Diagnostic and Prognostic Value of Indicators of Bone Metabolism Markers in Patients Following Mandibulectomy and Free Fibula Flap Reconstruction with Endosteal Implants.

Purpose: To evaluate and assess the indicators of bone metabolism markers osteocalcin and ß-Cross-Laps in blood serum as a tool for monitoring bone regeneration and determining the time of implantation in patients after mandibulectomy and reconstruction of a free fibular flap with subsequent endosteal implants. Materials and Methods: Forty-eight patients in a 6-year period participated in this study, due to resection for tumors. All patients underwent reconstruction with fibula free flap after tumor resection, 4-6 months after osteoectomy, dental implants were installed with further orthopedic rehabilitation. To assess the rate of bone remodeling after transplantation, the content biochemical markers of bone remodeling osteocalcin and ß-Cross-Laps serum were determined by enzyme immunoassay. Results: All 46 fibular free flaps were healed without complications and were survived. A total 326 implants installed, 8 implants failed to osseointegrate, and 6 implants failed after 5 years of loading (peri-implantitis). Success rate of implants after 5 years was 95,7%. In patients before surgery, the mean of osteocalcin levels was 8.5 ng/ml, two months later, there was a sharp increase in the content of osteocalcin by 15.4 ng/ml, after four months reached 24.7 ng/ml, after six months of 28.6 ng/ml, then the indicator began to decrease and after 12 months it was approaching the norm of 14.7 ng/ml. In patients before surgery, the mean level of ß-Cross-Laps was 0.76 ng/ml, after two months bone transplantation the mean level of ß-Cross-Laps decreased to - 0.65 ng/ml, after four months the indicator increased and reached of 0.98 ng/ml, after six months the indicator was - 1.56 ng/ml, then these indicators began to decrease and after 12 months, approaching normal values of - 0.87 ng/ml. There is a correlation between different concentrations of osteocalcin or ß-Cross- Laps and the success rate of implants. Implants were shown to be unsuccessful low concentrations of osteocalcin and high concentrations of ß-Cross-Laps in serum. Conclusion: Studies have shown that the long-term survival and success rates of implants placed in the reconstructed areas may guarantee an excellent prognosis of implant-supported prostheses. Bone markers in blood serum osteocalcin and ß-Cross-Laps can be used to evaluate the rate of bone remodeling, which allows you to determine the time of implantation.

Prosthetic rehabilitation of patients with maxillary oncology defects using zygomatic implants.

PURPOSE: Prosthetics for patients after oncological resection of the upper jaw is a complex problem associated with the physiological and anatomical separation of the oral cavity and the nasal/paranasal region. This study reports the clinical results of the use of the zygomatic implants for prosthetic rehabilitation in patients with maxillectomy due to upper jaw tumors. MATERIALS AND METHODS: The study included 16 patients who underwent prosthetic rehabilitation using a zygomatic implant after maxillectomy period from 2021 to 2023. After the tumor was removed, immediate surgical obturators were placed. Main prosthetic rehabilitation was performed 6-12 months after tumor removal, but before that, a temporary obturator was made and used. Six-twelve months after tumor resection, 1-4 zygomatic implants were inserted into the zygomatic bone unilaterally or bilaterally. A total of 42 zygomatic implants were installed, 2 of which were unsuccessful and were removed in 1 patient. The implants were placed using the surgical guide, which was planned and prepared digitally. RESULTS: No postsurgical complications were seen, and the patients were discharged from the hospital after 7-10 days. The patients were able to return to a normal diet (hard food) after just 7 days following surgery, with no further complaints regarding function or pain, apart from the residual edema caused by the intervention. CONCLUSIONS: The use of prostheses fixed on zygomatic implants in patients with maxillary defects is an effective method of prosthodontic rehabilitation in complex clinical cases after maxillectomy.

Collaborative Content-Dependent Modeling: A Return to the Roots of Salient Object Detection.

Salient object detection (SOD) aims to identify the most visually distinctive object(s) from each given image. Most recent progresses focus on either adding elaborative connections among different convolution blocks or introducing boundary-aware supervision to help achieve better segmentation, which is actually moving away from the essence of SOD, i.e., distinctiveness/salience. This paper goes back to the roots of SOD and investigates the principles of how to identify distinctive object(s) in a more effective and efficient way. Intuitively, the salience of one object should largely depend on its global context within the input image. Based on this, we devise a clean yet effective architecture for SOD, named Collaborative Content-Dependent Networks (CCD-Net). In detail, we propose a collaborative content-dependent head whose parameters are conditioned on the input image's global context information. Within the content-dependent head, a hand-crafted multi-scale (HMS) module and a self-induced (SI) module are carefully designed to collaboratively generate content-aware convolution kernels for prediction. Benefited from the content-dependent head, CCD-Net is capable of leveraging global context to detect distinctive object(s) while keeping a simple encoder-decoder design. Extensive experimental results demonstrate that our CCD-Net achieves state-of-the-art results on various benchmarks. Our architecture is simple and intuitive compared to previous solutions, resulting in competitive characteristics with respect to model complexity, operating efficiency, and segmentation accuracy.

Simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement: A retrospective clinical study of 23 patients.

OBJECTIVE: The aim of this study was to evaluate the efficacy of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement. PATIENTS AND METHODS: The study patients (n = 23) were partially or completely edentulous in the posterior maxilla and required maxillary sinus augmentation. All included patients had a sinus pathology confirmed clinically and radiographically. The technique of simultaneous endoscopic endonasal sinus surgery and sinus augmentation was used in 15 patients, with eight endonasal sinus surgery procedures being performed 2-3 months before sinus augmentation. Where possible, implants were placed during the same surgical procedure (with a ridge bone height of at least 4 mm). RESULTS: There were no any major intraoperative complications. Implants placed in the reconstructed areas were shown to integrate normally, and postoperative occlusal function and aesthetics were favorable. Of the 95 implants placed in these 23 patients, two failed to osseointegrate. CONCLUSION: The method of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement leads to a reduction in postoperative complications, significantly shortening the rehabilitation period for patients with maxillary sinus diseases and insufficient bone tissue.

The Treatment of Lower Jaw Defects Using Vascularized Fibula Graft and Dental Implants.

This study is based on an analysis of the results of treatment of 21 patients with mandibular defects of different localization and etiology who underwent reconstruction with fibula free flap. Postoperative clinical and radiographic controls were made regularly, the criteria for implant success were assessed.The postoperative evolution of the patients was favorable, with the integration of the fibula vascularized grafts. Complete engraftment of bone autografts and wound healing was obtained in all observations. In all 21 patients, fibula flaps provided adequate conditions for implant placement. The coefficient of osteointegration of implants 3 years after bone grafting was 97%.Using a vascularized autograft from the fibula to replace the defects of the lower jaw provides the conditions for a full rehabilitation of patients. The methods of reconstructive surgery and implantation make it possible to successfully perform the replacement of defects in the maxillofacial region, being one of the methods medical and social rehabilitation of patients with this pathology.