A randomised controlled trial comparing the effectiveness of guided bone regeneration with polytetrafluoroethylene titanium-reinforced membranes, CAD/CAM semi-occlusive titanium meshes and CAD/CAM occlusive titanium foils in partially atrophic arches.

PURPOSE: To compare the clinical effectiveness of three different devices used in guided bone regeneration procedures for partially atrophic arches. MATERIALS AND METHODS: A randomised controlled trial with three parallel arms was conducted. The study evaluated titanium-reinforced polytetrafluoroethylene membrane (PTFE group), semi-occlusive CAD/CAM titanium mesh (mesh group) and occlusive CAD/CAM titanium foil (foil group) in terms of surgical outcomes and complications as well as surgical times and surgeon satisfaction in 27 guided bone regeneration procedures, presenting results from 1 year post-implant placement. RESULTS: Complications occurred in seven patients. No significant difference was found between the groups in terms of the occurrence of complications (P = 0.51), device exposure (P = 0.12) and implant failure (P = 0.650). Surgeon satisfaction varied significantly, with the PTFE group differing from the mesh (P = 0.003) and foil groups (P 0.001), but not between meshes and foils (P = 0.172). Surgical times also differed significantly, with longer times for PTFE membranes compared to meshes (P 0.001) and foils (P = 0.006), but with no difference between meshes and foils (P = 0.308). The mean reconstructed bone volume was 1269.55 ± 561.08 mm3, with no significant difference observed between the three groups (P = 0.815). There was also no significant difference for mean maximum height (6.72 mm, P = 0.867) and width (7.69 mm, P = 0.998). The mean marginal bone loss at 1 year after implant placement was 0.59 ± 0.27 mm. CONCLUSIONS: Although this study provides valuable insights into the potential benefits of using different types of CAD/CAM devices, further research with larger sample sizes and longer follow-up periods is warranted to validate these findings. CONFLICT-OF-INTEREST STATEMENT: The authors declare there are no conflicts of interest relating to this study.

Four-mm-short implants in the rehabilitation of posterior atrophic jaws: A retrospective study on 212 patients with a mean follow-up of 8.02 years.

OBJECTIVE: This study aimed to assess clinical efficacy of 4-mm-short implants in patients with posterior severe vertical bone atrophy in the medium- and long-term follow-up. MATERIALS AND METHODS: Patients rehabilitated with 4-mm-short implants in the posterior atrophic jaws, with a minimum follow-up of 3 years post-loading, were included in the study. Data were collected for eligible patients, and marginal bone loss (MBL) for each implant was evaluated. The research outcomes were implant failure, MBL and complications. RESULTS: A total of 212 patients with 496 implants were included, resulting in a mean follow-up of 8.02 ± 2.17 years. The implant survival rate was 95.36% (95% CI: 93.12%-97.04%). More implant failures were observed in the maxilla (p = .02) and fewer failures were observed in patients undergoing more number of hygienic sessions per year (p < .001). The average MBL after 1-year-loading was 0.47 mm, increasing to 0.59 mm after 10 years; after 3 years no statistically significant increase in MBL was observed. Maxillary implants showed greater bone loss than mandibular ones (p < .001). More frequent professional oral hygiene sessions per year resulted being related with reduced MBL (p < .001). CONCLUSIONS: Four-mm-short implants showed high survival rates with an up to 10-year follow-up. Their use can offer a fixed prosthetic solution for patients with posterior vertical bone atrophy, minimizing surgical invasiveness, rehabilitative times and costs.

Immediate full-arch fixed rehabilitation of a narrow mandible with newly conceived connection system implants: A case report.

Rehabilitating thin jaws without reconstructive surgery entails using narrow implants. The proposed treatment adopted an innovative implant system, allowing the mini-screws to be parallel and immediately loaded. A mandible, wearing an overdenture, was functionalized contextually to the residual dental extraction and the placement of six 2.4-mm thick one-piece implants. Low-profile intermediate abutments, the LEMs, able to rotate over the spherical heads of the fixtures, were connected after suturing, oriented, and blocked in a mutual parallel position. The copings, engaging with a tapered juncture of the LEMs, resulted in their alignment to be intraorally wedged together. The provisional superstructure enclosed the copings and was immediately connected to the implants, and the definitive prosthesis was delivered after three months. No clinical signs of peri-implantitis or radiographically evident bone loss were recorded after a two-year follow-up without any prosthetic complication. No cases have been published regarding mini-implants bearing fixed prosthesis rehabilitation.

Accuracy of semi-occlusive CAD/CAM titanium mesh using the reverse guided bone regeneration digital protocol: A preliminary clinical study.

PURPOSE: The reverse guided bone regeneration protocol is a digital workflow that has been introduced to reduce the complexity of guided bone regeneration and promote prosthetically guided bone reconstruction with a view to achieving optimal implant placement and prosthetic finalisation. The aim of the present study was to investigate the accuracy of this digital protocol. MATERIALS AND METHODS: Sixteen patients with partial edentulism in the maxilla or mandible and with vertical or horizontal bone defects were treated using the reverse guided bone regeneration protocol to achieve fixed implant rehabilitations. For each patient, a digital wax-up of the future rehabilitation was created and implant planning was carried out, then the necessary bone reconstruction was simulated virtually and the CAD/CAM titanium mesh was designed and used to perform guided bone regeneration. The computed tomography datasets from before and after guided bone regeneration were converted into 3D models and aligned digitally. The actual position of the mesh was compared to the virtual position to assess the accuracy of the digital project. Surgical and healing complications were also recorded. A descriptive analysis was conducted and a one-sample t test and Wilcoxon test were utilised to assess the statistical significance of the accuracy. The level of significance was set at 0.05. RESULTS: A total of 16 patients with 16 treated sites were enrolled. Comparing the virtually planned mesh position with the actual position, an overall mean discrepancy between the two of 0.487 ± 0.218 mm was achieved. No statistically significant difference was observed when comparing this to a predefined minimum tolerance (P = 0.06). No surgical complications occurred, but two healing complications were recorded (12.5%). CONCLUSION: Within the limitations of the present study, the reverse guided bone regeneration digital protocol seems to be able to achieve good accuracy in reproducing the content of the virtual plan. Nevertheless, further clinical comparative studies are required to confirm these results.

The Italian Behavioral, Emotional, and Social Skills Inventory (BESSI-I).

The importance of social, emotional, and behavioral (SEB) skills is recognized worldwide, but their measurement has always been a challenge. The BESSI measures 32 SEB skills, divided into five domains (social engagement, cooperation, self-management, emotional resilience, and innovation), but its validity must be expanded to new languages and contexts. Across two studies (N1 = 990, N2= 824) we developed the Italian version of the BESSI, provided further support for its convergent and discriminant validity with the Big Five, and expanded its nomological network to procrastination, self-efficacy, and emotion regulation. The BESSI-I showed excellent internal reliability and satisfactory fit indices at the facet, domain, and overarching framework level. We also confirmed the correlations between the SEB skills and the Big Five personality traits and found meaningful correlations with the selected external outcomes. Overall, we confirm that the BESSI-I is a valid and useful instrument to assess SEB skills for research and clinical purposes.

Academic Achievement and Satisfaction Among University Students With Specific Learning Disabilities: The Roles of Soft Skills and Study-Related Factors.

Understanding the individual qualities sustaining students with and without specific learning disabilities (SLDs) is key to supporting their academic achievement and well-being. In this study, we investigated the differences between students with and without SLDs in terms of intraindividual factors (soft skills and study-related factors), academic and nonacademic outcomes (achievement, academic and life satisfaction), and the relationships between such intraindividual factors and the three outcomes. A total of 318 students (79 males; Mage = 22.7; SD = 3.56; age range = 19-45 years; 147 with SLDs) completed self-reported questionnaires and a measure of fluid intelligence. The results showed that students with SLDs reported higher creativity but lower academic self-efficacy, study resilience, and academic achievement, with small-to-medium effect sizes. In both groups, achievement significantly positively related to academic self-efficacy and negatively to creativity. Life satisfaction was positively related to study resilience; and academic satisfaction was related to critical thinking, curiosity, and academic self-efficacy. Nurturing such intraindividual factors can benefit students with and without SLDs.

A new impression reference technique to simplify the digital workflow for immediate loading zygomatic implant-supported rehabilitation.

Zygomatic implant-supported rehabilitation has grown in popularity for use in clinical practice. Although many studies have been carried out into the surgical procedure, the prosthetic workflow is not clearly defined and standard techniques are not readily applied; thus, a digital approach may ultimately streamline the procedure. In the present study, the authors examined a digital workflow for immediately loaded prostheses supported by zygomatic implants. The novel technique proposed by the present authors, involving use of an impression reference, achieved promising results in terms of accuracy and procedural simplification.

Semi-occlusive CAD/CAM titanium mesh for guided bone regeneration: Preliminary clinical and histological results.

PURPOSE: Guided bone regeneration is a widely used technique for the treatment of atrophic arches. A broad range of devices have been employed to achieve bone regeneration. The present study aimed to investigate the clinical and histological findings for a new titanium CAD/CAM device for guided bone regeneration, namely semi-occlusive titanium mesh. MATERIALS AND METHODS: Nine partially edentulous patients with vertical and/or horizontal bone defects underwent a guided bone regeneration procedure to enable implant placement. The device used as a barrier was a semi-occlusive CAD/CAM titanium mesh with a laser sintered microperforated scaffold with a pore size of 0.3 mm, grafted with autogenous and xenogeneic bone in a ratio of 80:20. Eight months after guided bone regeneration, surgical and healing complications were evaluated and histological analyses of the regenerated bone were performed. RESULTS: A total of 9 patients with 11 treated sites were enrolled. Two healing complications were recorded: one late exposure of the device and one early infection (18.18%). At 8 months, well-structured new regenerated trabecular bone with marrow spaces was mostly present. The percentage of newly formed bone was 30.37% ± 4.64%, that of marrow spaces was 56.43% ± 4.62%, that of residual xenogeneic material was 12.16% ± 0.49% and that of residual autogenous bone chips was 1.02% ± 0.14%. CONCLUSION: Within the limitations of the present study, the results show that semi-occlusive titanium mesh could be used for vertical and horizontal ridge augmentation. Nevertheless, further follow-ups and clinical and histological studies are required.

Hygienic maintenance in patients with maxillae atrophy and in oncological patients with maxillary resection rehabilitated with zygomatic implants: A nested monocentric prospective cohort study.

OBJECTIVE: To assess peri-implant soft tissues condition, comparing clinical parameters of implants placed in patients with atrophic upper jaws and patients who underwent maxillary resection for oncological reasons. BACKGROUND: Zygomatic implants (ZIs) in oncologic patients could be affected by more complications compared to implants placed in atrophic maxillae. The soft tissue condition is an essential requirement for implant success, but few studies have investigated this topic. METHODS: A nested monocentric prospective parallel cohort (atrophic vs. oncological patients) study was performed. Clinical visits and professional hygiene sessions were performed every three months, and bleeding on probing (BOP), probing pocket depth (PPD), gingival index (GI), plaque index (PI) and implant mobility were recorded by a blind outcome assessor. RESULTS: In total, 77 ZIs placed in 21 patients were evaluated: 54 (70.1%) ZIs were inserted in patients belonging to the atrophic cohort (PAM) and 23 (29.9%) ZIs in the oncologic cohort (OP). The probability of having BOP at the considered mean follow-up (27 months) was 24.8% (95% CI 19.0-31.9) for PAM and 22.9% (95% CI 15.1-33.9) OP. The mean PPD values were 2.78 ± 1.28 (range 1-8) in PAM and 2.91 ± 1.98 (range 0-10) in OP. None of the implants showed mobility. No associations between group belongingness and the entity of PPD, PI, GI and the risk of BOP were found, adjusting for the considered confounding factors (age, smoking and implant position). CONCLUSIONS: Under a strict supportive hygiene therapy protocol ZIs in oncologic patients showed similar peri-implant tissue conditions to that of patients with maxillary atrophy.

A Plaster Cast Contact Scan Method to Assess the Accuracy of Full-Arch Computer-Aided Implant Surgery.

PURPOSE: The aim of this study was accuracy assessment of placed implants in full-arch cases using specific software and hardware to perform static computer-assisted implantology and immediately loaded prostheses. The degree of deviation existing between planned and achieved implants was carried out by a new noninvasive measurement procedure of the implant position performed on stone casts. MATERIALS AND METHODS: Fourteen stone casts retrieved from 14 full-arch fully guided implant treatments were selected to perform the study. Each cast, manufactured for the surgical treatment by using a specific laboratory kit, was obtained from the respective surgical guide. A sleeve for each implant was embedded into the guide, which helped the examiners to manufacture a stone cast per guide containing the implant analogs, which was used to recover the final position of the planned implants. A total sample of 60 implants were assessed. The postoperative casts, poured to produce the immediate prostheses, were then processed by a contact (or tactile) scanner, and the generated standard tessellation language (STL) files were overlapped (best-fit alignment) using engineering software that revealed all the measured discrepancies. In terms of accuracy, differences relating to arch, assessed bone quality, implant length, and drill length (prolongation short or long) were reported. RESULTS: The use of a noninvasive tactile scanner revealed mean entry point horizontal deviations of 0.30 mm (SD: 0.39 mm), mean entry point vertical deviations of 0.20 mm (SD: 0.25 mm), mean apical horizontal deviations of 0.50 mm (SD: 0.73 mm), and mean apical vertical deviations of 0.24 mm (SD: 0.28 mm). The frontal and lateral angular deviations were investigated, and corresponding mean values of 1.99 degrees (SD: 2.30 degrees) and 1.80 degrees (SD: 2.44 degrees) were detected. CONCLUSION: The reported results demonstrate that the contact tactile scan is a viable and biologic way to assess implant deviations.

Guided bone regeneration using titanium mesh to augment 3-dimensional alveolar defects prior to implant placement. A pilot study.

OBJECTIVES: To evaluate the outcomes of bone regeneration using a customized titanium mesh scaffold to cover a bone graft for reconstruction of complex defects of the jaws. MATERIALS AND METHODS: 19 large defects were digitally reconstructed using CT scans according to the prosthetic requirements. A titanium mesh scaffold was designed to cover the bone (autologous/bovine bone particulate) graft. At least 6 months after surgery, a new cone-beam CT was taken. The pre- and postoperative CT datasets were then converted into three-dimensional models and digitally aligned. The actual mesh position was compared to the virtual position to assess the reliability of the digital project. The reconstructed bone volumes (RBVs) were calculated according to the planned bone volumes (PBVs), outlining the areas under the mesh. These values were then correlated with the number of exposures, locations of atrophy, and virtually planned bone volume. RESULTS: The mean matching value between the planned position of the mesh and the actual one was 82 ± 13.4%. 52.3% (40% early and 60% late) exposures were observed, with 15.8% exhibiting infection. 26.3% resulted as failures. The amount of reconstructed bone volume (RBV) in respect to PBV was 65 ± 40.5%, including failures, and 88.2 ± 8.32% without considering the failures. The results of the exposure event were statistically significant (p = .006) in conditioning the bone volume regenerated. CONCLUSIONS: This study obtained up to 88% of bone regeneration in 74% of the cases. The failures encountered (26%) should underline the operator's expertise relevance in conditioning the final result.

Artificial Intelligence: A New Diagnostic Software in Dentistry: A Preliminary Performance Diagnostic Study.

BACKGROUND: Artificial intelligence (AI) has taken hold in public health because more and more people are looking to make a diagnosis using technology that allows them to work faster and more accurately, reducing costs and the number of medical errors. METHODS: In the present study, 120 panoramic X-rays (OPGs) were randomly selected from the Department of Oral and Maxillofacial Sciences of Sapienza University of Rome, Italy. The OPGs were acquired and analyzed using Apox, which takes a panoramic X-rayand automatically returns the dental formula, the presence of dental implants, prosthetic crowns, fillings and root remnants. A descriptive analysis was performed presenting the categorical variables as absolute and relative frequencies. RESULTS: In total, the number of true positive (TP) values was 2.195 (19.06%); true negative (TN), 8.908 (77.34%); false positive (FP), 132 (1.15%); and false negative (FN), 283 (2.46%). The overall sensitivity was 0.89, while the overall specificity was 0.98. CONCLUSIONS: The present study shows the latest achievements in dentistry, analyzing the application and credibility of a new diagnostic method to improve the work of dentists and the patients' care.

Posterior jaws rehabilitation with < 7mm-short implants. A review.

INTRODUCTION: The results with shorter and shorter implants have been revolutionizing the implantology scenario and are worthy of being well-analyzed and understood. This review aims to add further knowledge about the last 10-years observation period on < 7mm-short implants in the posterior atrophic jaws, better defining the indication of their use. METHODS: From a Medline database research, systematic reviews, controlled and no- controlled trials (CT, n-CT) with ≥ 3years-follow-ups on <7 mm / ≥ 5mm-short implants (group A), and clinical studies with ≥ 1year-follow-up on 4mm-short implants (group B) were considered. The outcomes, in terms of implant survival rate (SR), marginal bone loss (MBL), and complications were analyzed according to the duration of follow-ups, implant site (maxilla and mandible), type of prosthesis (single crown or splinted units), vertically impaired or normal sites. RESULTS: Thirty-four trials (28 for group A and six for group B) were selected. Group A: a mean follow up of 5,8 (3-10) years came out; pre-and post-loading SR range was 94.4- 100% and 89.6-100%, respectively; the range of MBL was 0.12-1.49; 50% of CT found less statistically significant surgical complications in comparison with standard implants (ST) in reconstructed sites, while major prosthetic problems were recorded with short -implants (SH) in 37.5% of CT; in no atrophied sites, a mean SR range of 86.7-100 % vs. 88-100 % and a total bone loss of 2 vs.1.6 for SH vs.ST emerged. Group B: the overall mean follow-up period was 2,3 years, and the pre-and post- SR ranges were 93-100 % and 87.5-100 %, respectively. The MBL range was 0.02- 0.63 mm. All RCT reported significantly fewer surgical complications with SH than with ST in reconstructed mandibles within one year. No prosthetic complications were reported for up to 5 years using no pontics or cantilevers fixed bridges. CONCLUSIONS: Similar or even better results for SH than ST in terms of post-loading SR and MBL came out for < 7mm/ ≥ 5mm-short implants in atrophic bone regardless of the prosthetic solutions, with less surgical complications but a few more prosthetic problems; the good results up to 5 years for 4mm-short implants in mandibles are associated with splinted and no-risk prosthetic solutions.

A comparison of accuracy between three different facial detection systems for prosthodontic esthetic preview: a single-blinded in vitro study.

BACKGROUND: The aim of this study was to compare the accuracy of 3 different devices for facial images acquisition, useful for prosthodontic esthetic preview. METHODS: Bidimensional extraoral photographs (Nikon D300), facial scans (Bellus3D) and 3D digital stereophotogrammetry photos (3dMD Face System) were acquired from 15 patients. The intraoral impressions of all subjects were digitally taken through a scanner (i500; Medit). Files obtained from each acquisition method were transferred on Exocad Software, and the measurements of the frontal teeth were performed and compared with those of the intraoral scans, assumed as reference. The data were statistically analyzed (Friedman and Dunn tests) with P<0.05. RESULTS: As for central and lateral incisors, no significant difference emerged between 2D digital photography and intraoral scans, both in height and width. Measures obtained with Bellus3D significantly differed from the reference data in width of all teeth, except for central incisors. Values referred to canines were those more subjected to significant distortions in width for all devices. CONCLUSIONS: Within the limits of this study, measures of frontal teeth acquired by 2D digital photography were similar to those of intraoral scans both in height and width, while those obtained with 3D facial scanners were more subjected to distortions in mesial-distal dimension.

Use of Intraoral Scanners for Full Dental Arches: Could Different Strategies or Overlapping Software Affect Accuracy?

OBJECTIVES: The use of digital devices is strongly influencing the dental rehabilitation workflow both for single-crown rehabilitation and for full-arch prosthetic treatments. METHODS: In this study, trueness was analyzed by overlapping the scan dataset made with Medit I-500 (by using two different tips and two different scan strategies) with the scan dataset made with lab scanning, and the values of the (90°-10°)/2 method were reported. Precision was evaluated by using the same values of trueness coming from the intra-group overlapping (scan dataset made with an IOS overlapped and compared to each other). Moreover, two different software programs of overlapping were used to calculate accuracy values. RESULTS: The mean difference of trueness was 26.61 ± 5.07 µm with the suggested strategy of intraoral scanning and using a new design of the tip, 37.99 ± 4.94 µm with the suggested strategy of intraoral scanning and using the old design of the tip, and 51.22 ± 6.57 µm with a new strategy of intraoral scanning and using the old design of the tip. The mean difference of precision was 23.57 ± 5.77 µm with the suggested strategy of intraoral scanning and using a new design of the tip, 38.34 ± 11.39 µm with the suggested strategy of intraoral scanning and using the old design of the tip, and 46.93 ± 7.15 µm with a new strategy of intraoral scanning and using the old design of the tip. No difference was found in the trueness and precision data extracted using the two different programs of superimposition Geomagic Control X and Medit Compare. CONCLUSIONS: The outcomes of this study showed that the latest version of I-Medit 500 with the use of a new tip seems to be promising in terms of accuracy when a full arch needs to be scanned. Moreover, Medit Compare, which is an application of Medit IOS software, can be used to calculate IOS accuracy.

Dynamic Navigation in Implant Dentistry: A Systematic Review and Meta-analysis.

PURPOSE: Dynamic navigation is a technique that allows for the placement of dental implants using a computer-guided approach according to preoperative planning. Its accuracy has been assessed in several previous studies. The purpose of this study was to summarize data on implant placement accuracy using dynamic navigation, to synthesize the frequency of intraoperative complications and implant failures, and to compare this technique with static computer-guided surgery and a freehand approach. MATERIALS AND METHODS: Electronic and manual literature searches until December 2019 were performed. The outcome variables were implant placement accuracy using dynamic navigation, accuracy differences between dynamic and static techniques and between dynamic and freehand techniques, intraoperative complications, and implant failures. Random-effects meta-analyses were performed. RESULTS: A total of 32 studies were included; 29 reported accuracy values (2,756 implants), and 10 focused on complications and implant failures (1,039 implants). The pooled mean implant placement errors were 0.81 (95% CI: 0.677 to 0.943) mm at the entry point and 0.910 (95% CI: 0.770 to 1.049) mm at the apical point. The pooled mean vertical and angular deviations were 0.899 (95% CI: 0.721 to 1.078) mm and 3.807 (95% CI: 3.083 to 4.530) degrees. The navigation group showed significantly lower implant placement errors with respect to the freehand technique (P < .01) and similar accuracy values (P ≥ .05) compared with the static technique. The pooled prevalence of failures was 1% (95% CI: 0.00% to 2%). CONCLUSION: Dynamic navigation provided small implant placement errors, comparable with those obtained using static computer-guided surgery, and can be considered a more accurate technique than conventional freehand surgery.

Flapless and bone-preserving extraction of partially impacted mandibular third molars with dynamic navigation technology. A report of three cases.

AIM: Most of the intra- and postoperative patient discomfort related to complex mandibular third molar (M3M) extraction is proportional to the invasiveness of the surgery. This can be minimized through the support of dynamic navigation (DN) technology, which can be successfully applied in dental implantology. Materials and methods: Three patients, one female (aged 25 years) and two males (aged 18 and 51 years, respectively) underwent the DN-supported extraction of partially impacted M3Ms with a flapless approach that required minimal bone removal. The patients' discomfort and the speed of recovery were considered to be proof of the quality of the adopted procedure. RESULTS: No postoperative discomfort such as pain or swelling was recorded in the immediate postoperative period, and no complications were reported within a month of the surgery. No medications were prescribed. The procedure lasted no longer than 20 min in all cases. CONCLUSION: Using DN technology, the real-time 3D monitoring of the clinical situation in each surgical phase enabled the surgeon to avoid soft tissue detachment as well as limit bone loss and intraoperative bleeding, thanks to a precise multi--section of the tooth and important nearby anatomical structures, respectively.

A 4 mm-Long Implant Rehabilitation in the Posterior Maxilla with Dynamic Navigation Technology: A Case Report after a Three-Years Post-Loading Follow-Up.

The use of short (<8 mm long) and ultra-short (<6 mm long) implants allows the prosthetic rehabilitation of the posterior ridges of the jaws avoiding reconstructive procedures. Nevertheless, this approach requires vast experience to ensure the primary stability of the fixture in a correct position. Computer-aided implantology (CAI) achieves better results than the free-hand one in terms of placement accuracy, reducing the surgical risks and the operative timings. Dynamic navigation (DN) allows the surgeon to track the position and movements of the drill in real-time on the CT imaging data set. It is more versatile than the computed static system, enabling the operator to change the guidance coordinates according to the intra-operative feedbacks. A mono-edentulous upper right first molar site was rehabilitated with a four mm-long implant to avoid reconstructive techniques, drastically rejected by the patients. The case was managed within a DN protocol considering the minimal available bone and the prosthetic demands. The phases of this procedure were strictly documented up to a 3-year follow-up. No intra-operative problems occurred, and adequate primary stability of the implant was obtained. The prosthetic loading was carried out within only six weeks without any complications. No variation of the baseline clinical scenario as evidenced clinically and radiographically at the end of follow-up. No similar cases are reported in the literature.

Full Zirconia Implant-Born Prosthetic Rehabilitation with CAD/CAM Technology after Accurate Digital Planning. A Case Report.

CAD/CAM technology can enhance the dentistry application of ceramic materials that meet the more relevant biocompatibility and aesthetics demands. In implant-borne prosthesis rehabilitation, yttria-stabilized zirconia appeared to be a valid alternative to metal-alloys and titanium, with comparable mechanical properties and even better interaction with bone and soft tissues. The improvement of monolithic CAD/CAM manufacturing allows for a reliable, predictable, and rapid workflow that can correspond to a holistic treatment philosophy associated with zirconia fixtures. This reported clinical case highlights the advantages of this approach in resolving particularly functionally and aesthetically complex situations. A 40-year-old patient with permanent canine impaction and the persistence of a deciduous tooth compromised by caries was successfully rehabilitated with the surgical removal of the enclosed tooth, the seating of a mono-phase zirconia implant after the deciduous extraction and its loading with a zirconia single crown, without any clinical or radiographical alteration up to seven years follow-up.

Mandibular reconstruction using a new design for a patient-specific plate to support a fibular free flap and avoid double-barrel technique.

Mandibular reconstruction is a primary concern for head and neck reconstructive surgeons because of the aesthetic restoration needs after ablative surgery, as well as for functional reasons: the mandible has a central functional role in speaking, swallowing and mastication. It is generally agreed that the gold standard for mandibular reconstruction is a bone free flap supported by a reconstructive titanium plate. The fibular flap represents the first choice for multi-segment mandibular reconstruction. The fibula, harvested as a single barrel graft, does not exhibit sufficient thickness to reach the original height of the native mandible; therefore, the positioning of dental implants is often deeper than that of the native alveolar crest. The aim of this study was to evaluate the positioning of the fibular free flap as it pertains to the restoration of vertical mandible height, by modifying the design of a 3D-printed titanium patient-specific implant (PSI). In this novel reconstructive workflow, the customised plate was projected to support the fibular flap at an alveolar bone position above the typical inferior mandibular border, and carried out on four patients. All patients were treated for benign neoplasms involving mandibular bone. Clinical outcomes and accuracy of the procedure are described. Our reconstructive proposal appears to be a valid alternative to the double-barrel technique in order to restore the vertical height of the reconstructed mandible.^ieng

La ricostruzione mandibolare è particolarmente rilevante per il chirurgo cervico-cefalico, in quanto influenza significativamente i successi in termini di risultati estetici e funzionali per il paziente. Il gold standard per tale ricostruzione è l'utilizzo di lembi ossei rivascolarizzati, stabilizzati mediante una placca ricostruttiva in titanio. Il lembo di fibula rappresenta la prima scelta ricostruttiva laddove necessitino molteplici segmenti ossei. Tuttavia questo lembo, allestito secondo la tecnica della singola barra, non permette di ripristinare l'altezza mandibolare nativa, adeguata per una corretta riabilitazione masticatoria implanto-supportata. Lo scopo di questo studio è quindi presentare un nuovo design di placca ricostruttiva custom-made, atta a posizionare il segmento osseo di fibula in una posizione più coronale, evitando pertanto la necessità di allestire il lembo secondo la tecnica della doppia barra. La placca custom-made contribuisce inoltre al mantenimento del profilo mandibolare, garantendo il ripristino morfologico della ricostruzione. Questo protocollo è stato eseguito su quattro pazienti sottoposti a resezione mandibolare per tumori benigni. I risultati clinici e di accuratezza della procedura sono presentati. Il protocollo presentato sembra una valida alternativa alla tecnica della doppia barra al fine di ripristinare l'altezza mandibolare nativa.