What is the Incidence of Oral Cancer Recurrence in Patients Reconstructed With a Microvascular Free Flap, Endosseous Implants, and an Oral Prosthesis and How Does the Timing of Implant Placement Influence Recurrence?

PURPOSE: In patients with malignant oral disease, there is concern that immediate implant placement at the time of ablative and microvascular free flap surgery can contribute to tumor recurrence or delay the diagnosis of recurrence. The purpose of this study is to 1) estimate the incidence of recurrence in patients with malignant disease treated with immediate microvascular free flap reconstruction, endosseous implants, and an oral prosthesis, 2) measure and compare the timing of implant placement, immediate versus delayed, and the time to complete oral rehabilitation, and 3) measure the association between the timing of implant placement and tumor recurrence. MATERIALS AND METHODS: This is a retrospective cohort study utilizing medical record analysis involving patients with malignant oral cancer undergoing tumor resection and immediate microvascular reconstruction from 1996 to 2019 at the Mayo Clinic, Rochester, MN by the Division of Oral and Maxillofacial Surgery. Additional inclusion criteria comprised of immediate or delayed endosseous implant placement, the fabrication of an oral prosthesis, and a minimum of 2-year follow-up. Data on patient demographics, tumor characteristics, timing of implant placement and prosthesis loading, type of prosthesis, tumor recurrence, or second primary tumor events were analyzed. RESULTS: Thirty-three patients with a mean follow-up of 6.4 years were included. Twenty-four patients (72.7%) were diagnosed with squamous cell carcinoma with 3 patients experiencing tumor recurrence. Fifteen patients had immediate implant placement while 18 patients had delayed implant placement. The mean number of days to prosthetic loading of the implants was 680.4 days and 330.1 days for the delayed implant group and immediate implant group, respectively, which was statistically significant (P = .004). The timing of implant placement and the event of a recurrence were not statistically significant (P = .075). CONCLUSION: The incidence of recurrence in patients with malignant oral cancer treated with microvascular reconstruction, endosseous implants, and an oral prosthesis was 12.5% with one recurrence occurring beneath the oral prosthesis. Delayed implant placement resulted in a statistically significant delay in the completion of oral rehabilitation compared to immediate implant placement. There was no difference in the incidence of recurrence in the immediate implant group compared to the delayed implant group.

The Effect of Patient Specific Factors on Occlusal Forces Generated: Best Evidence Consensus Statement.

PURPOSE: The purpose of this Best Evidence Consensus Statement was to search the literature to determine if there is a relationship between patient specific factors and occlusal force. MATERIALS AND METHODS: A literature review was conducted in the following databases: Evidence-Based Medicine Reviews (EBMR), Cochrane Database of Systematic Reviews, Embase, and Ovid MEDLINE(R) and Epub Ahead of Print. Articles on patient factors and occlusal force were compiled by using a combination of the key words: "bite force," "occlusal force," "partial and complete edentulism," "bruxism," and "orthognathic class." Inclusion criteria included meta-analyses, systematic reviews, randomized controlled trials, case series, and journal articles. Exclusion criteria were case reports, studies in children, animals, and bench studies. RESULTS: Of the 1502 articles that met the initial search criteria, 97 related to patient-specific factors affecting occlusal forces. These articles were evaluated, rated, and organized into appropriate categories addressing questions of foci. CONCLUSIONS: The range of occlusal force is highly variable among subjects correlated to patient specific factors such as age, gender, partial and complete edentulism, the presence of a maxillofacial defect, location of edentulous area, orthognathic profile, and magnitude of occlusal vertical dimension. Tooth replacement therapies targeted at increasing occlusal contact seem to have a positive effect on increasing occlusal force. Bruxism does not necessarily demonstrate higher occlusal powering but may have greater tooth contact time. Occlusal force is not clearly affected by the type of dental restoration or restorative material used. The clinical significance of the changes in occlusal forces is yet to be determined.

Microvascular Reconstruction of Total Maxillary Avascular Necrosis as a Complication of Routine Orthognathic Surgery.

Severe complications and morbidity after orthognathic surgery are infrequently encountered and even more infrequently reported considering the extent to which this procedure is performed by surgeons within the specialty of maxillofacial surgery. Avascular necrosis of the maxilla after Le Fort I osteotomy is perhaps the most dreaded outcome of orthognathic surgery. However, it accounts for an extremely small subset of overall surgical complications. The reported risk factors associated with avascular maxillary necrosis include segmental osteotomies, vertical posterior impactions, large transverse expansions, anterior advancements exceeding 9 to 10 mm, an improper surgical technique, excessive soft tissue degloving of the maxilla, intraoperative hemorrhage, perforation or laceration of the palatal soft tissue pedicle, previous maxillary or palatal surgery, and other medical comorbidities. Although anecdotal cases of total maxillary necrosis after orthognathic surgery have been alluded to within the specialty as a whole, to the best of our knowledge, no previous studies have reported total maxillary necrosis occurring after routine orthognathic surgery. We have presented a truly unique case of total maxillary avascular necrosis that occurred after standard 1-piece Le Fort I osteotomy in a patient without medical or surgical risk factors for the complication either known preoperatively or identified postoperatively. The resultant maxillary defect from total avascular necrosis was comprehensively treated with surgical debridement of the nonviable maxilla, osteocutaneous fibular free flap reconstruction, staged endosseous implant reconstruction of the neomaxilla, and comprehensive prosthodontic rehabilitation.

Facial Versus Skeletal Landmarks for Anterior-Posterior Diagnosis in Orthognathic Surgery and Orthodontics: Are They the Same?

PURPOSE: The purpose of this investigation was to evaluate diagnostic agreement in anterior-posterior (AP) categorization of the maxilla and mandible between a skeletal-landmark analysis and a facial-landmark analysis for treatment planning of orthognathic surgery and orthodontics. MATERIALS AND METHODS: This retrospective, consecutive case series of adult patients who presented to the Mayo Clinic orthodontic department compared maxillary and mandibular AP diagnoses. Steiner's analysis of the sella-nasion-A point angle and sella-nasion-B point angle was used for a skeletal-landmark diagnosis. Element II of Andrews' 6 elements of orofacial harmony was used for a facial-landmark diagnosis. Both diagnoses were categorized as either deficient, optimal, or excessive for each jaw. Categorization of the skeletal landmark was determined by normative data, whereas the facial landmark provides a customized categorization unique to each individual. RESULTS: Weighted κ statistics were completed to test agreement between the categories determined by the skeletal and facial landmarks. The maxilla showed poor agreement, and the mandible showed slight agreement. CONCLUSIONS: No agreement was found for AP categorization of the maxilla and mandible between skeletal-landmark and facial-landmark analyses. Most mandibles were diagnosed as retrognathic by the facial landmark, whereas most were diagnosed as optimal by the skeletal landmark. When the 2 landmarks disagreed, the facial landmark defined the optimal position farther anterior. The landmark chosen for diagnosis will impact the optimal jaw position and can affect orthognathic and orthodontic outcomes.

Prosthetic rehabilitation of a maxillary defect with a bone anchored prosthesis: A clinical report.

Mucormycosis is an opportunistic fungal infection that frequently infects sinuses, brain, or lungs and arises mostly in immunocompromised patients. Although its occurrence in the maxilla is rare, debridement and resection of the infected and necrotic area is often the best treatment but usually results in an extensive maxillary defect. Protocols for prosthetic obturation versus microvascular reconstruction have been established and used effectively in tertiary institutions for patients with such large defects. Aramany Class VI defects involving more than half of the palatal surface can be managed effectively by surgical reconstruction using microvascular free flaps as a platform for supporting bone-anchored prostheses. Providing fixed prostheses may offer advantages over a conventional obturator prosthesis in terms of hygiene, function, and esthetics. Nonetheless, fixed prostheses retained by endosseous implants in patients with reconstructive osteomyocutaneous flaps often require a sequential team approach by the surgeon and prosthodontist. This clinical report describes the reconstruction of a maxilla by using a scapular free flap with subsequent prosthetic rehabilitation in a patient with maxillary sinus infection secondary to mucormycosis.

Association Between Early Implant Failure and Prosthodontic Characteristics.

PURPOSE: To identify associations between early implant failure and prosthodontic characteristics that could be used to guide subsequent continuous quality improvement efforts of patient care. MATERIALS AND METHODS: An implant-level analysis was performed in which data were abstracted from a prospective clinical database of all adult patients treated with implants and followed up from January 2000 through December 2014 at the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. These data were used to determine time to implant failure. Associations between prosthodontic characteristics and early implant failure were evaluated with Cox proportional hazards regression models and summarized with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Among 8762 implants in 2787 patients, 395 (4.5%) failed within the first year of placement at a mean (SD) of 127 (97) days (range, 2-364 days). Univariable analysis showed no associations between early implant failure and use of a cover screw, prosthesis, or definitive or provisional prosthesis at implant placement. Three of 25 single crowns failed, and use of a single crown was significantly associated with early implant failure (HR, 3.94; 95% CI, 1.08-14.35; P = 0.04). This study identified no significant associations between prosthodontic characteristics identified after implant placement and early implant failure. CONCLUSIONS: Use of a prosthesis at implant placement, use of a definitive or provisional prosthesis, and early mechanical complications were not associated with increased risk of early implant failure. Quality improvement efforts should focus on aspects of decision making that aim to decrease surgical complications.

Early Implant Failure Associated With Patient Factors, Surgical Manipulations, and Systemic Conditions.

PURPOSE: Systematic monitoring of important clinical outcomes is increasingly important for health-care decision making, especially in the context of continuous quality improvement. Dental implant failure within the first year (early failure) has been previously shown to be more common than subsequent failure. The purpose of this study was to identify associations between early implant failure and patient factors, surgical manipulations, and systemic conditions. MATERIALS AND METHODS: The authors retrospectively identified the records of consecutive adult patients with dental implants seen between 2000 and 2014 in the Department of Dental Specialties, at the Mayo Clinic. Demographic, surgical, and medical data were extracted from the database and individual medical records to determine time to first implant failure. Cox proportional hazards regression models were used to assess associations of demographic, surgical, and systemic conditions with implant failure during the first year post-implantation, summarized as hazard ratio (HR) (95% confidence interval [CI]). RESULTS: Among 8540 implants identified during the study period, 362 (4.2%) failed within the first year of placement at a mean (SD) of 129 (96) days after placement. On univariate analysis, most candidate predictors were not shown to influence first-year failure. Preplacement surgical manipulations associated with increased early implant failure were bone augmentation only (HR, 1.45; 95% CI, 1.02-2.05; p = 0.04), socket preservation (HR, 2.67; 95% CI, 1.33-5.38; p = 0.006), and xenogenic material (HR, 2.12; 95% CI, 1.11-4.04; p = 0.02). Alveoloplasty only at placement was associated with decreased early implant failure (HR, 0.33; 95% CI, 0.17-0.65; p = 0.001). Overall, 318 implants (3.7%) had surgical complications within the first year of placement at a mean (SD) of 110 (114) days after placement; any surgical complication was significantly associated with early implant failure (hazard ratio, 15.84; 95% CI, 11.10-22.61; p < 0.001). After adjustment for age, sex, and implant era, no single or multiple medical condition(s) and no single or multiple medication(s) increased patient risk of implant failure in the first year after placement. CONCLUSIONS: These findings support a targeted effort to reduce the incidence of surgical complications to reduce early failure of dental implants.

Effect of different resin luting cements on the marginal fit of lithium disilicate pressed crowns.

STATEMENT OF PROBLEM: The vertical marginal discrepancy of restorations can increase upon cementation, and poor marginal fit can lead to cement dissolution, marginal discoloration, microleakage, and secondary caries. The amount of increase is related to the type of luting cement used, but how lithium disilicate pressed crowns are affected by different resin cements is unclear. PURPOSE: The purpose of this in vitro study was to compare the effect of using different resin luting cements on the vertical marginal discrepancy of lithium disilicate pressed crowns. MATERIAL AND METHODS: A total of 18 intact extracted mandibular third molars were disinfected in a solution of 10% formalin for 7 days and were then prepared to receive a ceramic crown. Impressions were made with polyvinyl siloxane and lithium disilicate pressed crowns made and cemented with 1 of 3 resin luting cements. The marginal discrepancy was measured at 4 points on the finishing line of each tooth, with optical microscopy at ×200 magnification before and after cementation. Statistical analysis was done with the Kruskal-Wallis test to compare the median marginal increase among the 3 groups (a=.05). RESULTS: The least amount of marginal increase after cementation was with Harvard PremiumFlow cement, with an average marginal increase of 42 ±11 µm. RelyX Ultimate cement increased the margins by an average 45 ±29 µm. The highest marginal increase was found in the Enamel Plus HRi preheated composite resin group (116 ±47 µm). CONCLUSIONS: The marginal increase of pressed crowns cemented with preheated composite resin (Enamel Plus HRi) exceeded the clinically acceptable range of marginal discrepancy.

Whole-Arch Single-Stage Free Flap Reconstruction and Rehabilitation of the Mandible: A Case Report and Technical Considerations on a New Technique.

The purpose of this report is to describe the techniques used in the reconstruction of a complete angle-to-angle mandibular defect in the absence of any remaining mandibular teeth. Because no remaining dental or occlusal landmarks remain in such a case, additional challenges must be considered.

Practice-based clinical evaluation of ceramic single crowns after at least five years.

STATEMENT OF PROBLEM: Long-term practice-based clinical evaluations of various contemporary ceramic crown restorations from multiple practitioners are limited. PURPOSE: The aims of this study were to evaluate the clinical performance of ceramic single crowns and to identify factors that influence their clinical performance. MATERIAL AND METHODS: Ceramic single crowns that had been placed at the Mayo Clinic and in function since 2005 were identified and included in the study. The restorations were examined clinically, radiographically, and with photographs. Modified United States Public Health Services criteria were used for the clinical evaluation. The ceramic systems evaluated were bilayer and monolayer. RESULTS: Fifty-nine patients (41 women, 18 men) with 226 single teeth and implants restored with single ceramic crowns were identified. The mean duration from insertion date to study examination date was 6.1 years. Thirteen restorations (6%) were replaced at a mean 3.3 years after insertion date (range, 0.1-6.1 years). Estimated replacement-free survival rates (95% confidence interval [CI]; number of teeth/implants still at risk) at 5 years after insertion date were 95.1% (95% CI, 92.2-98.1; 153) and at 10 years were 92.8% (95% CI, 89.1-96.8; 8). The most common reason for replacement was fracture to the core of posterior layered ceramic crowns. The most commonly used luting agent was resin-modified ionomer cement. Most restorations exhibited clinically acceptable marginal integrity, shade, no caries recurrence, and no periapical pathology. CONCLUSIONS: The clinical performance of ceramic single crowns at 5 and 10 years supports their application in all areas of the mouth. With the majority of fractures to the core occurring early in the lifetime of layered ceramic posterior crowns, consideration of other monolithic ceramic systems for posterior crowns is advised.

Practice-based evidence from 29-year outcome analysis of management of the edentulous jaw using osseointegrated dental implants.

PURPOSE: The aim of this retrospective study was to summarize practice-based evidence associated with long-term outcomes (>20 years) in the management of edentulous patients. The patient population was managed with implant-supported prostheses, following the original osseointegration protocol, provided over the period from 1983 to 1991 in the group prosthodontics practice at the Mayo Clinic. The data are an example of practice quality assurance monitoring and are used to refine care delivery when needed and to provide information regarding expected outcomes in a shared decision-making interaction with prospective patients. MATERIALS AND METHODS: Two hundred and sixty four patients with at least one edentulous jaw were identified. Of these, 255 completed their care and follow-up at the Mayo Clinic (209 mandible only, 35 maxilla only, 11 mandible and maxilla). Prosthodontic outcomes categorized as anticipated or unanticipated prosthetic and biologic events and the respective interventions required for each were recorded to assess follow-up event dynamics for this care modality. RESULTS: The mean duration of follow-up for 190 of the 255 patients (65 died at a mean follow-up of 12.6 years) was 13.0 years (median 13.6; range 0.3 to 28). At least one prosthetic event was experienced by 148 patients (58%), and 81 (32%) experienced at least one biologic event. Overall, patients experienced 3.8 times more prosthetic events than biologic events. Twenty-four (9%) patients experienced 35 implant failures. Overall survival rates at 20 years were 86% for prostheses, 15% survived free of any event, and 92% experienced survival free of implant failure (95% confidence interval). CONCLUSION: Anticipated and unanticipated prosthetic events occur throughout the life of the hybrid prosthesis. Prosthetic events significantly surpass (four times more) biologic events and occur significantly later in the follow-up. For this patient group, 8.6% (22/255) had implant-supported prostheses remade during follow-up in this patient population. These findings support the recommendation that prosthodontic care for missing teeth be thought of in a "chronic condition" context, recognizing that long-term outcome monitoring to provide realistic care expectations is important for demonstrating care value in oral health promotion.

Evaluation of fracture resistance in aqueous environment under dynamic loading of lithium disilicate restorative systems for posterior applications. Part 2.

PURPOSE: The goals of part 2 of the study presented here were 1) to assess whether there is a difference in failure mode of different thicknesses (2.0, 1.5, 1.0, and 0.5 mm) of anatomically standardized full contour monolithic lithium disilicate restorations for posterior teeth, and 2) to assess if there is a difference among various crown thicknesses when these restorations are subjected to dynamic load forces common for posterior teeth. MATERIALS AND METHODS: Four groups (n = 10), each with a different thickness of anatomically appropriate all-ceramic crowns, were to be tested as established from the statistical analysis of the preliminary phase. Group 1: 2.0 mm; group 2: 1.5 mm; group 3: 1.0 mm; group 4: 0.5 mm. The specimens were adhesively luted to the corresponding die, and underwent dynamic cyclic loading (380 to 390 N) completely submerged in an aqueous environment until a failure was noted by graphic recording and continuous monitoring. RESULTS: There was a statistically significant difference of the fatigue cycles to failure among four groups (p < 0.001; Kruskal-Wallis test). The mean number of cycles to fail for 2.0 mm specimens was 17 times more than the mean number of cycles to fail for 1.0 mm specimens and 1.5 times more than the mean number of cycles to fail for 1.5 mm specimens. The 0.5 mm specimens failed with one cycle of loading. A qualitative characteristic noted among the 2.0 mm specimens was wear of the area of indenter contact followed by shearing of the material and/or crack propagation. CONCLUSION: Based on the findings of this study, it may be reasonable to consider a crown thickness of 1.5 mm or greater for clinical applications of milled monolithic lithium disilicate crowns for posterior single teeth.

Oral Health Clearance Outcomes for Cardiovascular Surgery.

Objective: To determine the risk of morbidity and mortality in patients receiving dental extractions before planned cardiovascular surgery (CVS) and examine factors that may affect the chance of oral health clearance. Patients and Methods: A retrospective medical record review was performed of patients who underwent dental screening before CVS from January 1, 2015, to December 31, 2021, at a major medical institution. A total of 496 patients met the inclusion criteria and were divided into 2 groups. Group 1 patients were cleared to advance to planned CVS (n=390). Group 2 patients were not cleared for surgery and subsequently underwent dental extractions before planned CVS (n=106). Results: Six patients (5.7%) experienced postoperative complications after dental extraction that resulted in an emergency room visit. No deaths occurred after dental extraction before CVS. However, 4 patients died within 30 days of CVS, 3 from Group 1 (0.77%) and 1 from Group 2 (0.94%). Dental extraction before planned CVS showed a borderline significant association with death based on unadjusted (P=.06) and age-adjusted analysis (P=.05). Patients who reported seeing a dentist routinely had a significantly higher chance of oral health clearance (P <.001). No differences were noted between the 2 groups with regard to age, sex, or 30-day hospital readmission rate. Conclusion: Patients who had dental extractions completed before planned CVS may be at an increased risk of mortality. Further studies are needed to examine this relationship. Emphasis should be on prioritization of routine dental visits before planned CVS.

Virtual surgical planning for treatment of severe mandibular retrognathia with collapsed occlusion using contemporary surgical and prosthodontic protocols.

PURPOSE: To meet functional and esthetic needs in an older adult for treatment of complex skeletal and dentoalveolar deformities using contemporary surgical and prosthodontic protocols. METHODS: An older adult with dentoalveolar complex and skeletal deformity (mandibular retrognathia) was treated by a combination of virtual planning and current surgical and prosthodontic protocols. Treatment planning steps and sequencing are presented. RESULTS: Skeletal, soft tissue, and dental harmonies were attained without biological or mechanical complications. Definitive oral rehabilitation was completed with a maxillary complete denture and a mandibular metal ceramic fixed implant-retained prosthesis. CONCLUSIONS: A surgical and prosthodontic team approach in combination with technologic advances can predictably optimize esthetic and functional outcomes for patients with complex skeletal and dentoalveolar deformities.

Intra-arch elastics technique: a novel method for controlling the abutment/soft tissue interface during implant reconstruction of the orofacial region.

In the past 30 years, composite microvascular free tissue transfer has become a popular and highly successful option for the reconstruction of defects in the head and neck region. However, inherent shortcomings exist with free tissue transfer in that the imported tissue often fails to adequately replicate the characteristics of the native tissues. This can lead to difficulties when attempting reconstruction from a surgical and prosthetic standpoint. Endosseous implants are often required to adequately retain prostheses, and management of the peri-implant soft tissues represents a critical challenge for the oral and maxillofacial surgeon. This report describes a novel technique for controlling the implant-abutment-soft tissue interface and the advantages of this technique as it pertains to orofacial reconstruction.

Predoctoral dental students' perceptions and experiences with prosthodontics.

PURPOSE: The aims of this study were to: (1) investigate the perceptions and experiences of predoctoral dental students and advanced standing students on mentorship, exposure to prosthodontics, and future need for the specialty, and (2) establish a baseline of students' perceptions of the impact of prosthodontics on salary, personal and patient quality of life, and the profession of dentistry. MATERIALS AND METHODS: A survey was distributed to 494 predoctoral and advanced standing students at the University of Pennsylvania School of Dental Medicine. Questions focused on the perceptions and experiences with the specialty of prosthodontics. A total of 410 surveys were analyzed using Chi Square tests and univariate and multivariate analysis with statistical software. RESULTS: Response rate was 83%. A positive initial introduction to prosthodontics was reported by 57% of students. Most students had positive experiences with prosthodontic faculty and enjoyed laboratory work and challenging/complex dentistry. A greater need for prosthodontists in the future was perceived by 82% of respondents, with 63% reporting that the future of prosthodontics had been emphasized. Students reported (1) a preclinical course directed by prosthodontists and (2) working in the clinic with prosthodontic faculty (p < 0.006) as having the biggest impact on their introduction to prosthodontics. A desire to pursue training or a career in prosthodontics was reported by 3.4% of the respondents, with 1.7% of them pursuing prosthodontics. Enjoyment of providing care in prosthodontics was the most important factor for those who decided to pursue prosthodontic postgraduate training. When compared to other specialties, prosthodontics ranked low with regards to its impact on salary (7(th) ), personal quality of life (5(th) ), patient quality of life (4(th) ), and strengthening of the dental field (7(th) ). CONCLUSION: Reasons few students are interested in prosthodontics as a career, despite a positive first introduction and high perceived future need for prosthodontists may be attributed to a number of factors. These include insufficient prosthodontically, trained faculty, lack of a mentorship program, lack of an advanced graduate program, a perception of feeling unprepared upon graduation, and misconception of potential income in prosthodontics.

Evaluation of fracture resistance in aqueous environment of four restorative systems for posterior applications. Part 1.

PURPOSE: The goals of this study were to: (1) establish a range of the performance of four restorative systems for posterior single-tooth crowns under single load to fracture submerged in an aqueous environment, (2) identify restorative system(s) of interest to be examined in the second study phase under sliding contact step-stress fatigue as full-contour anatomically appropriate single posterior tooth restoration(s), (3) establish a range for loading/testing for phase 2. MATERIALS AND METHODS: Forty specimens (n = 10/group) of 2 mm uniform thickness were tested. Group 1: monolithic lithium disilicate IPS e.max Press; group 2: IPS e.max ZirPress, 0.8 mm zirconia core with 1.2 mm pressed veneering porcelain; group 3: IPS e.max ZirPress, 0.4 mm zirconia core with 1.6 mm pressed veneering porcelain; group 4: IPS InLine PoM. Specimens were bonded to a block of polycast acrylic resin on a 30° sloped surface with resin cement. Specimens were axially single loaded to failure while submerged under water. RESULTS: There was a statistically significant difference (p < 0.001) in failure load among the four restorative systems. Lithium disilicate showed a mean failure load similar to mean maximum posterior bite forces (743.1 ± 114.3 N). IPS e.max Zirpress with a 0.4 mm zirconia core exhibited the lowest mean failure load (371.4 ± 123.0 N). CONCLUSION: Fracture resistance of monolithic lithium disilicate in an aqueous environment is promising and requires second phase testing to evaluate the potential of various thicknesses appropriate for posterior single tooth applications. Doubling the IPS e.max Zirpress zirconia core from 0.4 mm to 0.8 mm increased the fracture resistance of this restorative system threefold.

Probing Depth and Peri-implant Health as Related to Buccal and Lingual Bone Thickness Around Dental Implants: An Experimental Study.

A retrospective chart review was conducted of CBCT images captured between November 2019 and April 2021 on patients who underwent dental implant placement and had a periodontal charting. The buccal and lingual bone thickness around the implants was measured as an average of three measurements taken from the buccal and lingual aspects of implants. Implants with peri-implantitis were placed in Group 1, and implants with peri-implant mucositis or good peri-implant health were placed in Group 2. Wilcoxon rank sum test was used to compare the differences between the bone thicknesses of the groups. In total, 93 CBCT radiographs were screened, and 15 CBCT images with both an implant and corresponding periodontal charting were analyzed. Of the 15 implants examined, 5 presented with peri-implantitis (33%), 1 with peri-implant mucositis, and 9 with good peri-implant health. Within the limitations of this study, buccal bone thickness averaging ≥ 1.10 mm or midlingual probing depths ≤ 3.4 mm correlates with a more favorable peri-implant response. Larger studies are needed to substantiate these findings.

Surgical and prosthetic rehabilitation of siblings with Witkop tooth and nail syndrome using zygomatic implants: a familial case series of 3 patients with up to 15-year follow-up.

Witkop tooth and nail syndrome is a rare, autosomal dominant type of ectodermal dysplasia that can have significant effects on dentition, including hypoplastic and malformed dentition and significantly atrophic maxillas. Endosseous implants have become one possible solution to replace missing teeth, although their use in areas where bone is sparse becomes challenging. Due to the severe atrophy of the maxillary alveolus, extensive preprosthetic surgeries including orthognathic surgery, extensive bone grafting, and sinus floor augmentations have been recommended prior to placement of endosseous dental implants. Although this treatment has shown favorable outcomes, it requires multiple surgical procedures, contributing to a prolonged treatment course and increased morbidity. An alternative treatment of atrophic maxillas in patients with ectodermal dysplasia includes the use of zygomatic implants. This familial case series discusses 3 siblings, all previously diagnosed with Witkop Syndrome, who underwent comprehensive preprosthetic surgery and prosthetic rehabilitation using zygomatic implants with a follow-up period up to 15 years.

The influence of antimicrobial varnish on peri-implant soft tissue health: case report.

Bacterial biofilm in the oral cavity and around dental implants may trigger an inflammatory response of the peri-implant soft tissue. Emerging antimicrobial products have been developed to combat peri-implant soft tissue pathology; however, limited evidence is available evaluating their effectiveness. To the best of the authors' knowledge, this is the first documented case report in the literature assessing the effect of Cervitec Plus around dental implants. This case report provides an example of a patient presenting to a periodontal specialty clinic with peri-implant pathology and subsequently treated with antimicrobial varnish following dental hygiene peri-implant therapy. The report serves to evaluate the efficacy of peri-implant soft tissue pathology utilizing antimicrobial varnish as measured by percent of bleeding upon probing, presence of suppuration, and changes in implant probing depths. Understanding the impact of bacterial plaque on peri-implant soft tissue and the effectiveness of antimicrobial products in conjunction with dental hygiene peri-implant therapy may provide patients with optimal peri-implant health and long-term success of dental implants.