group II: Five Natea™ abutments, and group III: Implanet™ abutments. Abutments used in groups II and III were all compatible with Astra Tech Implant System™. Implants were embedded into resin. Simulating the human masticatory cycle, the axial force vector was increased up to a defined maximum (25, 50, 75, 100, 125, 150, 175, and 200 N) and inclined 30° to the implant axis. A radiograph amplifier was used to convert the X-ray projection into a picture. The visual evaluation of the frames and the provided X-ray videos were evaluated for an existing microgap in width and length between the implant and the abutment. RESULTS: An initial width gap was observed in groups II and III in four of the five samples with an average of 6.5 and 5 µm respectively. When the axial forces reach 75 N, only groups II and III demonstrated a gap width of 5.2 ± 3.63 and 4.8 ± 3.03 µm, and a gap length of 5.2 ± 3.63 and 94 ± 125.3 µm respectively. At 200 N, group I showed a gap width of 8.4 ± 1.67 µm and a gap length of 187.6 ± 43.6 µm, while groups II and III showed a gap width of 12.4 ± 3.29 and 22.8 ± 5.76 µm, and a gap length of 387.2 ± 84.36 and 641.2 ± 122.6 µm respectively. CONCLUSION: Within the limitations of this study and under the parameters used and from the resulting data collected, we can presume that the use of compatible components leads to significant micromovement when compared with the use of original ones. CLINICAL SIGNIFICANCE: The use of compatible prosthetic components with original implants showed significant micromovements when compared with the use of abutment and implant from the same manufacturer. Clinically, the micromovements when associated with leakage leads to bone loss around the neck of the implant and later to peri-implantitis.

Effectiveness of a Chlorhexidine Digluconate 0.12% and Cetylpyridinium Chloride 0.05% Solution in eliminating Candida albicans Colonizing Dentures: A Randomized Clinical in vivo Study.

BACKGROUND: Effective denture hygiene is important for patients suffering from denture stomatitis (DS). This study aimed to evaluate the efficacy of a solution containing 0.12% chlorhexidine (CHX) digluconate and 0.05% cetylpyridinium chloride (CPC) in eliminating Candida albicans colonizing dentures. MATERIALS AND METHODS: Forty denture wearers (11 men, 29 women; age range 40 to 80 years) with clinical evidence of DS were randomly divided into two groups, one test and one control. The dentures of the test group were treated by immersion in a solution of 0.12% CHX and 0.05% CPC while those of the control group were immersed in distilled water. Swabs were collected from the fitting surfaces of the upper dentures prior and post cleaner use and examined mycologically. RESULTS: Reduction in the number of colony-forming units (CFU) of Candida albicans after immersion of the dentures in a solution of 0.12% CHX and 0.05% CPC was significantly greater than that of the control group. CONCLUSION: A solution of 0.12% CHX and 0.05% CPC tested as a product of disinfection of the acrylic dentures showed significant results after immersion of 8 night hours for 4 days.

Deoxyribonucleic Acid Probes Analyses for the Detection of Periodontal Pathogens.

BACKGROUND: In clinical microbiology several techniques have been used to identify bacteria. Recently, Deoxyribonucleic acid (DNA)-based techniques have been introduced to detect human microbial pathogens in periodontal diseases. Deoxyribonucleic acid probes can detect bacteria at a very low level if we compared with the culture methods. These probes have shown rapid and cost-effective microbial diagnosis, good sensitivity and specificity for some periodontal pathogens in cases of severe periodontitis. MATERIALS AND METHODS: Eighty-five patients were recruited for the study. Twenty-one subjects ranging between 22 and 48 years of age fulfilled the inclusion and exclusion criteria. Seventy-eight samples became available for DNA probe analysis from the deepest pockets in each quadrant. RESULTS: All 21 patients showed positive results for Prevotella intermedia; also, Prevotella gingivalis was identified in 19 subjects, Aggregatibacter actinomycetemcomitans in 6 subjects. P. intermedia was diagnosed positive in 82% of the subgingival samples taken, 79% for P. gingivalis, and 23% for A. actinomycetemcomitans. CONCLUSION: This study shows a high frequency of putative periodontal pathogens by using DNA probe technology, which is semi-quantitative in this study. Deoxyribonucleic acid probes can detect bacteria at very low level about 10(3) which is below the detection level of culture methods. The detection threshold of cultural methods. CLINICAL SIGNIFICANCE: The three types of bacteria can be detected rapidly with high sensitivity by using the DNA probe by general practitioners, and thus can help in the diagnosis process and the treatment.

Influence of surgical and prosthetic techniques on marginal bone loss around titanium implants. Part I: immediate loading in fresh extraction sockets.

PURPOSE: Delayed placement of implant abutments has been associated with peri-implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. MATERIAL AND METHODS: A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an interim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant placement. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). RESULTS: One-stage immediate implant placement into fresh extraction sockets resulted in a significant reduction in marginal bone loss (p < 0.002) compared to the traditional two-stage technique. Whereas mesial surfaces remained stable for the 5-year observation period, significant marginal bone loss was observed on distal surfaces of implants after cementation of interim prostheses (p < 0.007) and after 12 months (p < 0.034). CONCLUSIONS: Within the limitations of this study, immediate loading of implants placed into fresh extraction sockets reduced marginal bone loss and did not compromise the success rate of the restorations.

Immediate placement and loading of maxillary single-tooth implants: a 3-year prospective study of marginal bone level.

AIM: The purpose of this study was to evaluate marginal bone level around single-tooth implants placed in anterior maxilla and immediately restored. MATERIALS AND METHODS: Twenty implants were placed in 20 patients (8 men and 12 women) that were selected for this study. Following atraumatic non-surgical extraction of tooth, all patients immediately received implants and the definitive prefabricated abutment was placed. Implant position was transferred to the scanning unit of the CAD/CAM system using prefabricated surgical guide. Temporary crowns were immediately fabricated and cemented. Eight weeks later final crowns were luted. Outcome assessment as implant survival and level of marginal bone radiographic evaluations were performed at 8 weeks, 1 and 3 years time period after loading. RESULTS: All implants placed osseointegrated successfully after 3 years of functional loading. The mean marginal bone loss was 0.16 mm (SD, 0.167 mm), 0.275 mm (SD, 0.171 mm) and 0.265 mm (SD, 0.171 mm) at 8 weeks, 1 and 3 years time period respectively. Four out of the 20 implants showed no bone loss. CONCLUSION: Immediate loading technique using the final abutment directly eliminated the need for a second stage surgery and prevented interruption of soft and hard tissue at implant neck, which resulted in better soft tissue response and reduced marginal bone loss. Clinical significance: Immediately loaded implants, in fresh extraction sockets by insertion of a provisional restoration on the titanium abutment without any later manipulation, helped to protect the initially forming blood clot and presented a template for soft tissue contouring that resulted in significant reduction of marginal bone resorption and maintenance of soft tissue architecture.

Stafne's Bone Defect Correlated with Submandibular Glands: A Case Report and CBCT and MRI Analysis.

Stafne's bone defect is a developmental anatomic bone defect in the lingual side of the mandible in the area of the mandibular angle that is filled with proliferation or translocation of adjacent structures such as salivary gland tissue. The etiology is still undefined, and two hypotheses are proposed: one is the glandular related to the submandibular or sublingual glands and the second is ischemic that affects the vascularization of the mandibular lingual. Usually, Stafne's bone defect is accidentally detected on panoramic radiographs during dental treatments as a well-limited radiolucency image with a clear peripheral regular condensation border, located below the mandibular canal. The differential diagnosis includes traumatic bone cyst, odontogenic and nonodontogenic cystic lesions, nonossifying fibroma, focal osteoporotic bone marrow defect, and other lesions. A case of Stafne's bone defect on a 60-year-old male patient extending in the lingual posterior part of the mandibular region was presented. The panoramic radiograph revealed a well-limited radiolucency image with a clear peripheral regular condensation border, located below the mandibular canal. The lesion was discovered in a routine radiographic exam: the cone beam computed tomography gave us more details about the localization, the shape and size, and the relation with the mandibular canal, and the magnetic resonance imaging identifies the nature of the inside soft tissue. The final diagnosis was a Stafne's bone defect resulting of a depression of the lingual cortical plate filled with expansion of the submandibular gland.

Immediate Placement and Loading of Maxillary Single-Tooth with Scalloped Shape Implants and Digitalized Customized Restoration: A 5-Year Prospective Study of Marginal Bone Level.

PURPOSE: To evaluate, within a period of 5 years, the bone level in mesial, distal, palatal, and buccal areas around scalloped shape implants immediately placed and loaded with temporary crowns fixed on final prefabricated abutments, and also to evaluate the thickness of buccal bone. MATERIALS AND METHODS: 18 implants were inserted and loaded immediately using computer-assisted design/computer-assisted manufacturing technology on 18 patients to replace single tooth in the esthetic part of the maxilla. The marginal bone level across the scalloped implant neck was measured mesially and distally using intraoral standardized radiographs after crown fixations and 1, 3, and 5 years later. Cone beam computed tomography para-axial cuts images were used to measure bone level buccally and palatally from the implant neck to the implant-to bone contact after 5 years of loading and to evaluate the thickness of the buccal bone at the implant neck and 4 mm apically, immediately after implant placement and 5 years later. RESULTS: All implants were assessed clinically and radiologically after 5 years. No implant failure was recorded, and the average marginal bone variation on mesial and distal sites was 0.114 ± 0.135 mm at crown cementation, 0.239 ± 0.158 mm 1 year later, 0.233 ± 0.182 mm 3 years later, and 0.180 ± 0.182 mm 5 years later. Our findings indicate that at T0, the average thickness of the buccal bone was 2.27 mm at implant neck M0 (ranging from 1.9 to 2.4) and 2.33 mm at 4 mm apically to the implant neck M1 (ranging from 1.9 mm to 2.9 mm). By T4, the mean had decreased to 1.94 mm at M0 (with a range of 1.7 mm to 2.3 mm) and 2.14 mm at M1 (with a range of 1.8 mm to 2.4 mm). After 5 years the mean changes at buccal and palatal bone for all implants were +0.187 ± 0.52 mm and +0.06 ± 0.38 mm respectively. Minor prosthetic problems were observed over the five years: incisal ceramic chipping occurred in two crowns, and two crowns were replaced for esthetic reasons after one year. No loosening of crowns or abutments was reported. CONCLUSIONS: Scalloped neck implants demonstrated a comparable behavior to regular neck implants with similar designs in an immediate implantation and temporization protocol over a five-year period.

Oral Rehabilitation for a Patient with Cocaine-Induced Midline Destructive Lesions.

Background: Cocaine is the second most consumed drug worldwide, more than 0.4% of the global population, and has become a real public health problem in recent years. Its inhalation causes significant centrofacial lesions, grouped under the name cocaine-induced midline destructive lesion (CIMDL). These destructions are due to the conjunction of the vasoconstrictor, local prothrombogenic effects, and cytotoxic effects of cocaine. The ischemia produced by this substance is due to vasoconstriction that leads to nasal tissue necrosis and perforation of the nasal septum secondary to chondral necrosis. Case Presentation. A 36-year-old man, previously grappling with cocaine addiction, was hospitalized to undergo comprehensive clinical, microbiological, and radiological examinations because he was suffering from the emergence of crusts and ulceration in the nasal mucosa, accompanied by a palate perforation, a 39°C fever, and chills. Standard bacteriological culture was positive for coagulase-negative staphylococci and Escherichia coli, while mycological culture was positive for Candida tropicalis. The CT scan images of the sinuses confirmed the presence of palatal perforation and total destruction of the nasal septum, cartilaginous portion, maxillary sinus medial wall, lower and middle turbinates, and middle meatus. Nasal endoscopy revealed an exposition of the bony wall and displayed the exposition of the occipital bone's clivus. A diagnosis of CIMDL was confirmed. Antibiotic therapy was decided based on antibiogram results by the consulting microbiologist. Debridement of necrotic tissue was done by nasal endoscopy with local cleaning and was repetitive during the first week to maintain the best cleanliness possible. The patient was discharged with oro-nasal hygiene instructions and referred for prosthetic rehabilation. As for the cocaine addiction, the patient was in follow-up with a psychologist in a specialized centre. Conclusion: The care is multidisciplinary. Psychological help and assistance are essential to guide patients to become cocaine free and to avoid a relapse. Weaning is a prerequisite for surgery. Rehabilitation of speech and swallowing is necessary. Many local flaps or micro-anastomoses are possible.

Combined conservative treatment of a recurrent mandibular keratocyst by enucleation, diode laser, 5-Fluorouracil and dental implants: a case report with 18 years-follow up.

In 2017, the World Health Organization classified the odontogenic keratocyst as a developmental odontogenic cyst. The posterior parts of the mandible, especially the angle and the ramus, are the most involved sites. Due to their high recurrence rate, keratocysts are managed surgically with careful complete excision. Additionally, chemical solutions such as Carnoy's solution, modified Carnoy's solution, and 5-Fluorouracil have been associated with surgical treatment. Diode lasers generate diverse wavelengths that have photothermal and photochemical special properties and could have some effects on the lining epithelium remnants of the cyst. In this paper, we discuss a case of mandibular recurrent odontogenic keratocyst treated with 5-Fluorouracil topical application after enucleation and diode laser application with 18 years follow-up and teeth replacement with dental implant. 5-Fluorouracil and diode laser have been found to be very effective in the treatment of keratocysts.

Treatment of Mucous Retention Cyst in Association with Sinus Lift and Implant Placement: A Case Report with 1-Year Follow-Up.

Sinus lift augmentation techniques, lateral or crestal approaches, have been well documented, with bone substitute graft, or without bone material, with immediate or delayed implant placement as a treatment option for the atrophic maxilla in the posterior area. However, the sinus lift procedures performed in the presence of cysts, mucoceles, mucous retention cysts (MRCs), and antral pseudo-cysts could mainly decrease the sinus cavity volume and could increase the possibility of ostium obstruction and might lead to infection followed by failure of the grafting procedure. A radiological assessment should be made with computerized tomography (CT) or cone-beam CT to evaluate the remaining bone volume and to detect any pathology in the sinus. Different techniques were described in the literature for sinus lifting and bone grafting in patients with cysts. For some authors, cysts should be treated before sinus grafting and six months later, the procedure could be performed. For others, sinus lifting can be performed without lesion removal. At this time, controversy exists regarding the decision on whether lesions must be removed/aspirated or not before sinus grafting. In this study, we report a case where an MRC was aspirated and instantaneously, the sinus membrane was lifted and grafted, and implants were installed with 1-year follow-up after loading. Identifying lesions in the maxillary sinus is essential before planning any type of sinus augmentation and implant placement.