Assessment of Changes in the Outcome of Autogenous Tooth Grafts Over Time: A Clinical Study Evaluating Periodontal Healing in Bone Defects After Lower Third Molar Removal.

BACKGROUND: The removal of impacted lower third molars (ILTMs) is associated with bone defects in the distal area of second molars. Different methods have been described to minimize these defects. PURPOSE: The primary objective was to assess changes in probing depth (PD) over time (up to 36 months) between test (grafted) and control (ungrafted) groups; the graft was obtained from the extracted ILTM. STUDY DESIGN, SETTING, SAMPLE: This split-mouth randomized clinical trial was conducted at the Postgraduate Course in Oral Surgery of the Faculty of Dentistry of the Complutense University of Madrid. Adult patients requiring bilateral ILTM extraction with adjacent second molars were recruited, excluding pregnant/lactating women, patients in treatment with nonsteroidal anti-inflammatory drugs and patients with periodontal diseases. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The predictor variable was the graft technique. The bone defect after ILTM removal was treated with autogenous tooth graft (ATG) in the test group, leaving the control group ungrafted. MAIN OUTCOME VARIABLE: PD on the distobuccal, distomedial, and distolingual surfaces was recorded in both groups and averaged at baseline (T0), 3 (T1), 6 (T2), and 36 months (T3) postoperatively. COVARIATES: Sex, age, surgical time, ILTM situation and position between groups were assessed. ANALYSES: ANOVA repeated measures for comparisons between groups and the Friedman test for comparisons within the groups over time were applied. Statistical significance was established with a confidence interval of 95% (P < .05). RESULTS: The sample comprised 22 patients (6 males, 16 females) with a mean age of 21.68 ± 2.19 years; 44 ILTM extractions were performed. Statistically significant differences in PD average were found between groups (P < .001, 95% confidence interval) at 3 (1.63 ± 0.29), 6 (1.76 ± 0.3), and 36 months (1.74 ± 0.36). Reductions from T0 to T3 of 2.74 ± 0.28 (P < .001) and 0.54 ± 0.3 (P = .43) were observed in test and control groups, respectively. CONCLUSION AND RELEVANCE: ATG placed on the distal surface of lower second molars and almost completely filling the extraction socket improved PD 3, 6 and 36 months after ILTM. Furthermore, no significant changes in PD were observed over time; no major complications occurred. ATG appears to be a viable alternative graft material for this procedure.

Influence of Schneiderian membrane perforation during maxillary sinus floor augmentation with lateral approach on dental implant survival rates: a retrospective study in a university setting.

OBJECTIVES: The primary objective of this study was to compare implant survival rates (ISR) in patients undergoing maxillary sinus floor augmentation (MSFA) with lateral approach with and without membrane perforation. Secondary objectives were to establish the percentage of perforations in these procedures and to evaluate the influence of perforation size on ISR. MATERIALS AND METHODS: This retrospective study included patients requiring MSFA with lateral approach. Cases were assigned to two groups according to the occurrence or not of perforation. The exact size of each perforation was registered. Descriptive statistics and associations between the groups were calculated. RESULTS: This study analyzed data from 90 MSFA in 72 patients. Membrane perforation occurred in 24.44%. A total of 170 implants were placed; 72.35% were placed under intact membranes and 27.65% on repaired membranes. The overall ISR in MSFA procedures with intact membranes was 98.37%, and 93.62% in perforated membranes. No statistically significant relationship between groups was observed although the odds of implant failure increased by 4.125 times when perforation occurred. In turn, no statistically significant relationship was observed between perforation size and ISR. CONCLUSIONS: Implants inserted below repaired membranes had a lower ISR compared with implants inserted below intact membranes although the difference was not statistically significant. Moreover, no significant statistical correlation was observed between perforation size and ISR. CLINICAL RELEVANCE: Membrane perforation does not have a significant influence on subsequent implant survival rates. Knowledge of the exact size of the membrane perforation is essential for deciding on the right treatment plan.

Reduction by air purifier of particulate concentration during orthodontic procedures: a pilot study.

BACKGROUND: The SARS-CoV-2 pandemic has raised awareness of the importance of air quality. This pilot study arose from the need to reduce the concentration of particulate matter in the dental office during orthodontic procedures. To evaluate the efficacy of using an air purifier during orthodontic care in the dental office to reduce the concentration of ambient particulate matter. RESULTS: Significant reductions in particle numbers were obtained for all particle sizes except the largest particles counted (10 µm) through use of the air filter. A marked association between higher humidity levels and higher particle counts was also observed. CONCLUSIONS: Using an air purifier during dental care achieves a significant reduction in the concentration of ambient particles in the dental office. There is a correlation between higher relative humidity and higher particle concentration. The probability of obtaining a maximum particulate concentration level of 0.3 and 0.5 µm is 1000 times lower when using an air purifier.

Current status of split-mouth controlled clinical trials comparing cyanoacrylate vs. conventional suture after lower third molar surgeries: a systematic literature review.

Objetive. During the last few years, cyanoacrylate has been used for wound closure in oral and maxillofacial surgery with growing frequency. When comparing cyanoacrylate with sutures, some authors report similar experiences, while others have found differences. Some agree on the similar outcomes obtained between cyanoacrylate and sutures, others have registered better effects with cyanoacrylate, and others with sutures. Therefore, the aim of this systematic review (SR) was to evaluate postoperative parameters - pain, swelling, trismus, healing and complications (bleeding and infection) - after lower third molar (LTM) removal using cyanoacrylate compared with sutures. Materials and methods. Electronic and manual literature searches were conducted independently by two reviewers up to March 2022. Results. Four studies met the pre-established inclusion criteria and were included for descriptive analysis. These were controlled clinical trials comparing the effects of cyanoacrylate with sutures in 116 patients and 232 split-mouth cases. Pain and haemostasis were significantly reduced on the cyanoacrylate group, swelling showed the same results on two of the studies analysed, trismus and healing had no significant differences between both groups. Conclusions. Both techniques were found to be effective in terms of wound closure, proposing cyanoacrylate as an effective resource that should be investigated in future research. Nevertheless, the literature on cyanoacrylate is scarce and lacks comparative studies of its outcomes and effects.

Mandibular third molar extraction: perceived surgical difficulty in relation to professional training.

BACKGROUND: Establishing the level of surgical difficulty pre-operatively is an essential step in ensuring correct treatment planning. This study set out to determine whether the knowledge and experience acquired by dentists who had received different levels of training influenced, firstly, the perceived levels of difficulty of a variety of cases of mandibular third molar (MTM) extraction and, secondly, the perceived difficulty deriving from a series of factors (patient-related factors, anatomical and radiographic factors, operative factors). METHODS: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Non-parametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. RESULTS: A total of 389 surveys were available for analysis. Dental practioners with no surgical training saw the intervention as presenting greater difficulty. Professionals with postgraduate training in oral surgery considered patient-related factors more important than operative factors, in contrast to dentists who had not received oral surgery training. CONCLUSIONS: Dental training has a signficant influence on the perceived difficulty of MTM extraction and also affects opinions about which factors have greater or lesser influence on surgical difficulty.

Patient-reported outcomes in patients with severe maxillary bone atrophy restored with zygomatic implant-supported complete dental prostheses: a systematic review.

Introduction and Objective: Zygomatic implants (ZI) offer a good and predictable alternative to reconstructive procedures of atrophic maxillae. The main objetive of this systematic review was to assess the effect of rehabilitation with zygomatic implants on patient's quality of life (QLP) using Patient Reported Outcomes Measures (PROMs).Materials and Methods: This review followed PRISMA guidelines. An automated electronic search was conducted in four databases supplemented by a manual search for relevant articles published until the end of January 2021. The Cochrane Collaboration Risk of Bias tool and the Newcastle-Ottawa Quality Assessment Scale were used to assess the quality of evidence in the studies reviewed.Results: General findings of this systematic review showed substantial increases in Oral health-related quality of life (OHRQoL) among patients restored with ZI and high scores in terms of general satisfaction, especially in chewing ability and esthetics. An overall survival rate of ZI was 98.3% after a mean follow-up time of 46.5 months was observed. Occurrence of 13.1% biological complications and 1.8% technical complications were reported.Conclusions: Patients rehabilitated with zygomatic implant-supported complete dental prostheses showed substantial improvements in OHRQoL and general satisfaction with the treatment received.

Clinical and radiographic evaluation of implants placed by means of inferior alveolar nerve lateralization: a 5-year follow-up study.

OBJECTIVE: To evaluate clinical and radiological responses of implants placed in combination with inferior alveolar nerve lateralization, analyzing survival and success rates over 5 years functional loading. MATERIALS AND METHODS: This prospective, longitudinal, single-center study recruited 40 patients with mandibular atrophy in the posterior sectors, who underwent lateralization of the inferior alveolar nerve. Three months after surgery and implant placement, the implants were loaded by means of screw-retained implant-supported partial prostheses or fixed complete prostheses. Clinical and radiographic examinations were performed immediately after implant placement and at 12, 24, 36, 48 and 60-month follow-up visits. RESULTS: The 40 patients received a total of 129 implants (Phibo TSA™ , Phibo Dental Solutions, Sentmenat, Barcelona, Spain). Two implants were lost in the first month after surgery, generating an implant cumulative survival rate (CSR) of 98.44%. The success rate after 5 years of loading was 98.44%. No intra-operative or postoperative soft tissue or prosthetic complications occurred during the 5-year follow-up. CONCLUSIONS: Inferior alveolar nerve lateralization performed to allow placement of (Phibo TSA™ ) implants in patients with mandibular atrophy obtained predictable clinical and radiological results over five years of functional loading.

Prosthetic hygiene and functional efficacy in completely edentulous patients: satisfaction and quality of life during a 5-year follow-up.

OBJECTIVES: The aim of this study was to compare satisfaction with function and hygiene maintenance in completely edentulous elderly patients rehabilitated with implant-supported fixed prostheses, overdentures, and conventional prostheses. MATERIALS AND METHODS: A total of 150 geriatric patients were divided into three groups: Group 1 (CD) patients rehabilitated with complete dentures; Group 2 (FP) patients with implant-supported fixed prostheses; Group 3 (OD) patients with overdentures. The patients responded to a questionnaire based on the Oral Health Impact Profile and the Dental Impact Profile to evaluate satisfaction with their prostheses. Data were analyzed using ANOVA F and the Kruskal-Wallis nonparametric test, with significance established as P < 0.05. RESULTS: Significant differences were found between the three groups. For oral hygiene, the group with overdentures showed better results, and the group with fixed prostheses was more satisfied with function. CONCLUSIONS: Satisfaction among these completely edentulous patients varied in relation to prosthetic type. The level of general satisfaction among patients with implant-supported prostheses was greater than the group using conventional dentures. Patients rehabilitated with fixed prostheses enjoyed a higher level of satisfaction than patients with overdentures.

Maxillary Sinus Augmentation with Autogenous Tooth Grafting Material: A Systematic Review.

The aim of this systematic review was to determine whether autogenous tooth grafting material (ATGM) is as safe and effective as other bone substitutes used for maxillary sinus augmentation procedures, evaluating histomorphometric and/or histological data, implant primary stability, associated complications and radiographic bone height measurements. An automated electronic search was conducted using four databases (Medline/PubMed, Scopus, Web of Science and Cochrane Library), supplemented by a manual search, to identify clinical human studies using particulate ATGM for the aforementioned procedure. The included studies had a sample size of at least four patients and were published before 31st July 2024. The Newcastle-Ottawa scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist were used to assess the risk of bias in cohort studies and case series, respectively. Seven studies were included in the descriptive analysis, obtaining 128 participants (46.8% only treated with ATGM) and 192 placed implants. Due to the heterogeneity of the studies, meta-analysis could not be performed. The authors concluded that ATGM appears to be a feasible and safe alternative for maxillary sinus augmentation procedures. These results should be interpreted with caution due to the limited amount of scientific evidence on this topic and the heterogeneity between the included studies.

A Strip Free Gingival Graft and a Xenogeneic Collagen Matrix to Increase Keratinized Tissue After Vertical Bone Augmentation.

After vertical bone augmentation (VBA) surgery, loss of both keratinized tissue (KT) and vestibule depth (VD) take place. This article evaluated KT gain, patient satisfaction, and aesthetic outcomes after a modified apically repositioned flap (ARF) in combination with a strip-free gingival graft (FGG) harvested from the palate and a xenogeneic collagen matrix (XCM) to correct mucogingival distortion (MGD) after VBA. This technique minimizes patient morbidity by reducing the need for extensive masticatory mucosa grafts. The study included 12 patients with ≤3 mm KT after vertical augmentation procedures. Keratinized tissue gain and tissue thickness were measured. Patient morbidity and aesthetic outcomes were also evaluated. Twenty-four months after surgery, significant VD gain was observed, obtaining a vertical KT augmentation of 5.38 ± 2.06 mm, although tissue thickness increase was only 0.42 ± 0.42mm. Regarding patient satisfaction, aesthetic results evaluating tissue color and texture were satisfactory; the pain was slight, obtaining a score of 2.10 ± 1.13 out of 10, measured using a Visual Analogue Scale (VAS). The present retrospective case series study shows that using an apically repositioned flap combined with a strip FGG and an XCM might offer a valid means of achieving KT gain.

Impact of prosthetic rehabilitation type on satisfaction of completely edentulous patients. A 5-year prospective study.

OBJECTIVE: The aim of this study was to evaluate the satisfaction of rehabilitated edentulous patients in relation to implant prosthetic type. MATERIALS AND METHODS: This prospective cohort study included 40 completely edentulous patients wearing conventional prostheses. They were divided into two study groups: Group A contained 20 patients rehabilitated with implant-supported fixed prostheses and Group B contained 20 patients with overdentures. Subjects were evaluated by means of a specially designed questionnaire before treatment and after 1, 3 and 5 years. RESULTS: Group A exhibited better results in terms of esthetics, function and personal satisfaction, although without statistically significant differences. However, statistically significant differences were found within parameters of oral hygiene after 1 year in favor of Group B. CONCLUSIONS: Overall satisfaction was seen to increase after implant rehabilitation, regardless of the type of prosthesis used. The satisfaction of edentulous patients differs depending on prosthetic type. Patients rehabilitated with fixed prostheses obtain a generally higher level of satisfaction than patients wearing overdentures.

Complications associated with vertical bone augmentation techniques in implant dentistry: A systematic review of clinical studies published in the last ten years.

Vertical bone augmentation procedures are increasingly necessary in daily practice. However, it has been reported that vertical ridge augmentation is one of the least predictable techniques in terms of complications. The aim of this systematic review was to evaluate and compare complications in relation to the different procedures used for vertical bone augmentation prior to implant placement. This review was conducted according to PRISMA guidelines. An electronic search was carried out in four databases: The National Library of Medicine (MEDLINE/PubMed); Web of Science; SCOPUS; and Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale, the Cochrane Collaboration tool for assessing risk of bias, and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. Twenty-five studies with a total of 749 vertically augmented sites were included in the review. Complication rates varied among the different procedures: 51.02% for distraction osteogenesis, 38.01% for bone blocks, and 16.80% for guided bone regeneration. Vertical bone augmentation procedures prior to implant placement are associated with frequent surgical complications and should be approached with caution due to their possible impact on clinical treatment success.

Autogenous particulated dentin for alveolar ridge preservation. A systematic review.

PURPOSE: This review aimed to investigate the clinical outcomes of autogenous particulated dentin (APD) used for alveolar ridge preservation (ARP), evaluating volume gain, histologic/histomorphometric data, and associated complications. MATERIAL AND METHODS: The review followed PRISMA guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An automated search was made in four databases (Medline/Pubmed, Scopus, Web of Science, and Cochrane Library) supplemented by a manual search for relevant clinical articles published before March 10th, 2022. The review included human studies of at least four patients in which extraction and subsequent ARP were performed in a single surgery. Both comparative studies and studies that assessed ARP with APD exclusively were admitted. The quality of evidence was assessed with the Cochrane bias assessment tool, the Newcastle-Ottawa Quality Assessment Scale, and the Joanna Briggs Institute Critical Appraisal tool. RESULTS: Eleven studies fulfilled the inclusion criteria and were included for descriptive analysis, with a total of 215 patients, and 337 alveoli preserved by APD, spontaneous healing (blood clot), or other bone substitutes, obtaining comparatively less vertical and horizontal resorption when APD was used. CONCLUSIONS: After dental extraction, autogenous dentin was effective in terms of volume maintenance, showing promising results in histologic/histomorphometric analysis, and a low complication rate. Nevertheless, few comparative studies with comparable parameters have been published and so more research providing long-term data is needed to confirm these findings.

Implant-supported full-arch rehabilitation with immediate loading using two different digital impression techniques: a case report with 2-year follow-up.

Immediate full-arch loading is a highly complex and technique-sensitive procedure. Digital impression techniques aim to replace conventional analog systems to carry out dental treatments in a more predictive, safer, and less time-consuming way. This case report describes a patient with a guarded periodontal prognosis, who was rehabilitated with implant-supported fixed prostheses after full-mouth extractions. Immediate full-arch loading was performed by means of two digital impression systems: photogrammetric technology with PIC dental in the maxillary arch, and MedicalFit in the mandible. Immediate provisional prostheses in acrylic resin (polymethyl methacrylate) were milled and placed within 12 hours after implant placement surgeries. Both provisional structures fitted properly providing adequate esthetics and function. After the implant osseointegration period, final digital impressions were registered, and definitive zirconia full-arch implant-supported prostheses were delivered. The 24-month follow-up did not show biologic or mechanical complications.

Medium-term clinical behaviour of one-piece zirconia implants supporting single crowns or fixed dental prostheses: A systematic review and meta-analysis.

PURPOSE: This systematic review aimed to evaluate the medium-term (3-year) overall survival and success rates, marginal bone loss and different biological parameters displayed with one-piece zirconia implants. MATERIALS AND METHODS: Electronic searches were conducted of the MEDLINE (via PubMed), Scopus (Elsevier), Cochrane Library (Wiley) and Web of Science (Clarivate Analytics) databases and manual searching was also performed for relevant articles published up to 14 November 2022. The review included human studies with a minimum of 10 subjects and/or 20 implants and with a follow-up period of at least 3 years after implant placement. RESULTS: Twelve studies met the inclusion criteria and were included for analysis, giving a total of 1,621 one-piece zirconia implants. Eleven studies were included to perform a meta-analysis of survival rates, and six for success rates and marginal bone loss. The survival and success rates at the 3-year follow-up were 94.4% (95% confidence interval 90.4%-98.4%; P < 0.001) and 91.6% (95% confidence interval 84.2%-98.9%; P < 0.001), respectively, and marginal bone loss was 0.231 mm (95% confidence interval 0.190-0.272; P < 0.001). CONCLUSIONS: One-piece zirconia implants appear to be a reliable option for restoring missing teeth, obtaining an implant survival rate of 94.4% and a success rate of 91.6% after a follow-up period of at least 3 years. Moreover, the results showed acceptable rates of marginal bone loss and adequate biological parameters.

Fixed dental prosthesis on six zirconia implants for an anterior maxillary rehabilitation: case report with 10-year follow-up.

This article reports a case of maxillary rehabilitation with an implant-supported fixed partial denture on six zirconia implants. A female patient with impacted maxillary canines attended our dental clinic seeking a metal-free maxillary restoration. After the extraction of both impacted maxillary canines and the placement of autogenous bone graft, six one-piece zirconia implants with conical abutments were placed in the anterior maxillary region. Two zirconia fixed dental prosthesis with porcelain veneering, separated at the mid-line, were placed on these zirconia implants. The ten-year follow-up monitored the adequate evolution of both implants and restorations with no signs of peri-implant disease.

Neurological complications following mRNA COVID-19 vaccination: Oral and lower limb paresthesia. A case discussion and literature review.

Vaccines used in the coronavirus pandemic have reported some minor side effects such as pain at the injection site, headache, myalgia and fever. Also major neurological side effects have been experienced by some patients. We present the clinical case of a healthy woman who two weeks after being vaccinated with the third dose of Moderna COVID-19 Vaccine, began to feel numbness in mouth, both feet, legs, interscapular space, and hands. She was diagnosed with distal sensory polyneuropathy caused by the vaccine. Progressive improvement was seen. The patient did not require corticosteroid medication. We reviewed the literature to assess the frequency of this type of complication. Key words:COVID-19, SARS-CoV-2, vaccine, vaccination, peripheral axonal neuropathy, transverse myelitis, oral manifestations.

Clinical epidemiological analysis of 173 supernumerary molars.

OBJECTIVES: To determine the prevalence of supernumerary molars in a sector of the population of Madrid, as well as the possible complications associated with the presence of hypergenetic molars. MATERIALS AND METHODS: A retrospective, descriptive study was carried out, which included a data assessment of all patients (13557) seeking dental care at a hospital's department of oral surgery across 4 years. The proposed methodology consisted of preparing a medical record in order to obtain data on the medical record number, age and sex of the patient, radiological findings such as location and type of supernumerary molar, retained/erupted molar, related accidents and tooth morphology. RESULTS: Supernumerary molars were found to be present in 130 patients, representing a prevalence of 0.96% of the total population studied. These patients had a total of 173 hypergenetic molars, consisting of 137 distomolars and 36 paramolars Mechanical-obstructive pathology was associated with 28.9%, whereas enlargement of the follicular sack bigger than 3 mm was present in 16.2% of the sample. CONCLUSION: Supernumerary molars are usually diagnosed as a coincidental radiological finding without any associated pathology. However a higher percentage of comorbidity was found than initially expected.

Anatomical variations and accessory structures in the maxilla in relation to implantological procedures: an observational retrospective study of 212 cases using cone-bean computed tomography.

PURPOSE: This study used cone-beam computed tomography (CBCT) to analyze the prevalence of several maxillary anatomical/accessory structures, as well as variations within each type, assessing how accurate diagnosis can minimize the risk of intraoperative complications during implantological procedures in the oral cavity. METHODS: 212 CBCT scans of the maxilla were analyzed, captured over a period of 18 months for surgical planning purposes. The prevalence of posterior superior alveolar arteries (PSAA), maxillary sinus septa (MSS), and branches of the canalis sinuosus (CS) were evaluated, as were the diameter and location of each anatomical structure in horizontal and vertical planes. P < 0.05 was considered statistically significant. RESULTS: PSAAs were observed in 99.1% of cases, the intrasinus type being the most frequent; MSS were noted in 15.6% of the sample, mainly in the posterior region with sagittal orientation; CS branches were observed in 50% of patients, mainly in relation to the incisors and significantly more prevalent among males. CONCLUSIONS: The use of CBCT significantly increases the possibility of clearly identifying these anatomical structures. The differences found between patients highlight the importance of carrying out an exhaustive radiological study of the individual to prevent complications, such as Schneiderian membrane perforation, neurovascular damage or bleeding during surgery.

Influence of Serum Vitamin D Levels on Survival Rate and Marginal Bone Loss in Dental Implants: A Systematic Review.

This systematic literature review set out to investigate the relationship between serum vitamin D levels and dental implants in terms of survival rates, marginal bone loss, and associated complications. The review was conducted according to PRISMA guidelines, performing an electronic search in four databases (Pubmed, Web of Science, Cochrane, and Scopus), complemented by a manual search up to April 2022. Four articles were selected for analysis. The Newcastle-Ottawa Quality Assessment Scale tool was used to assess the quality of evidence of cohort studies, and the Cochrane bias assessment tool was used to assess the quality of evidence of randomized clinical trials. The study included 1089 patients restored with 1984 dental implants, with follow-up periods ranging from 20-240 months. Cases presenting lower serum vitamin D levels obtained slightly worse results in terms of marginal bone loss. Longer follow-up periods are needed in order to determine whether serum vitamin D levels affect implant survival rates and osseointegration over time.