Clinical, radiographic, and aesthetic outcomes at two narrow-diameter implants to replace congenital missing maxillary lateral incisors: A 3-year prospective, clinical study.

INTRODUCTION: To present the 3-year clinical, radiographic, and aesthetic outcomes in patients with congenitally missing lateral incisors rehabilitated with two narrow-diameter implants (NDIs). METHODS: The original population consisted of 100 patients rehabilitated with a cement-retained bi-layered zirconia single-unit crown supported by either a Ø2.9 mm (Test) or a Ø3.3 mm (Control) NDI (n = 50). At the 1- and 3-year follow-up (T2, T3), implant survival rate, crestal bone level (CBL) changes, biological, and technical complications were recorded, while the assessment of the aesthetic outcomes was performed using the Copenhagen Index Score. RESULTS: Seventy-four patients Ø2.9 mm (n = 39) or Ø3.3 mm (n = 35) reached T3, as 24 patients were lost to follow-up and 1 implant (Ø3.3 mm) was removed. Throughout the observation period, minimal CBL changes (i.e., <1 mm) were detected between groups. Despite the positive aesthetic scores recorded (i.e., 1-2), at T3 20% of patients rehabilitated with a Ø3.3 mm versus 2.6% of patients Ø2.9 mm displayed an alveolar process deficiency (Score 3). No additional technical and/or mechanical complications were recorded between T2 and T3. Tooth vitality was maintained in all neighboring teeth. Peri-implant probing depths and plaque scores remained low in both groups (p > 0.05). CONCLUSION: The use of 2.9 or 3.3 diameter implants showed comparable favorable mid-term results in terms of survival rate, CBL, and aesthetic outcomes. Hence, clinicians should rely on the use of such NDIs when replacing maxillary lateral incisors.

Surgical and conservative treatment outcomes of medication-related osteonecrosis of the jaw located at tori: a retrospective study.

PURPOSE: Tori and exostoses are considered risk factors for the development of medication-related osteonecrosis of the jaw (MRONJ). The aims of this study were to present the prevalence of MRONJ located at tori in the Copenhagen ONJ Cohort, evaluate the surgical treatment of MRONJ located at tori and explore trauma to tori as an additional risk factor in patients on antiresorptive medication. METHODS: Data from a consecutive series of 506 patients with MRONJ (Copenhagen ONJ Cohort) were reviewed for the presence of tori and MRONJ located at tori. Demographic and medical data were analyzed, and healing outcomes and pain after the prophylactic removal of tori, surgical treatment of MRONJ located at tori, and conservative treatment of MRONJ located at tori were evaluated and compared using Fisher's exact test. RESULTS: MRONJ located at tori was frequent and could be identified in 53% of the patients with tori, which accounts for a prevalence of 5.1% in the entire cohort. Of the 28 surgically treated patients, 27 (96.4%) healed uneventfully with no exposed bone after their first or second revision surgery. Fourteen (41.2%) patients with tori underwent therapeutic removal, eight (23.5%) underwent prophylactic removal, and six (17.6%) underwent both therapeutic and prophylactic removals. Two (33.3%) of the six conservatively treated patients healed spontaneously. Both treatment types resulted in a significant decrease in pain. CONCLUSION: Prophylactic and therapeutic surgical removal of tori are reliable treatments and should be considered if a patient's general health allows surgery. TRIAL REGISTRATION: The study was approved by the Regional Scientific Ethical Committee (H-6-2013-010) on November 20, 2013, and was retrospectively registered.

Characterization of patients with odontogenic necrotizing soft tissue infections in the head and neck area. A retrospective analysis.

OBJECTIVE: Necrotizing soft-tissue infection (NSTI) in the head and neck area may develop from odontogenic infections. The aim of this study was to characterize patients with NSTI in the head and neck with odontogenic origin in a well-defined prospectively collected cohort. MATERIAL AND METHODS: Patients with NSTI in the head and neck, hospitalized between 2013 and 2017 at Copenhagen University Hospital and registered in the Scandinavian INFECT database were included. Medical records of identified patients and from the INFECT database were screened for a defined set of data including the primary focus of infection, comorbidities, predisposing factors, clinical and radiographic diagnostics, course of treatment, and treatment outcome. RESULTS: Thirty-five patients with NSTI in the head and neck area were included in the study. A total of 54% had odontogenic origin, primarily from mandibular molars, and 94% had radiographic signs of infectious oral conditions. Overall, comorbidities were reported in 51% with cardiovascular disease being the most prevalent. In 20%, no comorbidities or predisposing conditions could be identified. The overall 30-day mortality rate was 9%. CONCLUSIONS: More than half of NSTI cases in the head and neck region had an odontogenic origin, and special attention should be paid to infections related to mandibular molars.

Resin-bonded fixed dental prosthesis versus implant-supported single crowns in the anterior region.

BACKGROUND: Different treatment options exist for replacement of an anterior tooth, and as implant-supported single crowns (ISSC) and resin-bonded fixed dental prosthesis (RBFDPs) both are widespread treatment options, it is of clinical relevance to know which treatment modality can be considered superior. PURPOSE: The purpose of this comparative study was to evaluate the 3- and 5-year survival and failure rate of tooth-supported resin-bonded fixed dental prosthesis compared to implant-supported single crowns. The null hypothesis was that there was no significant difference in survival rate, occurrence of complications or patient-reported outcome between RBFDPs and ISSCs. MATERIALS AND METHODS: A total of 45 resin-bonded FDPs were inserted in 27 young patients (test group) with tooth agenesis in the anterior part of the maxilla or mandible and a control group of 28 patients also with tooth agenesis in the anterior region but treated with 40 implant-supported single crowns were included in this study. All patients and treatments were followed with a baseline and a 3- or 5-year examination. All patients had to fill out an Oral Health Impact Profile (OHIP-49) questionnaire at baseline and at the 3- or 5-year examination. The restorations were evaluated according to the Copenhagen Index Score (CIS). RESULTS: For the RBFDP (test) group there was an 82% survival rate and 18% failure rate, that is, four RBFDPs were not in situ after 3 years and four RBFDPs were not in situ after 5 years. Correspondingly, the ISSC showed a survival rate of 98% and a failure rate of 2%, that is, only one failure (ceramic fracture) after 3 and none after 5 years. Of the 82% RBFDPs in situ, there were no complications in 78% of the cases, whereas 22% had complications after 3 (4 complications) and 5 years (4 complications). There were 92% of the ISSCs without any complications and 8% (ie, 3 ISSCs) with complications after 3 or 5 years. In general, there was a significant reduction in the OHIP-49 scores, for example, an improved oral health quality of life for both treatment options. CONCLUSION: The results of this study indicate that ISSCs have lower complication and failure rates than RBFDPs. In general, the OHIP-scores were significantly reduced regardless of whether RBFDPs or ISSC were used.

Horizontal Alveolar Ridge Augmentation with Xenogenic Block Grafts Compared with Autogenous Bone Block Grafts for Implant-retained Rehabilitation: a Systematic Review and Meta-Analysis.

Objectives: The objective of the present systematic review and meta-analysis was to test the 0-hypothesis of no difference in implant treatment outcome after horizontal alveolar ridge augmentation with xenogenic block compared with autogenous bone block. Material and Methods: A literature search was conducted using PubMed, Embase and Cochrane Library databases in combination with a hand-search of relevant journals until 25th of January 2022. Comparative and non-comparative studies evaluating horizontal alveolar ridge augmentations with xenogenic blocks were included. Quality and risk of bias were evaluated by Cochrane Collaboration's revised tool and Newcastle-Ottawa scale. Results: Meta-analysis revealed no statistically significant difference in implant survival rate after more than 6 months of functional implant loading (P = 0.71), no difference in alveolar ridge width (P = 0.07) or gain of alveolar ridge width at re-entry (P = 0.13). Non-comparative studies revealed moderate to high short-term implant survival rate and gain in alveolar ridge width, however, complications including dehiscences, graft exposure and graft failure were observed in several studies. Conclusions: No significant difference could be identified in short-term implant treatment outcome following horizontal alveolar ridge augmentation using xenogenic block compared with autogenous bone block with the limited data available. A high incidence of healing complications and implant failures necessitates further investigation, as well as long-term results on implant survival rate.

Dental Implants in Patients with Osteogenesis Imperfecta - Clinical and Radiographic Outcome in Six Patients.

PURPOSE: To investigate the survival rate of dental implants in patients diagnosed with osteogenesis imperfecta (OI). MATERIALS AND METHODS: The study is a retrospective analysis of six individuals (2 males, 4 females) with OI (type I, III and IV) with a total of 25 dental implants. Clinical examination included plaque index, gingival index, periodontal pocket depth for each implant, presence of pus, and loosening of the implant(s). Marginal bone loss was measured on radiographs. The observation period ranged from 2-17 years (mean:7.5 years, median: 5 years). RESULTS: The overall implant survival rate was 80%. One patient with OI type III lost five implants. However, four out of five lost implants functioned for 11 years. CONCLUSION: Dental implant treatment seems to be a valid option for replacing missing teeth in OI patients. It is recommended that patients diagnosed with OI undergo the same preoperative evaluation as regular dental implant patients with special emphasis on a healthy periodontal status and ideal oral hygiene.

Outcome of healing after dental implant placement in patients with cancer on high-dose antiresorptive medications: a prospective feasibility study.

PURPOSE: Implant placement in patients with cancer receiving high-dose antiresorptive medication (HDAR) is considered contraindicated. This prospective, feasibility study tested the hypothesis that dental implants can be placed in such patients by applying a staged implant placement protocol with submerged healing. METHODS: Three groups of patients on HDAR were included as follows: group 1: patients who underwent tooth extraction, without the development of medication-related osteonecrosis of the jaws (MRONJ); group 2: patients with surgically treated MRONJ who had demonstrated clinical healing for at least 3 months; group 3: patients with established MRONJ who was planned for surgical resection and simultaneous implant placement. RESULTS: A total of 49 implants were placed in 27 patients (group 1: 12, group 2: 7 and group 3: 8). HDAR included bisphosphonates and denosumab. The mean HDAR time was 25 months (SD: ± 18.4, range 3-68 months). An abutment operation was performed 4 months following the implant placement (SD: ± 1.9, range 3-14 months). All patients healed uneventfully. CONCLUSIONS: This study demonstrated that it is feasible to insert dental implants and perform an abutment surgery in patients with cancer on HDAR, without the development of MRONJ. CLINICALTRIALS: gov Identifier: NCT04741906.

Narrow diameter implants to replace congenital missing maxillary lateral incisors: A 1-year prospective, controlled, clinical study.

OBJECTIVES: To report the clinical, radiographic, esthetic, and patient-reported outcomes after placement of a newly developed narrow-diameter implant (NDI) in patients with congenitally missing lateral incisors (MLIs). MATERIALS AND METHODS: Patients with MLIs with a mesio-distal distance between the canine and the central incisor of 5.9-6.3 mm received a dental implant with a diameter of 2.9 mm (Test), while a diameter of 3.3 mm (Control) was used when the distance was 6.4-7.1 mm. After healing, a cement-retained bi-layered zirconia crown was fabricated. At the 1-year follow-up (T2), implant survival rate, marginal crestal bone level (CBL) changes, biological and technical complications were registered. The esthetic outcome was assessed by using the Copenhagen index score, and the patient-reported outcomes were recorded using the OHIP-49 questionnaire. RESULTS: One hundred patients rehabilitated with 100 dental implants Ø0.9 mm (n = 50) or Ø3.3 mm (n = 50) were included. One Ø3.3 mm implant was lost, and seven patients dropped out of the study, yielding an implant survival rate of 99% (p = 1.000). At T2 a. CBL of -0.19 ± 0.25 mm (Test) and -0.25 ± 0.31 mm (Control) was detected, with no statistically significant difference between the groups (p = .342). Good to excellent esthetic scores (i.e., 1-2) were recorded in most of cases. Technical complications (i.e., loss of retention, abutment fracture, and chipping of veneering ceramic) occurred once in three patients with no statistically significant difference between the groups (p > .05). OHIP scores did not differ significantly at follow-ups between groups (p = .110). CONCLUSION: The use of Ø2.9 mm diameter implants represents as reliable a treatment option as Ø3.3 mm implants, in terms of CBL changes, biological and technical complications. Favorable esthetics and patient-reported outcomes were recorded for both groups.

Implant treatment after traumatic tooth loss: A systematic review.

BACKGROUND/AIMS: Treatment after traumatic tooth loss is challenging and is currently guided by expert opinion and the individual patient situation. The aim of this study was to provide an overview on the outcome of dental implant treatment in the anterior maxilla after traumatic tooth loss, based on a systematic review of the existing evidence. MATERIALS AND METHODS: A systematic search of the literature was performed on PubMed, Cochran Library and Web of Science following the PRISMA guidelines based on a structured research question (PICO). All clinical studies of five patients or more with follow-up of at least 1 year after implant loading were included. Patients were at least 18 years of age. Cohen's Kappa-coefficient was calculated. The Newcastle-Ottawa Scale was applied to assess the quality of the included studies. Descriptive statistical methods were applied. RESULTS: Nine hundred and ninety-nine articles were identified through the systematic search. Finally, six articles were eligible for inclusion. The studies comprised prospective and retrospective cohort studies and case series. From these, 96 patients with 120 implants were included. The age ranged from 18 to 59 years. The survival rates of implants and superstructures were 97% and 95%, respectively, after a mean follow-up of 3.5 years. Mean marginal bone resorption was 0.56 mm (range 0.21-1.30 mm). Complication rates were 7% and 11% on implant and superstructure level, respectively. Patient-reported outcome measures and objective evaluations showed a high level of satisfaction with the aesthetic outcome. Bone augmentation was performed in 60 implant sites. Three patients underwent pre-surgical orthodontic treatment. The maxillary central incisor was the most frequently replaced tooth (70%). CONCLUSIONS: This systematic review revealed a low level of evidence on the outcome of dental implant treatment after traumatic tooth loss. Systematic reporting of treatment outcomes of tooth replacements after dental trauma is highly encouraged to further guide dentists for the benefit of these challenging patients.

Need for lateral bone augmentation at two narrow-diameter implants: A prospective, controlled, clinical study.

OBJECTIVES: To detect the potential influence of implant diameter and anatomic factors on the need for bone augmentation procedures (BAPs) when replacing congenitally missing lateral incisors (MLIs). MATERIALS AND METHODS: Patients with congenitally missing MLIs with a mesio-distal distance between the canine and the central incisor of 5.9-6.3 mm received a Ø2.9 mm implant while Ø3.3 mm implants were placed when the distance was 6.4-7.1 mm. The following linear measurements were recorded using a calliper: width of the alveolar process (WAP), width of the bony alveolar ridge (WAR) and thickness of the facial bone after implant osteotomy (TFB). Guided bone regeneration was performed in case of fenestration- or dehiscence-type defects or a thin TFB (<1.7 mm). RESULTS: Fifty Ø2.9 mm and 50 Ø3.3 mm were included in 100 patients. WAP and WAR did not differ between the groups (p > .05). TFB was statistically significant larger in the Ø2.9 group (1.75 ± 0.59 mm) compared to the Ø3.3 group (1.5 ± 0.63 mm) (p = .041). Fenestration-type defects (p = .005) and a thin facial bone wall (p = .045) was observed more frequently in the Ø3.3 compared to the Ø2.9 group. Correspondingly, BAP was indicated more frequently in the Ø3.3 compared to the Ø2.9 group (p = .017). WAP, MD and WAR were statistically significant correlated to the need for BAP (p < .001). As independent variable, only WAR influenced the probability of BAP (p < .001). CONCLUSION: The use of 2.9 diameter implants was correlated to a reduced frequency of BAP compared to 3.3 mm implants, without reaching a statistically significant difference. Measurement of the WAP provides the clinician useful information to predict BAP.

The sandwich osteotomy technique to treat vertical alveolar bone defects prior to implant placement: a systematic review.

OBJECTIVES: The aim of this systematic review was to investigate the predictability of the sandwich osteotomy technique to provide sufficient alveolar bone height for dental implant therapy in vertically atrophic jaws. MATERIAL AND METHODS: A MEDLINE (Pubmed), EMBASE and Cochrane Library electronic search and a manual search were performed until July 2018. Any clinical study published in English, reporting data on at least 10 patients rehabilitated with implant-supported dental prostheses after vertical ridge augmentation by means of the sandwich osteotomy technique and followed for at least 12 months after loading, was included. Data on study and patients' characteristics, interventions provided, implant and prostheses survival rates and complications were extracted from the included studies. Each study design was evaluated using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Initially, 415 records were identified, from which 10 full-text articles could be included in the final qualitative analysis. Implant survival rate after a mean follow-up of 3.7 years (median: 3 years; range: 1-7 years) was 94% (median: 93%; range: 91-100%). Peri-implant mean marginal bone resorption was 1.6 mm (median: 1.4 mm; range: 0.6-4.7 mm). The calculated mean alveolar bone height available at the time of implant placement was 11.3 mm (median: 11.5 mm; range: 7.8-16 mm). A temporary sensory disturbance of the inferior alveolar nerve was the most commonly reported complication following the sandwich osteotomy. CONCLUSIONS: The present systematic review documents that implant survival rate after mandibular vertical ridge augmentation using the sandwich osteotomy technique is high after up to 5 years of loading. The complication rate can be considered moderate and has predominantly a transient nature. Data on the long-term behavior of the augmented bone and inserted implants are missing. CLINICAL RELEVANCE: The present technique can be considered a reliable treatment option in cases of moderate vertical bone deficiency of the posterior mandible to provide suitable conditions for later implant placement. Intra- and post-operative complications do not seem to jeopardize the final outcome.

Implant-supported 2-unit cantilevers compared with single crowns on adjacent implants: A comparative retrospective case series.

STATEMENT OF PROBLEM: The replacement of 2 adjacent missing teeth remains a clinical challenge. Among the different treatment options, the use of a single implant to support a 2-unit cantilever fixed dental prosthesis (FDP) has been proposed in situations of limited mesiodistal space, even though the evidence for its use is low. PURPOSE: The purpose of this retrospective comparative case series was to evaluate hard and soft peri-implant tissues in patients with 2 adjacent missing teeth in the anterior area (incisors or canines) rehabilitated with implant-supported 2-unit cantilevers or single crowns on adjacent implants. MATERIAL AND METHODS: Twenty-three from a cohort of 34 patients rehabilitated with 2-implant systems between September 2006 and November 2015 with 2-unit cantilever FDPs (test group) (n=16) or 2 adjacent dental implants supporting single crowns (control group) (n=7) were available for follow-up. At the baseline and follow-up examinations, the implant survival rate, peri-implant probing pocket depth, marginal bone level (MBL), as well as papilla scores and prosthetic outcomes from the Copenhagen Index Score were recorded and evaluated. RESULTS: One implant in the control group was lost during the observation period, leading to an overall implant survival rate of 97%. Mean peri-implant probing depths were low (≤5 mm) in both the groups. Stable marginal bone levels were detected around adjacent implants and around implants supporting cantilevers. Medium to high esthetic scores were obtained in most patients. Papilla index scores were high (score 1 and 2) in both the groups. Finally, no technical complications were recorded. CONCLUSIONS: The use of a single-implant-supported 2-unit cantilever FDP in anterior sites is a valid treatment option compared with 2 adjacent implants, especially when the available mesiodistal space is limited.

Timing of Implant Placement after Traumatic Dental Injury.

Dental implants are reliable to replace teeth lost because of traumatic dental injury. However, dental implants behave like ankylosed teeth and should not be placed in growing individuals because of the risk of infraposition. This risk may be reduced by ensuring arrested skeletal growth and ideal incisal support. The timing of implant placement may be immediate, early, conventional, or late and is determined by the extent of the trauma, remaining growth, and conditions of the hard and soft tissues. Timing should allow an observation period to properly evaluate the prognosis of concomitantly traumatized neighboring teeth. Orthodontic alignment is often necessary after traumatic dental injury in young individuals to provide symmetric dental conditions around the facial midline, to allow implant placement in the correct 3-dimensional position for the later prosthetic reconstruction, and to ensure sufficient mesiodistal space that leaves a minimum of 1.5 mm of healthy alveolar bone between the future implant and neighboring teeth. Space and stable occlusion should be maintained by bonded retainers and a splint used during the night. A partial prosthesis is usually recommended as a temporary replacement. If a fixed provisional prosthesis is required, it is crucial that it does not interfere with the remaining growth and incisal support and allows proper oral hygiene.

Maxillary Sinus Floor Augmentation With Synthetic Bone Substitutes Compared With Other Grafting Materials: A Systematic Review and Meta-analysis.

OBJECTIVE: To test the hypotheses of no differences in implant treatment outcome after maxillary sinus floor augmentation (MSFA) with synthetic bone substitutes (SBS) compared with other grafting materials applying the lateral window technique. MATERIALS AND METHODS: A MEDLINE/PubMed, Embase and Cochrane Library search in combination with hand-search of selected journals was conducted. RESULTS: Five randomized controlled trials with low risk of bias fulfilled the inclusion criteria. SBS disclosed high survival rate of suprastructures and implants with no significant differences compared to autogenous bone graft or xenograft. Meta-analysis revealed a patient-based implant survival rate of 0.98 (confidence interval: 0.89-1.08), indicating no differences between SBS and xenograft. SBS demonstrated significant less newly formed bone compared with autogenous bone graft, whereas no significant difference was revealed as compared to xenograft. High implant stability values, limited periimplant marginal bone loss, and few complications were reported with SBS. CONCLUSIONS: There seem to be no differences in implant treatment outcome after MSFA with SBS compared to other grafting materials.

Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study.

PURPOSE: This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge. METHODS: From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure. RESULTS: A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17-65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7 % after GBR procedures, 25.9 % after staged horizontal ridge augmentation, and 18.2 % after staged vertical ridge augmentation. Infections were diagnosed in 2 % after GBR procedures, 12.5 % after sinus floor elevation (SFE) (transcrestal technique), 5 % after staged SFE, 11 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2 % after GBR procedures, 37 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation. CONCLUSIONS: Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

5-year results comparing mineral trioxide aggregate and adhesive resin composite for root-end sealing in apical surgery.

INTRODUCTION: Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing. However, the information is mainly based on 1- to 2-year follow-up data. The present prospective study was designed to re-examine a large sample of teeth treated with apical surgery after 5 years. METHODS: Patients were recalled 5 years after apical surgery, and treated teeth were classified as healed or not healed based on clinical and radiographic examination. (The latter was performed independently by 3 observers). Two different methods of root-end preparation and filling (primary study parameters) were to be compared (mineral trioxide aggregate [MTA] vs adhesive resin composite [COMP]) without randomization. RESULTS: A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years (dropout rate = 20.1%). The overall rate of healed cases was 84.5% with a significant difference (P = .0003) when comparing MTA (92.5%) and COMP (76.6%). The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories (ie, sex, age, type of tooth treated, post/screw, type of surgery). CONCLUSIONS: The results from this prospective nonrandomized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing.

Severe bleeding after sinus floor elevation using the transcrestal technique: a case report.

AIM: To present a rare but clinically significant complication to sinus floor elevation (SFE) using the transcrestal technique. MATERIALS AND METHODS: Transcrestal SFE with simultaneous implant placement was performed in the maxillary right second premolar region of a healthy 70-year-old woman with no history of a bleeding disorder. RESULTS: The patient reported to the emergency care unit a few hours after the surgery with ongoing bleeding and progressive swelling of especially the right side of the midface. The buccal swelling did not allow the patient to close her mouth and the discoloration extended to the sternum. A computed tomography scan showed pronounced swelling of the facial soft tissue and the right sinus cavity completely filled with blood. The patient was kept hospitalised for 3 days until regression of the swelling was attained and acceptable oral function was regained. CONCLUSION: Transcrestal SFE is often recommended to the less experienced surgeon before the lateral window technique due to fewer complications and lower morbidity. The present case illustrates that severe complications may accompany transcrestal SFE. Although rare, clinicians performing SFE should be aware of this potential risk.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite.

INTRODUCTION: The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). METHODS: The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS: The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. CONCLUSIONS: MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars.

Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials.

PURPOSE: The objective of this review was to evaluate the efficacy of different grafting protocols for the augmentation of localized alveolar ridge defects. MATERIALS AND METHODS: A MEDLINE search and an additional hand search of selected journals were performed to identify all levels of clinical evidence except expert opinions. Any publication written in English and including 10 or more patients with at least 12 months of follow-up after loading of the implants was eligible for this review. The results were categorized according to the presenting defect type: (1) dehiscence and fenestration-type defects, (2) horizontal ridge augmentations, (3) vertical ridge augmentations, and (4) maxillary sinus floor elevations using the lateral window technique or transalveolar approach. The review focused on: (1) the outcome of the individual grafting protocols and (2) survival rates of implants placed in the augmented bone. RESULTS AND CONCLUSION: Based on 2,006 abstracts, 424 full-text articles were evaluated, of which 108 were included. Eleven studies were randomized controlled clinical trials. The majority were prospective or retrospective studies including a limited number of patients and short observation periods. The heterogeneity of the available data did not allow identifying one superior grafting protocol for any of the osseous defect types under investigation. However, a series of grafting materials can be considered well-documented for different indications based on this review. There is a high level of evidence (level A to B) to support that survival rates of implants placed in augmented bone are comparable to rates of implants placed in pristine bone.