Comparison of Marginal Bone Loss in Simultaneous Versus Delayed Implant Placement Following Horizontal Ridge Augmentation with Autogenous Lateral Ramus Bone Block.

Statement of the Problem: Alveolar ridge resorption after tooth extraction may interfere with optimal dental implant placement. Purpose: This study aimed to compare the marginal bone loss (MBL) and thickness of the buccal aspect of the augmented site in simultaneous versus delayed implant placement following lateral ramus horizontal ridge augmentation in the posterior mandible. Materials and Method: This prospective cohort study was conducted on patients who required horizontal bone augmentation of the posterior mandible using lateral ramus autogenous bone graft. Patients were divided into two groups of simultaneous implant placement (group 1) and delayed implant placement (group 2). Cone-beam computed tomography (CBCT) images were obtained before augmentation, at the time of implant placement, and 10 months later (6 months after implant loading). MBL and thickness of the buccal aspect were evaluated over time. Results: There were 18 patients in the group 1 and 16 patients in the group 2. Analysis of the CBCT scans demonstrated that the mean MBL was 1.21±0.35mm in the group 1 and 1.08±0.19mm in the group 2, with no significant difference between the two groups (p= 0.19). Thickness of the buccal aspect of the augmented site at the time of implant placement was 1.85±0.20mm in the group 1 and 2.16±0.29 mm in the group 2, with a significant difference (p< 0.001). However, data analysis regarding changes in the buccal plate thickness showed no significant difference between the two groups (p= 0.36). Conclusion: According to the results of this study, there was no significant difference in M-BL and post-operative changes in the thickness of the buccal aspect of the augmented sites with onlay lateral ramus bone blocks between simultaneous and delayed implant placement.

Effect of Local Injection of Lidocaine and Articaine plus Epinephrine on Methemoglobin Level during General Anesthesia.

Statement of the Problem: Methemoglobinemia is a potentially life-threatening rare medical condition, which refers to an increase in the level of oxidized form of hemoglobin (methemoglobin). Excessive replacement of hemoglobin with methemoglobin leads to functional hypoxia and even fatal conditions. Purpose: The aim of this study was to evaluate the effect of two common local anesthetic agents namely lidocaine and articaine administered for hemostasis during surgery on methemoglobin level. Materials and Method: This prospective cohort study was conducted from January 2017 to December 2019. Demographic data including age, gender, and weight of patients were collected. Sixty patients were randomly divided into three groups (n=20) regarding the local anesthetic agent administered for hemostasis during surgery as lidocaine group (group 1), articaine group (group 2), and control group (no local anesthetic; group 3). The patients were candidates for orthognathic surgery, reconstruction of the maxillary and mandibular atrophic ridges with autogenous grafts, and reconstruction of maxillofacial fractures. The methemoglobin level was measured before surgery and six hours after the initiation of surgery. Results: The mean age and weight of patients were not significantly different among the three groups (p= 0.891 and p= 0.416, respectively). No significant differences were observed among the three groups regarding the gender distribution (p= 0.343) or type of surgery (p= 0.990). Statistical analysis did not show any significant difference in the mean baseline methemoglobin level among the three groups (p= 0.109). Although the mean methemoglobin values increased in the three groups, paired sample t-test did not show any significant change in the values at six hours after the initiation of surgery compared with baseline in any of the three groups (p= 0.083 for group 1, p= 0.096 for group 2, and p= 0.104 for group 3). Conclusion: The results demonstrated that administration of lidocaine and articaine plus epinephrine for hemostasis during general anesthesia are equally safe.

Does P16 Protein Expression Affect Treatment Prognosis in Oral Squamous Cell Carcinoma - A Comparative Study.

INTRODUCTION: P16 is an independent and reliable surrogate for the detection of human papillomavirus (HPV) in oral squamous cell carcinoma (OSCC). The aim of this study was to assess the P16 expression as a marker for HPV infection in OSCC and its impact on the treatment outcome. METHODS AND MATERIALS: A cross-sectional study was conducted on patients with a definite diagnosis of OSCC. Patients were assigned into two groups with and without recurrence or metastasis. Tumour resection was performed in the same manner for all patients. P16 expression was evaluated by immunohistochemical staining. Independent t-test and Chi-square tests were used to find significant differences in age, gender, stage of the disease, tumour size, lymph node involvement, and P16 expression between the two groups. RESULTS: Of 50 patients, 37 did not show any recurrence or metastasis (group 1), while 13 had a relapse (group 2). There was no significant difference for age, gender distribution, stage of the disease, or lymph node involvement between the two groups (P > 0.05). A significant difference in tumour size was noted between the two groups (P = 0.001). The mean expression of P16 was 38.92 ± 24.36 in group 1 and 51.54 ± 33.63 in group 2. No significant difference was found between the two groups for the mean expression of P16 (P = 0.23). DISCUSSION: A review of the recent literature revealed that the HPV role in OSCC treatment is controversial. According to the results of this study, there was no significant difference in terms of P16 expression between OSCC patients with and without recurrence or metastasis.

Does Combined Low-Level Laser and Light-Emitting Diode Light Irradiation Reduce Pain, Swelling, and Trismus After Surgical Extraction of Mandibular Third Molars? A Randomized Double-Blinded Crossover Study.

PURPOSE: Complications after extraction of mandibular third molars, including pain, swelling, and trismus, are common problematic phenomena for both patients and surgeons. The main objective of the present study was to evaluate the therapeutic effect of combined low-level laser (LLL) and light-emitting diode (LED) irradiation on the recovery rate of such complications. PATIENTS AND METHODS: The authors implemented a prospective randomized, double-blind crossover design. Forty participants (80 teeth) were enrolled, each with bilateral and symmetrical impacted lower third molars. Participants had lower third molars extracted at 2 separate visits. Participants were randomized to receive LLL plus LED or placebo at the initial surgical procedure. Participants acted as their control during the second surgical procedure. The primary predictor variable was LLL plus LED. The primary outcome variable was pain measured at postoperative days 3 and 7. Secondary outcome variables were swelling and trismus. The Mann-Whitney U, Wilcoxon, and Friedman tests were used for statistical analysis with a P < .05 considered significant. RESULTS: The sample size of each group was 40 (male to female ratio of 1:1, mean age 24.8 ± 3.9). Preoperative scores of all scales were lower for both groups compared with days 3 and 7 (P < .0001). Postoperative pain levels on days 3 and 7 were significantly less in the intervention group (P = .03 and P = .01, respectively). Compared with the control group, the postoperative trismus level of the intervention group was significantly less on day 3 (P = .006). However, the difference on day 7 was not significant. Postoperative swelling levels on days 3 and 7 were significantly less in the intervention group (P < .0001). CONCLUSIONS: Combined LLL plus LED irradiation could be an effective therapy to decrease postoperative pain and swelling after impacted third molar extractions.

Efficacy of low-dose local clindamycin in different times for microbial decontamination of autogenous particulate bone graft.

BACKGROUND: Clindamycin in low concentration (20 µg/mL) is safe for vitality and osteogenic potential of bone cells. The aim of this study was to evaluate the efficacy of local clindamycin (20 µg/mL) in two different exposure times, for microbial decontamination of particulate bone graft, collected during implant site preparation. This non-randomized parallel-group study was conducted on samples from 17 patients. The particulate bone collected during implant site preparation was divided into three portions by weight: in group S1, the particulate bone was immersed in thioglycolate broth without any antibiotic treatment; in group S2, the collected particulate bone was irrigated with 100 mL clindamycin solution (20 µg/mL); and in group S3, the collected particulate bone was soaked in one ml clindamycin solution (20 µg/mL) for 3 min. Samples in the three groups were cultured in aerobic and anaerobic media and species and CFU count of isolated bacteria were determined. RESULTS: Analysis of the data demonstrated a significant difference among the three groups in the mean count of total microorganisms (P = 0.001). The difference in the mean count of anaerobic and aerobic microorganisms in the three groups was statistically significant as well (P = 0.001). Pseudomonas aeruginosa was the only microorganism that was not affected with the mentioned antibiotic. CONCLUSIONS: Local use of low-dose clindamycin (20 µg/mL)-irrigation or 3 min immersing-is effective for the decontamination of particulate bone grafts.

Do Patients have the Same Experience of Pain Following Tooth Extraction and Dental Implants?

INTRODUCTION: Postoperative pain is an important concern for patients who need dental implants. This study aims to compare the experience of pain in patients who undergo tooth removal and dental implant surgery. MATERIALS AND METHODS: This is a crossover study. Patients who underwent a simple tooth extraction and dental implant surgery were studied. The pain severity was assessed using a visual analog scale at 12, 24, 48, and 72 h after procedures. The repeated measure test was used to compare pain severity between two treatment sessions. RESULTS: Forty patients were studied. Patients reported higher pain levels in a tooth extraction at study times than implant surgery (P = 0.001). CONCLUSION: It seems patients who had experience of tooth extraction and a dental implant placement reported significantly lower pain in implant surgery.

Can Low-Level Laser and Light-Emitting Diode Enhance the Stability of Dental Implants?

PURPOSE: Stability of dental implants is an important factor for evaluation of osseointegration. The aim of this study was to evaluate the effect of combined use of low-level laser (LLL) and light-emitting diode (LED) therapy on the stability of dental implants during the healing phase. MATERIALS AND METHODS: This was a randomized clinical trial. Patients were assigned to two groups: In group 1, patients received LLL and LED 20 min/day for 10 days after implant insertion. Patients in group 2 (controls) did not undergo LLL and LED. The implant stability quotient (ISQ) was measured at 0 (time 0), 10 (time 1), 21 (time 2), 42 (time 3) and 63 days (time 4) after implant placement. Independent t test was used to compare the ISQs between the two groups. RESULTS: Fifty-eight patients were studied in two groups (n = 28). The mean ISQ did not differ immediately after insertion (P > 0.05). The mean ISQ differed significantly between the two groups on days 10, 21, 42 and 63 (P < 0.05). Results demonstrated an increase in the amount of ISQ in group 1 (intervention) at times 1, 2, 3 and 4. In the control group, the amount of ISQ decreased on days 10 and 21 following implant insertion, but increased afterward on days 42 and 63. CONCLUSION: The results of this study showed that simultaneous use of LLL and LED increased the stability of the implants after 9 weeks of follow-up.

Different osteogenic differentiation potential of mesenchymal stem cells on three different polymeric substrates.

The function of tissue cells is strongly depends on the extracellular matrix (ECM) that can guide and support cell structure. This support plays a crucial role in the process of cell proliferation and differentiation. Herein, three different nanofibrous scaffolds that are highly attractive for tissue engineering were selected and then osteogenic related genes and protein expression patterns of human adipose-derived mesenchymal stem cells (AT-MSCs) were investigated when grown on substrates. Polycaprolactone, Poly (L-lactic acid) and Polyvinylidene-fluoride nanofibrous scaffolds were fabricated using Electrospinning method and then AT-MSCs viability and osteogenic differentiation were evaluated while cultured on them. The highest AT-MSCs survival rate when grown on the scaffolds was detected when grown on Polyvinylidene-fluoride. In addition, the highest ALP activity and mineralization were also observed in differentiated AT-MSCs has grown on Polyvinylidene-fluoride. The expression levels of Runx2, osteonectin and osteocalcin genes and osteocalcin protein in the AT-MSCs has grown on the Polyvinylidene-fluoride were also significantly higher than the rest of the scaffolds. Based on the results, it seems that since the studied substrate have a similar structural characteristics, their nature may have an important role in the stem cell's osteogenesis process, where the Polyvinylidene-fluoride piezoelectricity was a most distinguished characteristic.

Platelet-rich plasma incorporated electrospun PVA-chitosan-HA nanofibers accelerates osteogenic differentiation and bone reconstruction.

Biologically active materials and polymeric materials used in tissue engineering have been one of the most attractive research areas in the past decades, especially the use of easily accessible materials from the patients that reduces or eliminates any patient's immune response. In this study, electrospun nanofibrous scaffolds were fabricated by using polyvinyl-alcohol (PVA), chitosan and hydroxyapatite (HA) polymers and platelet-rich plasma (PRP) as a bioactive substance isolated from human blood. Fabricated scaffold's structure and cytotoxicity were evaluated using scanning electron microscope and MTT assays. Scaffolds osteoinductivity was investigated by osteogenic differentiation of the mesenchymal stem cells (MSCs) at the in vitro level and then its osteoconductivity was examined by implanting at the critical-sized rat calvarial defect. The in vitro results showed that scaffolds have a good structure and good biocompatibility. Alkaline phosphatase activity, calcium content and gene expression assays were also demonstrated that their highest amount was detected in MSCs-seeded PVA-chitosan-HA(PRP) scaffold. For this reason, this scaffold alone and along with the MSCs was implanted to the animal defects. The in vivo results demonstrated that in the animals implanted with PVA-chitosan-HA(PRP), the defect was repaired to a good extent, but in those animals that received MSCs-seeded PVA-chitosan-HA(PRP), the defects was almost filled. It can be concluded that, PVA-chitosan-HA(PRP) alone or when stem cells cultured on them, has a great potential to use as an effective bone implant.

Does Orbital Volume Change Using the Mirror Technique Have a Correlation With Posttraumatic Enophthalmos?

An increase in orbital volume (OV) is an important factor in posttraumatic enophthalmos. The aim of this study was to evaluate the correlation of OV change using the mirror technique with posttraumatic enophthalmos.In this cross-sectional study, a 3-dimensional (3D) semi-automated volumetric method, using a 3D volume rendering tool, was applied to measure OV. The total orbital volume difference (TOVD), posterior orbital volume difference (POVD), and anterior orbital volume difference (AOVD) were measured as predictive factors in traumatic and intact orbits. Enophthalmos was also examined as the outcome, using a Hertel exophthalmometer.A total of 27 patients were examined in this study. The mean TOVD was 4.48 ±â€Š1.82 mm, the mean POVD was 1.91 ±â€Š0.31 mm, and the mean AOVD was 2.57 ±â€Š1.71 mm; also, the mean enophthalmos was 2.89 ±â€Š1.12 mm. Pearson's correlation test demonstrated a positive correlation between enophthalmos and TOVD, POVD, and AOVD (P <0.05). Based on the linear regression model, TOVD had a predictive power of 61.7% for enophthalmos. For every 1-mm volume change, a 0.38-mm enophthalmos was expected (R, 0.617; B, 0.38; P = 0.001).TOVD, POVD, and AOVD showed strong correlations with enophthalmos. However, it seems that POVD has the greatest effects on the occurrence of posttraumatic enophthalmos.

Does Open Rhinoplasty Alter Voice Quality?

PURPOSE: The voice can change after upper airway manipulation. The present study evaluated voice change after open rhinoplasty. MATERIALS AND METHODS: The present cross-sectional study was conducted on patients undergoing open rhinoplasty. Three acoustic parameters (frequency, bandwidth, and amplitude) were evaluated before open rhinoplasty and then 3, 7, and 10 months after the operation. Patients' sounds when pronouncing M, N, and A were examined. Acoustic factors were measured at the first and second nasal murmurs. Time was a predictive factor and multiple acoustic parameters were the outcome of the study. RESULTS: Twenty-five patients were studied. Amplitude and bandwidth decreased, whereas frequency increased, when pronouncing the vowel A after rhinoplasty. In contrast, for consonants M and N, amplitude decreased, whereas bandwidth and frequency increased, after rhinoplasty. CONCLUSION: Open rhinoplasty seems to affect voice quality. Open rhinoplasty altered the frequency, amplitude, and bandwidth of vowel and consonant sounds during 10-month follow-up.

Comparison of Envelope and Modified Triangular Flaps on Incidence of Dry Socket after Surgical Removal of Impacted Mandibular Third Molars: A Double-blind, Split-mouth Study.

AIM: This study aimed to investigate the impact of modified triangular flap (MTF) compared with the envelope flap (EF) on the incidence of dry socket and healing degree after lower-impacted third molar surgery. MATERIALS AND METHODS: Present research was executed on 31 patients between the ages 17 and 24 years with the indication of removing impacted mandibular third molars in both sides with similar difficulty. The impacts of MTF and EF on degree of incidence of dry socket and healing on 3rd day and 1 week after surgery were recorded and investigated in a double-blinded manner. The significant changes in mentioned indices in two groups were statistically judged using Chi-squared and Wilcoxon's statistical tests. RESULTS: Three patients were excluded during the survey and 28 patients (56 samples) remained. The patients' average age was 20.1 years. Totally, 19 patients were female and 11 of them had academic education. Degree of dry socket incidence in MTF group was 11.76% and it was 41.17% in EF group (p = 0.042). In the follow-up session after 3 days since the surgery, healing degree mean in MTF group was 3.16 ± 1.5 and it was 4.37 ± 1.8 in EF group (p = 0.112). In follow-up session 7 days after the surgery, mean healing degree in MTF group was 0.037 ± 0.6 and it was 0.89 ± 0.73 in EF group (p = 0.005). CONCLUSION: Present study indicated that application of MTF may lead to a reduction in dry socket incidence and an increase of healing after 7 days since lower-impacted third molar surgeries. CLINICAL SIGNIFICANCE: Reducing postsurgery complication incidences following third molar surgery is an important issue, which could easily be achieved by designing appropriate flaps.

The Risk Factors in Early Failure of Dental Implants: a Retrospective Study.

STATEMENT OF THE PROBLEM: Despite the low failure rate of dental implants, recognition of the risk factors can enhance the predictability of failure. PURPOSE: The aim of this study was to evaluate the risk factors for early implant failure. MATERIALS AND METHOD: This retrospective cohort study was conducted on two groups of patients, the patients with a failed implant before loading and those without a failed implant. Age, gender, implant type, implant surface, implant length, bone type, type of surgery (one- or two-stage) and immediate (fresh socket) or delayed placement of implant were the variables to be assessed in this study. RESULTS: Out of the 1,093 evaluated implants, 73 cases (6.68%) failed in early stages. The two groups were significantly different in terms of implant surface, fresh socket placement, prophylactic use of antibiotics, and bone density (p< 0.05). Age, gender, implant height, implant type (cylindrical or tapered) and one-stage or two-stage placement were not significantly different between the two groups (p> 0.05). CONCLUSION: It seems that prophylactic antibiotic therapy, implant surface, bone density and placement in fresh extraction socket may contribute to dental implant failure.

Ability of Oral and Maxillofacial Surgery Residents in Diagnosing Jaw Cysts: A Retrospective 20 Years Study.

INTRODUCTION: Diagnosis of odontogenic cysts despite of their benign nature is a critical and challenging problem especially among undergraduate and postgraduate students. AIM: This study aimed to evaluate the capability of oral and maxillofacial surgery residents in diagnosing odontogenic cysts. MATERIALS AND METHODS: This cross-sectional study was executed on 312 patient records over the past 20 years since October 1995 till December 2014 in Taleghani Hospital, Tehran, Iran. All recorded data was based on 2005 World Health Organization (WHO) classifications. The differential diagnosis was made by 65 residents based on clinical and paraclinical evaluations established in the charts. Differential diagnoses made by the residents were compared to the histopathological examination as the gold standard for identifying the nature of the cysts. Weighted kappa test was used to show the degree of agreement. RESULTS: Data extracted from 312 records were analyzed. The mean age of examined patients was 27.6 years. The accuracy of diagnosis among the residents was moderate (kw=0.5). The diagnosis made by the residents was significantly related to the radiographic view of the cysts (p<0.05). The residents were able to identify odontogenic keratocysts and dentigerous cysts in most cases. CONCLUSION: There are several factors associated with the occurrence of pathologic odontogenic cysts which could help either the clinician or the pathologist in diagnosing the odontogenic cysts of the jaws. The surgeons should consider these related factors before the final diagnosis and choosing the appropriate treatment plan.

Diagnostic Factors of Odontogenic Cysts in Iranian Population: A Retrospective Study Over the Past Two Decades.

BACKGROUND: Early diagnosis of odontogenic cysts due to their silent progression is always a challenging problem for clinicians. OBJECTIVES: The current study aimed to evaluate the frequency of odontogenic cysts and related factors in a selected Iranian population. PATIENTS AND METHODS: The current cross-sectional study was conducted on 312 patients' recorded data in Taleghani Hospital, Tehran, Iran, from April 1993 to December 2013. All related data were extracted from the records and categorized in tables. The correlation between the variables was analyzed by either chi-square or multinominal logistic regression tests. The P values < 0.05 were considered significant. RESULTS: Evaluation of 312 patients' records (185 males and 127 females) with the mean age of 27.6 showed that Odontogenic Keratocyst (OKC) was the most common odontogenic cyst of all followed by the dentigerous cyst as the second most common lesion. Most of the patients were in the second or third decades of their lives, although there was no statistically significant age distribution. The finding of the current study showed that calcifying odontogenic cyst (COC) occurrence was significantly related to the history of trauma. Enucleation and curettage of the odontogenic cysts were the most common treatment plans of all. CONCLUSIONS: The current study showed that clinicians should consider the many factors associated with the occurrence of odontogenic cysts.

Cutaneous Metaplastic Synovial Cyst: A Case Report and Literature Review.

INTRODUCTION: Cutaneous metaplastic synovial cyst (CMSC) is a rare cutaneous lesion characterized by a tender subcutaneous nodule, which usually occurs at the site of previous surgical or local trauma. Histologically, the lesion includes a cystic structure with villous-like projections and a lining mimicking hyperplastic synovium. CASE PRESENTATION: We reported the first case of CMSC which developed at the surgical incision site of treatment of a maxillofacial fracture. In addition, we reviewed English literature to evaluate all previously reported CMSC cases and discussed its clinical and histopathological features and etiology. From 1987 to now, reviewing the English literature about CMSC includes 17 studies that described 28 cases, and our presented case was the 29th. There was no sex predilection and age of patients ranged from 7 to 82 years, but most of them were over 40 years. We can see this lesion in any site of the body and hand/arm is the most prevalent involved region (28% cases). Most of the patients had a history of previous local trauma or operation in the involved area. CONCLUSIONS: Although the actual etiology of CMSC remains unclear, trauma, as the most probable etiologic factor, plays a role in development of CMSC. Surgical excision of the lesion is the preferable treatment choice and rate of recurrence is low.

Incidence and risk factors of functional upper airway complications of primary esthetic closed rhinoplasty in two residency programs: A 6-month preliminary prospective cohort study.

BACKGROUND: Although esthetic rhinoplasty has many advantages, it might lead to some complications as well. The literature includes scarce and severely controversial studies on these issues, and there is no research on complications of cosmetic closed rhinoplasty. In addition, some complications are not assessed after any rhinoplasty types. Besides, there is no investigation on the outcome of rhinoplasty carried out by graduate students. The purpose of this study was to determine these. MATERIALS AND METHODS: In this preliminary prospective cohort study, 96 healthy patients underwent closed esthetic rhinoplasty by senior residents of otolaryngology and maxillofacial surgery at Taleghani Hospital (Tehran, 2004-2006). Afterward, at 11 follow-up sessions (the 1(st), 2(nd), 3(rd), 4(th), 6(th), 8(th), 10(th), 12(th), 16(th), 20(th), and 24(th) postoperative weeks), five functional complications (hyposmia/anosmia, nasal obstruction, unpleasant voice changes, recurrent colds, and synechiae) were questioned/examined. The presence of a symptom during at least four subsequent sessions (without elimination until the sixth postoperative month) and the appearance of synechiae in any session were regarded as positive. The data were assessed using Spearman's correlation coefficient (α = 0.05). RESULTS: The incidence rates of synechiae, nasal obstruction, unpleasant voice changes, hyposmia/anosmia, and recurrent colds were 56.25%, 37.5%, 0%, 1.04%, and 29.17%, respectively. No statistically significant relationship was found between the complications with age, gender, or the surgeon's specialty (P > 0.05), but the correlation with home care compliance was significant (ρ = -0.29, P = 0.01). CONCLUSIONS: High complication rates were observed in both residency programs. Failure to follow home care instructions might prevent/delay recovery. Further in-depth studies are needed to assess this.

The effectiveness of barrier membranes on bone regeneration in localized bony defects: a systematic review.

PURPOSES: The aim of this study was to assess the effectiveness of barrier membranes in bone augmentation through a systematic review of the literature. MATERIALS AND METHODS: Electronic data banks and hand searching were used to find relevant articles on the reconstruction of localized bone defects published up to May 2011. Controlled animal and human studies with more than 4 weeks of follow-up were included; studies of periodontal lesions, extraction sockets, and maxillary sinus grafts were excluded. Applications of recombinant growth factor or assessments of membranes' effects on implant osseointegration were also considered exclusion criteria. Defects filled with bone graft/bone substitute material and covered with a membrane were considered the test group, while uncovered defects were considered the control group. Thereafter, human and animal studies were evaluated separately by meta-analysis. RESULTS: Of the 3,986 articles found in the initial search, 34 studies met the inclusion criteria. Four animal studies concluded that the use of barrier membranes would increase the amount of vertical augmented bone (mean difference 0.32 mm; P = .006). Qualitative results regarding horizontal bone augmentation were controversial. Membranes do not increase the risk of improper healing, according to both human studies (odds ratio 5.67; P = .32) and animal studies (odds ratio 3.35; P = .12). CONCLUSION: There is limited evidence to support the effectiveness of barrier membranes in the treatment of bone deficiencies. Membranes do not increase postoperative infection, wound dehiscence, or membrane/bone graft exposure in either human or animal models. Because a majority of the results are based on animal studies, more randomized clinical trials are needed to objectively measure the efficacy of membranes in human bone augmentation.

Sandwich bone graft covered with buccal fat pad in severely atrophied edentulous maxilla: a clinical report.

A 48-year-old woman with a severely atrophied maxilla was treated with open sinus augmentation surgery along with Le Fort I osteotomy with a pedicled buccal fat pad graft to position the maxilla in a right occlusal plane with respect to the mandible and to construct adequate bone volume allowing proper implant placement. Six dental implants were inserted in the maxilla, and a fixed metal-resin screw-retained prosthesis was fabricated for the maxilla and mandible.