Day Care Surgery for Unilateral Alveolar Bone Grafting of Residual Clefts With Mandibular Symphyseal Bone-A Prospective Questionnaire Study.

OBJECTIVE: To evaluate patients' experiences of shortened hospitalization in relation to bone grafting of unilateral alveolar clefts with mandibular symphyseal bone grafts. DESIGN: Prospective cohort questionnaire study. SETTING: Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark. PATIENTS: Thirty-nine (male n = 26, female n = 13) patients with unilateral residual clefts after primary reconstruction, mean age 10.4 years. INTERVENTIONS: All patients underwent a standardized procedure with closure of the alveolar defect using mandibular symphyseal bone grafts. Patients were discharged within a day after surgery. Within 24 hours after discharge from surgery, patients and their parents filled in a 14-item psychometric questionnaire assessing the quality of their recovery. For all questions, a visual analogue scale (VAS) (0-10) was used. MAIN OUTCOME MEASURE: Patients' experience of shortened hospitalization in relation to secondary bone grafting of alveolar defects. Factors influencing the overall experience were measured using a VAS scale. RESULTS: A significant correlation between "Information from the hospital" and feeling worried and anxious was found (P = .04). Additionally, the ability to sleep correlated with pain (P = .003) and with nausea (P = .001). CONCLUSIONS: Although this study included a limited number of patients, the findings suggest that treatment of alveolar residual cleft with bone grafting from the mandibular symphyseal region in a day care surgery setting is characterized by very high patient satisfaction.

A clinical and radiographic study of implants placed in autogenous bone grafts covered by either a platelet-rich fibrin membrane or deproteinised bovine bone mineral and a collagen membrane: a pilot randomised controlled clinical trial with a 2-year follow-up.

PURPOSE: To compare the survival and clinical performance of implants placed in sites previously augmented with autogenous bone grafts covered by either a platelet-rich fibrin (PRF) membrane (PRF group) or a standard procedure (gold standard) involving coverage of the autogenous bone graft with deproteinised bovine bone mineral and a resorbable collagen membrane (control group). METHODS: A total of 27 partially edentulous patients (test n = 14, control n = 13) with indication for staged lateral bone block augmentation and dental implant placement were included. Twenty-four months after crown placement (range: 14-32 months), patients were recalled for a final clinical and radiographic follow-up. Outcome measures were implant survival, implant crown survival, clinical parameters of the implant, peri-implant marginal bone level, marginal bone level of adjacent tooth surfaces, biological and technical complications and patient-related outcome measures. RESULTS: Two implants were lost in the control group (85% survival rate); none were lost in the PRF group (100% survival rate). None of the 26 initially placed implant crowns were lost, but one implant and therefore one implant crown were lost after 20 months. Consequently, the definitive implant crown survival was 92% (95% confidence interval (CI): 73-110%) in the control group and 100% in the PRF group. No statistical difference in implant survival rate (p = 0.13) or implant crown survival was seen between the groups (p = 0.28). The mean marginal bone level at the follow-up was 0.26 mm (95% CI: 0.01-0.50 mm) in the PRF group and 0.68 mm (95% CI: 0.41-0.96 mm) in the control group. The difference between the groups was - 0.43 mm (95% CI: - 0.80 to - 0.05 mm, p = 0.03), which was statistically significant (p = 0.03). Both groups demonstrated similar healthy peri-implant soft tissue values at the final follow-up. CONCLUSION: Although the current study is based on a small sample of participants, the findings suggest that the methodology of the PRF and the control group approach can both be used for bone augmentation with a similar outcome. A significant, but clinically irrelevant, higher peri-implant marginal bone level was registered in the PRF group than in the control group. Patients in both groups were highly satisfied with the treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04350749 . Registered 17 April 2020. Retrospectively registered.

Histology of augmented autogenous bone covered by a platelet-rich fibrin membrane or deproteinized bovine bone mineral and a collagen membrane: A pilot randomized controlled trial.

OBJECTIVES: This study aimed to evaluate histologic and histomorphometric bone characteristics with a focus on vitality after lateral alveolar ridge augmentation using an autogenous bone graft as a block covered by either a platelet-rich fibrin (PRF) membrane (test group) or a standard procedure involving coverage of the bone block with a deproteinized bovine bone mineral and a resorbable collagen membrane (control group). MATERIAL AND METHODS: A total of 27 (test = 14, control = 13) partially edentulous patients with indication for bone block augmentation before implant installation were included. For analyses, a biopsy of augmented bone was retrieved six months after bone grafting. RESULTS: Histologic evaluation of augmented bone revealed a predominance of non-vital bone toward the periosteum and few localized areas of vital bone in the center of the graft in both groups. In contrast, augmented bone toward the native bone demonstrated extensive bone remodeling in both groups. Histomorphometric analyses demonstrated a mean of 14% vital bone, 80% non-vital bone, 5% soft tissue, and 1% blood vessels in the test group. In the control group, the corresponding shares were 14% vital bone, 63% non-vital bone, 22% soft tissue, and 1% blood vessels. We observed no significant differences between the groups (p > .05). CONCLUSION: In conclusion, a comparable low bone vitality of augmented bone was observed in the PRF and in the control group. Consequently, the present study could not verify the potential beneficial effect of a PRF membrane on bone vitality of an autogenous bone graft used as a block.

Cone beam computed tomography evaluation of staged lateral ridge augmentation using platelet-rich fibrin or resorbable collagen membranes in a randomized controlled clinical trial.

OBJECTIVES: To evaluate the volumetric changes following lateral alveolar ridge augmentation using autogenous bone graft covered by either a platelet-rich fibrin membrane (test group) or an inorganic bovine bone substitute and a resorbable collagen barrier membrane (control group). MATERIAL AND METHODS: A total of 27 partially edentulous patients (test n = 14, control n = 13) with the indication for lateral bone block augmentation were included in this randomized, controlled clinical trial. Cone beam computed tomography (CBCT) examination was performed prior to grafting and 2 weeks and 6 months after grafting. The volumetric changes between the various examinations times were evaluated by planimetric measurements on two-dimensional CBCT images of the grafted regions. RESULTS: The mean bone volumetric loss in the test group was 14.7%, SD ±8.9%, while the mean bone volume loss in the control group was 17.8%, SD ±13.3%. This difference was not significant (p = 0.48). A total of ten patients were operated in the incisor and canine region with a mean bone volume loss of 23.41% SD, ±10.87%, while 17 patients were operated in the premolar region with a mean bone volume loss of 11.89% SD ±9.05%. This difference was significant (p = 0.01). CONCLUSION: The test and control group demonstrated no overall difference in volumetric bone changes of the augmented bone at the 6-month follow-up. The second major finding revealed a significantly larger amount of bone resorption in the incisor and canine region than in the premolar region of the maxilla, particularly in the control group.

Multidisciplinary Treatment Intervention in 24 Patients with Oligodontia: A Case-Cohort Study.

PURPOSE: To characterize the multidisciplinary treatment intervention for patients with nonsyndromic oligodontia, focusing on both the preprosthodontic intervention and the type of prosthodontic and functional occlusal units at the end of treatment. MATERIALS AND METHODS: A retrospective study on the multidisciplinary treatment of 24 patients with agenesis of 8 to 22 (median 15) permanent teeth was carried out by reviewing the patients' medical records, preprosthodontic surgical and orthodontic procedures, and the final dental and prosthodontic status. RESULTS: A total of 23 patients underwent orthodontic treatment, and one-third of them had additional orthognathic surgery. Presurgical intervention involved bone augmentation in 20 patients and insertion of 2 to 16 implants per patient (median 8). The number of implants was positively correlated with the number of missing teeth (P = .004). At the end of treatment, the number of functional occlusal units ranged from 20 to 28 (median 24). A single-tooth crown was mounted on 167 implants, 32 implants were part of a fixed partial denture, and 29 fixed partial dentures were tooth-borne. CONCLUSION: The treatment of patients with severe oligodontia is comprehensive and complex. Irrespective of the number of congenitally missing teeth, the final functional occlusion consisted of a minimum of 20 units, which in addition to permanent teeth included preserved deciduous teeth, implants, and fixed partial dentures.

Comparative Study of Skeletal Stability between Postoperative Skeletal Intermaxillary Fixation and No Skeletal Fixation after Bilateral Sagittal Split Ramus Osteotomy: an 18 Months Retrospective Study.

OBJECTIVES: The purpose of the present study was to evaluate skeletal stability after mandibular advancement with bilateral sagittal split osteotomy. MATERIAL AND METHODS: Twenty-six patients underwent single-jaw bilateral sagittal split osteotomy (BSSO) to correct skeletal Class II malocclusion. One group (n = 13) were treated postoperatively with skeletal elastic intermaxillary fixation (IMF) while the other group (n = 13) where threated without skeletal elastic IMF. RESULTS: The mean advancement at B-point and Pog in the skeletal elastic IMF group was 6.44 mm and 7.22 mm, respectively. Relapse at follow-up at B-point was -0.74 mm and -0.29 mm at Pog. The mean advancement at B-point and Pog in the no skeletal elastic IMF group was 6.30 mm and 6.45 mm, respectively. Relapse at follow-up at B-point was -0.97 mm and -0.86 mm at Pog. There was no statistical significant (P > 0.05) difference between the skeletal IMF group and the no skeletal group regarding advancement nor relapse at B-point or Pog. CONCLUSIONS: Bilateral sagittal split osteotomy is characterized as a stable treatment to correct Class II malocclusion. This study demonstrated no difference of relapse between the skeletal intermaxillary fixation group and the no skeletal intermaxillary fixation group. Because of selection-bias and the reduced number of patients it still remains inconclusive whether to recommend skeletal intermaxillary fixation or not in the prevention of relapse after mandibular advancement.

Patient satisfaction and esthetic outcome after immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment.

OBJECTIVES: To assess patient satisfaction and esthetic outcome after immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment and a provisional crown followed by later placement of a definitive crown. MATERIALS AND METHODS: In private practice, a single-tooth implant was placed immediately after tooth extraction in the esthetic zone of 54 patients. A definitive individual abutment and a provisional crown were mounted in the same visit. The definitive crown was placed after a mean period of 7 months. After a mean follow-up period of 33 months, the subjective and professional evaluation of the total implant treatment, peri-implant soft tissues, and implant crown were assessed on a 10-cm visual analog scale (VAS). The professional esthetic treatment outcome was also evaluated using pink esthetic score (PES), white esthetic score (WES), and total score of PES/WES. RESULTS: The evaluation of total implant treatment, peri-implant soft tissues, and implant crown demonstrated a significantly higher subjective than professional score for all 3 parameters (P < 0.001), for example, for the overall treatment, the mean scores were 9.4 and 7.0, respectively. A significant positive correlation was revealed between the professional VAS scores and the PESs and WESs. CONCLUSIONS: Immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment and provisional crown followed by later placement of a definitive crown demonstrated high subjective and professional satisfaction. Generally, the professionals seem to be more critical than the patients. A strong correlation was observed between the professional VAS scores and the PES and WES scoring systems.

Immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment: a clinical and radiographic retrospective study.

AIM: To assess with a mean follow-up period of 33 months (median: 31 month, range: 11-89 month) the treatment outcome after immediate placement and provisionalization of single-tooth oral implants involving a definitive individual abutment and a provisional crown followed by later placement of a definitive crown. MATERIALS AND METHODS: 68 patients with 68 single-tooth implants in the esthetic zone were consecutively treated; 55 of these patients were included in the study. The treatment involved tooth extraction, implant placement, placement of a definitive individual abutment, and a provisional crown in the same visit in private practice. The definitive crown was placed after a mean period of 7 months. The primary outcome measures included implant survival, definitive implant crown survival, and overall treatment survival. The secondary outcome measures included probing depth, bleeding on probing, peri-implant marginal bone level, marginal bone level of the neighboring tooth surfaces, biological complications, and technical complications. RESULTS: Of the inserted implants 98% survived and of the definitive crowns mounted a survival of 100% was observed. Consequently, the overall treatment survival was 98%. The mean probing depth was 2.9 mm at implant level and 63% of the implants were characterized by no bleeding on probing. The mean peri-implant marginal bone level was 2 mm. A significant mean peri-implant marginal bone level gain of 0.5 mm was observed from implant placement to the follow-up (95% CI: 0.07-0.89 mm, P = 0.022). No significant changes of the marginal bone level at the neighboring tooth surfaces were seen. Four episodes of peri-implant inflammation were identified in three patients, while 46 incidents of loosening of the provisional crown occurred in 33 patients. One abutment screw loosened before placement of the definitive crown. Finally, loosening of four definitive crowns occurred in four patients. CONCLUSIONS: Immediate placement and provisionalization of single-tooth oral implants involving a definitive individual abutment and a provisional crown followed by later placement of a definitive crown were characterized by high survival of the implant crowns and implants as well as healthy peri-implant tissues, after a mean follow-up period of 33 months. Loss of retention of the provisional crown occurred frequently.