Human Gingival Fibroblast Growth and Function in Response to Laser-Induced Meso-and Microscale Hybrid Topography on Dental Implant Healing Abutments.

PURPOSE: Laser-created titanium surface topographies enhance soft tissue attachment and implant stability. However, knowledge about the underlying mechanisms governing the tissue-level reaction is lacking. The objective of this study was to examine the behavior and function of human gingival fibroblasts growing on healing abutments with or without laser-textured topography. MATERIALS AND METHODS: Human primary gingival connective tissue fibroblasts were cultured on healing abutments with machined or laser-textured (Laser-Lok, BioHorizons) surfaces. Cellular and molecular responses were evaluated by cell density assay (WST-1), fluorescence microscopy, qRT-PCR, and detachment test. RESULTS: The machined surface showed mono-directional traces and scratches from milling, whereas the laser-textured surface showed a distinct morphology consisting of mono-directional meso-scale channels (15 µm pitch) and woven, oblique micro-ridges formed within the channel. There were no differences in initial fibroblast attachment, subsequent fibroblast proliferation, nor collagen production between the machined and laser-textured surfaces. Fibroblasts growing on laser-textured surface spread mono-directionally along the meso-channels, while cells growing on machined surfaces spread randomly. Fibroblasts on laser-textured surfaces were 1.8-times more resistant to detachment than those on machined surfaces. An adhesive glycoprotein (fibronectin) and trans-membrane adhesion linker gene (integrin beta-1) were upregulated on laser-textured surfaces. CONCLUSIONS: The increased fibroblast retention, uniform growth, increased transcription of cell adhesion proteins compellingly explain the enhanced tissue-level response to laser-created, hybrid textured titanium surfaces. These results provide a cellular and molecular rationale for the tissue reaction to this unique surface and support its extended use from implant fixtures and healing abutments to diverse prosthetic components where enhanced soft tissue responses would be desirable.

The Implant-borne Articulation Splint in Fibula Free Flap Mandibular Reconstruction: A Technical Note.

Computer-aided design and computer-aided manufacturing and digitally simulated surgeries have revolutionized maxillomandibular reconstruction. In particular, this technology has increased the accuracy and facilitated the process of dental implantation in fibula free flaps. Despite the efficacy of virtual planning, there is a minor degree of translational difference between digital and intraoperative measurements, which may affect the precision of implant and fibula orientations. This is especially concerning during the last stage of fibula insetting, where the graft segments have the potential to roll, yaw, or pitch. The objective of this study is to describe an advanced prosthodontic technique that ensures the fibula grafts and implants remain in a restorable position during final insetting. We describe the technique and workflow of the implant-borne articulation splint through a case presentation and demonstrate results at 4 months postoperative and postradiotherapy. Given the degree of investment placed in virtual planning, free flap reconstruction, and endosteal implants, a technique that ensures optimal restorability of each implant is pivotal. Larger studies are still required to fully elucidate the cost-effectiveness and long-term results of the implant-borne articulation splint.

Double sleeve guided placement of quadruple zygomatic implants for rehabilitation of a patient with ectodermal dysplasia: A clinical report.

The surgical and prosthodontic treatment for a 22-year-old man with ectodermal dysplasia is described and illustrated. He had never managed to wear complete dentures, and implant-retained or implant-supported prostheses were indicated. However, the placement of conventional maxillary endosseous implants was contraindicated. A novel surgical template with double sleeves was used to guide osteotomies for 4 zygomatic implants used with an unloaded, one-stage approach. After confirming osseointegration, prosthetic rehabilitation began with an interim implant-supported fixed prosthesis to evaluate esthetics, phonetics, and hygiene maintenance. Clinical challenges included lip biting and speech articulation.

Modified vestibuloplasty of the zygomaticoalveolar crest to gain intradefect support for an obturator prosthesis.

This clinical report details a novel surgical modification at the time of maxillectomy to improve obturator function. A vestibuloplasty and split thickness skin graft of the zygomaticoalveolar crest created a denture-bearing surface that, when engaged, provided support and stability for the obturator prosthesis. This report outlines the surgical and prosthodontic procedures and the results achieved.

An implant-retained auricular prosthesis complicated by a modified temporal bone resection.

A patient underwent a modified temporal bone resection and total auriculectomy to remove a sebaceous carcinoma arising from the tragus of the right auricle that extended into the external auditory meatus. Because the tumor extended into the temporal bone, the osseous sites originally selected for immediate placement of the craniofacial implants were resected and no longer available. Subsequently, after an appropriate period of healing, implants were placed into the residual temporal bone, considerably more superior and posterior to the external auditory meatus such that they emerged through hair-bearing skin. The purpose of this report was to describe the fabrication of an implant-retained auricular prosthesis with implants in suboptimal positions. Challenges included optimization of the stability and retention of the prosthesis, effectively managing the prosthetic space without compromising the esthetic outcome, providing adequate hygiene access for the implant connecting bar, and maintaining the health of the peri-implant tissues when the implant emerged through hair-bearing skin.

Prosthetic reconstruction of a patient with an irradiated total rhinectomy with navigated surgical placement of a single zygomatic implant: A clinical report.

This clinical report details the rehabilitation of a patient who underwent a total rhinectomy, subsequent adjuvant radiation therapy, and eventual prosthetic rehabilitation but then developed an empirically diagnosed medical adhesive intolerance. With the aid of digital planning and real time navigation, 2 zygomatic implants were placed by using a flapless surgical approach followed by early delivery of an interim prosthesis. In spite of the failure of 1 craniofacial implant, definitive restoration was accomplished by using a titanium bar, double magnetic attachments, and a new silicone prosthesis.

Direct chairside fabrication of a two-piece brachytherapy appliance.

This article reviews the prosthodontic steps in the direct chairside fabrication of a two-piece custom brachytherapy appliance consisting of an intraoral and extraoral component. This technique is described through the treatment of a 77-year-old patient with a T1N0M0 squamous cell carcinoma of the lower lip vermillion, referred for the most expeditious fabrication of a brachytherapy appliance because of the urgency of beginning brachytherapy. Fabrication of the appliance consisted of an expedited clinic visit in which both intraoral and extraoral components were fabricated chairside. A traditional indirect laboratory-based fabrication of such an appliance would have been more time-consuming, thereby delaying delivery of radiation treatment of the rapidly progressing malignancy.

Managing dental erosion.

The clinical signs of dental erosion are initially subtle, yet often progress because the patient remains asymptomatic, unaware and uninformed. Erosion typically works synergistically with abrasion and attrition to cause loss of tooth structure, making diagnosis and management complex. The purpose of this article is to outline clinical examples of patients with dental erosion that highlight the strategy of early identification, patient education and conservative restorative management. Dental erosion is defined as the pathologic chronic loss of dental hard tissues as a result of the chemical influence of exogenous or endogenous acids without bacterial involvement. Like caries or periodontal disease, erosion has a multifactorial etiology and requires a thorough history and examination for diagnosis. It also requires patient understanding and compliance for improved outcomes. Erosion can affect the loss of tooth structure in isolation of other cofactors, but most often works in synergy with abrasion and attrition in the loss of tooth structure (Table 1). Although erosion is thought to be an underlying etiology of dentin sensitivity, erosion and loss of tooth structure often occurs with few symptoms. The purpose of this article is threefold: first, to outline existing barriers that may limit early management of dental erosion. Second, to review the clinical assessment required to establish a diagnosis of erosion. And third, to outline clinical examples that review options to restore lost tooth structure. The authors have included illustrations they hope will be used to improve patient understanding and motivation in the early management of dental erosion.

Decision-making in the management of the patient with dental erosion.

The clinical signs of dental erosion are initially subtle; yet they often progress because the patient remains asymptomatic, unaware, and uninformed. Erosion typically works synergistically with abrasion and attrition to cause loss of tooth structure, making diagnosis and management complex. The purpose of this article is to outline clinical examples of patients with dental erosion that highlight the strategy of early identification, patient education, and conservative restorative management.