The Customized Alveolar Ridge-Splitting (CARS) Technique Combined with Guided Bone Regeneration or Sinus Elevation Augmentation in Maxillary Deficient Ridges.

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure-including lateral window sinus augmentation and guided bone regeneration-allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

Surgical Strategies Used to Successfully Re-implant an Implant that Failed Four Times at the Same Site: A Case Report.

Although implants have been shown to have high success rates, complications such as implant failure can occur. This presents a challenging dilemma for clinicians when attempting another implant placement in the failed site. The patient in this clinical case report presented with implant failure four times at the same site. This case report describes implant placement in a site where four failed implants were previously removed and evaluates the approach used to achieve a successful outcome.

Histologic Findings 8 Weeks After Customized Alveolar Ridge-Splitting Technique.

Different techniques have been introduced when replacement with an implant is planned after tooth extraction. The conventional approach consists of waiting 3 to 4 months before implant placement. However, many other options are available for implant placement, including immediate implant placement (IIP), IIP and immediate provisionalization (IIPIP), and early implant placement (EIP). When the ridge is deficient, guided bone regeneration (GBR) with simultaneous implant placement is often performed. However, this procedure has potential for postoperative complications and patient discomfort, as well as an extended treatment time. The recent introduction of the Customized Alveolar Ridge-Splitting (CARS) technique can help avoid many of these problems and treat atrophic ridges that will require two or three GBR surgeries. The purpose of this case report is to demonstrate the step-by-step surgical and restorative procedures for the CARS technique and present histologic data of the new bone generated utilizing this technique.

A New Concept of Safety Distance to Place Implants in the Area of the Inferior Alveolar Canal to Avoid Neurosensory Disturbance.

Inferior alveolar nerve (IAN) damage following implant placement is a severe complication that can compromise a patient's quality of life. Previous studies have suggested that a safety zone of 2 mm, if maintained, might avoid this problem. This retrospective study evaluates implants placed in closer proximity to the IAN without resulting in any postoperative neurologic complications and suggests a new concept of safety distance. A total of 60 consecutive patients receiving 101 mandibular implants < 2 mm from the IAN were included in this study. All enrolled patients had a CBCT scan done for radiologic assessment before implant placement and following final restoration. Measurements were obtained through cross-sectional views using Simplant software. In patients without neurologic disturbances, a mean distance of +0.75 mm was seen from the closest portion of the implant to the nerve bundle. In cases where a direct transection and/or compression of the nerve was not observed, the patients did not experience neurosensory disturbances.

Patient-Related Risk Factors for Maxillary Sinus Augmentation Procedures: A Systematic Literature Review.

The posterior maxilla has traditionally presented a challenge for successful placement of dental implants due to a combination of poor bone quality, ridge atrophy, and pneumatization of the sinus floor following tooth extraction. However, with the successful and predictable surgical outcomes reported in the literature, more clinicians and patients are choosing an implant-supported restoration in the edentulous posterior maxilla. Consequently, sinus elevation and augmentation have gained more popularity. Extensive research has been conducted on types of bone graft materials and implants, less-invasive techniques to perform sinus augmentation, and timing for implant placement for sinus grafting. Despite the predictability of the techniques and biomaterials employed in sinus grafting procedures, intra- and postoperative complications are common. Much of the current literature discusses the local risk factors related to sinus augmentation, with few studies focusing on the patient-related risk factors. The purpose of this review is to identify, evaluate, and discuss the possible management of patient-related risk factors to allow for more predictable maxillary sinus floor augmentation outcomes.

Expanded Clinical Applications of Narrow-Diameter Implants for Permanent Use.

This report discusses the expanded use of narrow-diameter implants (< 3.0-mm diameter) for permanent use and presents multiple clinical uses for supporting permanent restorations. The increased applications of narrow-diameter implants have expanded the options of treatment available to clinicians based on the patients' needs, desires, and limitations. The advantages, disadvantages, indications, and limitations are presented for the use of these narrow-diameter implants for permanent-case scenarios. These implants can serve as a treatment option in cases where standard-diameter implants cannot be placed due to limitations in volume or size of a planned implant site or due to financially or medically compromised patients.

Patient preferences for oropharyngeal cancer treatment de-escalation.

BACKGROUND: The excellent prognosis of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinomas (SCCs) against severe chemoradiotherapy (CRT) toxicities has opened discussion of deintensification trials. The purpose of this study was to describe the perspective of patients with HPV-positive and HPV-negative disease toward such studies. METHODS: Fifty-one patients with oropharyngeal SCC (post-CRT) underwent semistructured interviews contrasting toxicities of radiotherapy (RT) alone and CRT. Patients were asked what potential difference in cancer survival was acceptable to prefer RT over CRT. Initially, survival rate was the same for both treatments, then the RT rate was reduced until the preference switched. Treatment experience and preference for deintensified CRT were collected. RESULTS: Ninety-percent of patients initially selected RT, but 69% switched to CRT after 0% to 5% reduction in survival. Patients that rated their treatment experience as mild would accept lower survival versus severe treatment (p = .02). Eighty-one percent of patients (33 of 40) indicated they preferred reduced chemotherapy in CRT. CONCLUSION: Patients accept little difference in survival between treatments to avoid toxicity.