Custom allogeneic block graft for ridge augmentation: Case series.

INTRODUCTION: Alveolar bone deficiency is a common postextraction sequela that adversely affects implant placement. Therefore, ridge augmentation is often required to obtain proper bone quantity and quality for restoratively driven implant placement. This case series describes the successful horizontal and vertical alveolar ridge augmentation using custom-fabricated allogeneic block bone grafts. CASE SERIES: Two healthy partially edentulous patients presented to private practice seeking dental implant treatment. Initial clinical examination and cone-beam computed tomography (CBCT) radiographic analysis showed moderate to large horizontal ridge defects. Treatment options were discussed for alveolar ridge augmentation and the patients elected to undergo the custom allogeneic block graft procedure to regenerate the atrophied alveolar ridges. The CBCT scan in conjunction with computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to fabricate customized allogeneic block grafts based on alveolar ridge topography. The custom allogeneic block graft allowed less surgical time and decreased postoperative morbidity. The grafted area was allowed 6 months of healing time. Follow-up radiographs showed the stability of the graft followed by dental implant placement. The dental implants were functionally loaded, and successful implant esthetics and function achieved. CONCLUSION: Custom allogeneic block grafts could provide a promising innovative method for optimal ridge augmentation. Why are these cases new information? Less invasive procedure as an alternative conventional two-stage block augmentation. More predictable outcome due to customized block graft. What are the keys to successful management of these cases? It is important determining the type of bone defect. Vertical and horizontal bone loss. Primary closure. What are the primary limitations to success in these cases? Limited data from prospective clinical trials documenting the effectiveness of custom allogeneic block grafts. Limited data are available to confirm accuracy of the CAD/CAM process. Passive flap closure is needed.

Management of a Periodontal Patient With Dermatomyositis: A Case Report.

INTRODUCTION: Dermatomyositis is an uncommon inflammatory disease marked by muscle and joint weakness with skin rash. Dermatomyositis affects adults and children, with higher prevalence for females aged 40 to 60 years. Most common oral lesions include mucosal edema, erythema, and telangiectasia. CASE PRESENTATION: A 51-year-old white female with an unremarkable medical history presented for periodontal evaluation in 2010. She reported a 6-month history of gingival inflammation and skin irritation on her hands and a rash on the center of her chest and forehead. Other complaints included fatigue, hot flashes, decreased appetite, and weight loss. Periodontal examination revealed generalized acute marginal erythema, with localized slight incipient bone loss. Oral hygiene was deemed good to fair. Oral hygiene instructions were reviewed and a prescription for chlorhexidine gluconate was given. The patient was then referred to an allergist and dermatologist where a diagnosis of dermatomyositis was made. After the initial diagnosis, localized scaling and root planing was performed using local anesthetic. The patient was managed medically using prednisone, mycophenolate mofetil, and methotrexate and a 3-month periodontal maintenance recall interval. The patient remained stable over an 8-year period. CONCLUSIONS: Dermatomyositis is an uncommon inflammatory disease that requires medical and dental teams for proper diagnosis and management. Although the condition is chronic in nature with no definitive cure, signs, and symptoms can be managed with steroids and immunosuppressants to delay progression of the disease and improve quality of life for the patient.

Latinx Undocumented Older Adults, Health Needs and Access to Healthcare.

An estimated 10.5 million undocumented immigrants reside in the U.S.; 10% are 55 and older. Undocumented older adults do not qualify for Medicaid or Social Security benefits even though many pay taxes. The study examines undocumented older adults' perceptions on their health status and their experiences in accessing health care. In-depth semi-structured interviews were used to facilitate dialogue with undocumented older adults (N = 30) ages 55-63 (M = 61.67, SD = 5.50). Most of the participants were Mexican (n = 26, 87%) and had lived in the U.S. on average 21 years (SD = 8.78). A constant comparative approach was used while completing initial, focused, and axial coding. Participants were classified into a five-group typology that captures the intersection of perceived health status/need and access to health care; (1) High need, with access to care; (2) High need, with ambiguous access; (3) Undiagnosed need, with no access; (4) Perceived healthy status, with no access; (5) Healthy status, with access to care. Participants who reported high health needs experienced a range of chronic and degenerative health conditions. Participants accessed care by paying-out-of-pocket (between $100 and 300/visit for consultation, lab work, and medications). High need participants with ambiguous access have been able to access care through permanently residing under color of law status or Medically Indigent Services Programs; access is uncertain given their undocumented status and changes in policies. Participants faced multiple barriers to accessing health care-mainly high cost and documentation status. Limited access to care leads to several detrimental consequences such as debilitated health, emotional burden, and economic insecurity. Older undocumented adults are a vulnerable population that experience great health needs. The high cost for health care and limited access to care takes a toll on undocumented older adults. The findings highlight many opportunities for policy advocacy and practice with older undocumented adults.