[A minimally invasive extraction technique using Benex Extraction System in flapless immediate implant placement in anterior teeth].

PURPOSE: To evaluate the feasibility and clinical outcomes of an atraumatic extraction technique using Benex Extraction System in flapless immediate implant placement in anterior teeth. METHODS: Twenty-five patients with single hopeless anterior maxillary teeth were enrolled in the study. The involved teeth were extracted using Benex Extraction System and implants were immediately placed in a flapless way. Healing abutments were connected immediately. After 4-6 months of healing, screw-retained implant temporary crowns were used to reshape the peri-implant gingiva. Permanent restorations were delivered 3 months later. Extraction time was recorded and the technique feasibility was evaluated using visual analogue scale (VAS). Peri-implant marginal bone resorption was measured in X- ray films after loading for 1 year later. Pink esthetic score (PES) was checked to evaluate the gingival esthetics. Questionnaire was delivered and collected to assess patients' satisfaction on surgical experience and esthetic outcomes. SPSS 13.0 software package was used for statistical analysis. RESULTS: Twenty-five implants osseointegrated successfully. The marginal bone resorption was (0.21±0.23) mm and PES was 8.8±1.19 after loading for 1 year. The mean extraction time was 6.87 minutes and the VAS was 3.32. All patients were satisfied with the final esthetic outcomes and felt comfort during surgery. CONCLUSIONS: According to the limited data in the study, Benex extraction System is a convenient, atraumatic and predictable technique during flapless immediate implant placement in anterior teeth.

[A novel technique to preserve the alveolar ridge width following tooth extraction in the maxillary frontal area].

OBJECTIVE: To introduce a novel ridge preservation technique with micro-titanium plate avoiding the use of bone grafting materials, and evaluate the potential horizontal bone preservation effect of this new technique, applied on single maxillary central incisors after tooth extraction for future implant restoration. METHODS: Nine patients (six women and three men), mean age (26.0 ± 5.7) years(from 18 to 34 years) referred to the Department of Oral Implantology, Peking University School and Hospital of Stomotology, were selected and diagnosed with unsalvageable single middle incisor with fine general conditions, no signs of acute local inflammation, no ongoing or previous periodontitis, healthy neighboring teeth and intact buccal bone walls. Tooth extraction, delayed implant placement and implant-supported single crown restoration were selected as treatment plan. The teeth were extracted atraumatically with local anesthesia, followed by a reflection of a minor flap to exposed 2-3 mm of the buccal bone plate. After that, a micro-titanium plate was trimmed and bended to fit the convexity of the labial bone and fixed by two mini pins with intent to support the labial soft tissue. The flap was then repositioned over the micro titanium plate and secured with two single sutures. No bone grafting materials or releasing incisions were needed. The sockets were left to heal without any intention of primary wound closure. Cone-beam computed tomographic (CBCT) scans were obtained before and four months after tooth extraction. Horizontal ridge widths were measured with CBCT software, and the preservation effects were calculated and recorded by the percentage of horizontal ridge alteration. RESULTS: The nine extraction sockets were healed uneventfully. The average socket width before extraction was (7.51 ± 0.48) mm (6.92-7.82 mm). The average alveolar ridge labial-palatal width at the control point of the edentulous area was (6.81±0.44) mm (6.04-7.38 mm) 4 months after tooth extraction, the mean percentage of ridge width preserved was 90.87% ± 2.91% (87.28%-95.60%). CONCLUSION: This novel ridge preservation method by the usage of a micro-titanium plate did not interfere with the natural socket healing process, and at the same time, largely preserved the width of alveolar ridge without any bone grafting procedures. Long term results remain to be seen.

Nodular fasciitis in the orofacial region: a report of three cases.

Nodular fasciitis is a benign fibroblastic proliferate lesion that is thought to be a response of tissue to injury. It usually presents as a rapidly growing subcutaneous mass. Upper extremities are most commonly affected, followed by the head and neck region. The clinical behaviour and histological presentation mimic those of malignant tumours, thus the lesion is easily misdiagnosed. The authors report here three cases of orofacial nodular fasciitis and review the literature focused on the diagnosis of the disease. Patient one had a history of trauma. The physical examination, radiographic features and findings in surgery were suggestive of a malignant tumour. The final diagnosis of nodular fasciitis was made through the immunohistochemical pathology. The other two patients had no history of trauma, but presented typical clinical and pathological features of nodular fasciitis. It is essential that dentists are aware of the distinctions between nodular fasciitis and malignant tumours in order to limit overtreatment and treatment-related morbidity.

[Effect of provisional restoration on shaping the contour of the soft tissue during maxillary single tooth implant procedure].

OBJECTIVE: To evaluate the influence of soft tissue aesthetic outcomes following application of adhensive fixed partial denture and implant supported temporary restoration in maxillary single tooth implant procedure. Discuss the feasibility and details of the shaping the soft tissue by combine adhensive fixed partial denture and implant-supported temporary restoration. METHODS: The study included 29 patients(Male: 17, Female: 12) with hopeless maxillary single tooth from Sept. 2008 to Dec. 2010. All patients received tooth extraction and implant treatment in department of oral implantology, Peking University School and hospital of Stomatology. The adhesive fixed partial denture as a provisional restoration was used to support the soft tissue of the tooth extraction socket after tooth extraction. The average time of patient wearing adhensive fixed partial denture was 3.7 months. The implant supported temporary restoration was delivered to shape the soft tissue after implant placement. The average time of implant supported provisional restoration using was 8.3 months. Soft tissue esthetic condition was evaluated through 4 main index reference pink esthetic score (PES) before tooth extraction and at the time of the final restoration. Clinical observe items also included the survival rate of fixed partial denture and rate of re-adhesive, integrity of temporary restoration and degree of satisfaction of the patients. The control group included 29 cases with removable denture or without temporary restoration. The base line differences between control group and experiment group were not statistically significant. RESULTS: The survival rate of both the adhensive partial denture and implant-supported provisional restoration was 100%. The re-adhesive rate of adhesive partial denture was 16.2% during follow-up period. The PES at the time of final restoration were significant different between two groups by t test (7.48±0.51 vs. 5.69±0.71, P<0.000 1). Patients were satisfied with the clinical results. CONCLUSION: This study indicates that fixed partial restoration and implant-supported provisional restoration could be used to support and to shape the soft tissue contour and to improve the aesthetic effects.

[Comparison of shade matching accuracy of tabs of shadeguide and tabs out of shadeguide].

OBJECTIVE: To compare the shade matching accuracy between tabs of shade guide and tabs out of shade guide by prosthodontists. METHODS: Sixty-two graduate students who had 1 to 5 years clinical experience without color blindness were included in this study. Twenty-nine tabs from Vita 3D-Master shadeguide and 7 tabs out of Vita 3D-Master shade guide but from Vita Bleachedguide 3D-Master were taken as the targets of shade matching and observed under the standard light. Subjects' shade matching accuracy on tabs of shadeguide and tabs out of shadeguide was recorded. Frequency of right match was analyzed using Monte Carlo exact probability-test. Wilcoxin test was used to analyze the difference between each group on ranked data of value, chroma and hue. RESULTS: The shade matching accuracy of tabs of shade guide [45.9% (199/434)] was significantly higher than that of tabs out of shade guide [9.0% (39/434)]. There was significant difference between the two kinds of tabs of ranked data of value [0.2 (0.1 - 0.3), 0.4 (0.4 - 0.5)] and chroma [0.2 (0.1 - 0.4), 0.5 (0.4 - 0.6), P < 0.01, but there was no significant difference in hue data [0.3 (0.1 - 0.4), 0.3 (0.1 - 0.4)]. CONCLUSIONS: The shade matching ability of prosthodontists on tabs out of shade guide is lower than that on tabs of shadeguide. To fulfill clinical need, more training is necessary.