A randomized controlled clinical multicenter trial comparing the clinical and histological performance of a new, modified polylactide-co-glycolide acid membrane to an expanded polytetrafluorethylene membrane in guided bone regeneration procedures.

OBJECTIVES: To compare the clinical and histological outcomes of a resorbable modified polylactide/polyglycolide acid (PLGA) test membrane and a titanium-reinforced expanded polytetrafluorethylene (ePTFE) control membrane used for guided bone regeneration (GBR) around dental implants. MATERIALS AND METHODS: A total of 40 patients with peri-implant dehiscence-type defects were randomly allocated to a GBR procedure using either a modified PLGA test or an ePTFE control membrane. Soft tissue condition, implant integration, adverse events and quality of life were recorded during the 6-month healing period. At re-entry peri-implant bone defect dimensions were measured and compared with values recorded at implant/GBR surgery. A biopsy was retrieved for qualitative and quantitative histological analyses. A comparison between the groups was conducted using non-parametric statistical tests. RESULTS: Soft tissue complications were observed in five test patients and two control patients. Except for soft tissue complications and incomplete regeneration, no procedure- or device-related adverse events were observed. The vertical bone defect component was, in mean, reduced by-5.1 mm (95% CI -6.8, -3.3) in the test group and -6.9 mm (95% CI -8.2, -5.5 mm) in the control group. The mean residual vertical defect height measured 1.2 ± 2.4 mm in the test group and 0.3 ± 1.1 mm in the control group meaning a mean defect resolution of 81% in the test group and 96% in the control group (P = 0.161). The horizontal bone thickness at implant shoulder level decreased from a mean of 3.2 mm to 1.4 mm (-56%, mean -1.7 mm, 95% CI -2.3, -1.1) in the test group and from 3.3 mm to 2.5 mm (-24%, mean -0.8 mm, 95% CI -1.3, -0.3) in the control group (P = 0.022). Qualitative and quantitative histological analyses did not show significant differences in the tissue composition between groups. CONCLUSION: Peri-implant GBR was successfully performed using either of the membranes. The control membrane was able to better maintain the horizontal thickness of regenerated bone and revealed less soft tissue complications. No statistically valid evidence about the superiority of one membrane was found in any other parameters. Soft tissue dehiscences occur with both types of membranes and can impair the amount of regenerated bone.

[Neurologischer Notfall nach dentaler Implantation - was nun?]

Mit der Verbreitung von Zahnimplantaten ist die Zahl neurologischer Komplikationen gestiegen, wobei diese vor allem im Unterkiefer vorkommen. Verletzungen des Nervus alveo- laris inferior sind eine ernste Komplikation mit Inzidenzen für transiente Nervschäden bis zu 24% und persistierenden Schädigungen bis zu 11%.

Squamous Cell Carcinoma of the Gingiva Mimicking Periodontal Disease: A Diagnostic Challenge and Therapeutic Dilemma.

A case of squamous cell carcinoma of the gingiva (GSCC) in the left anterior maxilla in a 64-year-old woman that was treated for almost 5 years as suspected periodontal lesion prior to establishing the final diagnosis of oral cancer is presented in this case report. GSCCs have a variable clinical appearance, ranging from an exophytic mass to ulcerative lesions. They have been reported to pose a diagnostic challenge and are not infrequently initially misdiagnosed as periodontal disease. A delay in diagnosis and extraction of teeth in the vicinity of GSCCs has been demonstrated to increase the risk for lymph node metastasis and thus result in a lower 5-year survival rate. To avoid misdiagnosis and delay of the appropriate treatment, a proper histopathologic evaluation is mandatory whenever an incisional biopsy is performed. Furthermore, referral to a specialist in oral medicine or oral and maxillofacial surgery is indicated when a gingival lesion is nonresponsive to treatment, recurring, or rapidly growing in size.

Implants in the esthetic zone.

Over the last 15 years implant dentistry has made great progress. Especially in the anterior region, esthetics plays a vital role in treatment. Patients expect not only a fully functional restoration, but also an esthetically pleasing and long-lasting solution. A predictable and esthetic result can only be achieved by adhering to a proven clinical protocol, which is based on experience, precise diagnostic procedures, and meticulous treatment planning. This article presents a practical protocol used in the authors' practice for esthetic reconstructions with dental implants in the anterior region with four patient cases.