Sinusitis Due to the Presence of a Dental Implant Inside the Maxillary Sinus.

The migration of a dental implant into the maxillary sinus is an uncommon event of occurrence. Disrespect for concepts of implantology, low alveolar bone density at the site, high incidence of masticatory force in posterior region, and clinical intercurrences predispose to failure in rehabilitation.

Frenectomy with anterior lingual sulcoplasty for an implant-supported overdenture: A clinical report.

This clinical report describes the deepening of a patient's anterior mandibular lingual sulcus in combination with frenectomy and the use of an acrylic resin guiding device fixed to an osseointegrated dental implant to maintain the patency of the new sulcular depth.

The influence of electrical high-speed rotation on mandibular third molar surgeries: a prospective, randomized, split-mouth clinical and radiographic study.

The aim of this split-mouth randomized clinical trial was to evaluate the clinical outcomes (operative time, edema, trismus, and pain), the immediate histological effects, the alveolar repair (2 and 4 months), and the quality of life after the extraction of impacted third molars using high-speed pneumatic and electrical rotation. Sixteen patients underwent extraction of the two mandibular third molars with a minimum interval of 15 days. On one side of the participant's mouth, high-speed pneumatic rotation was used (Control Group-CG) while for the other side, high-speed electrical rotation was used (Study Group-SG). Statistical analysis included ANOVA repeated measures and Pearson correlations. SG group showed: shorter operative time (p = 0.019), less pain (p = 0.034), swelling (p < 0.001) and trismus (p = 0.025) on the 1st postoperative day; less pain (p = 0.034) and trismus (p = 0.010) on the 3rd postoperative day; less trismus (p = 0.032) on the 7th postoperative day; and better quality of life (p = 0.007). No differences were observed for peripheral bone damage or bone density of alveolar repair at 2 and 4 months between groups. Electric high-speed rotation provided better postoperative clinical parameters of pain, edema and trismus when compared with pneumatic high-speed rotation for mandibular third molar surgery.Trial registration: Brazilian Registry of Clinical Trials registration number RBR-4xyqhqm ( https://ensaiosclinicos.gov.br/rg/RBR-4xyqhqm ).

Vestibuloplasty by modified Kazanjian technique in treatment with dental implants.

Dentists are often faced with extensively resorbed mandibular ridges with shallow buccal vestibule and high insertion of the mentalis muscle in relation to the crest of the ridge, causing the displacement of the prosthesis. Vestibuloplasty techniques aim at eliminating the muscle insertions, reposition the mucosa, and increase the area chapeável, giving more stability to the prosthesis. Among the techniques to deepen the vestibule are submucosal vestibuloplasties by secondary epithelialization and with mucosal and skin grafts. We will discuss vestibuloplasty by secondary epithelialization with emphasis on the so-called modified Kazanjian technique. This technique provides an appropriate result and does not require hospitalization, additional surgery at the donor, or prolonged periods without the use of prosthesis.

Comparative study of the effect of different temperatures on bovine bone used for bone repair of critical calvaria defects in rats.

To evaluate the osteoconductive potential of inorganic biomaterials of bovine origin submitted to different temperatures in the bone repair of critical defects in rat calvaria. Forty-eight rats were divided into four groups according to the material used to fill the defect: control group (GC), the defect was filled only with blood clot (n = 12); GBO, defect filled with Bio-Oss®, deproteinzed at 300°C (n = 12); GOX, defect filled with Inorganic GenOx®, deproteinzed from 850 to 1200°C (n = 12) and G700, defect filled with Inorganic GenOx 700, deproteinzed at 700°C (n = 12). In each animal's calvaria, a trephine bur with 5 mm internal diameter was used to produce a 6 mm-diameter central defect. Gen Derm® resorbable bovine membrane was superimposed over all defects. Subsequently, animals were euthanized at 30 and 60 days after surgery. The pieces were sent for histological and histometric analysis to evaluate the following variables: bone neoformation, presence of biomaterial, mononuclear and polymorphonuclear leukocytes, presence of other tissues (granulation and medullary) and maturation of collagen fibers. The most representative group for bone neoformation was GC. At 30 days, there was a higher mean of mature bone tissue (75.8). At 60 days, there was no statistical difference between the GC (64.9), GBO (32.9), GOX (45.3), and G700 (26.6) groups. GBO presented the highest amount of biomaterial after 30 days (115.9) and 60 days (118.5). All bovine biomaterials were biocompatible and osteoconductive. GOX promoted the best bone repair of the studied materials.

Evaluation of deformation, mass loss, and roughness of different metal burs after osteotomy for osseointegrated implants.

PURPOSE: This study used bovine ribs to comparatively assess the deformation, roughness, and mass loss for 3 different types of surface treatments with burs, used in osteotomies, for the installation of osseointegrated implants. MATERIALS AND METHODS: The study used 25 bovine ribs and 3 types of helical burs (2.0 mm and 3.0 mm) for osteotomies during implant placement (a steel bur [G1], a bur with tungsten carbide film coating in a carbon matrix [G2], and a zirconia bur [G3]), which were subdivided into 5 subgroups: 1, 2, 3, 4, and 5, corresponding to 0, 10, 20, 30, and 40 perforations, respectively. The surface roughness (mean roughness [Ra], partial roughness, and maximum roughness) and mass (in grams) of all the burs were measured, and the burs were analyzed in a scanning electron microscope before and after use. Data were tabulated and statistically analyzed by use of the Kruskal-Wallis test, and when a statistically significant difference was found, the Dunn test was used. RESULTS: There was a loss of mass in all groups (G1, G2, and G3), and this loss was gradual, according to the number of perforations made (1, 2, 3, 4, and 5). However, this difference was not statistically significant (P < .05). Regarding the roughness, G3 presented an increase in Ra, partial roughness, and maximum roughness (P < .05) compared with G2 and an increase in Ra compared with G1. There was no statistically significant difference (P > .05) between G1 and G2. The scanning electron microscopy analysis found areas of deformation in all the 2.0-mm samples, with loss of substrates, and this characteristic was more frequent in G3. CONCLUSIONS: The 2.0-mm zirconia burs had a greater loss of substrates and abrasive wear in the cutting area. They also presented an increased roughness when compared with the steel and the tungsten carbide coating film in carbon matrix. There was no statistically significant difference (P < .05) between G1 and G2 in any mechanical test carried out.

Successful Osseointegrated Implants in Hypertensive Patients: Retrospective Clinical Study.

PURPOSE: The aim of this study was to investigate the association of hypertension and antihypertensive drugs with the failure of osseointegrated dental implants. MATERIALS AND METHODS: This study conformed to STROBE Guidelines regarding retrospective studies. Data from 602 medical records of patients who received rehabilitation treatment with osseointegrated implants between 2000 and 2017, completed at least 6 months before the study, were analyzed. Data on age, sex, presence or absence of hypertension, use or not of antihypertensive drugs, number of placed and lost implants, and type of prosthetic rehabilitation were collected. Statistical chi-square tests and the Fisher exact test were used to analyze the variables with implant loss, using a significance level of P < .05. RESULTS: One thousand eight hundred eighty-seven implants were placed with a success rate of 97.51% (47 implants lost in 41 patients). Of the 602 patients, 71.43% (432) were normotensive and 28.36% (171) were hypertensive. The success rate of implants in the normotensive group was 93.28%, and in the hypertensive group, it was 92.99%, with no statistical difference between the groups (P = .958). Of these patients, the success rate among the hypertensive group was similar for medication users (92.5%) and for nonusers (94.1%), with no statistically significant difference (P = .939). CONCLUSION: The presence of hypertension, as well as the use of antihypertensives, could not be associated with the failure of osseointegrated implants.

Digital radiographic evaluation of the level of alveolar bone crest in external hexagon implants submitted to 2 types of implant abutments under immediate loading.

PURPOSE: The aim of this study was to evaluate by means of digital radiography the behavior of the alveolar bone crest in external hexagon implants following the use of 2 different types of abutments, one for conventional cemented prosthesis and one for modified cemented prosthesis. METHODS: Ten external hexagon implants (platform 4.1) were placed in 5 patients. Initial instrumentation was carried out to obtain primary stability of the temporary prostheses under immediate loading. Each patient received both abutments for conventional and modified cemented prosthesis. Standardized digital periapical radiographies were performed at times T0 (immediately after implant placement) and T1 (4 months after implant placement). A straight line was initially established from the implant platform to the distal and mesial peri-implantar marginal bone tissue (immediately in contact with the implant) and measured by digital radiography, using Sidexis version 2.3 (Sirona Dental Systems GmbH, Bensheim, Germany) software. The data were submitted to paired-samples t-test analysis. RESULTS: There was no significant difference between the conventional and modified cemented prosthesis. In both cases, t-test results were within the null hypothesis level. CONCLUSION: The abutment for the modified cemented prosthesis resulted in no significant radiographic difference of alveolar bone crest height, when compared with the conventional cemented prostheses.

Sialolithiasis of the submandibular gland.

Sialolithiasis of the salivary gland is a benign pathology that occurs most frequently in the submandibular gland because of its anatomic features. Depending on the sialolith size and calcification degree, it can be visible in radiographic examinations. Commonly, patients may experience pain and/or edema, when the ducts are obstructed. The authors report the case of sialolithiasis of the submandibular gland in a 42-year-old, female, white-skinned patient, noticed during routine dental examination. Following diagnosis confirmed by clinical and radiographic examinations, the treatment plan consisted of surgery for removal of the calcified mass. The prognosis is often good, and generally there is no recurrence.

Maxillary bone defect reconstruction using porous polyethylene implants.

PURPOSE: The aim of this study was to evaluate the bone repair process in the maxillary sinus in monkeys treated with high-density porous polyethylene (Medpor) METHODS: Four capuchin monkeys (Cebus apella) were submitted to bilateral horizontal osteotomies in the anterior wall of the maxillary sinus and divided into 2 groups: control group, left side with no implants, and porous polyethylene group, right side with Medpor. After a period of 145 days after implant placement, the maxillae were removed for histologic and histometric analyses. RESULTS: Bone repair in osteotomized areas took place by connective tissue in 58.5% and 58.7% in the control group and the porous polyethylene group, respectively. In the contact surface with Medpor, bone repair occurred in 41.3%. CONCLUSIONS: Medpor was not reabsorbed within the period of this study and allowed bone repair surrounding it. The porous polyethylene constitutes a feasible alternative for bone defect reconstruction.

Mandibular movement restoration through bilateral coronoidectomy by intraoral approach.

The present study aimed at reporting a clinical and surgical case of bilateral coronoidectomy, using an intraoral approach. The patient is a 26-year-old man, who sought attendance complaining of a gradual reduction of his oral opening in the past 3 years; however, he had an aggravation in the last 2 months. After clinical examination and imaging evaluation, the diagnosis of coronoid process hyperplasia was confirmed, and the surgical treatment was proposed. Under general anesthesia, with nasotracheal intubation guided by a nasofiberendoscope, using an intraoral approach, the bilateral coronoidectomy was performed. In the immediate postoperative period, an increase of the buccal opening measured 29 mm, representing an enhancement of 11 mm, and in the 30th postoperative day, it measured 31.12 mm. During the clinical follow-up period, a reestablishment of the mandibular movements was observed. Therefore, coronoidectomy by an intraoral approach and the physiotherapy performed in the postoperative period were efficient procedures.

Foreign body in preauricular region.

Foreign bodies, although they are often found throughout the body, to a lesser degree in the face, still constitute a diagnostic challenge for the trauma surgeon. Its removal means danger of damaging important facial anatomic structures, even if its exact position from the image data was known. So, the objective is to describe a clinical report of a patient (42 years of age, male sex) who experienced falling to the ground, attended by the Department of Surgery and Traumatology Bucco-Maxillo-Facial Surgery, Faculty of Dentistry of Araçatuba, São Paulo State University, and 2 days after the trauma, he reported difficulty in mouth opening and pain. After clinical evaluation, we observed the presence of injury in the left preauricular region already in the process of healing. During the intraoral physical examination, a limitation of the mouth opening was noted. Radiographic posteroanterior and profile of the face showed 2 radiopaque foreign bodies in the left side, lying apparently at the region of the mandibular condylar process. Under local anesthesia, foreign body removal was carried from there with access to it through the preexisting facial injury. Further clinical examinations showed an improvement in mouth opening, absence of pain complaints, and/or functional complaints.

Remodeling of calvarial graft in increased atrophic maxillary thickness. A prospective clinical study.

PURPOSE: This study evaluated the autogenous graft resorption rate in a calvarial block graft in the anterior region of an atrophic maxilla and compared it with the thickness of the remaining ridge. MATERIALS AND METHODS: Twelve patients were included in the study. They were submitted to cranial calotte graft surgery, and there were 40 blocks in total. The thicknesses of the ridges in the crest, middle and apical regions of the blocks were evaluated by computed tomography scan at the times: preoperative (T0), 48 hours (T1) and 6 months (T2) after the reconstructions. RESULTS: The resorption of the blocks from T1 to T2 was 13.4%. The greatest remodeling occurred in the alveolar bone crest (20.07%), followed by the middle portion (12.28%), and the apical region (9.5%), but the three regions did not significantly differ between times T1 and T2 (crest P = .07, middle P = .124, apical P = .131). Recipient site with the lowest thickness had the greatest resorption rates (up to 2 mm = 17.6%; from 2 to 4 mm = 17.52%) while than those with a thickness greater than 4 mm had a mean resorption of 8.81%. CONCLUSIONS: The resorption of the grafts in this study was 13.4%. Higher resorption rates were observed in the alveolar crest areas, where the ridges were less thick.

Evaluation of immediate cell viability and repair of osteotomies for implants using drills and piezosurgery. A randomized, prospective, and controlled rabbit study.

PURPOSE: The objective of this study was to evaluate the immediate bone damage and bone repair after osteotomy for implants using conventional drills and drills powered by piezoelectric motor. MATERIALS AND METHODS: Twelve rabbits received a tibial osteotomy with a conventional drill (control), with a diamond like carbon drill (DLC) and with a piezoelectric drill (Piezo). The animals were euthanized immediately, 30 and 60 days postoperatively. The tibias were removed and analyzed by means of histomorphometry, immunohistochemistry and microtomography. RESULTS: The immediate damage to the tissue at the cavity margins was similar (P > .05). At 30 and 60 days, the amount of newly formed bone tissue was similar (P > .05). Osteocalcin was intense score at 60 days in Piezo group. Microtomography revealed that bone volume at 30 days (control 3.8; DLC 4.3; and Piezo 2.4) and 60 days (control 4.9; DLC 4.82; and Piezo 3.95) were similar. There was a significant difference in bone formation between 30 (2.4) and 60 days (3.95) for the Piezo group (P = .016). CONCLUSION: The immediate effects and repair of cavities made using conventional, DLC coated, or ultrasound drills were similar.

Assessment of bone repair in critical-size defect in the calvarium of rats after the implantation of tricalcium phosphate beta (ß-TCP).

OBJECTIVES: Evaluating the osteoconductive property of tricalcium phosphate beta (ß-TCP) in comparison to that of inorganic bovine bone for repair in a critical-size defect in the rat calvarium. MATERIALS AND METHODS: Critical-size defects of 7mm were made with a trephine in the calvaria of 48 Wistar rats. The animals were divided into four groups, and the defects in each group were filled with tricalcium phosphate beta (ß-TCP), inorganic bovine bone (Bio-Oss), autogenous bone, or left empty. The animals were euthanized at two different time points (30 and 60days post-operation). All defects were recovered with a absorbable membrane of bovine cortical bone. Histological, histometric, and immunohistochemical (osteocalcin) assessments were carried out at 30 and 60days post-operation. RESULTS: At 30days post-operation, all groups showed areas of bone formation, predominantly when autogenous grafts were used. However, there were no statistically significant differences between the treatment groups (p>0.05). After 60days, there were similarities in the bone formation patterns between the ß-TCP (26.32±) and Bio-Oss (17.35±) groups (p=0.549). In terms of the immunohistochemical assessment of osteocalcin, the clot group showed light to moderate staining at 30 and 60days. The autogenous group showed moderate staining at 30days and moderate to intense staining after 60days. The Bio-Oss group showed light to moderate staining after 30days and intense staining at 60days. The ß-TCP group showed moderate staining at 30 and 60days post-operation. CONCLUSION: ß-TCP is a good osteoconductive material with similar effects to those of inorganic bovine bone graft and is suitable for utilization in the repair of bone defects.

A Posterior Lingual Sulcoplasty in Implant Therapy: A Case History Report.

This case history report describes the deepening of a patient's posterior mandibular lingual sulcus in combination with an acrylic resin guiding device fixed to an osseointegrated dental implant to maintain the patency of the new sulcular depth.