Zygomatic Implants in a Patient With History of Mucormycosis: A Case Report.

Exposure to mucor mold can lead to mucormycosis, a rare fungal infection with severe consequences, especially in immunocompromised individuals. The year 2020 highlighted the need for orofacial rehabilitation, presenting challenges in cases of maxillary absence. This case report details zygomatic implants, which offer a promising solution by providing stable support even in the absence of significant bone mass due to surgical excision post-COVID-19 mucormycosis. Zygomatic implants outperform traditional grafting techniques. The atrophic or resected jaws can be effectively restored with a single-piece zygomatic implant, which has the lowest rate of postoperative problems, including bone loss, mucositis, peri-implantitis, and screw loosening or fractures. In this case report, four zygomatic implants were placed in the zygomatic bone, and immediate loading was performed. Restoration of patient aesthetics, phonetics, and functional masticatory efficiency were restored.

A Case of Accelerated Rehabilitation: Immediate Loading of Full Mouth Basal Implants.

Basal implantology, also known as bi-cortical implantology, is an advanced system using the dense basal cortical bone for anchoring dental implants, ideal for patients with severe bone loss. Unlike traditional implants that require healthy cancellous bone, basal implants engage with the cortical bone, providing superior stability and durability. These implants can be immediately loaded due to their load-bearing capacity, making them a quick and effective solution for full mouth rehabilitation. A case report of a 55-year-old male with significant bone resorption illustrates the benefits of basal implants. Conventional endosteal implants were not viable, so nine basal implants in the mandible and a combination of basal, pterygoid, and zygomatic implants in the maxilla were used. Within 72 hours, the patient experienced significant improvements in chewing, aesthetics, and overall oral function. Basal implants offer a reliable alternative for patients with challenging anatomical conditions, demonstrating excellent functional and aesthetic outcomes.

A Rare Case of Maxillary Mucormycosis in a Child With Juvenile Diabetes Mellitus.

Mucor and Rhizopus species are recognized as the primary culprits responsible for mucormycosis, a severe fungal infection known for its opportunistic nature. This infection primarily targets individuals with compromised immune systems, including those with diabetes mellitus and patients undergoing glucocorticoid therapy, where the immune response is weakened. This article aims to underscore the pivotal role of prompt diagnosis and intensive treatment in managing mucormycosis, particularly in pediatric patients, as it can avert death and mitigate serious morbidity. This case report emphasizes the urgency of identifying fungal infections in patients with diabetes early on and subsequently treating them aggressively to prevent adverse outcomes. It highlights the potential for excellent treatment outcomes when mucormycosis is promptly diagnosed and managed with intensive therapy. By doing so, significant morbidity and mortality associated with this condition can be effectively prevented, underscoring the importance of vigilance and proactive management in patients with predisposing factors for fungal infections.

Revolutionizing Maxillary Rehabilitation: Zygomatic Implants Addressing Severe Alveolar Atrophy.

This case report describes the care given to a 58-year-old male patient with severe upper jaw atrophy. The treatment strategy involved utilizing zygomatic implants in conjunction with endosteal implants to rehabilitate both the maxilla and mandible. Temporary prostheses were used during the healing phase, followed by the fabrication and placement of final prostheses. The utilization of zygomatic implants offers advantages such as immediate stabilization and function without the need for extensive bone grafting. This approach not only reduces treatment time and costs but also enhances patient outcomes. Furthermore, guided surgical techniques are increasingly employed to ensure precise implant placement, optimizing prosthetic support.

Unraveling Cherubism: Examining the Classical "Eye to Heaven" Phenomenon.

Cherubism, an infrequent disorder with paramount autosomal importance, predominantly targets the mandible, with occasional involvement of the maxilla. Manifesting in childhood, it typically improves over time but never fully resolves in adulthood. Clinically, it presents as a uniform enlargement of the bones, and when the upper jaw is involved, it can create a cherub-like appearance with exposure to the sclera. As the volume grows, it can cause symptoms such as dental misalignment, delayed tooth eruption, speech difficulties, and tooth loss, in addition to psychological and cosmetic effects that require medical attention. The disorder progresses naturally in youngsters, exhibiting phases of expansion, stabilization, and regression. Cherubism initially is encountered in early childhood, reaches its peak during early years, balances out around puberty, and then steadily recedes after that. We describe the example of a male patient, age 20, who sought correction due to worries about his appearance. He had a bilateral mandibular angle and malar edema. The patient's aesthetic discontent was satisfactorily resolved with surgical intervention, and further pharmaceutical therapy was implemented during follow-up visits.

Zygomatic Implant-Supported Prosthetic Rehabilitation of a Patient with Post-COVID-19 Mucormycosis and Maxillectomy.

Mucormycosis has been prevalent in the past few years with the COVID-19 pandemic largely affecting the maxilla due to its proximity to the respiratory corridor. Resection of the maxillary dentition along with the maxillary bone itself has a huge psychosocial impact on the patient. When seeking prosthetic rehabilitation, poor esthetics, difficulty in mastication, and social embarrassment are the patients' concerns. Hence, it becomes great responsibility for the clinician to restore the patient's natural teeth while causing him/her minimum discomfort. This article describes such a case of post-COVID-19 mucormycosis that has been provisionally restored by the means of all-on-four zygomatic implants.

Displacement of Zygomatic Implant in Infratemporal Region in a Case of COVID-19-Associated Mucormycosis.

Reconstruction of maxillary defects can be carried out using a variety of treatment modalities. The choice of modality depends on numerous factors, including the size and extent of the defect, patient characteristics, and existing comorbidities. One of the various options is reconstruction and rehabilitation using a fixed prosthesis supported over a zygomatic implant. In maxillectomy cases, a zygomatic implant can be used to improve the retention of the obturator prosthesis, as the loss of alveolar bone makes it impossible to use conventional endosseous implants. Although zygomatic implants are reported to have high success rates, they are not free of complication. We hereby present a rare complication associated with the placement of a zygomatic implant in a patient with COVID-19-associated mucormycosis who underwent operation. This rare complication has never been reported before. This case report also highlights on the management of complications involving displacement of a zygomatic implant in the infratemporal region.

Stem-Cell Therapy: Filling Gaps in Oro-Maxillofacial Region.

How do stem cells function? Why should we, as dentists, care about stem cells? How might dental procedures be substituted by stem cells? Are stem cells capable of regenerating a tooth or temporomandibular joint (TMJ)? Although the ability to regenerate a destroyed tissue has been known for a while, research into regenerative medicine and dentistry has made significant strides in molecular biology. A paradigm shift in the therapeutic toolbox for dental and oral diseases is likely to result from a growing understanding of biological concepts in the regeneration of oral/dental tissues along with stem cell research, leading to an intense search for "biological solutions to biological problems." Among other tissues, orofacial tissues effectively separate stem cells from human tissues. Because they can self-renew and produce different cell types, stem cells offer novel techniques for regenerating damaged tissues and curing illnesses. A number of significant milestone successes have shown their practical applicability, traditional biomaterial-based treatments in regenerative dentistry as therapeutic alternatives that offer regeneration of damaged oral tissues rather than merely "filling the gaps." In order to use these innovative accomplishments for patient well-being, the ultimate goal of this ground-breaking technology, well-designed clinical studies must be implemented as a crucial next step. The review's objective is to briefly synthesize the literature on stem cells in terms of their traits, subtypes, and uses for dental stem cells. It has been highlighted that stem cell therapy has the ability to treat craniofacial abnormalities and regenerate teeth in the oral and maxillofacial regions.

Enhancing Pain Relief in Temporomandibular Joint Arthrocentesis: Platelet-Rich Plasma and Hyaluronic Acid Synergy.

Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of using platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy in TMJ arthrocentesis to address these issues. The potential benefits of this approach are highlighted through an exploration of mechanisms, clinical studies, safety considerations, and future directions. PRP's regenerative properties and HA's lubrication and anti-inflammatory effects offer a comprehensive solution to multifactorial TMJ pain and dysfunction. Clinical studies reveal significant pain reduction, improved mobility, and enhanced satisfaction in patients treated with PRP and HA. Although mild and transient adverse effects have been reported, the safety profile remains favorable. While the evidence is promising, more extensive randomized controlled trials are needed to establish sustained efficacy and safety. As research evolves, collaborative efforts among clinicians and researchers are crucial in realizing the potential of PRP and HA combination therapy, ultimately providing a novel pathway to alleviate TMJ-related pain and enhance patient well-being.

Single Tooth Replacement Using Immediately Loaded Basal Implant-Supported Fixed Prosthesis in a Hyperdense Lesion: A Case Report.

Osseous modifications in the periapical areas are related to chronic endodontic infections. Often, teeth with periapical infections and hopeless prognosis are removed and replaced with dental implants. In this clinical report, a patient with a radiopaque lesion on the root apex of the mandibular right first molar root is presented. Bone- and tissue-borne lesions were the differential diagnoses for the radiopaque mass. Based on the clinical and radiological characteristics, condensing osteitis (CO) was the final diagnosis of osseous growth (bone density and trabeculation of the bone). Under local anesthesia, tooth 46 was atraumatically extracted, and the immediate basal implant was placed. This case report investigated the effectiveness and safety of dental implantation in the vicinity of hyperdense lesions.

Quad Zygoma: A Graftless Solution in Post-mucormycosis Maxillectomy.

Mucormycosis, a fungal infection that commonly affects individuals with diabetes and compromised immune systems, often requires surgical excision and debridement. However, this can result in significant defects, posing a challenge for clinicians in terms of reconstruction and rehabilitation. Prostheses, local and regional pedicled flaps with or without bone grafts, and titanium mesh application are available options for maxillary reconstruction. Soft-tissue flaps are not sufficient to provide osseointegrated implants with both bone repair and structural support, which emphasises the quad zygoma's beneficial role in treating maxillary abnormalities. Patients benefit from quad zygoma, which uses zygomatic implants and eliminates the need for subsequent procedures, which shortens the course of treatment and lowers costs. Because zygomatic implants are securely fixed into the zygoma, temporary prostheses can be loaded right away. Then, four to six months later, a fixed prosthesis may be introduced. Clinical results with zygomatic implants often surpass those of bone grafting, representing a potential novel gold-standard approach for the compromised maxilla. This case report details the rehabilitation of post-mucormycosis patients with maxillary defects using quad zygomatic implants. The absence of complications during follow-up, conducted at 15, 30, 45, and 90 days, and subsequently monthly for two years, highlights the success of this approach. Evaluation parameters included soft tissue recovery, infection, wound separation, stability of prosthesis, eating effectiveness, and aesthetic outcomes. The positive outcomes observed at follow-up appointment emphasize the viability and effectiveness of quad zygomatic implants in addressing maxillary defects post-mucormycosis.

Impacted Mandibular First Molar: A Rare Riddle.

Tooth impaction incidence is in the range of 5.6 to 18.8% of the population. Eruption failure of the first permanent molar is very rare; the prevalence is 0.01% of the population. The permanent molars are of particular importance in providing adequate occlusal support as well as coordinating facial growth. Failure of the eruption of permanent molars might lead to an array of complications like a reduction in the vertical dimension, extrusion of the antagonist teeth, a posterior open bite, inclination and resorption of adjacent teeth, and cyst formation. Various treatment modalities for impacted teeth include periodic observation, orthodontic relocation, and partial dislocation. More invasively, surgical exposure and extraction of teeth before prosthetic treatment may be performed. It is imperative to diagnose and manage the condition early, as delayed treatment may result in a myriad of problems, like a decreased force of the spontaneous eruption, a decreased percentage of treatment success, and a prolonged period of treatment, increasing the complications furthermore. Because of the importance of permanent molars, eruptive guidance is required before impacted tooth extraction. This article summarizes a case in which the surgical-orthodontic combined approach to the impacted mandibular first molar avoided the need for prolonged orthodontic treatment that would have required repositioning the deeply impacted first molar to the dental arch. As an outcome, patient satisfaction improves.

Partial Extraction Therapy for Implant Placement: A Newer Approach in Implantology Practice.

One of the most popular treatment modalities in routine implantology practice is extraction followed by immediate or delayed implant insertion. Teeth removal alone is insufficient, particularly in the maxillary anterior region of the jaw. Patients may experience several issues after tooth extractions. Due to trauma and the loss of periodontal ligaments, post-extraction alveolar ridge resorption cannot be prevented. Atraumatic extraction, socket preservation, grafting, and implant placement immediately after the extraction are some of the procedures that are carried out to minimize or prevent the resorption of alveolar bone. Osseointegration is essential for keeping the clinical effectiveness of dental implants. If the supporting tissues at an implant site resorb and are worsened by risk factors for recession, there may be considerable esthetic and functional failure. Implant placement at the retained root structure preserves the buccal bone resulting in an excellent emergence profile. Resorption in the posterior alveolar ridge may result in a decrease in attached keratinized tissue and a decrease in vestibular depth. This might have a negative impact on the stability of the implant and leads to peri-implantitis resulting in the failure of the implant. Without papilla loss or arch collapse, partial extraction therapy has resulted in effective esthetic outcomes. The socket shield technique is a minimally invasive surgical procedure that helps to maintain both soft and hard tissues by preserving a small section of the root. It lessens the necessity for surgeries on bone and mucogingival grafts, cutting the length of the overall recovery process and reducing the treatment time. When soft and hard tissue grafts are used to fill the socket before applying pressure with pontics, it is known as the pontic shield procedure. However, there is no published study that explains partial extraction therapy in a straightforward and clear manner that can guide a practitioner in determining a shield design with a proven track record of success. This review article focuses on the partial extraction procedure which is very helpful for preserving soft and hard tissues in cases involving immediate implant insertion post-extraction. It has long-term therapeutic success with implant and pontic therapy. This review article will also be helpful for clinicians to understand shield design in different case scenarios and help to learn step-wise procedures carried out in partial extraction therapy.

Combined Effect of Platelet-Rich Fibrin Matrix (PRFM) and Demineralized Freeze-Dried Bone Allograft (DFDBA) in Immediate Implant Placement: A Single-Arm Clinical Trial.

Introduction Placement of immediate implants in contrast to delayed implant placement may be favorable. The factors contributing to this are shortened overall treatment time, aid in ideal orientation and fixture placement, bone preservation following extraction, and achieving optimal aesthetics involving soft tissue. However, the gap distance between the surface of the implant and the buccal bony wall during implant placement is critical for subsequent bone healing in a fresh extraction socket. Considering that as the gap broadens, the amount of bone-to-implant contact (BIC) decreases, causing an apical shift of the highest bone-implant contact. Incorporating a bone substitute material (BSM) within the fixture-socket gap preserves alveolar ridge volume by minimizing socket remodeling and encouraging de-novo bone formation. Aim and objectives To evaluate the efficacy of platelet-rich fibrin matrix (PRFM) and demineralized freeze-dried bone allograft (DFDBA) in fresh extraction socket with simultaneous implant placement. Methods Implants were immediately placed in 12 patients following a two-stage submerged protocol. The combination of PRFM and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months following implant placement. The full mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at baseline, 3, and 6 months. The crestal changes were evaluated using intraoral periapical radiographs (IOPA) at baseline, 3, and 6 months. Cone beam computed tomography (CBCT) images were obtained at baseline and 6 months after implant loading to analyze the buccolingual changes. Results At 6 months follow-up, the coronal bone remodeling detected on CBCT revealed a minimal (0.1 mm) narrowing of the alveolar ridge in a buccolingual direction, with a mean bone loss of 0.10+0.09, which was statistically non-significant (p > 0.05). Implant success was 100% at 6 months after loading as determined by Akbrektsson's criteria for implant success. Conclusions The adjunctive use of PRFM with DFDBA following immediate implant placement yielded a significant reduction in bone resorption and maintenance of buccolingual dimensions.

Giant Osteoma of Zygoma Mimicking Pseudo-Temporo-Mandibular Joint Ankylosis: A Case Report.

Giant osteoma is a rare entity in the head and neck region when compared to long bones. Even in the head and neck region, the paranasal sinuses are commonly associated, but the involvement of jaw bones is very rare. The lesions are usually asymptomatic and so remain undiagnosed for years. In the reported case, the distinct presentation with reduced mouth opening made it more confusing to diagnose as it became somewhat similar to symptoms of temporo-mandibular joint disorder. The involvement of the zygomatic bone with its extension into the mandibular ramus region made it more unique in its presentation. The objective of the current article is to present an unusual case of giant osteoma of zygoma causing reduced mouth opening, misdiagnosed as a true intra-articular temporo-mandibular joint ankylosis previously. This was then diagnosed correctly with help of a computed tomography scan and histopathology and treated with surgical excision.

Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite.

Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF) over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF), and posttreatment occlusion. Results. Out of 388 mandibular fractures treated, ramus fractures were 12 (3.09%). In the present study, predominant cause of mandibular ramus fracture was road traffic accident (RTA) n = 07 (58.33%) followed by fall n = 04 (33.33%) and assault n = 1 (8.33%). The average age was 35.9 years with a male predilection. Of these, 9 patients were treated with ORIF while remaining 3 with closed treatment. The average MMF after closed treatment was 21 days and 3 to 5 days after ORIF. There was improvement in occlusion in all 12 patients posttreatment with no major complication except for reduced mouth opening in cases treated with ORIF which recovered with physiotherapy and muscle relaxants. Conclusion. Mandibular ramus fractures accounted for 3.09% with RTA as a common aetiology. ORIF of ramus fractures facilitated adequate functional and anatomic reduction with early return of function.