Predictability of single versus double-barrel vascularized fibula flaps and dental implants in mandibular reconstructions: A systematic review and meta-analysis of prospective studies.

STATEMENT OF PROBLEM: Patients with vascularized bone flaps from the fibula have reduced bone height, in which case a higher prosthetic abutment is needed for their implant-supported prosthesis. Although the double-flap technique seems promising, systematic reviews and meta-analyses of prospective studies are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the grafted areas of single barrel fibular flaps (SBFF) and double-barrel fibular flaps (DBFF) by considering failure rates, dental implant complications, and bone union at the osteotomy sites. MATERIAL AND METHODS: A systematic review and meta-analysis was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, population, intervention, control, and outcomes (PICO) question, and the National Health and Medical Research Council scales. The event rate of complications and failures was calculated with a confidence interval (CI) of 95%. RESULTS: A total of 13 prospective studies with 441 participants and 330 graft sites were identified. A total of 235 participants had SBFF with 445 implants, and 95 had DBFF with 164 implants. The overall combined graft failure rates were 4.2% for SBFF and 3.2% for DBFF. The complication rate was 10% for SBFF and 1.9% for DBFF. Implant failure was at 4.7% in the SBFF group and 3.4% in the DBFF group. CONCLUSIONS: Complication rates and implant failures were similar for SBFF and DBFF. Therefore, for long-term oral rehabilitation, both SBFF and DBFF are suitable procedures for mandibular reconstruction.

Effect of Splinting of Tilted External Hexagon Implants on 3-Unit Implant-Supported Prostheses in the Posterior Maxilla: A 3D Finite Element Analysis.

PURPOSE: To assess the effects of tilted external hexagon implants and splinted restorations in terms of stress distribution on the bone tissue, implants, and prosthetic screws, using three-dimensional finite element analysis. MATERIALS AND METHODS: Six models were used to simulate a posterior maxilla bone block (type IV) from the first premolar to the first molar. Each model included three 4.1-mm-diameter external hexagon implants with varying inclinations (0°, 17°, and 30°) and crown designs (splinted and nonsplinted restorations). The forces applied were as follows: 400 N axially (50 N for each slope of the cusp) and 200 N obliquely (45° only on the buccal slope of the cusp). Stress distribution on the implants and prosthetic screw was evaluated using Von Mises stress, while the maximum principal stress was used to evaluate the stress distribution in the bone tissue. RESULTS: The oblique load increased the stress on all the structures in all the models. Increased inclination of the implants resulted in higher stress concentration in the bone tissue, implants, and prosthetic screws. However, splinted restorations contributed to reduction of the stress for the oblique loading, mainly in the bone tissue and prosthetic screw of the first molar, as the stress was shared between the first and second premolar restorations. CONCLUSIONS: Tilted implants increased proportionally the stress on bone tissue and prosthetic screws of models. Additionally, splinting restorations reduced the stress concentration area in the simulated bone tissue, implants, and prosthetic screws in the first molar, as the stress was shared with the adjacent implants.

Evaluation of the accuracy and stress distribution of 3-unit implant supported prostheses obtained by different manufacturing methods.

The purpose of this in vitro study was to measure the vertical, positive-horizontal, and negative-horizontal misfit (VM, PHM, and NHM, respectively) of the zirconia three-element prosthetic framework, fabricated using different methods, and compare them with conventional fabrication methods (lost-wax casting). Furthermore, this study aimed to evaluate the influence of the misfit values on the biomechanical behavior of the 3-unit fixed prosthetic frameworks using three-dimensional finite element analysis (3D-FEA). Forty frameworks (n = 10) were fabricated as follow: G1, Cerec Bluecam; G2, iTero; G3, 3Series; and G4, conventional method. The samples were randomized to measure marginal misfit using a high-precision three-dimensional (3D)-optical microscope. The results were submitted to analysis of variance (ANOVA), with the significance level set at 5%. The mean VM values of each group were used in creating the models by 3D-FEA with the misfit found in optical microscopy. The programs used were the InVesalius, Rhinoceros, SolidWorks, FEMAP and NEiNastran. The von Mises map was plotted for each model. The G4 showed the lowest mean VM value (16.73 µm), followed by G3 (20.71 µm), G2 (21.01 µm), and G1 (41.77 µm) (p < 0.001). G2 was more accurate than G1 (p < 0.05) and similar to G3 (p = 0.319). For PHM, G4 was the most accurate and did not present overextended values. With regard to NHM, the computer-aided design and computer-aided manufacturing (CAD-CAM) systems were more accurate (-61.91 µm) than G4 (-95.36 µm) (p = 0.014). In biomechanical analysis, stress concentration caused by oblique loading is greater than caused by axial loading. In axial loading, G4 was the most favorable while G1 was the least favorable, biomechanically, in oblique loading, similar stress patterns were observed in all the models. The prosthetic screw was the most overloaded structure, but the material did not influence the stress distribution. The misfit prostheses showed a greater degree of stress than the controls (without misfit). The manufacturing method influenced the marginal misfit of the frameworks, with the conventional method being the most accurate and the Cerec Bluecam System (closed system) the least accurate. Biomechanically, fitting prostheses were more favorable than misfit prostheses.

Manual vs. rotary instrumentation in endodontic treatment of permanent teeth: A systematic review and meta-analysis.

PURPOSE: To systematically review all studies comparing manual instrumentation with at least one rotary instrument in the preparation of the root canal of permanent human teeth. METHODS: The electronic databases PubMed, EMBASE, LILACS, IBECS and BBO were searched. In vitro studies published until 27 of September, 2016 were included. For statistical analysis, we used the Comprehensive Meta-Analysis software (Biostat), considering P< 0.05 significant. RESULTS: A total of 1,104 articles published until September 27, 2016 were obtained, with 57 meeting the eligibility criteria. The studies were grouped according to the main methodology used (computerized tomography, periapical radiography, image amplification and scanning electron microscope). Due to the wide variability of the methodologies and evaluated parameters, a subgroup analysis was performed based on the evaluated parameter. The meta-analysis revealed that rotary instruments caused a significant reduction in instrumentation time and a smaller change of the canal curvature than manual instruments. The rotary instrumentation presented better results regarding root canal transportation, ability of centralization within the canal path and shaping of the canal. Manual instrumentation performed better with regard to the smear layer and debris production, more instrumented canal surfaces and fewer dentin defects. CLINICAL SIGNIFICANCE: An increasing number of studies have compared the efficiency of manual and rotary instrumentation in endodontic treatment of permanent teeth. This study helps elucidate which method is more efficient in the endodontic treatment of permanent teeth.

Biomechanical analysis of different implant-abutments interfaces in different bone types: An in silico analysis.

The purpose of this study was to analyze the stress distribution of bone tissue around implants with different implant-abutment interfaces: platform switching (PSW); external hexagon (EH) and Morse taper (MT) with different diameters (regular: Ø 4 mm and wide: Ø 5 mm), bone types (I-IV) and subjected to axial and oblique load conditions using three-dimensional finite element analysis (3D-FEA). Sixteen 3D models of various configurations were simulated using InVesalius, Rhinoceros 3D 4.0, and SolidWorks 2011 software, and processed using Femap 11.2 and NeiNastran 11.0 programs. Axial and oblique forces of 200 N and 100 N, respectively, applied at the occlusal surface of prostheses. Maximum principal stress values were obtained from the peri-implant cortical bone of each model. Statistical analyses were performed using ANOVA and Tukey's test for maximum principal stress values. Oblique loading showed higher tensile stress than axial loading (P < 0.001). Wide-diameter implants showed lower stress concentration rather than regular-diameter implants, regardless of both connection and bone type (P < 0.001). Under axial loading, wide-diameter EH implants with regular platforms showed more favorable stress distribution than PSW implants for axial loading (P < 0.001); however, under oblique loading, PSW implants exhibited lower stress concentrations (P < 0.001). Regular-diameter MT implants showed lower stress than EH implants (P < 0.001). Bone type IV showed higher stress in the cortical region than bone types I and II (P < 0.001), but no significant difference when compared with bone type III (P > 0.05). The conclusion drawn from this in silico is that MT implants should be considered for use in situations that preclude the placement of wide-diameter implants, particularly where bone types III and IV are concerned.

Estética imediata com implante Cone Morse - relato de caso / Immediate aesthetic with Morse Taper implant - case report

A procura por uma estética imediata durante a instalação de implantes em regiães anteriores tem sido observada gradualmente na Implantodontia, sendo assim, o cirurgião dentista deve estar habilitado para oferecer ao paciente a melhor opção de tratamento não apenas em termos funcionais, mas também em termos estéticos. Desta forma, a literatura tem sugerido o uso de implantes de conexão do tipo Cone Morse para a resolução de situações clínicas que envolvam regiões anteriores. Assim, a proposta deste estudo foi apresentar um caso clínico e sugerir as particularidades de um planejamento de estética imediata com implante de conexão do tipo Cone Morse instalado na região anterior da maxila. Paciente de 21 anos, do gênero masculino, foi diagnosticado com fratura horizontal ao nível cervical do elemento dentário 11 e submetido … cirurgia de extração, seguida da instalação do implante osseointegrável modelo Flash© (Conexão, Sistemas de Implantes, Arujá, Brasil) com dimensães de 4,3 x 13 mm e geometria de conexão do tipo de Cone Morse. Após os procedimentos cirúrgicos foi realizada a personalização da própria coroa remanescente para instalação imediata como provisório. O procedimento de estética imediata com implantes osseointegráveis empregando o remanescente dentário do paciente ‚ uma técnica eficaz de reabilitação

Patients often search for an immediate aesthetic result on the anterior region during implant placement. Therefore, the dentist should be able to offer the best treatment option in both aesthetic and functional terms. Literature has suggested the use of implants of the type Morse Taper connections to the resolution of clinical situations involving anterior regions. The aim of this study was to introduce a clinical case and suggest a specific immediate aesthetic planning using a Morse Taper connection implant installed in the anterior maxilla. A 21-year-old male with horizontal fracture at the cervical level of the tooth 11 was submitted to surgical extraction, followed by the placement of the implant model osseointegrated Flash© (Conexão, Sistemas de Implantes, Aruj , Brazil) sizes of 4.3 x 13 mm and Morse Taper connection. After surgical procedures the remaining crown was customized for immediate installation as a provisional. The procedure with immediate aesthetic using osseointegrated implants and patients’ coronal remainder is an effective rehabilitation technique