Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients.

PURPOSE: The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic. METHODS: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed. RESULTS: The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

Nasal Reconstruction in 4-years-old Child Affected by Nasal wing Cleft.

Congenital and pediatric nasal lesion resection and their reconstructive outcomes are not well studied. A surgeon must consider the site, depth, size, age, etiology and effect on future function (including growth). The path of total reconstruction or of portions of the cartilaginous / cutaneous nasal structure in the pediatric patient must undergo a series of totally different needs with respect to the management of the adult. First of all, it is essential to understand at what age to intervene, given that the child in the growth phase up to adolescence sees the nasal skeleton change significantly and in relation to the possible psychological repercussions that the tissue deficit can cause. This path will often require serious interventions in order to recreate a structure that is aesthetically ideal, functionally effective and finally suitable for the growth phase of the rest of the body and facial structures. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03364-y.

Working length determination in primary teeth pulpectomy: A systematic review and meta-analysis.

The present meta-analysis aimed to describe the methods to determine the working length in primary teeth pulpectomy, also evaluating and comparing their reliability. A systematic review was performed following the PRISMA Statement. The electronic search was conducted on PubMed, Scopus, Cochrane Library and Web of Science. After the screening protocol, a number of 14 studies were included in the qualitative analysis, while seven were included in the quantitative one. The mean working length determined by the electronic apex locator was 11.8 mm (9.0-15.55), while 12.42 mm (11.0-13.52) and 12.3 mm (9.73-15.93) were the mean working length observed with the conventional radiography and the digital radiography, respectively. No statistically significant difference was detected in quantitative analysis between the investigated methods. The present meta-analysis showed that electronic apex locator, conventional radiography and digital radiography are similar in determining working length in primary teeth.

Quality of life in patients affected by medication-related osteonecrosis of the jaws: A systematic review.

OBJECTIVE: The aim of this systematic review was to describe the quality of life and oral health-related quality of life of patients affected by medication-related osteonecrosis of the jaw. STUDY DESIGN: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A combination of keywords and MeSH terms was used in PubMed, Scopus, Cochrane Library, Web of Science, and EBSCO up to December 13, 2020. RESULTS: A total of 1066 results were obtained after duplicate exclusion and 11 articles were included in the final qualitative analysis. Most of the articles described the quality of life in patients with osteonecrosis of the jaw secondary to cancer treatment. The main drugs associated with the disease were bisphosphonates. Surgical treatment of the osteonecrosis improves the quality of life of these patients. CONCLUSIONS: The present systematic review suggested the negative influence of osteonecrosis of the jaw on the quality of life and oral health-related quality of life among oncologic and osteoporotic patients. The use of quality of life questionnaires in daily practice could be an important tool to better diagnose and manage patients affected by osteonecrosis of the jaws who have received or are receiving drugs associated with this complication.

Association between blood transfusions and complications in head and neck reconstruction: a systematic review and meta-analysis.

PURPOSE: The aim of this meta-analysis is to assess the correlation between blood transfusions and the medical/surgical complications after head and neck reconstructive surgery. METHODS: The PRISMA protocol was used and the literature search was performed on Pubmed, Scopus, Cochrane Library and Web of Science up to March 13, 2020. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. RESULTS: A total of 1219 records were screened after the electronic search, 22 of which were included in the qualitative analysis. Of there 22 scores, 18 articles were included in the meta-analysis. The OR for medical and surgical complications of transfused patients was 1,64 (95% CI 1.23-2.21); while, the OR for hospital readmission was 1.53 (95% CI 1.29-1.81). CONCLUSIONS: The results of this meta-analysis suggested that blood transfusions are associated with both an increased risk of surgical and medical complications of head and neck flaps and with the hospital readmission.

Three-Year Retrospective Comparative Study between Implants with Same Body-Design but Different Crest Module Configurations.

Crest module can be defined as the portion of a two-piece implant designed to retain the prosthetic components and to allows the maintenance of the peri-implant tissues in the transition zone. AIM: To evaluate the three-year after loading clinical and radiographic data, collected from patients that received a prosthetic rehabilitation on conical connection implants with partial machined collar (PMC; CC Group) and same body-designed implants, with flat-to-flat connection and groovy neck design (FC Group). MATERIALS AND METHODS: A retrospective chart review of previously collected data, including documents, radiographs, and pictures of patients who received at least one implant-supported restoration on NobelReplace CC PMC or NobelReplace Tapered Groovy implants was performed. Patients with at least three years of follow-up after final loading were considered for this study. Outcomes measures were implant and prosthesis failures, any biological or technical complications, marginal bone loss. RESULTS: Eight-two patients (44 women, 38 men; average age 55.6) with 152 implants were selected and divided in two groups with 77 (CC group) and 75 (FC group), respectively. Three years after final loading, one implant in CC group failed (98.7% survival rate), while no implants failed in FC group (100% survival rate). One restoration failed in CC group (98.7% survival rate) with no restoration failing in the FC one (100% survival rate). Differences were not statistically significant (p = 1.0). Three years after final loading, mean marginal bone loss was 0.22 ± 0.06 mm (95% CI 0.2-0.24) in CC group and 0.62 ± 0.30 mm (95% CI 0.52-0.72) in FC group. The difference was statistically significant (0.40 ± 0.13 mm; 95% CI 0.3-0.5; p = 0.003). CONCLUSION: with the limitation of this retrospective comparative study, implants with conical connection and partial machined collar seem to achieve a trend of superior outcomes if compared with implants with flat connection and groovy collar design.

Sinus augmentation grafting with anorganic bovine bone versus 50% autologous bone mixed with 50% anorganic bovine bone: 5 years after loading results from a randomised controlled trial.

PURPOSE: To compare the outcomes of implants inserted in maxillary sinuses augmented with 100% anorganic bovine bone (ABB) grafts versus mixed with 50% ABB and 50% autologous bone graft using a lateral window approach. MATERIALS AND METHODS: This study was designed as a randomised controlled trial of parallel groups. Patients in need of an implant-supported prosthesis in maxillary posterior areas, with a residual alveolar bone height ranging between 0 and 4 mm, were recruited for lateral sinus grafting and implant placement. Patients were randomly allocated to receive two different graft materials according to a parallel group design: group A was grafted with 50% ABB and 50% autogenous bone; group B was grafted with 100% ABB. After 7 months, tapered implants were inserted with an insertion torque between 20 and 45 Ncm. Three months later implants were loaded with screw-retained temporary crowns. Definitive crowns were delivered after 3 months. Outcome measures were implant and prosthesis survival rates, complications, radiographic marginal bone-level changes, probing pocket depths (PPDs) and bleeding on probing (BOP). Clinical data were collected at definitive prosthesis delivery, and 1, 2 and 5 years after definitive loading. RESULTS: Thirty-two consecutive patients were treated with 32 sinus elevation procedures (16 group A, 16 group B). A total of 46 implants were inserted. One patient (with two implants) dropped out in group A, and two patients (with three implants) dropped out in group B. No implant/crown failed by the end of the study. Three complications (one sinus membrane perforation and two chipping of the ceramic) were observed in three patients in group A, versus none in group B (relative risk was 0.81; 95% CI 0.64-1.03; P = 0.225). At the 2-year follow-up, the mean marginal bone loss was 1.18 ± 0.50 mm (95% CI 0.95-1.45 mm) in group A and 1.28 ± 0.48 mm (95% CI 0.97-1.43 mm) in group B, with no statistically significant differences between the two groups (difference 0.11 ± 0.22 mm; 95% CI -0.06-0.16 mm; P = 0.586). At the 5-year follow-up, the mean marginal bone loss was 1.37 ± 0.48 mm (95% CI 1.13-1.86 mm) in group A and 1.42 ± 0.48 mm (95% CI 1.17-1.90 mm) in group B (difference 0.15 ± 0.08 mm; 95% CI 0.10-0.22 mm; P = 0.426). At the 2-year follow-up, the mean PPD value was 2.70 ± 0.39 mm for group A and 2.54 ± 0.66 mm for group B, with no statistically significant difference between groups (difference 0.17 ± 0.39 mm; 95% CI 0.06-0.32 mm; P = 0.456). At the 5-year follow-up, the mean PPD value was 3.20 ± 0.44 mm for group A and 3.32 ± 0.49 mm for group B (difference 0.12 ± 0.43 mm; 95% CI 0.02-0.22 mm; P = 0.672). At the 2-year follow-up, the mean BOP value was 1.21 ± 0.79 for group A and 1.28 ± 0.68 for group B (difference 0.06 ± 0.49; 95% CI -0.23-0.25; P = 0.297), and at the 5-year follow-up, the mean BOP value was 1.77 ± 0.62 for group A and 1.91 ± 0.48 for group B (difference: 0.14 ± 0.51; 95% CI -0.05-0.33; P = 0.492). CONCLUSIONS: Within the limitations of this study, the present data confirm similar clinical outcomes of implants inserted in sinuses grafted with ABB versus implants inserted in sinuses grafted with mixed 50% ABB and 50% autologous bone.

Low-grade intraductal carcinoma of salivary glands: A systematic review of this rare entity.

BACKGROUND: Low-grade intraductal carcinomas are rare, malign tumors of salivary glands most commonly affecting parotid gland. It is a slow-growing tumor considered with a favourable prognosis after surgical excision. METHODS: To define the characteristics and management of low-grade intraductal carcinoma a systematic review was performed using the electronic databases Pubmed, Cochrane and Scopus. A new case report was also described. RESULTS: Including this case the review of literature identified only 54 cases reported thus far. Demographics, clinical presentation, diagnostic tools, treatment, follow-up and recurrence rate, histological and immunohistochemical patterns of this kind of tumor were summarized. CONCLUSION: Low-grade intraductal carcinoma has already been well defined but is important to focus on the fact that in few cases component of high-grade infiltrations have been reported: this may modify surgical approach because a simple tumorectomy may not be enough.

1-year results from a split-mouth randomised controlled pilot trial comparing implants with 0.75 mm of machined collar placed at bone level or supracrestally.

PURPOSE: The present study evaluated the hypothesis that implants inserted at bone level or supracrestally have different outcomes in single tooth replacements against the alternative hypothesis of no difference. MATERIALS AND METHODS: This study was designed as a randomised, split-mouth, controlled pilot trial. Ten patients, each missing two bicuspids or molars, were treated with 20 implants featuring 0.75 mm of machined collar. Each patient randomly received one implant inserted at bone level (BL) and one inserted 0.75 mm to 1 mm above the alveolar crest (SC), measured with a periodontal probe during surgery. All the implants were inserted into healed healthy bone with an insertion torque ranging between 35 Ncm and 45 Ncm. Both implants were loaded with screw-retained acrylic-resin temporary crowns 3 months after implant insertion and 3 months later with screw-retained zirconia-ceramic definitive crowns. Outcome measures were implant/crown failures, biological and prosthetic complications, radiographic marginal bone level changes (MBL), probing pocket depth (PPD) and bleeding on probing (BOP). Clinical data were collected at baseline (implant insertion) and 1 year after implant placement (9 months after initial loading). RESULTS: After 1 year of follow-up, no patients dropped out, no implants failed, and no complications occurred. The mean MBL at the 1-year follow-up was 0.28 ± 0.21 mm in the SC group and 0.93 ± 0.37 mm in the BL group. While the difference in MBL was statistically significant between the two treatment groups (difference 0.65 ± 0.34; 95% CI = 0.59 to 1.01; P = 0.0001), the soft-tissue parameters were not statistically different. The mean PPD was 2.63 ± 2.4 in the SC group and 2.40 ± 0.70 in the BL group (P = 0.419) and mean BOP was 0.50 ± 0.71 in the SC group and 0.40 ± 0.70 in the BL group (P = 0.754). CONCLUSIONS: The smooth-collar implants inserted supracrestally showed 0.7 mm less radiographic marginal bone loss compared with implants inserted at the bone level 9 months after loading.

Association between third molar and mandibular angle fracture: A systematic review and meta-analysis.

PURPOSE: The aim of this study was to investigate the risk of mandibular angle fracture associated with the presence of a mandibular third molar and its position when the mandibular fracture occurs. METHODS: A systematic literary search was performed in Pubmed, Scopus, and the Cochrane Library for observational studies with at least 250 patients that included frequency of mandibular angle fracture, presence of third molar, and its position. RESULTS: A total of seven studies were included in the review, from an initial search of 622 titles. The relative risk of mandibular angle fracture with third molar was 1.90 (95% CI = 1.47-2.46). The relative risk of mandibular angle fracture related to third molar position (according to the Pell and Gregory classification) was 1.18 (95% CI = 0.62-2.25), 1.98 (95% CI = 0.95-4.10), 2.72 (95% CI = 1.78-4.16), 1.31 (95% CI = 0.80-2.14), 2.21 (95% CI = 1.69-2.87) and 2.99 (95% CI = 2.12-4.22) for Class A, Class B, Class C, Class I, Class II, and Class III, respectively. CONCLUSIONS: Our meta-analysis reported a two-fold increased risk of mandibular angle fracture with the presence of a third molar in patients who presented with mandibular fractures. Even the third molar position seemed to influence mandibular angle fracture, especially Class C, Class II, and Class III.

Sinus lift grafting with anorganic bovine bone vs 50% autologous bone mixed with 50% anorganic bovine bone: 2 years after loading results from a randomised controlled trial.

PURPOSE: To compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone (ABB) grafts vs mixed 50% ABB and 50% autologous bone graft, using a lateral window approach. MATERIALS AND METHODS: This study was designed as a randomised controlled trial of parallel groups. Patients in need of an implant-supported prosthesis in a maxillary posterior area with a residual alveolar bone height no greater than 4 mm (range 0-4 mm) were recruited for lateral sinus grafting. Patients were randomly allocated to receive 50% ABB and 50% autogenous bone (group A) or 100% ABB (group B). After 7 months, tapered implants were inserted with an insertion torque between 20 and 45 Ncm. After 3 months, implants were loaded with screw-retained temporary crowns. Definitive crowns were delivered 3 months later. Outcome measures were implant survival, complications, radiographic marginal bone-level changes, probing pocket depths (PPD) and bleeding on probing (BOP). Clinical data were collected at definitive prosthesis delivery, 1 and 2 years after loading. RESULTS: Thirty-two consecutive patients were treated with 32 sinus lift procedures (16 group A, 16 group B). A total of 46 implants were installed. No patient dropped out. No crown/implant failed by the end of the study. Three complications (one sinus membrane perforation and two chipping of the ceramic) were observed in three patients in group A, vs none in group B (RR 0.81; 95% CI 0.64 - 1.03 mm; P = 0.225). At the 2-year after final loading follow-up, the mean marginal bone loss was 1.18 ± 0.50 mm (95% CI 0.95 - 1.45 mm) in group A and 1.28 ± 0.48 mm (95% CI 0.97 - 1.43 mm) in group B, with no statistically significant differences between the two groups (difference 0.11 ± 0.22 mm; 95% CI -0.06 - 0.16 mm; P = 0.586). At the same follow-up, the mean PPD value was 2.70 ± 0.39 for group A and 2.54 ± 0.66 for group B, with no statistically significant difference between groups (difference 0.17 ± 0.39 mm; 95% CI 0.06 - 0.32 mm; P = 0.456), while the mean BOP value was 1.21 ± 0.79 for group A and 1.28 ± 0.68 for group B, (difference: 0.06 ± 0.49 mm; 95% CI -0.23 - 0.25 mm; P = 0.297). CONCLUSIONS: Within the limitations of this study, the present data seem to confirm the hypothesis that the clinical outcome of implants inserted in sinuses grafted with ABB vs implants inserted in sinuses grafted with mixed 50% ABB and 50% autologous bone are comparable. Conflict-of-interest statement: This study was not supported by any company. All the authors declare no conflict of interest.

Single post-extractive ultra-wide 7†mm-diameter implants versus implants placed in molar healed sites after socket preservation for molar replacement: 6-month post-loading results from a†randomised controlled trial.

PURPOSE: To test the hypothesis that there is no difference in clinical, radiographic and aesthetic outcomes positioning single post-extractive ultra-wide 7 mm-diameter implants or waiting 4 months to place implant, after molar extraction and the socket preservation procedure. MATERIAL AND METHODS: Patients requiring one implant-supported single restoration to replace a failed tooth in the molar region of both maxilla and mandible were selected. Patients were randomised according to a parallel group design into two arms: implant installation in fresh extraction sockets augmented with corticocancellous heterologous bone and porcine derma (group A) or delayed implant installation 4 months after tooth extraction and socket preservation using the same materials (group B). Ultra-wide 7 mm-diameter implants were submerged for 4 months. Outcome measures were implant success and survival; complications; horizontal dimensional changes measured on cone beam computed tomography (CBCT) scans at three levels, localised 1, 2 and 3 mm below the most coronal aspect of the bone crest (level A, B and C); peri-implant marginal bone level changes; implant stability quotient (ISQ); and pink esthetic score (PES). RESULTS: Twelve patients were randomised to group A and 12 to group B. No patients dropped out. No implant failed or complications occurred up to 6-months post-loading. Six months after loading there was more horizontal alveolar bone reduction at immediate post-extractive implants, which was statistically significant. At level A was 1.78 mm ±â€…1.30 in group A, 0.45 mm ±â€…0.42 in group B, (difference 1.33 mm ±â€…1.39; 95% CI: 0.38 to 1.95; P = 0.003); at level B was 0.98 mm ±â€…1.13 in group A, 0.14 mm ±â€…0.22 in group B, (difference 0.84 mm ±â€…1.16; 95% CI: 0.24 to 1.07; P = 0.019); at level C was 0.55 mm ±â€…0.74 in group A, 0.03 mm ±â€…0.24 in group B, (difference 0.51 mm ±â€…0.76, 95% CI: 0.01 to 0.87; P = 0.032). One year after implant placement, mean peri-implant marginal bone loss was 0.43 mm ±â€…0.37 for group A and 0.10 mm ±â€…0.10 for group B, showing a statistically significant difference between groups (difference 0.33 mm ±â€…0.30; 95% CI: 18 to 0.52; P = 0.010). Mean ISQ value was 78.8 ±â€…2.8 for group A and 79.9 ±â€…3.6 for group B, showing no statistically significant differences between groups (difference 1.1 ±â€…2.6; 95% CI: 0.04 to 2.96; P = 0.422). Mean PES was similar in both groups (10.7 ±â€…1.5 [range: 8 to 13] in group A and 11.7 ±â€…1.2 [range: 10 to 13] in group B; difference 1.0 ±â€…2.2; 95% CI: -0.23 to 2.23; P = 0.081). CONCLUSIONS: Single post-extractive ultra-wide 7 mm-diameter implants, in combination with socket preservation, might be a possible strategy in the replacement of hopeless molars in both jaws, with high implant and prosthetic survival and success rates, and good aesthetic outcomes. Longer follow-ups are needed to properly evaluate this therapeutic option. Conflict-of-interest statement: Dr Marco Tallarico is Research and Scientific Project Manager of Osstem AIC Italy. However, this study was not supported by any company and all authors declare no conflicts of interest.

Guided implant surgery after free-flap reconstruction: Four-year results from a prospective clinical trial.

AIM: The aim of this prospective clinical study is to assess the 4-year outcomes of implant-supported restorations performed using a computer-guided template-assisted flapless implant surgery approach in patients reconstructed with fibula or iliac crest free flaps. MATERIALS AND METHODS: Twelve jaws in 10 patients were reconstructed with osteomyocutaneous free flap after tumour resection or gunshot wound, after complete healing computer-assisted template-based flapless implant placement, based on prosthetic and aesthetic analysis, was performed using a customized protocol. Treatment success was evaluated using the following parameters: survival of implants/prostheses, prosthetic and biologic complications, marginal bone remodelling, soft tissue parameters and patient satisfaction. RESULTS: A total of 56 implants were placed; the implants ranged between 8 and 16 mm in length and were either 3.5, 4.3 or 5 mm wide. All the patients have reached the 4-year follow-up. Three implants were lost accounting for an overall implant survival rate of 94.6%. No prosthesis were lost. Some complications were recorded. Four years after loading the mean marginal bone loss was 1.43 ± 0.49 mm at the palatal/lingual site and 1.48 ± 0.46 mm at the vestibular site. All the patients showed healthy soft tissues with stable probing depth (4 .93 ± 0.75%) and successful bleeding on probing values (12 ± 5.8%); 90% of patients were satisfied of the treatment at the 4-year follow-up. CONCLUSIONS: Computer-guided template-assisted flapless implant surgery seems to be a viable option for patients undergoing reconstruction with free flaps after tumour resection or gunshot trauma, although many challenges remain. A high degree of patient satisfactorily was reported.

Platform switching vs regular platform implants: nine-month post-loading results from a randomised controlled trial.

PURPOSE: To compare the clinical outcome of platform switching (PS) and regular platform (RP) implants in bilateral single molar replacements. MATERIAL AND METHODS: This study was designed as a randomised, controlled, split-mouth trial. Eighteen patients, with bilaterally missing single molars had one site randomly assigned to a PS implant or a RP implant. A total of 36 implants were bilaterally installed. Both implants were loaded with screw retained temporary crowns 3 months after implant insertion and with screw retained definitive crowns 3 months later. Outcome measures were implant/crown failure, complications, radiographic marginal bone-level changes, pocket probing depth (PPD) and bleeding on probing (BOP). Clinical data were collected at baseline 6 and 12 months after implant placement. RESULTS: No patients dropped out and no implant failed. No prosthetic or major biological complications were observed. One year after implant placement, mean marginal bone level was 0.93 ± 0.26 mm (95% CI 0.81 to 1.05) in RP group and 0.84 ± 0.23 mm (95% CI 0.73 to 0.95) in the PS group and no statistically significant differences between the two groups were observed (P = 0.18). Mean PPD and BOP values were, 6 and 12 months after implant placement, 2.74 ± 0.49 mm (95% CI 2.51 to 2.97) and 1.28 ± 0.75 (95% CI 0.93 to 1.63) in the RP group, and 2.70 ± 0.38 mm (95% CI 2.53 to 2.88) and 1.39 ± 0.78 (95% CI 1.03 to 1.75) in the PS group respectively, with no statistical differences between groups (P = 0.81 and P = 0.16, respectively). CONCLUSIONS: No statistically significant difference was observed between platform switched and non-platform switched implants.

Computer-assisted orthognathic surgery for correction of facial asymmetry: results of a randomised controlled clinical trial.

In this randomised controlled clinical trial, 2 homogeneous groups of patients with facial asymmetry (n=10 in each) were treated by either classic or computer-assisted orthognathic corrective surgery. Differences between the 2 groups in the alignment of the lower interincisal point (p=0.03), mandibular sagittal plane (p=0.01), and centering of the dental midlines (p=0.03) were significant, with the digital planning group being more accurate.

Chimeric lateral supramalleolar artery perforator fibula free flap in the reconstruction of composite head and neck defects.

The authors evaluate the use of an osteomyocutaneous fibula free flap, combined in a chimeric fashion, with a lateral supramalleolar flap, in 10 patients with composite head and neck defects. All reconstructions were performed successfully. With the exception of one patient who died after disease recurrence, all patients were decannulated and resumed an oral diet. Speech intelligibility was good in seven of 10 patients. Dental implants were used in two of 10 patients, with a total of 10 fixtures placed successfully. The donor site healed without complications in all except one case, where necrosis of the skin graft occurred with fungal infection. The chimeric lateral supramalleolar artery perforator fibula free flap may be a valid option for maximizing the quality of life in patients with composite oromandibular defects.

Arthrocentesis and temporomandibular joint disorders: clinical and radiological results of a prospective study.

Purpose. We evaluated the efficacy of arthrocentesis in the treatment of temporomandibular joint (TMJ) disorders. Material and Methods. In this prospective clinical case series, 30 consecutive patients with TMJ disorders underwent arthrocentesis using saline and sodium hyaluronate injections. Outcome measures were TMJ pain, maximum mouth opening (MMO), joint noises, and anatomical changes in the TMJ architecture. Patients were evaluated using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) at the beginning of treatment and 60 days after the last arthrocentesis. Pretreatment and posttreatment clinical parameters were compared using paired and unpaired t-tests, and McNemar's test was used to evaluate CBCT and MRI changes (P < 0.05). Results. At 1-year follow-up examinations, visual analogue scale scores indicated that pain was reduced significantly and mean postoperative MMO was increased significantly. CBCT findings showed no significant change, and MRI showed only slight reductions in inflammatory signs. Conclusions. Within the limitations of this study, we can conclude that arthrocentesis is a simple, minimally invasive procedure with a relatively low risk of complications and significant clinical benefits in patients with TMJ disorders. This trial is registered with NCT01903512.

Implant Restoration of Edentulous Jaws with 3D Software Planning, Guided Surgery, Immediate Loading, and CAD-CAM Full Arch Frameworks.

Purpose. The aim of this study was to analyze the clinical and radiographic outcomes of 23 edentulous jaws treated with 3D software planning, guided surgery, and immediate loading and restored with CAD-CAM full arch frameworks. Materials and Methods. This work was designed as a prospective case series clinical study. Twenty patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis. A total of 120 fixtures supporting 23 bridges were placed. 117 out of 120 implants were immediately loaded. Outcome measures were implants survival, radiographic marginal bone levels and remodeling, soft tissue parameters, and complications. Results. 114 of 117 implants reached a 30 months follow-up, and no patients dropped out from the study. The cumulative survival rate was 97.7%; after 30 months, mean marginal bone level was 1.25 ± 0.31 mm, mean marginal bone remodeling value was 1.08 ± 0.34, mean PPD value was 2.84 ± 0.55 mm, and mean BOP value was 4% ± 2.8%. Only minor prosthetic complications were recorded. Conclusion. Within the limitations of this study, it can be concluded that computer-guided surgery and immediate loading seem to represent a viable option for the immediate rehabilitations of completely edentulous jaws with fixed implant supported restorations. This trial is registered with Clinicaltrials.gov NCT01866696.

Facial artery myomucosal free flap for cheek mucosa reconstruction: a case report.

Squamous cell carcinoma (SCC) of the buccal mucosa is an aggressive form of oral cancer. It tends to spread to adjacent tissues and often metastasizes to occult cervical node. There are multiple techniques for cheek reconstruction after tumor removal, including temporalis myocutaneous and temporoparietal fascial pedicled flaps and a forearm free flap. In this report, a case of a 76-year-old man with SCC of the left cheek mucosa and extending to the posterolateral superior alveolar ridge is presented. The patient underwent radical excision of the tumor, omolateral modified radical neck dissection (MRND-III), and contralateral selective neck dissection (levels I-III). Reconstruction was performed with a facial artery myomucosal free flap. The flap was transplanted successfully, and there were no donor or recipient site complications. This technique is a good reconstructive option because of its adherence to the plastic surgery principle of "replacing like with like" and its minimal donor-site morbidity.