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Purpose: To evaluate the response of human peri-implant soft tissue (PIST) to different healing abutment materials 24 hours after positioning by assessing the expression of genes related to the early connective tissue wound healing response. Materials and Methods: The following four materials were used to create experimental abutments that were mounted on implants placed in five patients (four different abutments in each patient): group A--grade 4 titanium (Ti), group B--grade 5 Ti, group C--zirconia (Zr), and group D--polyetheretherketone (PEEK). Before implant placement, a gingival biopsy (control, CT) sample was obtained using a 2-mm-diameter punch (T0). After 24 hours, PIST biopsy samples were collected using a specifically designed custom-made cutting device. Real-time polymerase chain reaction (PCR) was performed to analyze the expression of the following genes: COL-I, COL-III, MMP-1, TIMP-1, TGF-^1, FN, ITGA4, ITGA5, ITGB1, RAC-1, COL-IV, aSMA, IL-6, and CXCL-1. Results: Gene expression analysis showed some differences between CT and the experimental groups; however, no significant differences were detected when comparing the experimental groups. COL-I was significantly downregulated in groups A and C compared to CT. Expression of MMP-1 and TIMP-1 increased in all the experimental groups but to a lesser extent in group A. FN, RAC-1, COL-IV, and aSMA were downregulated, especially in group A, in which CXCL-1 and IL-6 showed the lowest expression. Conclusions:The results of grade 4 Ti and Zr abutments seem to be promising, because a lower expression of genes related to inflammation, myofibroblast activation, and extracellular matrix remodeling was observed when compared with grade 5 Ti and PEEK, without triggering a profibrotic response in the early phases of PIST repair. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the accuracy of linear measurements and dental implant selection performed in a smartphone application compared to a computer software. Materials and Methods: Forty-four DICOM files from the posterior mandible in partially edentulous patients were evaluated by three trained and calibrated examiners. Images were analyzed using three visualization methods: cross-sectional view (CScr) and coronal (CSco) plane using the CS 3D Imaging software, and coronal (DRco) plane using the DroidRender smartphone application. For standardization, bone width and height measurements were taken in the edentulous posterior mandible, 10 mm posterior to the mental foramen. Implants were selected according to the 2022/2023Straumann Standard implant catalog. Linear measurements were compared using repeated-measures ANOVA, and implant selection was compared using Friedman test. Statistical analysis was performed using SPSS software, with a significance level of 5%. Results: Linear measurements showed a statistically significant difference for bone width (P = .030), but not for height (P = .685). The choice of implant was not influenced by the visualization method (P = .614). Conclusions: It is possible to suggest the use of smartphone applications as an additional diagnostic tool for DICOM evaluation and implant planning in the posterior mandible. Smartphone applications allow an assessment not limited to 2D images or to static environments. Therefore, information exchange and diagnostic opinion in emergency situations may be facilitated. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the clinical accuracy of a robotically assisted implant guidance system in partially edentulous patients without the use of postoperative CBCT. Materials and Methods: A total of 10 implants (7 patients) were placed in partially edentulous patients utilizing a robotically assisted implant guidance system. Following the implant placement, an intraoral scan was performed to register the implant position after attaching a scan body. The virtual plan and the postoperative intraoral scan with the scan bodies were exported as STL files and superimposed, and discrepancies were analyzed using Geomagic Control X software. Positional deviations were measured between the midpoint of the platform and apex of the planned and achieved implant positions. Results: Seven of the 10 implants in this study were defined as fully robotically guided, while 3 were partially robotically guided. For the fully robotic dynamically guided group, the mean deviation at the midpoint of the restorative platform of the implant, the apex of the implant, the top of the scan body, and the mean angular deviation were 1.31 ± 0.46 mm, 1.58 ± 0.61 mm, 1.11 ± 0.57 mm, and 2.34 ± 1.71 degrees, respectively. For the partially robotic dynamically guided cases, these values were 1.31 ± 0.49 mm, 1.45 ± 0.3 mm, 1.74 ± 0.47 mm, and 3.75 ± 2.53 degrees, respectively. Eight of the 10 implants (irrespective of full or partial guidance) showed a buccal displacement. Conclusions: Robotic surgery offers a level of accuracy similar to fully guided implant placement, without the need for a physical template, and allows for changes in the surgical plan at any time. The analytical method described in this study is an effective and radiation-free quality-control tool that can be used in implant dentistry as well as in other areas of dental research. [ABSTRACT FROM AUTHOR]

The article discusses studies which show that full-ceramic prosthetic restorations for single crowns (SCs) and fixed dental prostheses (FDPs) are high quality and have a satisfactory survival rate comparable to porcelain-fused-to-metal (PFM). These studies include the survival outcome and complications in a retrospective clinical study of complete-arch fixed implant-supported prostheses (CAFIPs), the prevalence of prosthetic complications, and clinical performance of implant-supported FDPs.

Purpose: Dental implants are a common treatment method after tooth loss, the accuracy of which directly affects efficacy and stability. Through a network meta-analysis, this study compared the accuracy of different modalities of implant placement: dynamic navigation (DN), fully guided static navigation (FG), partially guided static navigation (PG), and free handed (FH). Materials and Methods: This study followed the Preferred Reporting Items for Meta-Analyses (PRISMA) guidelines. An electronic literature search was conducted on October 2, 2022. The comparison of implant accuracy in all included randomized controlled trials (RCTs) conformed to at least one of the following: deviation at the implant crown, deviation at the apical portion of the implant, or angular deviation of the implant. Results: Twenty-six articles were included for the qualitative analysis (17 RCTs, 3 prospective studies, and 6 retrospective studies), and the 17 RCTs were included for network meta-analysis. The data included in this study had high consistency, and the funnel plot showed that the articles had low publication bias. Compared to FH, FG and DN had higher accuracy for coronal deviation (P < .05), and FG, DN, and PG had higher accuracy for apical and angular deviations (P < .05). According to the SUCRA (surface under the cumulative ranking curves) value, FG had the highest accuracy for coronal deviation, while DN had the highest accuracy in apical and angular deviations. Conclusions: According to the present results, the accuracies for DN, FG, and PG were higher than those for FH. DN showed the highest accuracy in terms of apical deviation and angular deviation. FG had the best control over the coronal deviation. There was no statistical difference between DN and FG in terms of accuracy. Given the limitations of the current study, further validation is required. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the study were to evaluate the clinical performance and the complications of combined tooth-/implant-supported three-unit fixed partial dentures (FPDs) in the posterior mandible. Materials and Methods: A total of 78 partially edentulous patients in the posterior mandible were recruited for the study (n = 26/group). Group 1 served as the control group and received two dental implants to support a three-unit FPD. Groups 2 and 3 were the experimental groups in which one implant was placed in conjunction with support from an adjacent tooth to support a three-unit FPD. Standard implants (= 8 mm) were included in Group 2, while short implants (< 8 mm) were included in Group 3. Periapical radiographs were taken for evaluation of crestal bone loss (CBL). Modified plaque index (MPI), bleeding index (BI), and sulcus depth values of the abutment teeth were recorded at the time of FPD delivery, 6 months after FPD delivery, and annually thereafter. Recorded complications included abutment tooth intrusions, cementation failures of the restorations, porcelain chipping/delamination, framework fracture, abutment screw loosening, abutment and abutment screw fracture, and implant fracture. Results: Statistically significant differences were observed between Group 1 (0.06 ± 0.17) and Group 2 (0.18 ± 0.32) and between Group 1 and Group 3 (0.17 ± 0.30) in terms of MPI (P = .05). No difference was observed between Group 2 (0.11 ± 0.34) and Group 3 (0.14 ± 0.36) or between Group 1 (0.04 ± 0.22) and Group 2 in terms of BI. There were statistically significant differences in terms of CBL between Group 1 (0.259 ± 0.05 mm) and Group 3 (0.11 ± 0.03 mm) and between Group 2 (0.03 ± 0.03 mm) and Group 3 (P = .05). The mean abutment tooth sulcus depth was 1.11 ± 0.31 mm for Group 2 and 1.20 ± 0.46 mm for Group 3. Conclusions: Within the limitations of the current study, it was concluded that combined tooth/implant-supported prostheses (CTISPs) are a predictable treatment choice in the posterior mandible. When a CTISP is planned, it is more predictable to use a short implant than a standard-length implant. [ABSTRACT FROM AUTHOR]

Radiation treatment plays a mainstream role in the management of head and necksquamous cell carcinomas (HNSCCs). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathologic fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCCs. Adverse impacts on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCCs exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathologic fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC who had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with the growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dental practitioner may encoun-tersuch patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management. [ABSTRACT FROM AUTHOR]

Traditional GBR procedures have been associated with frequent complications and compromised peri-implant esthetics. Tunneling techniques have been proposed as a promising alternative in this regard. More recently, a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) was reported to have been clinically successful in a prospective case series. This technique includes the use of a bone graft/recombinant human platelet-derived growth factor-BB combination delivered to the site by a tunneling method. However, published histologic information regarding the nature of the regenerated tissue has been limited. The current study evaluated the histologic and histomorphometric findings of four human specimens harvested at 2, 5, 9, and 14 months after ridge augmentation using the SMART method. Evaluations of the wound healing and bone regeneration sequence over time found that the ridge augmentation was the result of extensive new bone formation that progressed through the woven bone to lamellar bone stages, with remodeling of the xenogeneic graft material and replacement by patient bone. This is the first study utilizing sequential human specimens to histologically examine the chronology of wound healing following alveolar ridge augmentation. [ABSTRACT FROM AUTHOR]

Successful rehabilitation of severely atrophic, short-span edentulous ridges in esthetic regions can seldom be done without some form of vertical ridge augmentation (VRA). The best available evidence shows that guided bone regeneration procedures may present a very predictable option with reduced potential for complications compared to alternative options. The present case series presents a novel technique to achieve predictable VRA with a low complication rate using tenting screws and cross-linked resorbable membranes. A total of 10 patients (5 men, 5 women) with severe vertical defects in the esthetic zone participated in this study. Following a mean healing time of 9.3 months, the mean defect resolution was 80%, with a mean vertical bone gain of 6.2 ± 1.61 mm. Only one case presented with reduced defect resolution (50%); however, the bone gain for this case was 6 mm. [ABSTRACT FROM AUTHOR]

Background: Certain bone diseases of congenital origin are associated with dental alterations and with oromaxillofacial (OMF) disorders. The objective of this study was to evaluate and compare the OMF alterations presented by patients affected by bone pathology with respect to a healthy population from the same geographical environment. Material & methods: A cross-sectional study was carried out at Mount Meru Regional Referral Hospital and Kaloleni secondary school in Arusha, Tanzania. The patients with bone pathologies (n = 60) were consecutively recruited from the hospital, while the controls (n = 581) comprised a population of healthy students from the school, which was located in the same neighbourhood as the hospital. In the case group, the different bone pathologies were divided into two subgroups: (i) disorders in cellular metabolism (DCM); and (ii) disorders of bone growth/deformity (DGD). Musculoskeletal and oral clinical examinations were performed in both groups. Results: The case group presented significantly higher values of moderate and severe inflammation on the Löe & Silness Gingival Index (GI 2: 65%, GI 3: 25%) than the control group (p < 0.001), where mild inflammation predominated (GI 1: 88%). The case group also had higher scores for decayed, missing and filled teeth. Dental fluorosis was reported in 75.2% of controls and in only 26.6% of cases, the differences being clearly significant (p < 0.001). Significant differences for fluorosis were also reported between the two subgroups (p < 0.001), with a higher incidence for the DCM subgroup (43.8%). Twenty-two patients (36.7%) in the case group displayed clinical absence of teeth: the rate was significantly higher in the DGD subgroup (n = 15, 50%) than in the DCM subgroup (n = 8, 25%) (p = 0.045). In relation to the type of dental occlusion, the group with bone pathology presented a significant predominance of Angle class II - III malocclusions (p < 0.001). Craniofacial abnormalities were more frequent in the DGD subgroup, although the difference was not significant. The spine was normal in 41 patients (68.3%) and the differences between subgroups were not significant. Pathological fractures were significantly more frequent in the DGD subgroup (50% vs. 6.3%; p < 0.001). Assessing whether there was a relationship between malocclusion and skeletal deformities (spine and upper limb) in the case group, subjects with upper limb deformity (n = 16) presented significant differences for inverted overjet (p = 0.031). Conclusion: Patients with bone disease had worse oral health and more severe dental malocclusion than controls. The results presented here may help to raise awareness among orthopedic and pediatric professionals of abnormalities related to OMF conditions in childhood. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy is an integral component of the comprehensive and sequential treatment approach for advanced oral squamous cell carcinoma (OSCC). One of the significant complications associated with radiotherapy is osteoradionecrosis (ORN), which most frequently affects the mandible. Differentiating between osteoradionecrosis (ORN) and recurrent oral squamous cell carcinoma (ORSCC) can be challenging when relying solely on clinical and radiologic characteristics. The diagnosis becomes even more difficult when bone necrosis of jaw presents as the first clinical symptom. Objectives: This study aims to present the clinical manifestations and treatment processes of patients at our institution who have developed bone necrosis of jaw after radiotherapy and subsequently diagnosed with recurrent oral squamous cell carcinoma (ORSCC). Case presentation: We have collected six patients with recurrent oral squamous cell carcinoma (ORSCC) who developed bone necrosis of jaw after radiotherapy. These patients subsequently underwent surgical repair and reconstruction and were eventually diagnosed with ORSCC. We present a case series reviewing their basic characteristics, radiological reports, surgical treatment, and pathological diagnosis. All six patients initially presented with oral or facial pain and were diagnosed with osteoradionecrosis (ORN) through imaging studies. All patients underwent surgical treatment, with free flaps used to repair postoperative defects. Among them, five patients were diagnosed with tumor recurrence through preoperative or intraoperative frozen biopsy, and one patient was confirmed with recurrence in the osseous resection through postoperative examination. Conclusion: Identified ORSCC in the suspected ORN of the jaw following radiotherapy is relatively rare, yet it poses identification challenges and can significantly impact treatment decisions. Consequently, surgeons must remain vigilant and ensure clear pathological diagnoses for suspicious patients, either before or during surgery. [ABSTRACT FROM AUTHOR]

Objectives: To assess changes and factors influencing in buccolingual width and cyst cavity depth at the stoma site during marsupialization with cyst plug decompression for jaw cystic lesions. Materials and methods: Data were collected from patients who underwent marsupialization and cyst plug decompression for mandibular cystic lesions. A total of 15 cases were analyzed, including 10 odontogenic keratocysts (OKC), 1 unicystic ameloblastoma (UA), and 4 dentigerous cysts (DC). Cone beam computed tomography (CBCT) scans were conducted pre-surgery (T0), three months post-surgery (T1) and at the end of marsupialization (T2, > 2 months post-T1). Three-dimensional models were created to analyze bone dimensional changes in buccolingual width, vertical depth, and cyst volume. Results: The Friedman two-way rank analysis and subsequent pairwise comparisons demonstrated the cyst volume significantly decreased from T0 to T1, T1 to T2, respectively (p < 0.05). The buccolingual width remained basically unchanged from T0 to T1 (p = 0.423), but gradually decreasing from T1 to T2 (p < 0.001). Meanwhile, the cyst cavity depth consistently decreased throughout the study (p < 0.05). The Spearman rank correlation coefficient test indicated the final change in buccolingual width positively correlated with the initial width of the stoma site (p < 0.001). Conclusions: Buccolingual width remains stable before decreasing, whereas cyst cavity depth and cyst volume decreases continuously. The larger the initial width of the stoma site, the greater change in width at the end of marsupialization. Clinical relevance: During marsupialization, cyst plug modifications should align with bone remodeling patterns in jaw cystic lesions. Initially, only the plug's depth is adjusted, while in later stages, both stoma width and depth are gradually reduced. This understanding can contribute to the digital prefabricated series of cyst plugs by integrating clinical insights to develop more minimally invasive treatment strategies and to appropriately lengthen the decompression period during marsupialization. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the clinical outcome of biofluorescent imaging system (BIS) guided MRONJ surgery through analyzing 3D volumetric changes in CBCT data of bone structure. Methods: BIS-guided surgery for MRONJ surgery was performed by grinding red-fluorescent area from remained residual bone detected by Qray-pen. CBCT data was collected preoperatively, postoperatively, and at last follow-up more than 3 months of each patient. Healing ratio per month was calculated through measuring difference between postoperative defect and last follow-up defect volume by analyzing CBCT. Results: With mean follow-up period of 7.8 ± 4.8 months, twelve MRONJ surgeries of 11 patients (2 males, 9 females, mean 72.8 ± 13.7 years old) showed bone healing tendency without recurrence in average healing ratio of 5.49 ± 2.22% per month, with complete soft tissue closure. It was observed that the healing ratio per month did not show statistically significant differences based on location of MRONJ, size of post-operative defect volume, nor duration of bisphosphonate intake before surgery. Conclusions: Based on three-dimensional bone analysis, efficacy of BIS-based MRONJ surgery was proved through the recovery pattern of underlying bone structure and no recurrence sign showing. Clinical trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Aims: Bone preservation is a requirement for long-term stability of dental prostheses, which is all the more important in the posterior mandible, given the particular challenges these areas pose to prosthetic treatment. The objective was to investigate the implications of different prostheses on the atrophy of posterior alveolar bone after tooth loss. Materials and methods: A total of 457 treatment cases were retrieved from the medical documentation and information network. Baseline panoramic radiographs taken at prosthetic delivery and follow-up radiographs (≥ 3 years post-treatment) were available for analysis, with a mean follow-up duration of 6.42 ± 2.37 years. Posterior mandibular bone height in these radiographs was compared using one-way ANOVA followed by the Tukey post hoc test for statistical analysis. Results: Sites supporting fixed prostheses commonly used in partially edentulous mandibles exhibited less bone atrophy compared to sites with clasp- or telescope-retained removable partial dentures (RPDs) (p < 0.001). Furthermore, sites with clasp-retained RPDs and telescope-retained RPDs demonstrated less bone atrophy when distal support was present (p < 0.001). In edentulous mandibles, bar-retained overdentures supported by four implants exhibited significantly less bone atrophy compared to mucosa-supported complete dentures, bar-retained overdentures supported by two implants, or overdentures retained by Locator abutments on two implants (p < 0.001). Conclusion: Bone atrophy in the posterior mandible should be expected to vary greatly with prosthetic designs. Long-term stability is possible with fixed partial prostheses, RPDs are less favorable in the absence of a distal support and bar-retained overdentures on four or more implants exhibited the lowest bone atrophy in fully edentulous mandibles. Clinical trial number: Not applicable – retrospective analysis. [ABSTRACT FROM AUTHOR]

Background: The continuous development in digital prosthodontics allowed the customization of attachments and retentive inserts which offers an easy and cheap solution for regular maintenance of locator overdentures during daily practice. The present study compared the change in retention values of the fully digitally manufactured custom-made locator attachment retentive insert with the ready-made ones after insertion, removal, and masticatory cycles. Methods: A complete denture was constructed over a mandibular edentulous epoxy model. Two implants were inserted into the model between the laterals and canines following the prosthetically driven implant protocol. Locator retentive attachment inserts were digitally designed using free-form modeling software and milled from PEEK (Poly Ether Ether Ketone). After the pick-up of the ready- and custom-made retentive inserts, an insertion, removal, and masticatory cycles test simulating 1 year of patient usage was performed. The change in retention values was recorded at baseline, 6 months, and after one year of simulated clinical use. An independent sample t-test was used to compare the data between the two studied groups. Results: There were statistically significant differences in retention values between the custom-made and ready-made locator inserts at baseline and after 6 months. (p = 0.001*). On the other hand, there was no significant difference in retention after 1 year of simulated use. (p = 0.083, NS) Conclusions: The custom-made milled locator retentive attachment insert can be used as an alternative to the ready-made one due to their comparable retention values after 1 year of simulated use. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the relationship between radiographic measurements of the alveolar bone in posterior single-tooth edentulous regions and radiographic measurements of non-alveolar jawbones using multidetector computed tomography (MDCT). Methods: The sample consisted of 47 patients aged between 20 and 42 years who underwent MDCT. All patients had a posterior single-tooth edentulous region. Extraction was performed 1–8 years ago at the time of inclusion (mean = 3.2). The alveolar bone in the edentulous region and non-alveolar bone regions (maxillary tuberosity, condyles, inferior to the mandibular foramen, and mandibular angle) were studied radiographically (radiographic density, dimensions, and cortical bone ratio). Pearson correlation, independent sample t test, and linear regression analysis were used for the statistical analysis. Results: Radiographic density of the alveolar bone (measured in the axial or buccolingual directions) correlated significantly with that of the maxillary tuberosity (0.3 < r < 0.4; P value ≥ 0.001) and, to a lesser extent, with the radiographic density of the region inferior to the mental foramen (r ≈ 0.3). Based on these correlation coefficients, non-alveolar bone density could explain 10–16% of the alveolar bone density after extraction according to linear regression analysis. Conclusions: This study revealed that alveolar bone radiographic density was correlated with that of the maxillary tuberosity and inferior to the mental foramen region. Accordingly, linear regression models were suggested to aid in predicting future alveolar bone density in areas where extraction is to be performed. [ABSTRACT FROM AUTHOR]

Immediate full-arch loading is a highly complex and techniquesensitive 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. [ABSTRACT FROM AUTHOR]

The management of horizontally fully edentulous atrophic ridges is a common problem in dental implantology. This case report describes an alternative modified two-stage presplitting technique. The patient was referred for an implantsupported rehabilitation of their edentulous mandible. CBCT scans showed a mean available bone width of about 3 mm. At the first stage, four linear corticotomies were performed using a piezoelectric surgical device. At the second surgical stage 4 weeks later, bone expansion was performed, and four implants were placed in the interforaminal area. The healing process was uneventful. No fractures of the buccal wall and no neurologic lesions were observed. Postoperative CBCT scans showed a mean bone width gain of about 3.7 mm. Implants were uncovered 6 months after the second surgery, and 1 month later, a fixed provisional screw-retained prosthesis was delivered. This approach could be used as a reconstructive technique that avoids using grafts and reduces treatment times, possible complications, postsurgical morbidity, and costs by exploiting the patient's native bone as much as possible. Considering the limitations of a case report, randomized controlled clinical trials are needed to confirm the results and validate this technique. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare the marginal bone loss (MBL), survival rates, and periodontal parameters of immediately loaded implants with either Dolder bar or Locator attachments placed in the interforaminal region of edentulous mandibles. Materials and Methods: A total of included 19 patients with edentulous mandibles each received two implants in the interforaminal area of the symphysis. Randomly allocated Dolder bar or Locator attachments were then attached immediately, and both clips and a framework were fastened to the denture by the dental laboratory within 24 hours. Results: A total of 28 subjects with 56 implants were treated in accordance with the immediate-loading study protocol. Of these, 9 patients were lost to follow-up; 1 patient reported a serious illness and 8 patients moved and couldn't be reached. The 19 subjects not lost to follow-up (11 women and 8 men; average age: 68 years) were included. Every patient received either two Locator abutments and were assigned to group A (7 patients; 36.8%) or two multiunit abutments and were assigned to group B (12 patients; 63.2%). No implant failure was detected for either group, and therefore the survival rate for both groups was 100% after 5 years. After 5 years without any symptoms, 2 implants from group A and 7 implants from group B showed > 2 mm of MBL, which makes the group A success rate 85.7% and the group B success rate 70.8%. Modified sulcular bleeding index (mSBI) did not differ significantly at any of the measurement intervals. However, the modified plaque index (mPI) of group B was significantly higher than group A at the 60-month follow-up. Conclusion: It can be concluded that either splinting or not splinting the immediately loaded interforaminal implants to retain mandibular overdentures (OVDs) does not affect marginal bone levels after 5 years and immediate loading of nonsplinted implants with Locator attachments can be safely preferred to retain mandibular OVDs. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 3-year success and survival rates of fixed prostheses supported by 4-mm extra-short implants splinted to 10-mm implants in patients with shortened maxillary arches and low maxillary sinus floors. Methods: A total of 11 patients with reduced alveolar bone heights due to low maxillary sinus floors received two or three titaniumzirconium tissue-level implants: one or two extra-short (4 mm) implants, and one implant 10 mm in length. After 6 months, prosthetic rehabilitation with splinted crowns connecting the 4- and 10-mm implants was performed. Follow-up visits and maintenance protocols were implemented every 4 to 6 months. Results: The 11 patients were treated with 11 10-mm implants and 17 4-mm implants. One extra-short implant failed and was removed before loading, and its planned design was modified from three splinted crowns to a bridge between the 10- and 4-mm implants. After 36 months, all (11/11) prosthetic rehabilitations connecting the 10-mm (11/11) and 4-mm (16/16) implants were functional. At the 10-mm implant sites, the median (interquartile range [IQR]) probing depth and marginal bone loss measured 2.9 mm (2.3 to 3.2) and 1.3 mm (1.0 to 1.5), respectively. At the 4-mm implant sites, the median (IQR) probing depth and marginal bone loss measured 2.9 mm (2.4 to 3.1) and 0.3 mm (0.1 to 0.5), respectively. Conclusion: Prosthetic rehabilitation with splinted crowns connecting 4-mm and 10-mm implants showed promising outcomes in shortened maxillary dental arches after 3 years. Additional studies are needed to further validate these findings. [ABSTRACT FROM AUTHOR]

Currently, several techniques are used in the posterior mandible to increase alveolar bone height and width. However, each has potential complications and limitations. The purpose of the current study was to present the surgical technique and restorative considerations for implant placement lateral to the inferior alveolar nerve (IAN) in cases of severely atrophic edentulous posterior mandibles. In total, 26 implants were successfully placed lateral to the IAN in 16 patients and restored with splinted screw-retained prostheses. The postloading follow-up time ranged between 3 months and 6 years. Two patients reported complications: One patient had a temporary paresthesia that resolved 3 months after implant placement, and the second patient had minor paresthesia that was reduced after implant removal but remained in a small area on the left corner of her lip. [ABSTRACT FROM AUTHOR]

Purpose: To validate guided surgery for zygomatic implants (ZIs) by analyzing the final position of the implants relative to the preoperatively planned position. Material and Methods: Five patients with fully edentulous atrophic maxillae treated with four ZIs through a fully guided implant surgical approach were evaluated. The preoperative phase included digital planning, through which the surgical guide was designed and created. Analysis of the guided surgery accuracy was carried out by superimposing the digital planning over the final position of the implants using preoperative and postoperative CBCT. The radiologic evaluation included implant angular deviation, entrance deviation, exit deviation, platform deviation, and apex apicocoronal and mesiodistal deviation. Results: All five patients (two men and three women; mean age: 61.8 ± 3 years) were each treated with four ZIs using a fully guided approach with an extrasinusal path, obtaining ideal emergence of the implants. Superimposition comparison found a mean axial angular implant deviation of 0.79 ± 0.41 degrees and a mean implant entrance deviation of 0.95 ± 0.26 degrees. The platform deviation was 0.62 ± 0.19 mm buccopalatally and 0.76 ± 0.14 mm mesiodistally, while the apical deviation was 0.42 ± 0.13 mm buccopalatally and 1.06 ± 0.37 mm mesiodistally. Conclusions: Guided surgery in zygomatic implants appears to be sufficiently accurate to make it a safe and predictable technique. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study is to evaluate the accuracy of a digital template on the three-dimensional accuracy of edentulous implantation through a retrospective study to provide more clinical evidence for the use of digital templates in edentulous patient. Materials and methods: This study evaluates the efficacy of a digital surgical template in edentulous jaws, comparing preoperative plans with postoperative outcomes across four metrics: platform, apex, depth, and angular deviations. Utilizing a patient with an edentulous maxilla as a case study, this research employs CBCT for preoperative and postoperative assessments, with deviations analyzed via 3-Shape software. Comparing these deviations with average deviations in lierature. Results: The average platform deviations at positions 12, 14, 16, 22, 24, 26 were 0.98 ± 0.03 mm, 1.43 ± 0.02 mm, 1.27 ± 0.04 mm, 1.35 ± 0.03 mm, 1.34 ± 0.02 mm, and 1.42 ± 0.03 mm, respectively. The average apex deviations were 1.28 ± 0.02 mm, 1.39 ± 0.03 mm, 1.47 ± 0.04 mm, 1.26 ± 0.04 mm, 1.40 ± 0.04 mm, and 1.48 ± 0.03 mm, respectively, the average angular deviations were 3.50°± 0.08°, 2.87°± 0.07°, 3.49°± 0.06°, 3.36°± 0.10°, 3.41°± 0.13°, and 3.69°± 0.11°, and average depth deviations were 0.29 ± 0.03 mm, 0.26 ± 0.05 mm, 0.59 ± 0.05 mm, 0.28 ± 0.04 mm, 0.47 ± 0.02 mm, 0.53 ± 0.03 mm. Compared with a total mean deviation of 1.2 mm (1.04 mm to 1.44 mm) of platform deviation, 1.4 mm (1.28 mm to 1.58 mm) of apex deviation, angular deviation of 3.5°(3.0° to 3.96°) and depth deviation of 0.2 mm (-0.25 mm to 0.57 mm) reported in literature. While all measured deviations fell within clinically acceptable limits, certain parameters exceeded the benchmarks, suggesting areas for improvement in digital surgical planning and execution. Conclusions: This study indicates that while all measured deviations fell within clinically acceptable limits, certain parameters exceeded the benchmarks, suggesting areas for improvement in digital surgical planning and execution. Based on these data, the potential of digital guide plates to fulfill precision requirements in edentulous jaw implantation can be proved, contributing valuable insights into the optimization of implant surgery protocols. Clinical relevance: Now, the digital template is accepted by many doctors. However, clinical research has not thoroughly verified whether the new digital technology is more accurate than traditional technology. So, this study aims to explore the effect of a whole-process digital template on edentulous implantation and provide more clinical evidence. [ABSTRACT FROM AUTHOR]

Immediate loading implant surgery has emerged as a significant advancement in the rehabilitation of edentulous patients. This approach requires meticulous planning and precise execution to ensure successful outcomes. Transferring established intermaxillary and occlusal relationships to the definitive prostheses can be challenging. However, with a digital approach, this procedure can be standardized in cases of fully guided surgery with a flapless technique or by using disposable guides. Conversely, when extensive open flap implant surgery is required, such as in the treatment of severely atrophic patients (e.g., with zygomatic implants or simultaneous bone augmentation), the digital workflow can be demanding. The impression reference technique was proposed to enhance the digital workflow for immediate loading in zygomatic implant rehabilitation. This study aims to describe the impression reference technique, applied to both upper and lower jaws for immediate loading open flap rehabilitations, using standard implants. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of maxillofacial defects is challenging due to the region's complex anatomy. During the COVID-19 era, many patients lost their maxilla and chewing efficiency as a result of Mucormycosis. In such cases, custom-designed implants offer a graftless solution for seemingly hopeless situations. This case report aims at miraculous dental transformation utilizing the Patient Specific Implant (PSI) approach. Case Presentation: A 64-year-old male patient presented to the Prosthodontics Department with the chief complaint of missing teeth. He had been struggling with chewing for two years due to a post-mucormycotic maxillary jaw. A CT scan was obtained to evaluate and investigate the affected site. After a comprehensive diagnosis, the treatment of choice was a patient-specific implant decided using 3D printing technology. Reconstructing maxillofacial defects poses significant challenges due to the region's intricate anatomy, as well as its aesthetic and functional implications. The use of pre-formed alloplastic implants and autogenous grafts often leads to complications such as resorption, infection, and displacement. However, recent technological advances have made it possible to fabricate customized patient-specific implants (PSIs) through computer modeling, offering new opportunities for reconstructive surgery. Conclusion: This case report demonstrates the dental management of post-mucormycotic patients with specially designed implants, customized according to the availability and anatomy of the bone in the entire head region. The absence of complications during follow-up, conducted at 15, 30, 45, and 90 days, and subsequently monthly for two years, highlights the success of this approach. Evaluation parameters included infection, soft tissue recovery, wound separation, masticatory efficiency, stability of the prosthesis, and aesthetic outcomes. The positive outcomes observed at follow-up appointments emphasize the viability and effectiveness of patient-specific implants in addressing maxillary defects caused by post-mucormycosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the difference in bone-implant contact (BIC) and the rate of infratemporal fossa intrusion among different apex sites for quad zygomatic implants (ZIs) design in edentulous patients with severe alveolar bone resorption. Methods: Patients with maxillary edentulism were evaluated. Alveolar bone resorption was assessed using the Cawood and Howell classification. Participants with Class IV or Class V/VI bone resorption were selected. The zygomatic bone was devided into upper, middle and lower thirds, with four potential implant apex locations identified in each third. Virtual planning for quad ZIs, along with measurements of BIC were performed. Additionally, the occurrence of ZIs intrusion into the infratemporal fossa was examined, and the distance between ZI and orbital cavity was measured. Results: A total of 28 CBCT scans of edentulous patients, encompassing 56 zygomas, were analyzed. Thirty-nine single lateral posterior edentulous jaws were classified into Class IV subgroup, while 17 into Class V/IV subgroup. Among all patients and patients in subgroups, the anterior and posterior ZI exhibited the highest BIC at points A3 and B2, respectively. The average zygomatic BIC at A3 apex point was 18.3 ± 3.9 mm, and that at the B2 apex point was 16.3 ± 5.3 mm. Quad ZIs risk intrusion into the infratemporal fossa when positioned at B2, B3, and at all apex points of the lower zygoma segment. Three anterior ZIs at A3 point show less than 1 mm distance to orbital cavity. Overall, A3 and B1 apex points showed high BIC and low infratemporal intrusion rate for quad ZIs, irrespective of patient's alveolar bone resorption status. Conclusions: The optional apex point for anterior and posterior quad ZIs is A3 and B1, respectively, regardless of the patients's alveolar bone resorption level. Alveolar bone resorption does not affect the BIC for quad ZIs. Anterior ZI positioned at A3 point may present high risk for orbital penetration and may not be reccomended in a Quad ZI approach. Trial registration: The clinical research is registered under the number ChiCTR2100044472. [ABSTRACT FROM AUTHOR]

Background: The present systematic review evaluated clinical and radiographic features and treatment outcomes of peri‐implantitis‐induced medication‐related osteonecrosis of the jaws (Pi‐MRONJ). Materials and Methods: Literature search was performed in PubMed/MEDLINE, Cochrane CENTRAL, Web of Science, and Scopus databases. Studies reporting Pi‐MRONJ were included. No time restrictions were applied. Results: In total, 571 articles were retrieved, and 24 articles were included in the final review. Study population consisted of 111 patients (70% pharmacologically treated for osteoporosis and 30% for oncologic disease). Pi‐MRONJ was characterized by pain, bone exposure and suppuration, and involved a single implant in 55 cases, two implants in 37 cases, three implants in 10 cases, and more than four implants in nine cases. Most of the lesions were assigned Stage II and III. MRONJ developed on average 46.5 ± 33.2 months following implant placement. Sixty‐one lesions were surgically treated with implant removal and debridement of the surrounding necrotic bone. Complete wound healing was observed in 85% of cases. Conclusions: The presence of dental implants in patients treated with antiresorptive drugs should be considered as a potential risk factor for MRONJ onset. In cases of periimplantitis with delayed wound healing following nonsurgical therapy, the clinician should rule out the presence of Pi‐MRONJ. [ABSTRACT FROM AUTHOR]

Introduction: Exodontia is commonly considered as a risk factor for the development of medication‐related osteonecrosis of the jaw (MRONJ) in individuals exposed to bone modifying agents. This study was aimed at assessing the efficiency and safety of a gaseous oxygen–ozone mixture as an adjuvant to a standard exodontia to reduce the risk of MRONJ development. Methods: A randomized, open‐label, phase II, single‐center clinical trial involving 117 patients at risk of MRONJ was conducted. The study protocol tested injections of an oxygen–ozone mixture in the post‐extraction site. Participants were randomly assigned to two groups: oxygen‐ozone therapy, and standard tooth extraction protocol. Post‐extraction wound healing was assessed using the Inflammatory Proliferative Remodeling (IPR) Wound Healing Scale. Results: The oxygen‐ozone therapy group exhibited a significant improvement in wound healing post‐extraction during the inflammatory and proliferative phases, as indicated by the IPR scale scores at 3–5 days (p = 0.006) and 14 days (p < 0.001) respectively. Conclusion: Oxygen–ozone therapy shows promise in improving post‐extraction healing in patients at risk of MRONJ. Future studies with larger sample sizes and multicenter collaborations are recommended to confirm the validity of these findings and explore the long‐term efficacy of ozone therapy. [ABSTRACT FROM AUTHOR]

Background: The literature is unclear about how the different attachment systems for overdentures impact the maximum bite force, the masticatory efficiency and how this impact in the oral health self‐perception in patients. Objective: To evaluate the effect of two attachment systems (O‐ring and Locator) for mandibular overdenture using single implant on quality of life, maximum bite force (BF) and masticatory efficiency (ME). Methods: Twenty‐eight completely edentulous denture wearers with a mandibular symphysis implant were randomly selected and allocated into two groups in a crossover study, considering O‐ring and Locator attachment types. The quality of life and self‐perception of oral health were assessed using the Oral Health Impact Profile (OHIP‐Edent) and Geriatric Index of Determination of Oral Health (GOHAI) questionnaires, respectively. BF was measured using a gnathodynamometer and ME by chewing silicone cubes and almonds in different numbers of cycles. Results: There was no difference between the attachment systems about self‐perceived oral health and impact on quality of life (p >.05). The O‐ring‐type system obtained a significantly higher BF than the locator‐type system (p =.04). Regardless of the food chewed, no statistically significant difference was observed with the type of attachment (p >.05). The ME was directly proportional to the masticatory cycles only for almonds (p <.01). Conclusions: Locator and O‐ring inserts had a similar impact on patients' quality of life, self‐perception of oral health and ME. Additionally, the O‐ring system exhibited superior properties in the BF. [ABSTRACT FROM AUTHOR]

There are a number of protocols that the clinician has to consider when providing implant treatment. Immediate implant placement has its place in implant dentistry and should be considered following a strict case selection. This article discusses the factors that should be taken into account when planning and providing immediate implant placements, with an emphasis on achieving a good outcome. The evidence base is discussed with a description of the surgical stages involved and subsequent restoration. Cases to illustrate this technique and its limitations are presented. CPD/Clinical Relevance: Principles for single tooth implant replacement in the anterior maxilla, where aesthetic expectations are high are relevant to clinicians. [ABSTRACT FROM AUTHOR]

Background: As a result of the dental alterations pacifiers can cause, several designs have been described, differing in the shape and size of the teat. The aim of this review was to compare the influence of the physiological pacifier on the development of malocclusions in children with other types of pacifier. The research question was: does the use of physiological pacifiers cause less dentomaxillary alterations than other designs? Methods: A scoping review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, and Scopus. The ROBINS-I risk of bias tool was used for the methodology assessment of the included studies. Results: Of the 122 articles identified in the initial search, 5 articles met all the inclusion criteria. In all of them, in general, the use of the pacifier caused malocclusions such as an anterior open bite, a posterior crossbite, an increased overjet, and an involvement of the overbite. Children who began using the physiological pacifier very early, between 0 and 3 months, were less likely to develop finger sucking/thumb sucking compared to children who started after 3 months. In the prevalence of open anterior bite and overjet, there was a significant difference between the use of conventional pacifiers and anatomical pacifiers compared to the use of physiological pacifiers. Conclusions: the physiological pacifier can cause fewer oral alterations and could be the best option as a pacifier, however, more well-designed and high-quality randomised clinical trials are required. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the scanning strategies affecting the accuracy of virtual interocclusal records (VIR) in partially edentulous arches using an intraoral scanner in vitro. Methods: A reference model of a partially edentulous arch with implant analogs in positions 45,46 and 47 was constructed. Six pairs of 1-mm diameter metal beads were placed on the gingival tissue as markers for measurement. Four scanning strategies were tested: Quadrant-arch Scan (group 1), Quadrant-arch Scan with Auxiliary occlusal devices (AOD) (group 2), Full-arch Scan (group 3), Full-arch Scan with AOD (group 4). The model was digitalized with a lab scanner as a reference and 15 scans were obtained for each group. The accuracy of VIR was assessed by comparing the experiment data to the reference digital model. Results: The mean surface deviations of VIR for Groups 1–4 were 89.4 ± 105.2 μm,95.6 ± 132.8 μm,152.3 ± 159.7 μm and 107.6 ± 138.2 μm respectively. Quadrant-arch scans resulted in lower errors of VIR than full-arch scan (P < 0.001). There was a significant interaction between the AOD and scanning span (P = 0.017). The Quadrant-arch scan with AOD (group 2) produced the least error in the distally extended edentulous area. Conclusions: Quadrant-arch scans showed better accuracy of VIR than full-arch scans across all tooth positions. The combination of AOD and quadrant-arch scan further enhances VIR accuracy in distally extended edentulous areas. [ABSTRACT FROM AUTHOR]

Objectives: Anti‐resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian Society of Periodontology and Implantology members in the management of patients treated with anti‐resorptive agents and with the risk of developing MRONJ. Materials and Methods: An 18‐item questionnaire was submitted by e‐mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro–Wilk test. Results: Four hundred and fifty‐one questionnaires were returned by e‐mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti‐resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti‐resorptive therapy for osteometabolic disorders. One or more MRONJ‐affected patients were encountered by 63.2% of the respondents. Conclusions: This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti‐resorptive agents. [ABSTRACT FROM AUTHOR]

Background: Limited data exist on the mid‐ to long‐term masticatory capacity of mandibular overdenture (IOD) wearers, particularly regarding the use of posterior implants to retention. Objectives: To periodically evaluate mastication of IOD wearers, comparing the effectiveness of two to four implants to retain the prosthesis. Methods: In a randomised controlled clinical trial, 20 complete edentulous patients (14 women), aged 51–84 years (mean age 69.1 ± 9.6), received new bimaxillary complete dentures (CD). After adaptation, baseline measurements of masticatory performance (X50) and swallowing threshold were conducted using the sieving method. Patients were then randomly assigned to groups: control (two intra‐foraminal regular implants) and experimental (two intra‐foraminal regular implants and two extra‐short posterior implants) (n = 10 each). After 4 months, implants were splinted, and a new mandibular IOD was fabricated with bar/clip retention. Mastication was reassessed after 6, 12, and 48 months, and data analysed with repeated measures ANOVA and Sidak's post hoc (α = 0.05). Results: Despite a loss of two patients per group, masticatory performance significantly improved after mandibular IOD installation (p =.031) in both groups (p =.670). A second improvement was observed after 6 months (p =.027), with no subsequent changes (p >.05). Swallowing threshold improvements were noted with IOD, and no discernible differences between groups were observed (p >.05). Conclusion: Masticatory function significantly improved after mandibular IOD installation, with the number of implants demonstrating minimal influence. Clinical Trial Registration: The present study was not registered in a public database, as mandated. It is important to note that the recommendation for registration was initiated in 2017 by the Committee of Medical Journal Editors, while patient inclusion in the research took place in 2016. Given that the data presented in this manuscript cover a follow‐up period of up to 4 years post‐surgical intervention, delayed registration was not feasible. [ABSTRACT FROM AUTHOR]

Tooth loss may affect the dietary patterns, phonetics, appearance, and lifestyle of affected individuals. Therefore, patients require the replacement of missing teeth to allow adequate function, appearance, and psychological wellbeing. However, the replacement of missing teeth in patients at the transitional stage from the natural to the artificial dentition can pose a significant challenge to a clinician. This case describes the management of a patient with an ill-fitting upper complete denture, which rested on an anterior fibrous edentulous maxilla, opposing a partially dentate mandible. CPD/Clinical Relevance: Selection of the optimum treatment option available to manage a patient with an anterior fibrous edentulous maxilla opposed by a partially dentate mandible is important. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to clarify numerical values for differentiating nasopalatine duct cysts (NPDCs) from radicular cysts (RCs) arising in the anterior maxilla on computed tomography (CT) or cone-beam CT (CBCT) images. Methods: CT or CBCT images of histologically proven NPDCs (n = 30) and RCs (n = 33) beyond the midline of the maxilla were investigated to determine two asymmetry indices on axial images of the maximum lesion area. The lateral asymmetry index was calculated based on two distances from each of the lateral ends of the lesion to the midsagittal plane. The index was defined as the difference between the two distances divided by their sum. The labio-palatal asymmetry index was determined by the distance between the labial and palatal ends of the lesion and the coronal plane passing through the central incisor root apex. The performance of these indices was assessed by receiver operating characteristic (ROC) analysis. The cutoff values for differentiating NPDCs from RCs were determined with the Youden procedure on the ROC curve. Results: The area under the ROC curve was 0.97 for the lateral asymmetry index and 0.88 for the labio-palatal asymmetry index. The cutoff values for differentiation were 0.36 and 0.68 for the lateral and labio-palatal asymmetry indices, respectively. Conclusion: The lateral asymmetry index appeared to be an effective reference for differentiating NPDCs from RCs on CT or CBCT images. When the index was less than the cutoff value, a diagnosis of NPDC was strongly suggested. [ABSTRACT FROM AUTHOR]

Background: In edentulous jaws, factors such as the number of implants, cross-arch distribution, and the angle among implants may affect the accuracy of the implant impression. This study explored factors influencing the accuracy of implant abutment-level digital impressions using stereophotogrammetry in edentulous jaws. Methods: Two standard all-on-4 and all-on-6 models of edentulous jaws were constructed in vitro. In the stereophotogrammetry group (PG), the implant digital impression was made using stereophotogrammetry and saved as an STL file. In the conventional group (CNV), the impression was made using the open-tray splint impression technique. An electronic and optical 3D measuring instrument was used to scan the standard model and the conventional plaster model to obtain STL files. Using 3D data processing software (GOM Inspect Pro, Zeiss), the distance and angle between the abutments in the CNV impression and the PG impression were measured and compared with the data from the standard model. Results: The distance deviation in the PG and the CNV was 145 ± 196 μm and 96 ± 150 μm, respectively, with a significant difference (P < 0.001). The angle deviation in the PG and the CNV was 0.82 ± 0.88° and 0.74 ± 0.62°, respectively, with no significant difference (P = 0.267). In the PG, the distance deviation was negatively correlated with the distance between implants (r = -0.145, P = 0.028) and positively correlated with the angle of implants (r = 0.205, P = 0.002). The angle deviation was negatively correlated with the distance between implants (r = -0.198, P = 0.003) and positively correlated with the angle of implants (r = 0.172, P = 0.009). In the CNV, the effect of inter-implant distance on impression accuracy was also shown by Spearman correlation analysis: r = 0.347 (P < 0.001) for distance deviation and r = -0.012 (P = 0.859) for angle deviation. The effect of inter-implant angulation on impression accuracy deviation was r = -0.026 (P = 0.698) for distance deviation and r = 0.056 (P = 0.399) for angle deviation. Conclusions: The CNV method is closer to the real value of the original model. The distance between implants and the distribution angle had a weak correlation with the accuracy of digital impressions but no significant correlation with the accuracy of traditional impressions. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: The degenerative joint disease is a temporomandibular disorder. By analysing texture parameters, it becomes possible to characterize and differentiate various tissues, based on their textural properties according to cone-beam computed tomography (CBCT). This study evaluated degenerative diseases in the temporomandibular joint through texture analysis. Methods: Eighty images of the jaw condyle with three types of degenerative diseases, flattening, osteophytes, erosion and control group were analysed, obtained through CBCT. The analyses were carried out through texture analysis with three regions of interest (ROIs) corresponding to specific bone sites. The scans were exported to MaZda software, in which the ROIs were delimited following previously marked contours, and the co-occurrence matrix values were calculated for selected texture analysis parameters. Results: The erosion group showed a significantly different behaviour from the other groups for all analysed parameters. Conclusion: This study highlights the potential of texture analysis in characterizing medullary bone changes in condyles affected by erosion. Texture analysis allows for a more comprehensive assessment of bone condition on CBCT images. These results have implications for early detection and monitoring of degenerative changes in the temporomandibular joint, thus allowing preventive intervention and personalized treatment planning, improving the prognosis of the disease.

Hyperparathyroidism Jaw Tumour Syndrome (HPT-JT) is a rare autosomal dominant disorder within the familial hyperparathyroidism group. Individuals with the disorder carry a CDC73 gene mutation that predisposes them to early-onset primary hyperparathyroidism, ossifying jaw tumours, renal cystic disease, uterine tumours and parathyroid carcinomas. We present a case of a 41-year-old man referred to nephrology clinic with haemoproteinuria who was noted to have the constellation of renal cystic disease, personal and family history of hyperparathyroidism and recent jaw tumour excision. Detailed family history prompted whole exome genetic testing which confirmed the presence of a pathogenic CDC73 gene mutation, ten years after the patient's initial parathyroidectomy. This case demonstrates the importance of detailed family history taking and the need to consider lesser-known familial hyperparathyroid syndromes to ensure timely diagnosis, genetic testing and cancer surveillance for those affected. [ABSTRACT FROM AUTHOR]

Purpose: Although immediate-loading implant (ILI) treatment is a general treatment strategy for fully edentulous maxillae, long-term evidence is required. The purpose of this study was to evaluate the long-term clinical results of, and risk factors for, ILI treatment in fully edentulous maxillae. Materials and Methods: ILI treatments of maxillae using 526 implants in 117 patients were reviewed retrospectively. The longest and mean observation periods were 15 years and 9.2 years, respectively. Kaplan-Meier survival curve analysis, log-rank tests, and multilevel mixed-effects parametric survival analysis were used for statistical analyses. Results: Overall, 38 of 526 implants failed in 23 patients, and the estimated 15-year cumulative implant-level and patient-level survival rates were 90.7% and 73.7%, respectively. The cumulative implant survival rate was significantly higher in female patients than in male patients. Sex, implant length, and implant diameter were significantly associated with implant survival. Conclusion: ILI treatment of completely edentulous maxillae demonstrated viable long-term clinical outcomes. Male sex, shorter implant length, and narrow implant diameter negatively affected implant survival. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively evaluate the clinical outcomes of immediately loaded zygomatic implants combined with anterior regular implants (hybrid zygoma) for the fixed rehabilitation of atrophic maxillae. Materials and Methods: A total of 18 patients were enrolled in this study and treated with the hybrid zygoma concept by an experienced surgeon. Followup visits were planned after 1 week, 3 weeks, 4 months, 6 months, then annually. At the last follow-up appointment (mean: 36 months after surgery; range: 24 to 52 months), the prostheses were unscrewed and the implants and periimplant tissues were examined. The primary outcome evaluated was implant success. Following the criteria proposed by Aparicio et al, implant success was classified in five grades, with grade I representing the best condition and grade V representing a failure. At the annual check-up, patients were asked to fill out a questionnaire to evaluate their satisfaction with their oral rehabilitation. Results: A total of 80 implants (34 zygomatic and 46 regular) were inserted. One zygomatic implant was lost in one patient, and two regular implants failed in two other patients. Of the zygomatic implants, 24 (70.6%) presented a success grade I, 9 (26.5%) a success grade II, and 1 (2.9%) a grade V. Sinusitis was the most common biologic complication, occurring in two patients (5.6%). Two patients showed unilateral upper lip paresthesia that was persistent at the last follow-up appointment. According to the annual follow-up visit questionnaire data, 72%, 89%, and 94% of patients declared that they were satisfied with their phonetic ability, chewing ability, and esthetics, respectively. Conclusion: Although zygomatic implants combined with anterior regular implants present a higher risk of complications than traditional implantology, they allow for immediately loaded full-arch fixed rehabilitation of patients with advanced atrophy of the posterior maxilla, which provides satisfactory chewing ability, esthetics, and phonetics. [ABSTRACT FROM AUTHOR]

Following the extraction of a compromised tooth, the edentulous alveolar ridge undergoes physiologic bone remodeling, which may create a bone volume too deficient for implant placement. Guided bone regeneration (GBR) provides a predictable treatment option to increase the alveolar bone volume for implant placement, but a soft or hard tissue deficiency may remain even after this augmentation procedure has been completed. These deficiencies can be especially challenging in the esthetic zone, where patient expectations and esthetics often determine the satisfaction of the treatment outcome. This paper presents a case report of a xenograft bone substitute used at the secondstage surgery and abutment insertion to provide a solution to these deficiencies even after the patient had undergone a GBR procedure, thus improving the esthetic and functional outcomes of the final implant-supported restoration. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of incisive papilla on esthetic ratings and lip support for patients who are treated with implant-supported fixed prostheses on edentulous maxillae. Materials and Methods: A study population of 118 patients with maxillomandibular edentulism was identified. A self-administered questionnaire was used to evaluate treatment outcomes through a patient perspective. Also, clinical factors such as smile line, maxillary resorption, incisive papilla position, and lip support were evaluated. Results: Lip support has a significant effect on the facial esthetic scores of patients, while smile line and incisive papilla localization have not had a proven statistically significant effect on esthetic and facial esthestic scores of patients treated with implant-supported fixed prostheses on maxillae. Conclusion: Although the patients were diagnosed with disadvantageous clinical factors such as crestally localized incisive papilla, they still noted higher esthetic scores with their fixed prostheses. Factors that affect the esthetic perception of patients or their priorities should be investigated more to understand the reasons for patient satisfaction with prostheses. [ABSTRACT FROM AUTHOR]

Background: Fibrous dysplasia (FD) is a benign fibro-osseous lesion, a skeletal developmental anomaly of the bone-forming mesenchyme. The diagnosis of fibro-osseous lesions, particularly those of the jaw bones, poses significant challenges to clinicians and pathologists since it requires a correlation of clinical, radiological, histological, and surgical findings. Accurate and specific diagnosis is crucial as treatment modalities differ with different fibro-osseous lesions. Methods: This retrospective analysis presents a case series of a rare condition of monostotic FD in the maxillofacial region affecting jaw bones diagnosed and/or treated over period of 10 years. Results: Five cases of monostotic FD were diagnosed and treated between a period of 2013 and 2023. The cases from the 2nd to 8th decade were included in the analysis with equal involvement of males and females. Out of five cases, four cases were involving maxilla and 1 showed involvement of mandible. Conclusion: FD is a rare entity affecting the jaw bones which often lead to disfigurement of face. Early detection is warranted to decrease potential complications. In addition, genetic analysis could help in understanding the occurrence in certain population. Highlights: Fibrous dysplasia presents clinically in varied forms which may appear as the collision of different pathologic processes. We present a case series of a rare condition of monostotic fibrous dysplasia in the maxillofacial region affecting jaw bones- over the period of 10 years of an institutional database. We discussed the present knowledge on fibrous dysplasia, emphasizing the need to understand its clinical, radiographic, and histological characteristics, as well as essential aspects relevant to differential diagnosis and patient management. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to describe the 2023 update position paper on MRONJ developed by the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Maxillofacial Surgery (SICMF). Methods: This is the second update following the 2013 and 2020 Italian position papers by the Expert panel, which is a representation of the two scientific societies (SIPMO and SICMF). The paper is based on an extensive analysis of the available literature from January 2003 to February 2020, and the subsequent review of literature conducted between March 2020 and December 2022 to include all new relevant published papers to confirm or modify the previous set of recommendations. Results: This position paper highlights the main issues of MRONJ on risk estimates, disease definition, diagnostic pathway, individual risk assessment, and the fundamental role of imaging in the diagnosis, classification, and management of MRONJ. Conclusion: The Expert Panel confirmed the MRONJ definition, the diagnostic work‐up, the clinical‐radiological staging system and the prophylactic drug holiday, as recognized by SIPMO‐SICMF; while, it presented novel indications regarding the categories at risk of MRONJ, the prevention strategies, and the treatment strategies associated with the therapeutic drug holiday. [ABSTRACT FROM AUTHOR]

Aim: To validate the performance of a deep learning system with detection and classification functions for a mix of radiolucent and radiopaque lesions in the anterior maxilla on panoramic radiographs. Methods: Patients with radiolucent or radiopaque lesions in the anterior maxilla on panoramic radiographs were selected retroactively from May 2022 until Feb 2002 to obtain 100 preoperative radiographs each for nasopalatine duct cysts (NDCs), radicular cysts (RCs), and impacted supernumerary teeth (ISTs). An additional 100 patients with no lesions in the anterior maxilla were selected. Two deep learning systems (Systems 1 and 2) were created and tested. For System 1, the models were created and tested using datasets of radiolucent lesions (NDCs and RCs) and No lesions. For developing System 2, the data of radiopaque lesions (ISTs) were added to those used in System 1. The neural network used was You Only Look Once ver. 7 (YOLOv7). The recall, precision, F1 score, and accuracy calculated from the confusion matrix were used to evaluate diagnostic performance. Results: The performance of System 2, which included the IST data, was worse than that of System 1. Even when NDCs and RCs were addressed as a joint category of radiolucent lesions, the addition of IST data resulted in a worse performance than that of System 1. Conclusion: Our results indicate that combined use of radiopaque lesions (ISTs) with radiolucent lesions (NDCs and RCs) reduces the deep learning performance for radiolucent lesions with the volume of data used in the present study. [ABSTRACT FROM AUTHOR]

This study aimed to design a new surgical guide for controlling the mesiodistal distance between implant osteotomies and adjacent teeth as well as the osteotomy depth in partially edentulous patients. The guide kit was designed with design software and milled with a CNC (computer numerical control) router. The guide consisted of 2 components--stoppers and crown guides--for determining the drilling depth and mesiodistal position, respectively. The stoppers were designed in 7.5-, 9.5-, and 11.5-mm lengths, and the crown guides were fabricated with outer diameters of 5.0, 6.0, 7.0, and 8.0 mm. The accuracy of the guide was assessed by preparing a total of 20 implant osteotomies in 4 partially edentulous models and comparing the dimensions of the actual osteotomies to the values that were predicted to occur with the use of the surgical guides. Osteotomies were prepared using the 7.5-mm stopper with either the 7.0- or 8.0-mm crown guide. Corie beam computed tomography (CBCT) was used to obtain images for analysis of osteotomy-tooth mesiodistal distances, which were predicted to be 3.0 or 5.5 mm, depending on position; interosteotomy mesiodistal distances, which were predicted to be 3.0 mm; and osteotomy depth, which was predicted to be 11.5 mm. A 1-sample t test was used to determine if there were significant differences between the predicted values and the measurements of the guided osteotomies on the CBCT images of the mandibular models, and an independent t test was conducted to compare the results of 3.0- and 5.5-mm osteotomy-tooth distances (α = 0.05). Differences between the predicted and actual values of the interosteotomy mesiodistal distance (P = 0.516) and osteotomy depth (P = 0.847) were not statistically significant. The actual osteotomy-tooth mesiodistal distances were significantly different from the predicted values of 3.0 (P = 0.000) and 5.5 mm (P = 0.001), with higher mean differences of 0.46 and 0.60 mm, respectively. The designed guide had a high accuracy in achieving optimal linear interosteotomy mesiodistal distances and osteotomy depths, and the obtained mean values were clinically acceptable. [ABSTRACT FROM AUTHOR]

Purpose: The impact of posterior edentulism on the management of temporomandibular disorder remains unclear, with a paucity of studies examining the influence of posterior edentulism on symptoms. The objective of this study is to investigate the relationship between posterior edentulism and bruxism, tinnitus, and depression in temporomandibular disorder patients and to compare treatment outcomes in two groups with and without posterior edentulism. Material and Methods: In a quasi-experimental controlled trial, 26 patients with temporomandibular disorder participated in a six-week intervention, including manual therapy, massage, postural exercises and kinesiotaping. The patients were divided into 13 in the posterior edentulous group and 13 in the full dentate group. The participants attended 12 physiotherapy sessions, twice a week, over six weeks. Outcome measures, including bruxism, tinnitus, joint clicking, Beck Depression Inventory, and cervical range of motion, were evaluated at baseline and the end of the six weeks. Results: The six-week physiotherapy program significantly improved bruxism, tinnitus, cervical range of motion, and depression (p<0.05). The posterior edentulous group showed significantly greater improvement in cervical range of motion compared to the full dentate group (p<0.05). Conclusion: Physiotherapy effectively reduces temporomandibular disorder symptoms and highlights the importance of considering posterior edentulism in comprehensive temporomandibular disorder management. [ABSTRACT FROM AUTHOR]

Background: Medication-related osteonecrosis of the Jaw (MRONJ) is a rare but severe side effect in patients treated with medications such as Bisphosphonates (BPs). Its pathophysiological mechanism needs to be more precise. Establishing preventive measures and treatment standards is necessary. This study aimed to develop a composite hydrogel scaffold constituted by methacrylated gelatin (GelMA), methacrylated heparin (HepMA) and PRF, and investigate its potential application value in the prevention of MRONJ. Methods: GelMA, HepMA, and PRF were prepared using specific ratios for hydrogel scaffolds. Through mechanical properties and biocompatibility analysis, the release rate of growth factors and the ability to promote bone differentiation in vitro were evaluated. To explore the healing-enhancing effects of hydrogels in vivo, the composite hydrogel scaffold was implanted to the MRONJ rat model. Micro-computed tomography (Micro-CT) and histological examination were conducted to evaluate the bone morphology and tissue regeneration. Results: The Hep/GelMA-PRF hydrogel improved the degradation rate and swelling rate. It was also used to control the release rate of growth factors effectively. In vitro, the Hep/GelMA-PRF hydrogel was biocompatible and capable of reversing the inhibitory effect of zoledronic acid (ZOL) on the osteogenic differentiation of MC3T3-E1s. In vivo, the micro-CT analysis and histological evaluation demonstrated that the Hep/GelMA-PRF group exhibited the best tissue reconstruction. Moreover, compared to the ZOL group, the expression of osteogenesis proteins, including osteocalcin (OCN), type collagen I (Col I), and bone morphogenetic protein-2 (BMP-2) in the Hep/GelMA-PRF group were all significantly upregulated (P < 0.05). Conclusions: The Hep/GelMA-PRF hydrogel scaffold could effectively control the release rate of growth factors, induce osteogenic differentiation, reduce inflammation, and keep a stable microenvironment for tissue repair. It has potential application value in the prevention of MRONJ. [ABSTRACT FROM AUTHOR]