3D printed implant surgical guides with internally routed irrigation for temperature reduction during osteotomy preparation: A pilot study.

OBJECTIVE: The purpose of this study was to test a novel through-the-guide means of irrigation in an in-vitro bovine bone model and to explore the method clinical applicability. MATERIALS AND METHODS: Surgical guides were designed to fit over five fresh bovine samples. Control osteotomy sites were compared to experimental sites irrigated through a 3D printed surgical guide with customized channels that direct the coolant toward the interface of the alveolar crest and drill. Temperature was measured during surgery with thermocouples located at 3 and 6 mm from the crestal height of the bone, and with an infrared thermal camera taking direct temperature readings from a window cut into axial wall at 9 mm from the crestal height of the ridge. RESULTS: Incorporation of routed irrigation significantly decreased heat generation, keeping temperature consistently below 47°C. A clinical case illustrates the method applicability using standard implant planning software, 3D printing technology, and regular implant armamentarium. CONCLUSIONS: The in-vitro analysis shows that this method mitigates temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique can be incorporated in the surgical guide design using commercially available software and 3D printing technology and has immediate applications in practice. CLINICAL SIGNIFICANCE: The in-vitro analysis shows that this method can significantly mitigate the temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique also has the advantage that it can be incorporated in the digital surgical guide design using commercially available software and 3D printing technology. The method has immediate applications in practice, and especially in the treatment of edentulism in esthetic zone where use of guided surgery for implant placement is crucial in obtaining consistent results.

Adverse events during sedation for oro-dental trauma in an Israeli paediatric emergency department.

There is a paucity of data regarding the safety of the practice of sedation for oro-dental trauma in paediatric emergency departments (ED). A previous study reported the safety of intramuscular ketamine administered as a single agent. In the paediatric ED of a tertiary trauma centre in Israel, one of two ketamine-based regimens is used for sedating children with intraoral injuries according to the physician's discretion: a single dose of intramuscular ketamine or a combination of ketamine and propofol (KP) intravenously. The aim of this study was to assess the safety of KP sedation in children undergoing emergency treatment of oro-dental injuries in this paediatric ED. The primary outcome was sedation adverse events that required intervention (SAERI): prolonged oxygen desaturation and apnoea, laryngospasm, hypotension, bradycardia, partial or complete airway obstruction, and pulmonary aspiration. During the 2 years study period, 17 children were sedated with KP, 20 with intramuscular ketamine and 29 with nitrous oxide. Patients who were treated with ketamine-based sedation or with nitrous oxide sedation had a median (interquartile range, IQR) age of 3 (2-4) years and 7 (5-9) years, respectively. No SAERI occurred in patients who were sedated with intramuscular ketamine. One (3.4%) SAERI was reported in a patient who was sedated with N2 O. Six/17 (35%) SAERI occurred in patients who were sedated with KP. These findings suggest that caution should be used when young children with oro-dental injuries are sedated with KP in the ED.

Management of Ankylotic Root Resorption Following Dental Trauma: A Short Review and Proposal of a Treatment Protocol.

Ankylotic root resorption is a serious complication following traumatic dental injuries. The aetiology of root resorption includes acute injury to the cementum and periodontal ligament, and subsequent biological processes that propagate the harm. The aim of the present paper is to present a structured treatment protocol for teeth that have experienced trauma and are at risk of developing ankylotic root resorption, followed by a decoronation protocol for situations in which ankylotic root resorption developed. This protocol provides a structured road map from the primary dental trauma, through the initial development of ankylosis detected radiographically, to the clinical manifestation that results in significant infra-occlusion. The current protocol integrates the best available evidence from the literature and from published guidelines. Ample contradictory data, which mainly consists of case reports related to the treatment of ankylotic root resorption, is available in the current literature. No accepted protocol or uniform guidelines for treatment in these cases exist, and many clinicians prefer avoiding replantation of an avulsed tooth that seems to have an uncertain longterm prognosis, or performing decoronation when infra-occlusion developed. As a result, young patients lose the benefits associated with replantation and decoronation procedures. The option of re-implantation of the avulsed teeth should be considered irrespective of the negative long-term prognosis. Following ankylosis development, the goal of submerging the tooth root (decoronation) is to maintain the horizontal dimension of the alveolar ridge and also to gain vertical dimension, allowing implant placement in the future.

Lip buccal mucosa traumatic overgrowth due to sucking habit - a 10-year follow-up of a non-surgical approach: a combination of behavioural and myofunctional therapy.

OBJECTIVE: Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention. MATERIAL AND METHODS: 56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space. RESULT: The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment. CONCLUSION: Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit.

Analyzing Oral Health Conditions in Sex Workers-A Comparative Retrospective Clinical and Radiographic Study.

This study highlights the oral health condition of female sex workers (SWs), who face increased risks associated with habits such as excessive alcohol and tobacco use. These behaviors heighten the likelihood of issues like oral cancer and dental diseases, underscoring the need for targeted health interventions. The study examines the oral health disparities between SWs and the general population (GP). A retrospective study analyzed the health records of 40 SWs and 40 controls matched by age and gender who were examined between 1 January 2020 and 30 May 2023. Intra-oral and panoramic radiographs, alongside clinical examination, were used to evaluate missing teeth, periodontal bone support, and caries. T-tests and chi-square tests were used to compare dental health indicators. A comparative analysis of these 80 patients revealed significant disparities: SWs had a higher incidence of missing teeth (5.8 ± 7.3 vs. 0.7 ± 1.4, p < 0.01) and caries (6.1 ± 6.2 vs. 0.8 ± 1.2, p < 0.05) compared to the GP. The DMFT (Decayed, Missing, and Filled Teeth) index was notably higher in SWs (16.1 ± 8.09) than in the GP (7.95 ± 5.48, p < 0.001). Additionally, 12% of SWs used removable dentures, unlike the GP. This study underscores significant oral health challenges in SWs, emphasizing the need for targeted healthcare strategies to improve their health conditions.

Guiding the practitioner through the caries management by risk assessment (CAMBRA) protocol.

In the past, the approach for treating caries was mainly symptomatic and involved removal of caries, teeth restoration, oral hygiene instructions, and fluoride applications in cases that presented with significant disease. As the bacterial component of the disease was revealed, questions emerged concerning the significance of each strain present and intervention in the process of caries development. This article reviews the evidence that supports the implementation of the current caries risk assessment and management protocol (CAMBRA). It details the current risk factors, techniques and devices for assessing them and, interventions that should be considered in order to address the risk. The paper defines specific guidelines for managing risks related to caries. Intervention should be customized according to the risk determined for each specific patient.

The effect of a surgeon's position on the axial inclination of dental implants placed freehand: a single-blind study.

OBJECTIVES: To examine whether a surgeons' position affects the axial angulation of dental implants placed freehand. METHOD AND MATERIALS: Implants' axial angulation was assessed on digital panoramic radiographs. An occlusal line was plotted based on the neighboring teeth/crowns. The mesial angle between the long axis of the implant and the occlusal line was measured. In addition, post-hoc ideal implant-positioning planning was done on the panoramic digital image, and the angle of the intersection between the long axis of the actual and post-hoc ideal implant was measured. Student t test for unpaired observations and the Kolmogorov-Smirnov nonparametric tests were utilized to compare the ipsi- and contralateral sides and between clinicians. RESULTS: Seventy-seven patients (149 implants) were eligible for the study. Implants had slight mesial inclination (mean 97.7 ± 8.7 degrees) which was similar for both the ipsi- (98.2 ± 8.4 degrees) and contralateral sides (97.2 ± 9.1 degrees), P = .491. For the post-hoc planning versus actual placement comparison, the overall median (interquartile range) of implant angular deviation was minimal (-0.25 degrees [-2.98, +3.47]). This was true for both the ipsilateral (-0.5 degrees [-2.9, +2.9]) and contralateral (-0.2 [-4.2, +5.4]) sides, P = .55. For the actual versus post-hoc planning, most observations clustered around the midline (zero to minimal deviation), while for the implant to occlusal plane angle, a tendency towards slight mesial angulation was observed. CONCLUSIONS: Dental implants placed freehand by experienced clinicians have only slight axial deviation as measured from post-hoc optimal position. Implants placed in ipsilateral and contralateral sides and by left- and right-dominant-hand clinicians had similar angulations.

The effect of software updates on the trueness and precision of intraoral scanners.

OBJECTIVES: The goal of the study was to determine the effects of software updates on the trueness and precision of digital impressions obtained with a variety of intraoral scanner (IOS) systems. METHOD AND MATERIALS: Seven IOS systems were investigated. Each system was tested using two versions of software, with the second version being the latest at the time of conducting the study. Scans were performed on a custom mandibular typodont model with natural teeth that were either unrestored or restored with amalgam, composite, lithium disilicate, zirconia, and gold. Eight scans were obtained for each software version on any of the tested IOS systems. Experimental IOS scans were compared against an industry-standard master scan of the typodont obtained with an ATOS Capsule scanner proven to have a trueness of 3 µm and a precision of 2 µm. Isolation of each substrate material on the digital experimental and master scans was achieved using the Geomagic metrology software for subsequent analysis of the substrate influence on accuracy. A generalized linear mixed model was used to determine the influence of the software version on the trueness and precision of the impression scan. RESULTS: For some IOS systems, scans made with older software versions differ in accuracy compared with those obtained with the most recent software versions. Trueness was improved for most scanners following the software update, although the Element2 IOS performance deteriorated. Software updates had lesser effects on precision and showed variable trends among different systems. Software updates also influence different substrate materials scans' accuracy, although the results show variability among IOS systems. When comparisons were done among IOS systems updated with the latest software version, best performers for complete arch trueness were the Emerald S, Trios 3, and Primescan systems. CONCLUSION: Software updates have a statistically significant effect on the trueness and precision of different IOS systems. These updates can have both positive and negative effects on scan accuracy, although it appears that these variations are within the clinical acceptability levels.

Evaluation of the accuracy of multiple digital impression systems on a fully edentulous maxilla.

OBJECTIVE: This study aimed to compare the accuracy performance of five different intraoral scanning systems for a full-arch scan on an edentulous cadaver maxilla. METHOD AND MATERIALS: Five digital intraoral impression systems were used to scan a fully edentulous cadaver maxilla. A master scan obtained with an ATOS Capsule industrial grade scanner provided the point of comparison. Experimental scans were compared to the master scan using a metrology software that allows images to be overlayed on one another and deviations interpreted. Once aligned, three comparisons were made between the experimental scans and the reference: the entire maxilla, the ridge area only, and the palate area only. RESULTS: Trueness deviations between the experimental scans and the master digital model were up to 0.1 mm in the 75th percentile. For the whole maxilla, only the Medit scanner had statistically significantly inferior trueness compared to other scanners. When only the palate was considered, Medit was significantly different from Element (P = .0025) and Trios 4 (P = .0040), with no differences found between other scanners. For the ridge region the results replicate the trend observed for the whole maxilla. In regard to precision, differences were found only in the whole maxilla and the ridge area. In both areas, only Medit's precision was significantly different compared to other scanners, with the exception of Element. However, Element performance was similar to all other scanners. CONCLUSION: Most intraoral scanners exhibited similar performance. Although several statistically significant differences were identified, the clinical impact of these variances is probably not meaningful. (Quintessence Int 2021;52:488-495; doi: 10.3290/j.qi.b1244373).

Emergency department visits at Rambam health care campus, Israel: non-trauma related dental conditions.

OBJECTIVES: Studies of emergency department (ED) visits for non-traumatic dental conditions (NTDCs) have been carried out in the USA and Canada. In Israel, there is a shortage of such studies. In the current retrospective study, we report on the frequency and distribution of NTDCs ED visits at Rambam Health Care Campus (Rambam), in Haifa, which is an academic hospital serving more than 2.4 million residents of Northern Israel. MATERIALS AND METHODS: The data concerning ED visits at Rambam between 2010 and 2017 were obtained retrospectively from Rambam's computerized clinical and personal database of adult patients (≥18 years) visiting the ED for NTDCs. RESULTS: Overall, 1.8% of the patients who visited the Rambam ED, were identified as presenting with NTDCs. From 2010 until 2017, the number of NTDCs admissions increased by 45%, while the total ED admissions rose by 16%. The average waiting time for maxillofacial consultations for patients with NTDCs increased from 102 min in 2010 to 138 min in 2017. The busiest hours in the ED for NTDCs were during the morning shifts (47% of daily visits). CONCLUSIONS: The results of the study show that systemic and conceptual changes are needed to reduce the number of non-trauma related applications to ED.These changes can be by increasing the number of personnel or by introducing recent advances such as tele-medicine for prescreening of patients. This change calls for a greater involvement of the health policy leaders to provide alternative solutions for emergency dental care.

Flexural strength of minimum thickness ceramic veneers manufactured with different techniques.

OBJECTIVE: The objective of the present study was to assess the effect of monolithic and bilayer restorations considering heat-pressed and milled/CAD/CAM reinforced lithium disilicate ceramic veneers, on the flexural strength after cementation. METHOD AND MATERIALS: Thirty-five specimens were divided into five groups (n = 7), according to the restorative solution: 2-mm thickness composite resin (CR2); heat-pressed monolithic ceramic 0.6 mm (HPM), CAD/CAM monolithic ceramics 0.6 mm (CCM); heat-pressed monolithic ceramic 0.4 mm + 0.2 mm glass-ceramic (HPB); CAD/CAM monolithic ceramic 0.4 mm + 0.2 glass-ceramic (CCB). Specimens were cemented on composite resin bars and submitted to a three-point bending test on a Universal Testing Machine, until fracture. Fractured samples were analyzed under stereomicroscope and SEM. Flexural strength data were analyzed by one-way ANOVA and Tukey test. RESULTS: The control group showed the highest flexural strength results (119.57 ± 19.49 MPa), with values similar to groups HPM (98 ± 25.62 MPa) and CCM (96.14 ± 20.60 MPa). Groups HPB and CCB showed lower values when compared with the other groups. Fracture started from the base on monolithic groups and from ceramic on bilayer groups. CONCLUSION: Both ceramic systems (CAD/CAM and heat-pressed) have similar fracture strength, although bilayer restorations present lower strength when compared with monolithic ceramics.

A nouveau collagen scaffold to simplify lateral augmentation of deficient ridges between natural teeth.

The volume of the bone in a site past an extraction degrades significantly and thus it is imperative to evaluate the situation for implant placement. Besides the need for sufficient bone, the amount and quality of the soft tissue covering the bone in the missing tooth area and nature of the adjacent teeth must be carefully assessed. In anterior sites, reconstructive surgery is usually performed to restore these hard and soft tissues, mainly for esthetic reasons, but it is equally essential in posterior sites to ensure adequate functional support. In guided bone regeneration procedures, barrier membranes block the augmented areas, provide and maintain space for regenerative material, and protect the blood clot, allowing a normal wound stability process. Clinicians prefer using resorbable membranes in most cases, whereas a nonresorbable membrane is selected to correct large defects. This report proposes the use of a collagen scaffold as a core material for guided bone regeneration in the case of a missing tooth between two existing teeth, when there is sufficient bone to place an implant but a horizontal defect is present in the crestal ridge. The tested question is whether a thick, reinforced, resorbable collagen scaffold (Ossix Volumax) can provide a stable basis for restoring the lost volume of a deficient ridge. The regeneration procedure presented with the collagen scaffold resulted in restoration of the lost tissue volume and a favorable lifelike emergence profile for the implant-supported crown. This augmentation procedure is simpler to perform in certain cases than existing procedures with bone substitute material and/or an interpositional connective tissue graft harvested from a remote donor site, the harvest of which is not required.

Surgical treatment of unilateral severe overeruption and opposing alveolar atrophy.

Overeruption with simultaneous alveolar deficiency is not uncommon but very difficult to treat. In mild cases of overeruption without opposing alveolar deficiency, selective removal of enamel from the overerupted teeth may be an option, yet not advocated. Extraction of the overerupted teeth should be avoided if the teeth are intact with sufficient bone support. The Schuchardt operation is a good option for cases limited to the overeruption. In cases of overeruption with simultaneous opposed alveolar deficiency, it is suggested to perform simultaneous maxillary and mandibular surgical procedures: alveolar segmental operation, followed by a sandwich osteotomy on the opposing arch. This article presents a posterior segmental osteotomy in the maxilla and a simultaneous sandwich procedure in the mandible utilizing the bone graft removed from the maxilla. The results showed good functional and esthetic outcomes. This method preserves the native teeth. It also utilizes an autogenous bone graft that is harvested regardless of the interpositional graft and spares a second surgical site. In addition, it allows for a one-stage procedure which enables for both treatment of the overeruption and augmentation of the opposing arch.

Orthodontic extraction space closure with and without socket preservation: a comparative case analysis.

Preorthodontic socket preservation after tooth extraction is intended to enhance favorable dentoalveolar ridge morphology and architecture, and facilitate orthodontic tooth movement (OTM) and extraction space closure. This 13-year-old skeletal Class II case presents a unique opportunity to evaluate and compare the OTM extraction space closure by means of a split-mouth analysis in a single patient. The comprehensive orthodontic-periodontal treatment included nonsimultaneous extraction of the bilateral periodontally compromised mandibular first molars and the eruption of bilateral impacted mandibular canines. While the right post-extraction space underwent a natural healing process, the left one was grafted using 4BONE BCH (hydroxyapatite ß-tricalcium phosphate [HA-ß-TCP], HA 60%, and ß-TCP 40%). The 3-year multidisciplinary treatment approach resulted in Class I relationships on the right side and Class II on the left side, improved facial appearance, and dento-skeletal jaw relationships. However, a 3-mm residual alveolar space remained unclosed on the grafted left-site, along with an unerupted left third molar. This split-mouth comparative analysis of the orthodontic space closure demonstrated a significant clinical difference in the outcome. Preorthodontic placement of HA-ß-TCP grafting material on the left segment, proved to be an obstacle for OTM extraction space closure, hindering the establishment of good occlusion.

Use of transforming growth factor-ß loaded onto ß-tricalcium phosphate scaffold in a bone regeneration rat calvaria model.

BACKGROUND: Transforming growth factor-ß (TGF-ß1 ) enhances mesenchymal stem cell (MSC) differentiation into osteoblasts. PURPOSE: The aim of the study was to assess whether TGF-ß1 loaded onto ß-tricalcium phosphate (ß-TCP) synthetic scaffold enhances bone regeneration in a rat calvaria model. The release kinetics of TGF-ß1 from ß-TCP scaffold was evaluated in vitro. MATERIALS AND METHODS: TGF-ß1 in various concentrations (1-40 ng/mL) was loaded onto the ß-TCP scaffold, and release kinetics was monitored by ELISA. The effect of TGF-ß1 on the proliferation of MSCs was assessed using AlamarBlue, and MSC differentiation was evaluated by Alizarin Red quantification assay.Bone augmentation following transplantation of TGF-ß1 loaded onto ß-TCP in a rat calvaria model was evaluated in vivo. RESULTS: Greater TGF-ß1 release from the 40 ng/mL concentration was found. A suppressive effect of TGF-ß on the MSCs proliferation was observed with maximum inhibition obtained with 40 ng/mL compared to the control group (P = .028). A positive effect on MSCs osteogenic differentiation was found.Bone height and bone area fraction in vivo were similar with or without TGF-ß1 ; however, blood vessel density and degradation of the scaffold were significantly higher in the TGF-ß1 group. CONCLUSION: TGF-ß1 adsorbed to ß-TCP stimulated angiogenesis and scaffold degradation that may enhance bone formation.

Dimensional changes in the sinus membrane following maxillary sinus augmentation.

OBJECTIVE: The aim of this retrospective study was to measure the sinus membrane's dimensional changes following maxillary sinus augmentation via a lateral approach, and to examine the variables affecting changes in the membrane's thickness. METHOD AND MATERIALS: Sixty-six sinuses corresponding to 50 patients (15 males and 35 females) who underwent lateral wall maxillary sinus augmentation (34 unilateral and 16 bilateral) were retrospectively evaluated. The sinus membrane thickness was measured on cross-sectional cone beam computed tomography (CBCT) scans which were performed prior to and 9 to 11 months' post maxillary sinus augmentation. The Wilcoxon signed-rank test and the Mann Whitney U test were both used to compare between baseline and postoperative sinus membrane thickness. Pearson correlation tests were used to analyze correlations between graft height and sinus membrane thickness changes. RESULTS: The mean age was 53 ± 4 years (45 to 71 years). A total of 132 CBCT scans were analyzed pre- and postoperatively (n = 66). The mean thickness of the sinus membrane before the procedure was 2.61 ± 3.61 mm, while the mean thickness of the membrane after the procedure was 2.94 ± 3.51 (P > .20). Thin membranes at baseline (< 1.56 mm) thickened by a mean of 2.21 ± 2.34 mm, range -0.413 to 10.62 mm, (P < .0001); thicker membranes (≥ 1.56 mm) lost 1.46 ± 3.96 mm thickness, range -7.8 to 9.31 mm (P < .0001). A moderate negative correlation between the baseline membrane thickness and change in thickness was observed (P < .0001, r = -.52). No correlation was found between the graft height and changes in the sinus membrane thickness. CONCLUSION: Lateral wall maxillary sinus augmentation seems to affect the sinus membrane thickness. These changes are associated with the preoperative thickness of the membrane.

CAD/CAM diamond tool wear.

OBJECTIVE: This study evaluated the wear of computer-aided design/computer-assisted manufacture (CAD/CAM) burs and the morphologic changes after a number of millings. METHOD AND MATERIALS: Diamond burs (cylinder and step-bur) were divided into four milling groups: zero millings (G0); 15 millings (G1); 25 millings (G2); and 35 millings (G3). Seventy-five premolar crowns were milled using the Cerec Compact Milling unit and VitaBlock Mark II. Surface roughness, three-dimensional profile, and SEM were used for wear and surface damage evaluation. RESULTS: Two-way ANOVA and Tukey test (α = .05) showed that G3 produced statistically different values compared to G0 and G2, but not G1. The cylinder burs showed higher roughness values than step-burs for all groups. SEM showed similar diamond particle damage for cylinder burs and step-burs, and signs of surface damage, cracks, and particle losses for G3. CONCLUSION: Both cylinder burs and step-burs were able to sustain a larger number of milling procedures than indicated by the manufacturer.

Dental implants for immediate fixed restoration of partially edentulous patients: a 1-year prospective pilot clinical trial in periodontally susceptible patients.

BACKGROUND: The aim of this study was to evaluate the survival of dental implants in periodontally susceptible patients using immediate loading/restoration (ILR) protocols and the factors that modulate this response. METHODS: Systemically healthy patients who were treated previously for chronic periodontitis and who required implant therapy were recruited. Following data collection, "surgical templates" and provisional fixed restorations were fabricated. Transgingival implants were inserted, and surgical measurements were performed. After abutment connection, the crown/bridge was relined and cemented. Patients were monitored for 12 months, at which time final measurements were performed. RESULTS: Twenty patients (49 implants) completed this study; five implants failed and were removed (90% survival rate). All implants were removed during the first 6 months. At 12 months, the mean implants' probing depth was 2.87 +/- 0.9 mm. The mean electronic mobility testing device value (-1.3 +/- 0.7) was slightly higher than at baseline (-3.53 +/- 10.7). Radiographic bone loss ranged between -1.24 and 2.77 mm (mean +/- SD: 0.91 +/- 0.2 mm). All of the implants (16) that were inserted in the premolar region were successful, whereas three of nine implants in the molar region and two of 24 implants in the canine/incisor region failed (P = 0.0278). Survival in the immediately loaded group (83%) was slightly lower than in the immediately restored group (96%); however, these differences did not reach statistical significance. None of the other variables (smoking, arch, stability, implant length and diameter, and bone width) affected the outcome of this procedure. CONCLUSIONS: ILR protocols are predictable alternatives in periodontally susceptible patients. Results in the molar regions suggested that careful consideration should be given to implants placed in these sites. Long-term success in these patients has not been addressed.

Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis.

AIM: Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph. SUMMARY: This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e., a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture. A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.

A comparative study on the use of digital panoramic and periapical radiographs to assess proximal bone height around dental implants.

OBJECTIVE: The purpose of this study was to compare periapical radiographs (PA) and panoramic radiographs (PAN) in the measurement of proximal bone height around implants. METHOD AND MATERIALS: Patients files that contained digital PAN and PA together with information on implant lengths and diameters were selected for this study. For each radiograph, the implant size served as reference for calibration. Proximal radiographic bone levels and the linear distance between the bone crest and implant shoulder were measured twice by one examiner. Paired t test was used to assess intra-examiner variability and differences between the two radiographic methods. Correlation was then assessed using Pearson correlation coefficient test. Significance level was determined at 5%. RESULTS: For the PAN measurements, the median mesial distances from bone crest to implant shoulder were 0.53 and 0.56 mm (first and second sets, P = .53). Likewise, for distal measurements these readings were 0.92 and 0.86 mm respectively (P = .66). For PA measurements, the corresponding measurements were 0.33 and 0.44 mm (P = .48) and 0.99 and 0.99 mm (P = .42), respectively. When PAN and PA measurements were compared, no statistically significant differences were detected between the two radiographic modalities. A very high positive correlation (r > 0.91) was attained for the PAN - PA measurements (P < .0001). CONCLUSION: PAN are potentially as reliable and reproducible as PA for the assessment of proximal bone height around dental implants.