Three-dimensional digital planning of class III decompensation with clear aligners: Hard and soft tissue augmentation with concomitant corticotomy to stretch the limits of safe orthodontic treatment.

PURPOSE: Three-dimensional diagnosis has shown that orthodontic therapy could potentially move the roots of the teeth outside the original bone structure. The purpose of these case studies was to test the possibility of obtaining correct three-dimensional tooth positioning with clear aligners, thereby modifying the periodontal structure accordingly, at the same time. METHODS: Regenerative Corticotomy (RC) was performed with clear aligners on ten adult patients (40 anterior teeth) with skeletal Class III malocclusion, for dental decompensation, prior to the orthognathic surgery. The CBCT examinations were performed before treatment (T0) and 1 year after orthognathic surgery (T1). The vertical and the horizontal hard tissue changes, the width of keratinized gingiva, the incisors proclination (IMPA) and the percentage of inclination compared to the planning were analyzed. RESULTS: The distance between the Cemento-Enamel Junction (CEJ) and the Bone Marginal Level (BML) decreased in average from 5.5 â€‹± â€‹3.2 â€‹mm to 1.39 â€‹± â€‹0.53 â€‹mm. The horizontal changes were at the 3 â€‹mm level 1.42 â€‹± â€‹0.5 â€‹mm, at the 5 â€‹mm level 1.98 â€‹± â€‹0.66 â€‹mm and at the 7 â€‹mm level 2.70 â€‹± â€‹0.87 â€‹mm. The width of Keratinized gingiva changes were on average 1.42 â€‹± â€‹0.36 â€‹at T0 and 4.16 â€‹± â€‹2.25 â€‹at T1. All the changes were statistically significant with p â€‹< â€‹0,05. The mean proclination based on IMPA values was +9.16 +-1.19°. The mean difference of the incisor's proclination compared to the digitally planned was -1 +-0.6° (89.87 +- 6.46%). CONCLUSION: Clear Aligners with three-dimensional digital planning seems to be reliable in controlling teeth movements in the pre-orthognathic decompensation phase. Regenerative Corticotomy seems to have the ability to improve the periodontal tissues despite proclination.

Regenerative Orthodontics: GBR and Corticotomy to Stretch the Limits of Orthodontic Treatment.

Orthodontic therapy could lead to marginal bone resorption in cases where the teeth are moved outside the envelope of bone. The purpose of this case series was to test corticotomy with a guided bone regeneration (GBR) procedure to regenerate bone in the direction of movement outside the original bony housing. Ten adult patients (60 anterior teeth), all presenting with severe anterior crowding, were enrolled in the study. Orthodontic therapy in all investigated sites was associated with selective surgical corticotomies and a simultaneous GBR procedure. CBCT examinations were performed before starting orthodontic treatment (T0) and at the end of treatment (T1; mean: 7 months; range: 6 to 9 months). Pre- and postoperative CBCTs were superimposed with a DICOM viewer (3D Slicer) and studied with an image-processing software (ImageJ, National Institutes of Health) to measure the area of interest of the buccal plate. The average area was found to be 0.58 ± 0.22 mm2 at T0 and 1.76 ± 0.4 mm2 at T1, with a statistically significant difference (P < .05). The combination of corticotomy and a regenerative procedure seems to have the ability to augment the original osseous anatomy when the root is moved outside of the original bony envelope.

Tunnel Regenerative Corticotomy (TURC): A modified approach in surgically-assisted orthodontics.

We present a modified surgical technique which encompasses a combination of surgically-assisted accelerated orthodontics and guided bone regeneration for combined surgical and orthodontic management of dental crowding and maxillary transverse deficiency malocclusions with minimally invasive surgery, in a rapid manner, and without the use of general anesthesia.

Surgery First and Invisalign System: Combined Digital Approach.

PURPOSE: The aim of the present paper is to verify the long-term results in dental and skeletal stability in terms of symmetry, occlusion and functional balance by the association between the IS and the SF technique. METHODS: In this paper, the authors described 12 cases of severe class III malocclusion treated by the association between the IS and the SF technique. RESULTS: At 1 year of post-orthodontic follow up, the patients present an Angle class I occlusal relationship, no deep bite, no scissor or cross-bite and no open bite. No one patient referred TMJ discomfort nor severe post-surgical complications and no surgical-orthodontic relapse occurred. The surgical and occlusal results are stable in terms of stability in all patients. CONCLUSION: The results of this study suggest the validity of our protocol in management of class III malocclusion patients.

Buccal Plate Preservation with Immediate Implant Placement and Provisionalization: 5-Year Follow-Up Outcomes.

PURPOSE: Despite socket preservation and/or immediate implant placement, resorption of the buccal plate after dental extraction continues to pose esthetic challenges to clinicians. Buccal plate preservation (BPP) is a technique that has been recently proposed with an aim to reduce the incidence of such resorption. This study was conducted to assess the long-term efficacy of BPP in maintaining the thickness of the buccal cortical plate after immediate implant insertion and provisionalization. MATERIALS AND METHODS: Ten consecutive patients were included in this study. Each patient underwent extraction of a non-restorable tooth, BPPPBPP, single immediate implant placement and immediate provisionalization. Cone beam CT scans were taken 3 months after surgery (T1) and 5 years after surgery (T2) to evaluate the effectiveness and longevity of the BPPPBPP technique in maintaining the augmented bone width. Two distinct measurements were taken for bone evaluation: (a) R1: 1 mm apical to the implant platform and (b) R2: 5 mm apical to the implant platform. The long axis of the implant was used as a fixed reference. Statistical test analysis was conducted using the SPSS software. Student's t test was used to assess statistical significance, and a p value of < 0.05 was considered significant. RESULTS: There were six females and four males in the study. The mean age of the sample was 37.6 years (range 23-64 years). At T1, the mean bone thickness of the buccal plate was found to be 2.36 mm at R1 (range: 1.9-3.1), and 2.23 at R2 (range: 1.9-3). At the T2 interval, the mean thickness of the plate was 2.28 mm at R1 (range: 1.7-3) and 2.18 at R2 (range: 1.9-3). The differences in these mean values were not statistically significant. CONCLUSIONS: BPPPBPP is an effective means for augmentation and maintenance of the buccal cortical plate around an immediately placed and provisionalized dental implant. It is a viable alternative to socket preservation with the added benefit that it allows for immediate implant placement.

Can corticotomy (with or without bone grafting) expand the limits of safe orthodontic therapy?

PURPOSE: To assess whether concomitant particulate bone grafting makes a difference in the ability to safely orthodontically reposition teeth outside the bony envelope after corticotomy. MATERIAL AND METHODS: Retrospective analysis of patients who underwent corticotomy as part of their orthodontic therapy for treatment of severe crowding. Patients were divided as: a) Group 1: corticotomy with bone grafting, and, b) Group 2: corticotomy without bone grafting. CT scan examinations were performed before and at the end of the treatment. Measurements of bone and tooth positions were obtained and differences between pre- and post-treatment values were calculated. RESULTS: The study sample included 20 adult patients between the ages of 25 to 58 years. A total of 144 teeth were orthodontically repositioned outside their native bony envelope after corticotomy. Average follow-up was 9 months. Teeth that were repositioned after corticotomy and bone grafting maintained the alveolar bone volume around them while corticotomy without bone grafting was not successful in maintaining bone thickness around teeth that were moved outside the alveolar housing. CONCLUSIONS: Corticotomy in combination with guided bone regeneration has the potential to increase the scope of conventional orthodontic treatment by allowing for expansive movements beyond the traditional limits.

Piezosurgery-assisted, flapless split crest surgery for implant site preparation.

INTRODUCTION: Bucco-lingual resorption of the alveolar ridge can, at times, be predictably corrected at the time of implant placement. Among the different options available to achieve this are a group of surgical techniques described as split crest or split ridge procedures. Most of these procedures require the use of a mallet and some type of chisels and/or osteotomes; they are very technique-sensitive and can be uncomfortable for patients. Recently, alternative tools to split the crest have been presented, and these include the newer bone expanders and the piezoelectric scalpel. A flapless approach to implant dentistry has become popular with the aim to alleviate post treatment side effects, accelerate healing and avoid bone resorption caused by flap elevation. METHODS: We present a technique combining the use of a piezoelectric scalpel and a tapered bone expander in a flapless fashion as a novel way to perform split crest procedures with an aim to optimize outcomes and acceptability by patients. RESULTS: All implants were successfully placed and the resorbed ridge expanded in the same setting. Findings were confirmed by postoperative cone beam cat scan (CBCT) evaluation. CONCLUSIONS: This new technique is a predictable approach for split crest procedures and has high acceptability by patients and is technically simple for surgeons.

Lingual orthodontics: accelerated realignment of the "social six" with piezocision.

Despite the growing number of adults interested in improving their smiles through orthodontic treatment, the visual impact and the duration of the treatment itself are frequently obstacles to patient acceptance. A treatment that is fast and less visible is a desirable option that adult patients often request of their orthodontists. Presented in this case report, which involves a young woman who wanted treatment completed in a limited amount of time, is a new application of a minimally invasive surgical approach to accelerate orthodontic movement combined with a simplified 2-dimensional lingual orthodontic treatment to resolve mild crowding in the anterior region, otherwise known as the "social six.".

Efficacy evaluation of a new buccal bone plate preservation technique: a pilot study.

Twenty extraction sockets in 16 patients were included in this study. Ten were treated with buccal plate preservation (BPP, test group), which consisted of placing a bone graft overlying the buccal plate in a surgically created pouch, and 10 were left untreated (control). Pre- and postoperative differences in buccolingual dimension at the midpoint of the extraction area were calculated using study casts. Statistically significant differences were found between the test group (mean, 0.85 ± 0.75 mm) and control group (mean, 0.9 ± 0.65 mm, P < .5). Clinically, BPP after extraction may help to maintain or augment the soft tissue appearance compared to nontreatment.

A pilot study to determine the effectiveness of different amoxicillin regimens in implant surgery.

The aim of this study was to attempt to determine the minimum effective regimen of amoxicillin antibiotic prophylaxis for dental implant surgery. One hundred patients were randomly allocated to 4 different antibiotic prophylactic treatment groups. At second-stage surgery, only 2 implants failed in the nonantibiotic group. No statistically significant differences were found in the 4 groups, probably because of the limited number of the samples. Until a study with a larger population may definitely rule on the role of antibiotics in oral implant surgery, in may be prudent for the practitioner to adopt the single preoperative antibiotic dose as the minimal effective regimen.

A case report of bilateral mandibular vertical guided bone regeneration with and without bovine thrombin/calcium chloride activated platelet-rich plasma.

One patient with a bilateral vertical defect was treated on one side with guided bone regeneration (GBR) and an autologous bone graft and on the contralateral side with the addition of platelet-rich plasma (PRP). At the 6-month reentry, clinically and radiographically enough bone width and height were present to allow implant placement in both sites. At the same time point, at the histologic level, no differences were noticeable. Similar results were obtained in this case in vertical bone regeneration with and without bovine thrombin/calcium chloride activated PRP applied to GBR techniques.

Buccal plate augmentation: a new alternative to socket preservation.

Alveolar ridge resorption occurs after tooth extraction and has the potential to either complicate implant placement or impair the final esthetic result. Techniques to preserve natural bone and soft tissue contours are of great interest to clinicians and patients because even subtle postextraction buccal plate resorption may have significant clinical effects, particularly in the esthetic zone. Buccal plate augmentation (BPA) is a novel approach for ridge preservation aiming to avoid recession of the facial wall of the socket without interfering with the natural healing mechanism of the extraction socket. It consists of placement of bone graft material over an intact buccal plate, underneath the soft tissues in a surgically created pouch with an aim to maintain or augment the soft tissue esthetics of the region.

Local intraoral autologous bone harvesting for dental implant treatment: alternative sources and criteria of choice.

Dental implants are established alternatives for replacing missing teeth. In case of alveolar bone resorption, implant placement may be prevented unless the volume of hard tissues is increased before or during implantation. Autologous bone graft is still regarded as the "gold standard" in alveolar reconstruction., but many factors may influence the final outcome. The success of intraoral bone grafts, in fact, depends, among other factors, on the choice of donor graft material as well as on how the material is handled. The evidence supporting the use of autogenous intramembranous bone with or without the use of barrier membranes is briefly reviewed. The rational of donor site choice is also presented. Advantages and disadvantages of different harvesting site are discussed.

Prosthetically driven implant placement. How to achieve the appropriate implant site development.

Dental implants are established alternatives for replacing missing teeth. Tooth loss for different reasons may leads to alveolar resorption. Shortage of bone can prevent proper positioning of dental implants according to prosthetic needs and treatment planning, unless the volume of hard and soft tissues is increased before implantation. In the esthetic area it is essential not only to achieve well-anchored implants but also sufficient soft and hard tissue in order to obtain natural looking result. This article will present several treatment modalities to augment the soft and hard tissues in order to obtain proper insertion of implants according to prosthetic needs and patient satisfaction.