Fonseca's Questionnaire Is a Useful Tool for Carrying Out the Initial Evaluation of Temporomandibular Disorders in Dental Students.

Background: Temporomandibular disorders (TMDs) represent a prevalent multifactorial condition that impacts a significant portion of the global population. The objective of this study was to employ Fonseca's questionnaire for an initial assessment of TMDs. Methods: A cross-sectional study was conducted on a sample of 250 undergraduates from the Dental School of the University of Perugia, Italy. The chi-square test, with a significance level set at p < 0.05, was used to evaluate a statistically significant relationship between TMDs and several variables such as gender, age, employed/unemployed, and physically active or not. Results: The data obtained through the questionnaire indicated that a considerable percentage of students (78%) exhibited signs consistent with TMDs. The most frequently reported signs and symptoms included psychological stress (49.6%), dental clenching and grinding (34%), joint clicking (33.6%), frequent headaches (15.2%), and neck pain (23.2%). Notably, when considering moderate to severe symptoms of TMDs, females were more significantly affected than males. Furthermore, factors such as age, employment status, and physical activity did not appear to influence the prevalence of TMDs. Conclusions: The high prevalence of TMDs identified within this young population (university students), as measured by this questionnaire (albeit warranting validation through more rigorous methodologies) underscores the necessity for the implementation of new preventive strategies that specifically address this demographic.

New test for systematic skills enhancement and improvement in maxillofacial surgery training: multicentre pilot study.

We know of few studies in the international scientific literature that specifically address the evaluation of surgical and clinical progress among physicians undergoing specialist training in maxillofacial surgery. Identifying a reliable tool to accurately assess both theoretical knowledge and surgical skills of trainees is essential. The primary aim of this study therefore was to design a comprehensive assessment tool that is capable of evaluating both the theoretical and practical skills of physicians undergoing specialist training in maxillofacial surgery. The methodology employed aims to ensure fairness and effectiveness in skills development, thereby optimising training activities. To meet this need, an evaluation and self-assessment test was developed for maxillofacial surgery trainees at the Ospedali Riuniti of Ancona. Data collection involved digitally administered evaluations and self-assessment tests focused on maxillofacial traumatology, based on AO trauma surgery references. Data were processed into graphs which revealed a progressive learning trend following an initial adjustment phase, leading to optimal outcomes in both clinical and surgical domains. The evaluation and self-assessment test proved to be a valuable learning tool with which to gauge advancements in clinical and surgical skills among maxillofacial surgery residents.

Working length determination in primary teeth pulpectomy: A systematic review and meta-analysis.

The present meta-analysis aimed to describe the methods to determine the working length in primary teeth pulpectomy, also evaluating and comparing their reliability. A systematic review was performed following the PRISMA Statement. The electronic search was conducted on PubMed, Scopus, Cochrane Library and Web of Science. After the screening protocol, a number of 14 studies were included in the qualitative analysis, while seven were included in the quantitative one. The mean working length determined by the electronic apex locator was 11.8 mm (9.0-15.55), while 12.42 mm (11.0-13.52) and 12.3 mm (9.73-15.93) were the mean working length observed with the conventional radiography and the digital radiography, respectively. No statistically significant difference was detected in quantitative analysis between the investigated methods. The present meta-analysis showed that electronic apex locator, conventional radiography and digital radiography are similar in determining working length in primary teeth.

Quality of life in patients affected by medication-related osteonecrosis of the jaws: A systematic review.

OBJECTIVE: The aim of this systematic review was to describe the quality of life and oral health-related quality of life of patients affected by medication-related osteonecrosis of the jaw. STUDY DESIGN: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A combination of keywords and MeSH terms was used in PubMed, Scopus, Cochrane Library, Web of Science, and EBSCO up to December 13, 2020. RESULTS: A total of 1066 results were obtained after duplicate exclusion and 11 articles were included in the final qualitative analysis. Most of the articles described the quality of life in patients with osteonecrosis of the jaw secondary to cancer treatment. The main drugs associated with the disease were bisphosphonates. Surgical treatment of the osteonecrosis improves the quality of life of these patients. CONCLUSIONS: The present systematic review suggested the negative influence of osteonecrosis of the jaw on the quality of life and oral health-related quality of life among oncologic and osteoporotic patients. The use of quality of life questionnaires in daily practice could be an important tool to better diagnose and manage patients affected by osteonecrosis of the jaws who have received or are receiving drugs associated with this complication.

Sinus augmentation grafting with anorganic bovine bone versus 50% autologous bone mixed with 50% anorganic bovine bone: 5 years after loading results from a randomised controlled trial.

PURPOSE: To compare the outcomes of implants inserted in maxillary sinuses augmented with 100% anorganic bovine bone (ABB) grafts versus mixed with 50% ABB and 50% autologous bone graft using a lateral window approach. MATERIALS AND METHODS: This study was designed as a randomised controlled trial of parallel groups. Patients in need of an implant-supported prosthesis in maxillary posterior areas, with a residual alveolar bone height ranging between 0 and 4 mm, were recruited for lateral sinus grafting and implant placement. Patients were randomly allocated to receive two different graft materials according to a parallel group design: group A was grafted with 50% ABB and 50% autogenous bone; group B was grafted with 100% ABB. After 7 months, tapered implants were inserted with an insertion torque between 20 and 45 Ncm. Three months later implants were loaded with screw-retained temporary crowns. Definitive crowns were delivered after 3 months. Outcome measures were implant and prosthesis survival rates, complications, radiographic marginal bone-level changes, probing pocket depths (PPDs) and bleeding on probing (BOP). Clinical data were collected at definitive prosthesis delivery, and 1, 2 and 5 years after definitive loading. RESULTS: Thirty-two consecutive patients were treated with 32 sinus elevation procedures (16 group A, 16 group B). A total of 46 implants were inserted. One patient (with two implants) dropped out in group A, and two patients (with three implants) dropped out in group B. No implant/crown failed by the end of the study. Three complications (one sinus membrane perforation and two chipping of the ceramic) were observed in three patients in group A, versus none in group B (relative risk was 0.81; 95% CI 0.64-1.03; P = 0.225). At the 2-year follow-up, the mean marginal bone loss was 1.18 ± 0.50 mm (95% CI 0.95-1.45 mm) in group A and 1.28 ± 0.48 mm (95% CI 0.97-1.43 mm) in group B, with no statistically significant differences between the two groups (difference 0.11 ± 0.22 mm; 95% CI -0.06-0.16 mm; P = 0.586). At the 5-year follow-up, the mean marginal bone loss was 1.37 ± 0.48 mm (95% CI 1.13-1.86 mm) in group A and 1.42 ± 0.48 mm (95% CI 1.17-1.90 mm) in group B (difference 0.15 ± 0.08 mm; 95% CI 0.10-0.22 mm; P = 0.426). At the 2-year follow-up, the mean PPD value was 2.70 ± 0.39 mm for group A and 2.54 ± 0.66 mm for group B, with no statistically significant difference between groups (difference 0.17 ± 0.39 mm; 95% CI 0.06-0.32 mm; P = 0.456). At the 5-year follow-up, the mean PPD value was 3.20 ± 0.44 mm for group A and 3.32 ± 0.49 mm for group B (difference 0.12 ± 0.43 mm; 95% CI 0.02-0.22 mm; P = 0.672). At the 2-year follow-up, the mean BOP value was 1.21 ± 0.79 for group A and 1.28 ± 0.68 for group B (difference 0.06 ± 0.49; 95% CI -0.23-0.25; P = 0.297), and at the 5-year follow-up, the mean BOP value was 1.77 ± 0.62 for group A and 1.91 ± 0.48 for group B (difference: 0.14 ± 0.51; 95% CI -0.05-0.33; P = 0.492). CONCLUSIONS: Within the limitations of this study, the present data confirm similar clinical outcomes of implants inserted in sinuses grafted with ABB versus implants inserted in sinuses grafted with mixed 50% ABB and 50% autologous bone.

Association between third molar and mandibular angle fracture: A systematic review and meta-analysis.

PURPOSE: The aim of this study was to investigate the risk of mandibular angle fracture associated with the presence of a mandibular third molar and its position when the mandibular fracture occurs. METHODS: A systematic literary search was performed in Pubmed, Scopus, and the Cochrane Library for observational studies with at least 250 patients that included frequency of mandibular angle fracture, presence of third molar, and its position. RESULTS: A total of seven studies were included in the review, from an initial search of 622 titles. The relative risk of mandibular angle fracture with third molar was 1.90 (95% CI = 1.47-2.46). The relative risk of mandibular angle fracture related to third molar position (according to the Pell and Gregory classification) was 1.18 (95% CI = 0.62-2.25), 1.98 (95% CI = 0.95-4.10), 2.72 (95% CI = 1.78-4.16), 1.31 (95% CI = 0.80-2.14), 2.21 (95% CI = 1.69-2.87) and 2.99 (95% CI = 2.12-4.22) for Class A, Class B, Class C, Class I, Class II, and Class III, respectively. CONCLUSIONS: Our meta-analysis reported a two-fold increased risk of mandibular angle fracture with the presence of a third molar in patients who presented with mandibular fractures. Even the third molar position seemed to influence mandibular angle fracture, especially Class C, Class II, and Class III.

1-year results from a split-mouth randomised controlled pilot trial comparing implants with 0.75 mm of machined collar placed at bone level or supracrestally.

PURPOSE: The present study evaluated the hypothesis that implants inserted at bone level or supracrestally have different outcomes in single tooth replacements against the alternative hypothesis of no difference. MATERIALS AND METHODS: This study was designed as a randomised, split-mouth, controlled pilot trial. Ten patients, each missing two bicuspids or molars, were treated with 20 implants featuring 0.75 mm of machined collar. Each patient randomly received one implant inserted at bone level (BL) and one inserted 0.75 mm to 1 mm above the alveolar crest (SC), measured with a periodontal probe during surgery. All the implants were inserted into healed healthy bone with an insertion torque ranging between 35 Ncm and 45 Ncm. Both implants were loaded with screw-retained acrylic-resin temporary crowns 3 months after implant insertion and 3 months later with screw-retained zirconia-ceramic definitive crowns. Outcome measures were implant/crown failures, biological and prosthetic complications, radiographic marginal bone level changes (MBL), probing pocket depth (PPD) and bleeding on probing (BOP). Clinical data were collected at baseline (implant insertion) and 1 year after implant placement (9 months after initial loading). RESULTS: After 1 year of follow-up, no patients dropped out, no implants failed, and no complications occurred. The mean MBL at the 1-year follow-up was 0.28 ± 0.21 mm in the SC group and 0.93 ± 0.37 mm in the BL group. While the difference in MBL was statistically significant between the two treatment groups (difference 0.65 ± 0.34; 95% CI = 0.59 to 1.01; P = 0.0001), the soft-tissue parameters were not statistically different. The mean PPD was 2.63 ± 2.4 in the SC group and 2.40 ± 0.70 in the BL group (P = 0.419) and mean BOP was 0.50 ± 0.71 in the SC group and 0.40 ± 0.70 in the BL group (P = 0.754). CONCLUSIONS: The smooth-collar implants inserted supracrestally showed 0.7 mm less radiographic marginal bone loss compared with implants inserted at the bone level 9 months after loading.

Sinus lift grafting with anorganic bovine bone vs 50% autologous bone mixed with 50% anorganic bovine bone: 2 years after loading results from a randomised controlled trial.

PURPOSE: To compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone (ABB) grafts vs mixed 50% ABB and 50% autologous bone graft, using a lateral window approach. MATERIALS AND METHODS: This study was designed as a randomised controlled trial of parallel groups. Patients in need of an implant-supported prosthesis in a maxillary posterior area with a residual alveolar bone height no greater than 4 mm (range 0-4 mm) were recruited for lateral sinus grafting. Patients were randomly allocated to receive 50% ABB and 50% autogenous bone (group A) or 100% ABB (group B). After 7 months, tapered implants were inserted with an insertion torque between 20 and 45 Ncm. After 3 months, implants were loaded with screw-retained temporary crowns. Definitive crowns were delivered 3 months later. Outcome measures were implant survival, complications, radiographic marginal bone-level changes, probing pocket depths (PPD) and bleeding on probing (BOP). Clinical data were collected at definitive prosthesis delivery, 1 and 2 years after loading. RESULTS: Thirty-two consecutive patients were treated with 32 sinus lift procedures (16 group A, 16 group B). A total of 46 implants were installed. No patient dropped out. No crown/implant failed by the end of the study. Three complications (one sinus membrane perforation and two chipping of the ceramic) were observed in three patients in group A, vs none in group B (RR 0.81; 95% CI 0.64 - 1.03 mm; P = 0.225). At the 2-year after final loading follow-up, the mean marginal bone loss was 1.18 ± 0.50 mm (95% CI 0.95 - 1.45 mm) in group A and 1.28 ± 0.48 mm (95% CI 0.97 - 1.43 mm) in group B, with no statistically significant differences between the two groups (difference 0.11 ± 0.22 mm; 95% CI -0.06 - 0.16 mm; P = 0.586). At the same follow-up, the mean PPD value was 2.70 ± 0.39 for group A and 2.54 ± 0.66 for group B, with no statistically significant difference between groups (difference 0.17 ± 0.39 mm; 95% CI 0.06 - 0.32 mm; P = 0.456), while the mean BOP value was 1.21 ± 0.79 for group A and 1.28 ± 0.68 for group B, (difference: 0.06 ± 0.49 mm; 95% CI -0.23 - 0.25 mm; P = 0.297). CONCLUSIONS: Within the limitations of this study, the present data seem to confirm the hypothesis that the clinical outcome of implants inserted in sinuses grafted with ABB vs implants inserted in sinuses grafted with mixed 50% ABB and 50% autologous bone are comparable. Conflict-of-interest statement: This study was not supported by any company. All the authors declare no conflict of interest.

Complications of mandibular reconstruction in childhood: Report of a case of Juvenile Aggressive Fibromatosis.

Juvenile aggressive fibromatosis is an acquired disease affecting young children. There are two types: superficial and deep; the first is not aggressive whilst the second invades other tissues deeply. This is a case report of the deep variant of juvenile aggressive fibromatosis of the lateral mandible affecting a 24-month-old young female patient. The tumour has been treated surgically by resection of the mandible and reconstruction with a rib-graft. To by-passs resorption of the rib-graft and to re-establish the correct three-dimensional shape of the facial skeleton, osteodistraction of the reconstructed mandible was performed six months post-peratively. In this article the surgical techniques to reconstruct the mandible in young children are discussed.

Single post-extractive ultra-wide 7†mm-diameter implants versus implants placed in molar healed sites after socket preservation for molar replacement: 6-month post-loading results from a†randomised controlled trial.

PURPOSE: To test the hypothesis that there is no difference in clinical, radiographic and aesthetic outcomes positioning single post-extractive ultra-wide 7 mm-diameter implants or waiting 4 months to place implant, after molar extraction and the socket preservation procedure. MATERIAL AND METHODS: Patients requiring one implant-supported single restoration to replace a failed tooth in the molar region of both maxilla and mandible were selected. Patients were randomised according to a parallel group design into two arms: implant installation in fresh extraction sockets augmented with corticocancellous heterologous bone and porcine derma (group A) or delayed implant installation 4 months after tooth extraction and socket preservation using the same materials (group B). Ultra-wide 7 mm-diameter implants were submerged for 4 months. Outcome measures were implant success and survival; complications; horizontal dimensional changes measured on cone beam computed tomography (CBCT) scans at three levels, localised 1, 2 and 3 mm below the most coronal aspect of the bone crest (level A, B and C); peri-implant marginal bone level changes; implant stability quotient (ISQ); and pink esthetic score (PES). RESULTS: Twelve patients were randomised to group A and 12 to group B. No patients dropped out. No implant failed or complications occurred up to 6-months post-loading. Six months after loading there was more horizontal alveolar bone reduction at immediate post-extractive implants, which was statistically significant. At level A was 1.78 mm ±â€…1.30 in group A, 0.45 mm ±â€…0.42 in group B, (difference 1.33 mm ±â€…1.39; 95% CI: 0.38 to 1.95; P = 0.003); at level B was 0.98 mm ±â€…1.13 in group A, 0.14 mm ±â€…0.22 in group B, (difference 0.84 mm ±â€…1.16; 95% CI: 0.24 to 1.07; P = 0.019); at level C was 0.55 mm ±â€…0.74 in group A, 0.03 mm ±â€…0.24 in group B, (difference 0.51 mm ±â€…0.76, 95% CI: 0.01 to 0.87; P = 0.032). One year after implant placement, mean peri-implant marginal bone loss was 0.43 mm ±â€…0.37 for group A and 0.10 mm ±â€…0.10 for group B, showing a statistically significant difference between groups (difference 0.33 mm ±â€…0.30; 95% CI: 18 to 0.52; P = 0.010). Mean ISQ value was 78.8 ±â€…2.8 for group A and 79.9 ±â€…3.6 for group B, showing no statistically significant differences between groups (difference 1.1 ±â€…2.6; 95% CI: 0.04 to 2.96; P = 0.422). Mean PES was similar in both groups (10.7 ±â€…1.5 [range: 8 to 13] in group A and 11.7 ±â€…1.2 [range: 10 to 13] in group B; difference 1.0 ±â€…2.2; 95% CI: -0.23 to 2.23; P = 0.081). CONCLUSIONS: Single post-extractive ultra-wide 7 mm-diameter implants, in combination with socket preservation, might be a possible strategy in the replacement of hopeless molars in both jaws, with high implant and prosthetic survival and success rates, and good aesthetic outcomes. Longer follow-ups are needed to properly evaluate this therapeutic option. Conflict-of-interest statement: Dr Marco Tallarico is Research and Scientific Project Manager of Osstem AIC Italy. However, this study was not supported by any company and all authors declare no conflicts of interest.

Guided implant surgery after free-flap reconstruction: Four-year results from a prospective clinical trial.

AIM: The aim of this prospective clinical study is to assess the 4-year outcomes of implant-supported restorations performed using a computer-guided template-assisted flapless implant surgery approach in patients reconstructed with fibula or iliac crest free flaps. MATERIALS AND METHODS: Twelve jaws in 10 patients were reconstructed with osteomyocutaneous free flap after tumour resection or gunshot wound, after complete healing computer-assisted template-based flapless implant placement, based on prosthetic and aesthetic analysis, was performed using a customized protocol. Treatment success was evaluated using the following parameters: survival of implants/prostheses, prosthetic and biologic complications, marginal bone remodelling, soft tissue parameters and patient satisfaction. RESULTS: A total of 56 implants were placed; the implants ranged between 8 and 16 mm in length and were either 3.5, 4.3 or 5 mm wide. All the patients have reached the 4-year follow-up. Three implants were lost accounting for an overall implant survival rate of 94.6%. No prosthesis were lost. Some complications were recorded. Four years after loading the mean marginal bone loss was 1.43 ± 0.49 mm at the palatal/lingual site and 1.48 ± 0.46 mm at the vestibular site. All the patients showed healthy soft tissues with stable probing depth (4 .93 ± 0.75%) and successful bleeding on probing values (12 ± 5.8%); 90% of patients were satisfied of the treatment at the 4-year follow-up. CONCLUSIONS: Computer-guided template-assisted flapless implant surgery seems to be a viable option for patients undergoing reconstruction with free flaps after tumour resection or gunshot trauma, although many challenges remain. A high degree of patient satisfactorily was reported.

Chimeric lateral supramalleolar artery perforator fibula free flap in the reconstruction of composite head and neck defects.

The authors evaluate the use of an osteomyocutaneous fibula free flap, combined in a chimeric fashion, with a lateral supramalleolar flap, in 10 patients with composite head and neck defects. All reconstructions were performed successfully. With the exception of one patient who died after disease recurrence, all patients were decannulated and resumed an oral diet. Speech intelligibility was good in seven of 10 patients. Dental implants were used in two of 10 patients, with a total of 10 fixtures placed successfully. The donor site healed without complications in all except one case, where necrosis of the skin graft occurred with fungal infection. The chimeric lateral supramalleolar artery perforator fibula free flap may be a valid option for maximizing the quality of life in patients with composite oromandibular defects.

Computer-assisted orthognathic surgery for correction of facial asymmetry: results of a randomised controlled clinical trial.

In this randomised controlled clinical trial, 2 homogeneous groups of patients with facial asymmetry (n=10 in each) were treated by either classic or computer-assisted orthognathic corrective surgery. Differences between the 2 groups in the alignment of the lower interincisal point (p=0.03), mandibular sagittal plane (p=0.01), and centering of the dental midlines (p=0.03) were significant, with the digital planning group being more accurate.

Platform switching vs regular platform implants: nine-month post-loading results from a randomised controlled trial.

PURPOSE: To compare the clinical outcome of platform switching (PS) and regular platform (RP) implants in bilateral single molar replacements. MATERIAL AND METHODS: This study was designed as a randomised, controlled, split-mouth trial. Eighteen patients, with bilaterally missing single molars had one site randomly assigned to a PS implant or a RP implant. A total of 36 implants were bilaterally installed. Both implants were loaded with screw retained temporary crowns 3 months after implant insertion and with screw retained definitive crowns 3 months later. Outcome measures were implant/crown failure, complications, radiographic marginal bone-level changes, pocket probing depth (PPD) and bleeding on probing (BOP). Clinical data were collected at baseline 6 and 12 months after implant placement. RESULTS: No patients dropped out and no implant failed. No prosthetic or major biological complications were observed. One year after implant placement, mean marginal bone level was 0.93 ± 0.26 mm (95% CI 0.81 to 1.05) in RP group and 0.84 ± 0.23 mm (95% CI 0.73 to 0.95) in the PS group and no statistically significant differences between the two groups were observed (P = 0.18). Mean PPD and BOP values were, 6 and 12 months after implant placement, 2.74 ± 0.49 mm (95% CI 2.51 to 2.97) and 1.28 ± 0.75 (95% CI 0.93 to 1.63) in the RP group, and 2.70 ± 0.38 mm (95% CI 2.53 to 2.88) and 1.39 ± 0.78 (95% CI 1.03 to 1.75) in the PS group respectively, with no statistical differences between groups (P = 0.81 and P = 0.16, respectively). CONCLUSIONS: No statistically significant difference was observed between platform switched and non-platform switched implants.

Full arch restoration with computer-assisted implant surgery and immediate loading in edentulous ridges with dental fresh extraction sockets. One year results of 10 consecutively treated patients: guided implant surgery and extraction sockets.

There is a growing need for patients to be rehabilitated with a fixed, implant-supported prosthesis immediately after surgery. The present study aims to describe the results of a modified prosthetic and surgical protocol of computer-assisted implant insertion and immediate loading in edentulous jaws with extraction sockets. Ten patients were consecutively treated with a modified computer assisted implant surgery protocol and screw-retained provisional metal-acrylic prosthesis prepared ahead of surgery and delivered immediately. Overall, 60 implants (Nobel Replace Tapered Groovy) were inserted, of which 22 were inserted in fresh extraction sockets. Definitive prosthesis was delivered after 6-12 months. Outcome measures were radiographic marginal bone-level changes, survival of implants, and patient satisfaction. The follow-up period was of at least 12 months. All the patients felt comfortable and none withdrew from the study. No implants were lost, resulting in a cumulative survival rate of 100 %. Radiological estimation showed a mean peri-implant marginal bone loss of 1.4 ± 0.3 mm. No other complications, biological or mechanical, were recorded. In all cases, patients appeared to be very satisfied with the aesthetic and function. Within the limitations of this study, our data seem to validate this surgical and prosthetic protocol with valid functional and aesthetic results when applied in selected cases.

Arthrocentesis and temporomandibular joint disorders: clinical and radiological results of a prospective study.

Purpose. We evaluated the efficacy of arthrocentesis in the treatment of temporomandibular joint (TMJ) disorders. Material and Methods. In this prospective clinical case series, 30 consecutive patients with TMJ disorders underwent arthrocentesis using saline and sodium hyaluronate injections. Outcome measures were TMJ pain, maximum mouth opening (MMO), joint noises, and anatomical changes in the TMJ architecture. Patients were evaluated using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) at the beginning of treatment and 60 days after the last arthrocentesis. Pretreatment and posttreatment clinical parameters were compared using paired and unpaired t-tests, and McNemar's test was used to evaluate CBCT and MRI changes (P < 0.05). Results. At 1-year follow-up examinations, visual analogue scale scores indicated that pain was reduced significantly and mean postoperative MMO was increased significantly. CBCT findings showed no significant change, and MRI showed only slight reductions in inflammatory signs. Conclusions. Within the limitations of this study, we can conclude that arthrocentesis is a simple, minimally invasive procedure with a relatively low risk of complications and significant clinical benefits in patients with TMJ disorders. This trial is registered with NCT01903512.

Mandibular coronoid process grafting for alveolar ridge defects.

OBJECTIVE: We describe the clinical results of mandibular augmentation with coronoid process bone grafts for dental implant insertion. STUDY DESIGN: Fifteen patients with vertical and transverse defects of the posterior alveolar process of the mandible were treated. All patients underwent mandibular rehabilitation with autogenous coronoid process bone grafts via minimal-access surgery. After 6 months, 40 dental implants were inserted. RESULTS: At the time of implant insertion, the grafted alveolar ridges showed mean transverse and vertical augmentations of 3.07 and 2.80 mm, respectively. At 24 months after implant surgery, the cumulative implant survival rate was 95% and mean marginal bone loss was 1.6 ± 0.18 mm. No complete bone graft loss or infection occurred. CONCLUSIONS: Coronoid process bone grafts can be used to reconstruct moderate defects in edentulous alveolar processes. The insertion of the graft with minimal access in a tunneled fashion minimizes the risk of infection.

Immediate versus delayed loading of single mandibular molars. One-year results from a randomised controlled trial.

PURPOSE: To compare the outcome of immediate non-occlusal loading and that of delayed implant loading in the bilateral replacement of single mandibular molars. MATERIALS AND METHODS: This study was designed as a randomised, controlled, split-mouth trial. Twenty patients with bilaterally missing first mandibular molars had one of the sites to be restored randomly assigned to be treated with immediately or conventionally loaded single implants. A total of 40 implants were bilaterally installed. All the implants were inserted in healed healthy bone with an insertion torque between 35 and 45 Ncm. One molar was restored with a non-occluding temporary crown within 24 h after implant placement, while the contralateral molar was restored with a definitive crown 4 to 5 months later, according to a two-stage procedure. Final restorations were provided 4 to 5 months after implant placement for all implants. Outcome measures were implant survival, complications, radiographic marginal bone-level changes, PPD and BOP. RESULTS: No patients dropped out and no implant failed. Only minor prosthetic complications were observed (2 provisional acrylic crown fractures in the immediate loading group and 2 ceramic chipping in the delayed loading group). Mean marginal bone loss was 0.83 ± 0.16 mm (95% CI 0.75 to 0.91) in the immediate loading group and 0.86 ± 0.16 mm (95% CI 0.78 to 0.94) in the conventional loading group and no statistically significant differences between the two groups were observed (P = 0.530). Mean PPD and BOP values were, respectively, 2.76 ± 0.48 (95% CI 2.55 to 2.97) and 1.30 ± 0.73 (95% CI 0.98 to 1.62) in the immediate loading group, and 2.70 ± 0.37 (95% CI 2.54 to 2.86) and 1.40 ± 0.75 (95% CI 1.07 to 1.73) in the conventional loading group. Also, a statistical comparison of BOP and PPD did not show any significant difference (P = 0.163 and P = 0.652, respectively). CONCLUSIONS: Within the limitations of this study, the present data seem to confirm the hypothesis that the clinical outcome of immediate versus delayed loading of implants in single mandibular molar sites is comparable.

Computed tomography-guided implant surgery for dental rehabilitation in mandible reconstructed with a fibular free flap: description of the technique.

The fibular free flap, with or without a cutaneous component, is the gold standard for reconstructing mandibular defects. Dental prosthetic rehabilitation is possible this way, even if the prosthesis-based implant is still a challenge because of the many anatomical and prosthetic problems. We think that complications can be overcome or reduced by adopting the new methods of computed tomography (CT)-assisted implant surgery (NobelGuide, Nobel Biocare AB, Goteborg, Sweden). Here we describe the possibility of using CT-guided implant surgery with a flapless approach and immediate loading in mandibles reconstructed with fibular free flaps.

Biomechanics of the press-fit phenomenon in dental implantology: an image-based finite element analysis.

BACKGROUND: A fundamental pre-requisite for the clinical success in dental implant surgery is the fast and stable implant osseointegration. The press-fit phenomenon occurring at implant insertion induces biomechanical effects in the bone tissues, which ensure implant primary stability. In the field of dental surgery, the understanding of the key factors governing the osseointegration process still remains of utmost importance. A thorough analysis of the biomechanics of dental implantology requires a detailed knowledge of bone mechanical properties as well as an accurate definition of the jaw bone geometry. METHODS: In this work, a CT image-based approach, combined with the Finite Element Method (FEM), has been used to investigate the effect of the drill size on the biomechanics of the dental implant technique. A very accurate model of the human mandible bone segment has been created by processing high resolution micro-CT image data. The press-fit phenomenon has been simulated by FE analyses for different common drill diameters (DA=2.8 mm, DB=3.3 mm, and DC=3.8 mm) with depth L=12 mm. A virtual implant model has been assumed with a cylindrical geometry having height L=11 mm and diameter D=4 mm. RESULTS: The maximum stresses calculated for drill diameters DA, DB and DC have been 12.31 GPa, 7.74 GPa and 4.52 GPa, respectively. High strain values have been measured in the cortical area for the models of diameters DA and DB, while a uniform distribution has been observed for the model of diameter DC . The maximum logarithmic strains, calculated in nonlinear analyses, have been ϵ=2.46, 0.51 and 0.49 for the three models, respectively. CONCLUSIONS: This study introduces a very powerful, accurate and non-destructive methodology for investigating the effect of the drill size on the biomechanics of the dental implant technique.Further studies could aim at understanding how different drill shapes can determine the optimal press-fit condition with an equally distributed preload on both the cortical and trabecular structure around the implant.