Zygomatic Implant Insertion in MRONJ: A Case Report with a Follow-Up of 3 Years.

The oral rehabilitation of MRONJ patients represents a challenging situation. Conventional dental implant insertion is not indicated because of the risk of creating a new necrotic area. This case study describes the oral rehabilitation of a 78-year-old female patient, who developed an osteonecrotic lesion in the fourth year of bisphosphonate treatment. The patient underwent a series of surgeries, including resection of the necrotic tissue on the right maxillary region and removal of conventional implants. The patient had a large maxillary defect, and no other treatment modalities such as conventional prosthetic appliances and traditional dental implant insertions were applicable. The patient had a very poor quality of life and as a rehabilitation option, two zygomatic implant insertions were planned and performed as an anchorage for maxillary fixed prosthesis. Radiographic and clinical examination after three years of follow-up indicated that healing was achieved, and healthy tissues formed around zygomatic implants. The patient did not suffer from any additional necrotic tissues or other complications in the oral cavity. According to the results of this case report, zygomatic implantation after resective surgery might be considered as a promising alternative for MRONJ patients with large defects when other treatment alternatives fail or are not applicable.

Melatonin as host modulating agent supporting nonsurgical periodontal therapy in patients affected by untreated severe periodontitis: A preliminary randomized, triple-blind, placebo-controlled study.

OBJECTIVES: The aim of the current clinical trial was to evaluate if the oral supplementation of melatonin after nonsurgical periodontal therapy (NSPT) determined a better periodontal healing than NSPT alone, in patients affected by untreated severe periodontitis. BACKGROUND: Melatonin's anti-inflammatory, antioxidant and immunomodulatory capacities, together with its pharmacokinetic and pharmacodynamic profiles are key characteristics that justify the therapeutic use for the treatment of periodontitis. METHODS: This is a randomized, triple-blind, placebo-controlled study. Twenty patients were blindly randomized either to melatonin or placebo group. The melatonin group received NSPT and melatonin capsules 1 mg per day for 1 month, while the placebo, NSPT, and placebo capsules for 1 month. The patients were evaluated at baseline and 6 months after. Mean change from baseline probing depth (PD) was the primary outcome; site of probing was used as unit of analysis; FMBS (%) and FMPS (%) were also calculated. Mann-Whitney test was used to evaluate statistical significance (α = 0.05). RESULTS: Melatonin was well tolerated by all patients. Both treatments were effective in reducing PD, but no statistical difference was found when comparing posttreatment PD (probing all sites), P = .62. When considering the primary outcome, melatonin administration resulted in greater mean PD change at 6 months if compared to control group: for 4-5 mm sites 1.86 (0.81) vs 1.04 (0.69), P = .00001 and for sites >5 mm 3.33 (1.43) vs 2.11 (0.96), P = .00012. No difference was found for FMBS and FMPS. CONCLUSION: Current study, within its limitations, concluded that oral administration of melatonin (1 mg per day for 30 days) after one-stage full mouth NSPT determined a greater change from baseline PD if compared to NSPT alone, in untreated stage III periodontitis. This could provide a non-pharmacological support to improve periodontal healing of periodontal sites after NSPT.

Effect of Peri-implant Keratinized Tissue Width on Tissue Health and Stability: Systematic Review and Meta-analysis.

PURPOSE: There is uncertainty in the literature on whether the presence of keratinized tissue (KT) ameliorates the state of peri-implant tissue health. A systematic review and meta-analysis was performed to synthesize evidence on the association between peri-implant keratinization, defined as adequate (≥ 2 mm) or inadequate (0 to 2 mm), and peri-implant health and stability, measured as tissue inflammation, plaque accumulation, tendency to bleeding, and probing depth (PD). MATERIALS AND METHODS: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was registered on PROSPERO. According to predefined inclusion criteria, full papers for potentially eligible studies resulted from electronic databases (PubMed, Cochrane, and OpenGrey) and screening of titles/abstracts. Publication bias and risk of bias in primary studies were assessed. The primary outcome was gingival inflammation, measured with Gingival Index (GI) and modified Gingival Index (mGI). Additional outcomes were plaque accumulation (mPI/PI), bleeding (bleeding on probing/modified Bleeding Index), and PD. For each outcome, a random-effects meta-analysis was performed comparing the adequate group (≥ 2 mm, KT1) and the inadequate group (< 2 mm, KT0) KT width. The mean number of implants and proportion of mandibular implants were investigated as potential causes of heterogeneity using meta-regression. Sensitivity analysis was performed excluding low-quality studies. RESULTS: From 362 screened studies, a total of 15 papers were included in the systematic review, and 8 articles were finally included in the meta-analysis. Heterogeneity was found for all outcomes. The main analysis showed a statistically significant association between adequate KT level and a lower mGI-GI (standard mean difference [SMD] KT1 vs KT0 = -1.25, 95% CI = -2.12 to 0.37, P = .01). For plaque accumulation (SMD = -1.18, 95% CI = -2.36 to 0.00, P = .05), bleeding (SD = -1.99, 95% CI = -4.60 to 0.61, P = .13), and PD (MD = -0.06, 95% CI = -0.13 to 0.01, P = .10), no statistically significant difference was detected; however, the trend of results was in favor of the KT1 group. The sensitivity analysis supported the main analysis conclusions. CONCLUSION: The importance of having an adequate KT width around implants was confirmed by this review; adequate KT was significantly associated with less peri-implant inflammation evaluated qualitatively with mGI/GI. No difference was found for plaque accumulation and bleeding, but a positive trend was found favoring implants with adequate KT.

Immediate loading of implants in the aesthetic zone: comparison between two placement timings.

AIM OF THE STUDY: Implant rehabilitation delivered in accordance with the traditional protocol has proven to be highly predictable and acceptable (1). Nevertheless, the application of immediate loading on post-extraction implants, especially for aesthetic zones, has now considerably increased (2). The aim of this work is to illustrate the immediate loading of implants placed in the aesthetic zone through tapered design fixtures with microgeometry of a high degree of porosity inserted at the same time or 4-8 weeks from dental avulsion (TSA® Advance, Phibo®). MATERIALS AND METHODS: A total of 15 implant fixtures of which 8 at an interval of 4-8 weeks from extraction (type 2) and the remaining according to the immediate post-extraction technique (type 1) were positioned. All implants were prosthesized within 24 hours from the placement. Definitive crowns replaced provisional restorations after 20-24 weeks. After 4 and 12 months from implant insertion, the following parameters were assessed: X-ray image, pain, mobility or suppuration, soft tissue condition and aesthetic appearance. RESULTS: Percentage of osseointegration was 93.75%, and 53.5% of the osseointegrated fixtures was type 2. No statistically significant difference between the mean ISQ values for implants of type 1 and 2 both in the post-operative period and after 12 months was evident, indicating that the timing of insertion did not affect the achievement of stability for the implant fixtures tested in our study. Immediate post-extraction implants showed a greater propensity for gingival recession and a peri-implant radiolucency greater than those placed at an interval of 4-8 weeks. The values obtained for the PES/WES and the subjective evaluation of the analyzed sample showed the considerable aesthetic value and the high level of satisfaction guaranteed by the implant technique illustrated. CONCLUSION: Although well-designed, high quality, randomized clinical trials are still needed as well as the requirement to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome, immediate/early placement and loading of a single TSA® Advance, Phibo® may be considered a valuable and predictable option in terms of implant success as well as hard and soft tissue stability.

Odontogenic maxillary sinusitis with oro-nasal fistula: a case report.

AIM OF THE STUDY: The odontogenic sinusitis has an incidence between 38 and 40.6%. Increased risk of maxillary sinusitis has been reported with the presence of periapical abscesses, periodontal disease, dental trauma, tooth extraction and implant placement when the sinusal membrane is perforated. MATERIALS AND METHODS: A patient with odontogenic maxillary sinusitis associated with oro-nasal fistula was treated. RESULTS: The follow-up at six months showed the complete resolution of maxillary sinusitis, palatal fistula got closed and pain symptoms disappeared. CONCLUSION: This case report describes a rare complication of odontogenic maxillary sinusitis: the oro-nasal fistula.

Bone augmentation with TiMesh. autologous bone versus autologous bone and bone substitutes. A systematic review.

AIM OF THE STUDY: Reconstruction of segmental defects and the atrophic maxilla and mandible is performed using various techniques. Bone substitutes have received a wealth of reports in the literature demonstrating a long-term success when used in alveolar bone augmentation procedures. MATERIALS AND METHODS: We reviewed articles comparing TiMesh GBR technique with different percentage of bone: autogenous bone alone (AB); anorganic bovine bone alone (ABB); 50:50 or 70:30. From an initial pool of 122, we selected 14 studies. ANOVA followed by Tukey HSD test was used for statistical analysis. RESULTS: We present a table analysing fundamental parameters to value a successful GBR therapy. Autogenous bone remains the gold standard in GBR technique with TiMesh; however, the combination between AB/ABB in relation 50:50 and 70:30 allows reducing surgical cost exploiting properties of eterologous bone. CONCLUSION: The use of autologous bone is associated with a height and width gain of bone, which are greater compared to other techniques, with a lower exposure of the mesh and a lower bone resorption. The use of heterologous graft leads to a lower bone earn and to percentage of resorption greater than autologous graft but does not differ from the gain and resorption of the bone of AB/ABB in percentage 50:50 and 70:30.

Implant-supported prostheses with temporomandibular joint reproduction after hemimandibular resection: a case report.

AIM OF THE STUDY: The change in anatomy and physiology resulting from radical mandible surgery is often exacerbated by radiation therapies that make the mucosa atrophic and susceptible to irritation and ulceration rendering the task of areating functional complete dentures for edentulous subjects very challenging to prosthodontists. The aim of this study is to describe an implant supported denture rehabilitation in an edentulous hemimandibulectomized patient with a singular prosthetic design in order to compensate for the lack of a condylar process. MATERIALS AND METHODS: The subject of the clinical case, had a history of squamous cell carcinoma of the right tonsillar region for which it was subjected to a hemimandibulectomy and was primarily rehabilitated with an over denture mounted onto a bar furnished by a resin condylar eminence in articulation with the glenoid fossa of the upper denture. The need to provide greater stabilization for the upper prosthesis led to a maxillary implant insertion and to the realization of a new joint connection that was constituted inferiorly by a titanium condyle and superiorly by a teflon acetabulum. DISCUSSION: The prosthetic balance guaranteed by the second rehabilitation greatly affected the biomechanics of mastication leading to a reduction of eccentric interferences, a stabilization of centric occlusion, and a lowering of intensity contraction by masticatory muscles. This difference is well represented by two and three-dimensional plans obtained from the application of a T-Scan III device. CONCLUSIONS: The rehabilitative solution proposed was effective in resolving the lateral deviation, in relieving masticatory and speech discomfort, as well as restoring an aesthetically acceptable appearance in a hemimandibulectomized and not reconstructed patient.

Central osteoma of the maxilla: implant rehabilitation with immediate loading in fresh extraction socket.

AIM OF THE STUDY: Solitary central osteomas of the jaw seem to be especially rare lesions; since 1955, only 12 cases have been reported and 4 of these were located in the maxilla. Osteomas are benign osteogenic lesions considered as real tumours but without infiltrative or metastatic potential. Their growth potential is usually limited, but certain rare and large cases of peripheral osteoma are described in literature. Although surgery is recommended, there are no reports of malignant transformation. In this study, we describe successful implant rehabilitation in a patient with a central osteoma of the maxilla with immediate loading in a fresh extraction socket. MATERIALS AND METHODS: The report concerns a 33-year-old woman with a compromised deciduous first molar in the left premolar region of the maxilla; an asymptomatic bony expansion of the palatal and vestibular sides of the left canine/premolar/molar area of the maxilla and by radiograph revealed a well-defined radiopaque mass. An immediate non-occlusal loading was performed, and complete loading of the implant was completed five months later. DISCUSSION AND CONCLUSION: The pathogenesis of these osteomas is unclear. Several authors reported a clear history of traumatic events, but others had no history of previous trauma or contributory medical factors. Since in our case no cancer growth happened over a period of more than four years, we decided to perform an immediate loading procedure during the implant rehabilitation. The outcome was successful.

Immediate loading with LASER-treated surface implant: two-year resonance frequency analysis follow-up.

BACKGROUND: The chemical, physical, and morphologic characteristics of the implant surface play a fundamental role during the osteointegration process. Implant design is of paramount importance in determining implant primary stability and implant ability to sustain loading during and after osteointegration. LASER treatment of the surface allows defining the precise parameters of roughness to obtain a regular and repeatable surface in total absence of contamination. PURPOSE: The aim of this study was to analyze the behavior of implant stability of LASER-treated surface implants by repeated resonance frequency analysis (RFA) measurements during 2 years in patients with complete upper maxilla edentulism subject to an immediate-loading protocol. METHODS: Ten patients were included, and each treated with the insertion of 6 or 8 LASER surface implants according to the individual surgical-prosthetic planning. During the bone drilling and implant insertion, torque values were monitored with a specific handpiece and software. All implants were loaded within 24 hours from the insertion with the application of a temporary full-arch prosthesis. Subsequent follow-up has been done at 24 months from the loading with radiographic controls (OPT) and RFA measurement on all implants at time of implant insertion and at 1, 3, 6, 12, and 24 months from loading. RESULTS: Resonance frequency analyses at 3 and 6 months from the implant loading have shown a rapid increment of implant stability quotient (ISQ) values in the first phases of bone remodeling, subsequent to the peri-implant bone remodeling. The paired comparisons between mean ISQ values by patient showed a statistically significant decrease in primary stability from baseline up to 1 month (P = 0.0039). Subsequent measurements revealed a statistically significant increase in implant stability from 1 up to 3 months (P = 0.0156), from 3 up to 6 months (P = 0.0020), from 6 up to 12 months (P = 0.020), and 12 up to 24 months (P = 0.0391). CONCLUSIONS: Resonance frequency analysis of the LASER-treated surface implants showed good ISQ values at all time point measurements. These results are consistent with data from literature on the analysis of RFA in protocols of immediate loading at the upper maxilla.

Evaluation of the correlation between dental occlusion and posture using a force platform.

OBJECTIVES: Force platforms are widely used to evaluate the relationship between posture and dental occlusion. This study evaluated whether force platforms are able to detect eventual postural modifications resulting from dental occlusion. METHOD: A total of 44 healthy volunteers who were given no information on the aim of the study underwent six postural stabilometric exams under different mandibular and visual conditions. Four parameters were considered: sway area, sway velocity, X axis displacement of the center of the foot pressure and Y axis displacement of the center of the foot pressure. RESULTS: An analysis of variance (ANOVA) revealed the relative influence of each factor; specifically, the ocular afference significantly influenced the sway area and sway velocity parameters, and the mandibular position had only a weak influence on the sway area parameter. CONCLUSIONS: Vision was shown to influence body posture, and a weak correlation was observed between mandibular position and body posture in healthy subjects. However, the force platform is most likely not able to clearly detect this relationship. Gnathologists must use caution when using force platform analysis to modify a therapeutic plan. The sway area seems to be the most sensitive parameter for evaluating the effect of occlusion on body posture.

Evaluation of the correlation between dental occlusion and posture using a force platform

OBJECTIVES: Force platforms are widely used to evaluate the relationship between posture and dental occlusion. This study evaluated whether force platforms are able to detect eventual postural modifications resulting from dental occlusion. METHOD: A total of 44 healthy volunteers who were given no information on the aim of the study underwent six postural stabilometric exams under different mandibular and visual conditions. Four parameters were considered: sway area, sway velocity, X axis displacement of the center of the foot pressure and Y axis displacement of the center of the foot pressure. RESULTS: An analysis of variance (ANOVA) revealed the relative influence of each factor; specifically, the ocular afference significantly influenced the sway area and sway velocity parameters, and the mandibular position had only aweakinfluence on theswayareaparameter. CONCLUSIONS: Vision was shown to influence body posture, and a weak correlation was observed between mandibular position and body posture in healthy subjects. However, the force platform is most likely not able to clearly detect this relationship. Gnathologists must use caution when using force platform analysis to modify a therapeutic plan. The sway area seems to be the most sensitive parameter for evaluating the effect of occlusion on body posture.

Gnathological postural treatment in a professional basketball player: a case report and an overview of the role of dental occlusion on performance.

AIMS: During competitions and training many professional athletes use to wear occlusal splints to improve their sports performance. However, notwithstanding some studies concluded that achieving a balanced cranial-occlusal system could bring to an improvement of sports performances, the results are still contrasting. Probably the gnathological postural treatment of athletes has greater influence on performance when the individual suffers of Temporomandibular Joint Disfunction (TMJ) or physio-postural pathologies owing to the consequent alteration of the "tonic-postural system". This clinical case details a gnathological postural approach to a professional basketball player suffering from muscular problems related to the stomatognathic apparatus and a low back pain unresolved with the only physiotherapy, which limited her performance. METHODS: Force platform and T-Scan III appliances were used in order to check the postural and occlusal condition of the athlete and as an aid to clinical parameters in achieving a correct splint balance. RESULTS: After the treatment involving inserting an occlusal splint and physiotherapy sessions, the patient no longer complained of low back pain problems and the symptoms associated with the stomatognathic apparatus improved considerably. In particular, after the tests carried out on an isokinetic machine, a force increase related to the quadriceps muscles was detected when the patient was wearing the occlusal splint. CONCLUSIONS: All athletes must however be analysed individually and carefully with clinical and instrumental analyses in order to consider the possible real effectiveness of an occlusal splint for improving postural structure and sports performance.

Gnatho-postural treatment in an air force pilot.

BACKGROUND: Due to the stresses of flight, air force pilots are more likely to experience oral parafunctions such as bruxism when compared to the general population. Further, their craniocervical mandibular system is subjected to particular stresses in the course of their duties. The aim of this study was to analyze an air force pilot who was undergoing gnatho-postural treatment in order to protect the masticatory system and achieve better occlusal balance. CASE REPORT: A 32-yr-old pilot from the Italian Air Force national aerobatic team P.A.N. Frecce Tricolori was chosen from the pilots analyzed and treated at the Istituto Medico Legale A. Mosso. A resin stabilization splint was designed for the pilot's lower arch, allowing for the unobstructed excursive glides of the mandible in the protrusive position, and laterality and occlusal balance in the centric position. DISCUSSION: The clinical gnatho-postural treatment involving a functional diagnostic instrument used on Italian Air Force pilots protects the masticatory system from dental abrasion and, in this particular case, seemed to improve the pilot's posture control system as analyzed by the stabilometric platform.

Intraoral luting: modified prosthetic design to achieve passivity, precision of fit, and esthetics for a cement-retained, implant-supported metal-resin-fixed complete denture.

An intraoral luting technique between electroformed gold copings and a metallic framework for a cement-retained, implant-supported metal-resin-fixed complete-denture is presented. The peculiarity is the different prosthetic design with the metallic framework that was 1.5 mm shorter than the margin of the electroformed copings. As a consequence, the conventional thick prosthesis margin (electroformed copings, cement for the luting phase, framework) was modified into a thin electroformed prosthesis seal (0.3 mm) just beyond the apical limit of the esthetic material. Passive fit between the framework and the electroformed gold copings was achieved during the intraoral luting phase. The procedure was efficient and standardized and enhanced esthetics.

Immediate loading: a simple protocol to create a passively fitting provisional fixed implant-supported complete denture in 1 day.

Many studies have shown success with immediate loading of dental implants. The purpose of this paper is to report on a procedure that places implants with a sand-blasted and acid-etched surface and loads them with a fixed, provisional, immediately loaded mandibular complete denture, all in a single day. The various surgical, prosthetic, and laboratory phases are explained, with particular attention paid to a luting technique that is able to reduce prosthetic misfit. A series of 14 patients was treated with this protocol and followed for a mean of 28.2 months. A 100% implant survival rate was achieved, and all prostheses were in place and functioning at the most recent follow-up.

Preliminary clinical and histologic evaluation of a bilateral 3-dimensional reconstruction in an atrophic mandible: a case report.

This article presents the case report of the bilateral 3-dimensional reconstruction of a posterior mandible in a 48-year-old woman. Titanium meshes and Regenaform demineralized freeze-dried bone allograft were used for bone regeneration. After 5 months the titanium mesh was removed, and after another 4 months, 4 Straumann sandblasted, large-grit, acid-etched implants were placed, 2 on each side of the mandible. During implantation a bone specimen was collected and sent for histologic examination. The definitive fixed prosthesis was fabricated after an additional 4 months. The clinical and histologic results are shown. The implants were followed for 18 months after implant loading; no signs of bone loss or infection were observed.

Lingual vascular canals of the mandible: the risk of bleeding complications during implant procedures.

PURPOSE: The aim of this article is to investigate the potential risk of a critical life-threatening hemorrhage due to the perforation of the lingual cortical plate and arterial trauma of the terminal branches of the sublingual artery. In fact, in many cases, implants are placed in the mandibular interforaminal region, and this area is also often involved in oral surgery as a bone donor site. MATERIALS AND METHODS: One hundred dry skull Caucasian mandibles and 100 computed tomographies (CTs) of the mandible of Caucasian patients were examined. The entrances of the lingual vascular canals were analyzed. Positions and dimensions of the entrances are reported. RESULTS: In 80% of the dry skull mandibles, at least 1 lingual canal was found, and the CT scan detected the presence of at least 1 lingual vascular canal in up to 60% of patients. CONCLUSIONS: A CT examination should routinely be performed before any surgical approach to the interforaminal region.

Passive definitive fit of bar-supported implant overdentures.

A passive fit is an important prerequisite for implant-supported prostheses. It limits the amount of stress transferred to the bone-implant interface and ensures long-term osseointegration. A simplified technique is proposed for the fabrication of passive bar-supported implant overdentures. The use of titanium industrial components enhances the precision of fit, and the passivity is achieved with an intraoral luting sequence and laser welding. The method is quick and standardized, and does not require sophisticated steps. This article shows the results of 7 cases 18-24 months (mean 21.4) after the loading of cases.

New telescopic crown protocol for partially edentulous patients: report of 32 cases.

In some periodontal cases, biomechanical, esthetic, medical, or economic concerns make it difficult for clinicians to employ either traditional therapy or restoration with an implant-supported prosthesis. To avoid any compromise and ensure a good result in such cases, we chose a removable telescopic prosthesis on natural teeth. In this paper we present a new clinical and technical method for the telescopic prosthesis, and we show that this is a predictable, reliable solution that is easy to realize, inexpensive, and comfortable for patients.

A simplified method to reduce prosthetic misfit for a screw-retained, implant-supported complete denture using a luting technique and laser welding.

An important aim of implant-supported prostheses is to achieve a passive fit of the framework with the abutments to limit the amount of stress transfer to the bone-implant interface. An efficient and standardized technique is proposed. A definitive screw-retained, implant-supported complete denture was fabricated for an immediately loaded provisional screw-retained implant-supported complete denture. Precise fit was achieved by the use of industrial titanium components and the passivity, by an intraoral luting sequence and laser welding.