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This clinical study retrospectively analyzed cone beam computed tomography (CBCT) images to determine the potential influence of implant inclination on periimplant marginal bone loss after 18 to 24 months of functional loading. Twenty-five consecutive patients presenting with an edentulous or partially edentulous maxilla or mandible and an adequate bone volume for receiving oral implants were selected for analysis of the marginal bone loss around tilted and/or axial implants. The study population included patients rehabilitated with Toronto bridges (TBs), fixed partial dentures (FPDs), or single crowns (SCs) on axial and/or tilted implants. The primary outcome was the CBCT analysis of peri-implant marginal bone level change, depending on inclination of implants and type of prostheses. The secondary outcome was analysis of survival and success rates of tilted and axial implants. A significant difference was observed for peri-implant buccal bone loss (mean of axials 0.42 ± 0.06; mean of tilted 0.70 ± 0.09) (P = .009). The difference in peri-implant lingual/palatal/mesial/distal bone loss was not significant between axial and tilted implants (P > .05). No significant difference was observed between the marginal bone level and the type of prostheses for both tilted and axial implants in all the assessed sites (P > .05). The success rate for both tilted and axial implants was 100%, and no complications were observed for all the prosthetic rehabilitations, with a 100% survival rate. Compared to axial implants, tilted implants showed a significant statistical difference for peri-implant buccal bone loss, but no other differences were observed for peri-implant bone loss or for implant survival and success rate. Fixed partial or total rehabilitation using tilted or axial implants, or with tilted and axial implants, could be a reliable technique with advantages to patients and operators. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate, through a systematic review of the literature, the published data regarding marginal bone loss, implant failure proportion, biologic and prosthetic complications, and risk factors associated with short (≤ 8 mm) implants supporting fixed or removable full-arch restorations in the edentulous mandible. Materials and Methods: Two reviewers performed a search of five databases, with handsearching through the reference lists and gray literature. Controlled clinical trials and prospective cohort studies were selected in a two-phase process. The data were independently gathered by the same two reviewers. Quality assessment of the studies was done using the Cochrane Handbook for Systematic Reviews of Interventions for Randomized Clinical Trials and the Newcastle-Ottawa Scale for Prospective Cohort Studies. Marginal bone loss and implant failure proportion were meta-analyzed using random and fixed-effects models, respectively, with 95% confidence intervals. A descriptive analysis was performed of the prevalence of biologic and prosthetic complications. Meta-regression analysis was run as fixed-effect models for risk factors. Results: Six studies met the eligibility criteria and had data extracted. A total of 291 short implants (lengths 5 to 8 mm) were placed in 122 patients (82 women; mean age, 64.7 ± 10.8 years) supporting 23 fixed and 99 removable full-arch restorations. The pooled marginal bone loss overall was 0.12 mm (0.07 to 0.17 mm). Marginal bone loss for fixed full-arch restorations was 0.11 mm (0.01 to 0.21 mm) and for removable full-arch restorations was 0.14 mm (0.07 to 0.21 mm). The pooled overall implant failure proportion was 2.0% (1.0% to 5.0%) for the studies. Implant failure proportion for fixed and removable restorations was 2.0% with confidence intervals of 0.0% to 9% and 0.0% to 6%, respectively. The prevalence of prosthetic complications was 34.5% for fixed restorations and 2.6% for removable restorations. No biologic complications were found for fixed restorations, while 13.1% of removable restorations did have biologic complications. Risk factors did not demonstrate statistical differences regarding implant failure proportion and marginal bone loss. All included studies demonstrated a high methodologic quality. Conclusion: Findings from this systematic review and meta-analysis suggest that full-arch restorations supported by short implants in atrophic edentulous mandibles might be a viable treatment option, presenting minimal marginal bone loss and implant failure in the short term. However, further well-performed prospective clinical trials with long-term observation are needed. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the clinical outcomes of four-implant--supported overdentures retained by stud or bar attachments for patients with an edentulous maxilla. Materials and Methods: From January 2008 to December 2014, patients with maxillary edentulism were enrolled in this retrospective study. The insertion of four maxillary dental implants was followed by restoration with either stud-retained or barretained overdentures. The characteristics of the subjects and implants were recorded. Implant survival rates, marginal bone loss, peri-implant clinical parameters, prosthetic maintenance efforts, and patient satisfaction score were evaluated at the last follow-up time. The data were statistically analyzed, and the level of significance was set at α = .05. Results: A total of 132 implants were placed in 33 patients, of whom 18 were restored with four-implant--supported overdentures retained by stud attachments, and the other 15 with four-implant--supported overdentures retained by bar attachments. Thirty-one patients and 124 implants were available for the entire follow-up. During a mean follow-up period of 77 months (range: 36 to 111 months), five among 72 implants failed for three patients in the stud-retained group and two among 60 implants failed for two patients in the bar-retained group, resulting in estimated cumulative implant survival rates of 81.4% and 86.2% for the stud-retained group and the bar-retained group, respectively. Except for the modified Plaque Index (P = .035), no significant differences were indicated between the two attachment groups in terms of implant survival rate, marginal bone loss, peri-implant clinical parameters, or prosthetic maintenance treatment. Peri-/inter-implant gingival hyperplasia occurred only with implants under bar attachments. Patients in both groups reported a high degree of satisfaction. Conclusion: Within the limitations of this study, no significant differences were indicated between the clinical outcomes of maxillary four-implant--supported overdentures with either stud or bar attachments, although a higher modified Plaque Index was observed for the bar-retained group. Furthermore, prostheses with stud attachments were advantageous for their convenient cleaning and repair. [ABSTRACT FROM AUTHOR]

The aim of the present randomized study was to radiographically evaluate the early marginal bone remodeling (EMBR) around one-stage implants with a collar surface that is laser-microtextured (LM), placed with the mirograp/interface at different levels relative to the bone crest, and to clinically evaluate the influence of keratinized tissue thickness (KTT) on outcomes. Thirty partially edentulous patients were selected to each receive at least two one-stage implants with LM collars placed at different depth levels in the mandible and maxilla: one implant placed at an equicrestal level (E group) and one implant placed at a supracrestal level (SP group). Rank-based analysis of variance test was used for statistical comparison between groups. Before loading, the E and SP groups showed a mean marginal bone loss of 0.03 ± 0.04 mm and 0.02 ± 0.03 mm, respectively, without a statistically significant difference (P > .05) between the groups. Moreover, no statistically significant correlation between EMBR and the amount of KTT was found (P > .05). Within the limitations of the present study, it can be concluded that neither the vertical position of the microgap/interface of one-stage implants with an LM surface nor the thickness of keratinized tissue around the implant site influences the amount of EMBR. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the accuracy of conventional and computer-assisted implant planning and template-guided placement (CAIPP) protocols. Partially edentulous patients (N = 73) were randomly assigned to either a conventional implant planning and freehand placement protocol (control group, n = 26) or one of two different CAIPP protocols (stereolithographic guide [T1, n = 24] or 3D-printed guide [T2, n = 23]). The virtually planned and final implant positions were compared. Differences between the planned and the obtained implant position were evaluated as horizontal, vertical, and angular measurements. Descriptive statistics were calculated for overall deviation values and their fragmented mesiodistal and bucco-oral vectors at each evaluation plane. To study overall accuracy differences between study groups, analysis of variance (ANOVA) was used with Bonferroni post hoc test (Scheffé method). Possible confounding variables were analyzed using multiple linear regression with respect to treatment group. The mesiodistal or bucco-oral distribution of the positioning errors was evaluated with chi-square test. A multiple linear logistic regression was used to identify confounding variables. Inaccuracy at the level of the occlusal plane of the restoration averaged 0.65 ± 0.26 mm in the control group, 0.59 ± 0.4 mm in T1, and 0.76 ± 0.5 mm in T2. At the implant shoulder level, the inaccuracy amounted to 1.25 ± 0.62 mm, 0.97 ± 0.36 mm, and 0.72 ± 0.31 mm in the control group, T1, and T2, respectively. At the implant apex, mean deviations of 2.32 ± 1.24 mm were recorded in the control group, 0.97 ± 0.57 mm in T1, and 1.08 ± 0.57 mm in T2. Mean discrepancies in vertical direction measured 0.28 ± 1.01 mm (control), 0.2 ± 0.65 mm (T1), and -0.1 mm ± 1.0 mm (T2). Angular deviations of 7.36 ± 3.36 degrees (control), 4.23 ± 2.68 degrees (T1), and 3.13 ± 2.12 degrees (T2) were measured. Statistically significant differences were observed between the conventional and the two CAIPP groups for overall deviations at implant shoulder, apex, and implant angulation. CAIPP protocols seemed to provide a higher accuracy and precision compared to conventional freehand protocols. Still, the amount of inaccuracy using guides demands a safety margin. Moreover, intrasurgical verification during drilling and the implant placement procedure should be performed, including clinical parameters that may not be available from cone beam computed tomography data during the planning phase. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare patient-related outcomes of conventional protocols with computer-assisted implant planning and template-guided implant placement (CAIPP) protocols. Partially edentulous patients (N = 73) were assigned to either surgical planning based on two-dimensional radiographs and freehand implant placement (control; n = 26) or using three-dimensional computer-tomography data and implant placement using a tooth-supported surgical guide (test groups T1 [n = 24] and T2 [n = 23]). The two test groups differed from each other in digital data acquisition, software functionality, and the guide-manufacturing process. All surgeries were performed as open-flap procedures. Patient-related outcome measures were evaluated using questionnaires. Statistical tests were performed to investigate differences between treatment groups. Before treatment, 53% of patients in the control group and 83% of patients in the test groups (T1: 88%, T2: 78%) were satisfied with their group allocation. In the control group, 37% of patients favored CAIPP technology, while only 11% in the test groups would have preferred a conventional procedure. After treatment, 50% of patients in the control and 86% in the test groups (T1: 76%, T2: 94%) were satisfied with their allocation. Twenty-one percent of control-group patients favored the CAIPP treatment, while 6% of the test-group patients would have preferred a conventional treatment. The quality-of-life parameters during and after surgery did not show significant differences between groups. More postoperative discomfort was reported after longer and more-complex surgeries including guided bone regeneration and surgeries with two surgical sites. Generally, patients preferred computer-based technologies. No differences in the intra- or postoperative discomfort were observed compared to control protocols. More-extensive surgical procedures negatively affected the intra- and postoperative quality of life, irrespective of the treatment group allocation. [ABSTRACT FROM AUTHOR]

The goal of this case series report is to demonstrate the predictability of providing immediate restorations with an implant specifically designed to achieve high primary stability, and to report on 12-month survival outcomes. Twenty-nine implants were placed in eight patients with various tooth-replacement needs, from single teeth to partially edentulous spans to fully edentulous mandibles. A new tapered-implant system (The Marc Nevins, Little Implant) was utilized that incorporates a self-tapping thread design with a thread pitch and thread lead to improve primary stability at insertion. All implants were placed with a minimum insertion torque of 45 Ncm. Four immediate implants and two early placements at extraction sites were included in the cohort. Twenty-seven implants were clinically successful at 1 year. Two implants in a healed ridge were found to have failed at 6 weeks postoperative in one patient wearing an ill-fitting removable partial denture. The radiographic crestal marginal bone levels were recorded in millimeters from the top of the implant platform to the first bone-to-implant contact. The mean crestal marginal bone level change was -0.57 ± 0.82 mm. This case series report demonstrates the ability of an implant designed for high primary stability to achieve successful integration in the presence of an immediate restoration for various clinical presentations, including single-tooth, multi-unit, and edentulous cases. [ABSTRACT FROM AUTHOR]

After guided bone regeneration (GBR) with different devices, a layer of connective tissue called pseudo-periosteum can be observed above the newly formed bone. The aim of this study is to evaluate the clinical and histologic features and to suggest a classification of this connective tissue after GBR with nonresorbable membranes or titanium (Ti)-mesh plus resorbable membranes. Forty patients with partial edentulism in the posterior mandible were randomized into two groups: 20 patients were treated by means of Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membrane (group A), while the other 20 patients were treated with Ti-mesh and a cross-linked collagen membrane (group B). After 9 months and during re-opening surgery, bone density and pseudo-periosteum type were recorded. Pseudo-periosteum was classified into Type 1 (no tissue or tissue < 1 mm); Type 2 (regular tissue between 1 and 2 mm); and Type 3 (irregular tissue or tissue > 2 mm). Histologic analyses were performed to identify the features of pseudo-periosteum. Out of 40 patients, 36 (n = 19 in Group A; n = 17 in Group B) with 99 implants were analyzed after GBR and according to the study protocol. The vertical bone gain was 4.2 ± 1.0 mm in Group A and 4.1 ± 1.0 mm in Group B. Group A had a higher bone density and greater amounts of type 1 periosteum than Group B (P = .01 for both). The preliminary results of this study show that both d-PTFE membranes and Ti-mesh plus collagen membranes are two valid options for bone augmentation in the mandible. However, nonresorbable membranes achieve higher bone density and a thinner pseudo-periosteum layer above the newly formed bone. [ABSTRACT FROM AUTHOR]

Purpose: Different navigation markers in dynamic guided implant surgery could cause different degrees of artifacts, which would affect the accuracy and efficiency of the implant navigation system. This study aimed to quantify artifacts caused by navigation markers made of different materials and to evaluate their effects on registration accuracy under various oral conditions. Materials and Methods: Four U-shaped tubes with different navigation markers (440c stainless steel, silicon nitride, zirconium oxide, and aluminum oxide) were produced by three-dimensional printing. Four kinds of maxillary plaster models were prepared to simulate four tooth crown conditions. U-shaped tubes combined with different tooth models were scanned using cone beam computed tomography. The size of artifacts from different navigation markers and registration rate were measured. Abrasion performance of navigation markers was evaluated by scanning electron microscopy images. Results: Aluminum oxide navigation markers showed the fewest artifacts. Silicon nitride markers caused fewer artifacts than zirconium oxide and 440c stainless steel ones (P < .05) and had the best registration performance under all tooth crown conditions with the lowest volume of abrasion. Registration data suggested aluminum oxide worked badly under artificial crown and natural tooth conditions for its lower radiopacity, and zirconium oxide worked undesirably in edentulous conditions. 440c stainless steel was worst in all dental conditions. Conclusion: Navigation markers made of silicon nitride have the best overall performance and perform the best in registration under all circumstances owing to less artifact generation, better radiopacity, and desirable abrasion resistance. Silicon nitride can be regarded as an ideal material, including but not limited to oral implant navigator-guided surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical and radiographic outcomes of full-arch mandibular rehabilitation with fixed prostheses supported by three immediately loaded implants after at least 5 years of follow-up. Materials and Methods: The sample comprised 58 patients who underwent treatment with immediate loading. Radiographic evaluation of bone loss was carried out in Adobe Photoshop CS5 by a single calibrated examiner using digitized panoramic radiographs. Clinical examination of the technical conditions of the prosthetic device assessed the condition of the acrylic resin base, dental occlusion, metal framework, presence of cover screws, screw fixation of the prosthesis and abutments, and length of cantilever and resistance arms. Results: Five implants in four patients failed, for an overall success rate of 97.13%. Mean bone loss was 2.65 ± 1.06 mm around central implants and 2.11 ± 0.84 mm around distal implants. The most common complication was loss of abutment torque. Half of all patients in the sample experienced some prosthetic complication. There was no evidence of a statistically significant relationship of cantilever length with bone loss or prosthetic complications. Conclusion: The immediately loaded three-implant-supported fixed prosthesis protocol tested in this study proved to be a viable therapeutic strategy for mandibular rehabilitation in edentulous patients, with favorable outcomes after 5 years of clinical and radiographic follow-up. [ABSTRACT FROM AUTHOR]

Purpose: This review article evaluated biomechanical studies, finite element analyses, and clinical papers on the prosthetic and surgical principles for the survival of implants when reconstructing the edentulous mandible, including the use of a three-implant-supported fixed prosthesis. Materials and Methods: A comprehensive search of studies published from 1983 to December 2017 listed in the PubMed/MEDLINE databases was performed. Relevant studies were selected according to predetermined inclusion and exclusion criteria. Results: The initial database search yielded 942 titles. After filtering, 157 abstracts were selected, with 68 articles considered relevant and included. Consensus among authors was identified in regard to the number and the distribution of implants, limiting or eliminating distal cantilevers, and the principles of biomechanical loading of a cross-arch splinted prosthesis. Conclusion: The result of this review suggests that reconstruction of the edentulous mandible with a fixed prosthesis using three, four, or six implants is a viable treatment option. However, when using three implants, wider-diameter implants are recommended for favorable force control. [ABSTRACT FROM AUTHOR]

Purpose: This cohort study evaluated patient satisfaction for maxillary implant-retained overdentures (IODs) on two implants up to 4 years and assessed the treatment effect over time. Materials and Methods: Patients encountering problems with their conventional dentures were included and received maxillary IODs on two titanium-zirconium implants and ball anchors in the canine area. Patient satisfaction was assessed using the oral health impact profile (OHIP-20E) questionnaires both for dentures and IODs. Two months after insertion of IODs (baseline), the patients chose the preferred overdenture design with full or reduced palatal coverage. OHIP-20E questionnaires were followed according to the individual choice at 1 and 4 years, and outcomes were compared with baseline. Results: Sixteen out of 21 patients were evaluated at a mean follow-up of 4 years (range: 2.4 to 4.8 years). There was no significant difference in the OHIP domains for IODs at 1 year (OHIP_total_1y: 9.5, SD: 13.0) and 4 years (OHIP_total_4y: 14.2, SD: 19.1) compared with baseline (OHIP_total_BL: 12.4, SD: 14.7). Patients were most satisfied with social disability both for IODs (OHIP_BL: 6.0, SD: 7.6; OHIP_1y: 3.4, SD: 5.4; OHIP_4y: 5.7, SD: 9.5) and dentures (OHIP_CD_old: 28, SD: 29.7; OHIP_CD_new: 25.4, SD: 28.67). Patients were least satisfied with functional limitation both for IODs (OHIP_BL: 6.0, SD: 7.6; OHIP_1y: 3.4, SD: 5.4; OHIP_4y: 5.7, SD: 9.5) and dentures (OHIP_CD_old: 28, SD: 29.7; OHIP_CD_new: 25.4, SD: 28.67). Conclusion: Patient satisfaction with maxillary IODs on two implants did not change from baseline to 4 years and was high at 4 years of function. [ABSTRACT FROM AUTHOR]

Purpose: This study compared the three-dimensional (3D) accuracy of conventional impressions with digital impression systems (intraoral scanners and dental laboratory scanners) for two different interimplant distances in maxillary edentulous arches. Materials and Methods: Six impression systems comprising one conventional impression material (Impregum), two intraoral scanners (TRIOS and True Definition), and three dental laboratory scanners (Ceramill Map400, inEos X5, and D900) were evaluated on two completely edentulous maxillary arch master models (A and B) with six and eight implants, respectively. Centroid positions at the implant platform level were derived using either physical or virtual probe hits with a coordinate measuring machine. Comparison of centroid positions between master and test models (n = 5) defined linear distortions (dx, dy, dz), global linear distortions (dR), and 3D reference distance distortions between implants (ΔR). The two-dimensional (2D) angles between the central axis of each implant to the x- or y-axes were compared to derive absolute angular distortions (Absdθx, Absdθy). Results: Model A mean dR ranged from 8.7 ± 8.3 µm to 731.7 ± 62.3 µm. Model B mean dR ranged from 16.3 ± 9 µm to 620.2 ± 63.2 µm. Model A mean Absdθx ranged from 0.021 ± 0.205 degrees to -2.349 ± 0.166 degrees, and mean Absdθy ranged from -0.002 ± 0.160 degrees to -0.932 ± 0.290 degrees. Model B mean Absdθx ranged from --0.007 ± 0.076 degrees to -0.688 ± 0.574 degrees, and mean Absdθy ranged from -0.018 ± 0.048 degrees to -1.052 ± 0.297 degrees. One-way analysis of variance (ANOVA) by impression system revealed significant differences among test groups for dR and ΔR in both models, with True Definition exhibiting the poorest accuracy. Independent samples t tests for dR, between homologous implant location pairs in model A vs B, revealed the presence of two to four significant pairings (out of seven possible) for the intraoral scanner systems, in which instances dR was larger in model A by 110 to 150 µm. Conclusion: Reducing interimplant distance may decrease global linear distortions for intraoral scanner systems, but had no effect on Impregum and the dental laboratory scanner systems. Impregum consistently exhibited the best or second-best accuracy at all implant locations, while True Definition exhibited the poorest accuracy for all linear distortions in both models A and B. Impression systems could not be consistently ranked for absolute angular distortions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate whether fully digitally guided implant surgery may be performed with sufficient accuracy based on printing virtually designed templates after matching a surface scan with the magnetic resonance imaging (MRI) dataset mimicking edentulous cases based on cadaver maxillae of pigs. Materials and Methods: The palatal mucosa of five young pig cadavers was scanned with an intraoral scanner. High-resolution MRI of the jaws was performed, and the images were exported as DICOM files and uploaded into software for implant planning. Six implant osteotomies were virtually planned in each jaw. The intraoral surface scans were fused with the volumetric MRI data based on the palatal soft tissue, and virtual templates for guided implant surgery were created and exported as STL files. These were printed and the templates were used to perform flapless guided osteotomy, with the templates fitting on the soft tissue of the jaws alone. Cone beam computed tomography (CBCT) of the jaws was performed after osteotomy. These data were fused with the virtually planned osteotomies, and the 3D crestal, apical, and axial deviations between the virtually planned and physically performed osteotomies were determined. Results: Matching the surface scans with the mucosa was possible in three cases automatically; additional manual corrections were necessary in two cases. Thirty osteotomies were performed by applying the printed mucosa-supported templates. The mean angular deviation between the planned and realized cavities was 3.29 degrees (0.3 to 11.1 degrees; SD = 2.5 degrees), the mean 3D apical deviation was 1.3 mm (0.22 to 3.98 mm; SD = 0.94 mm), and the mean crestal deviation was 1.76 mm (0.39 to 3.79 mm; SD = 0.88 mm). Conclusion: MRI in combination with the presented workflow may be used in edentulous cases for guided implant surgery. Further studies are needed to prove the promising accuracy of this alternative approach in clinical trials. [ABSTRACT FROM AUTHOR]

When surveyed, edentulous patients commonly state that they would prefer an implant-supported restoration to conventional removable dentures. However, acceptance of implant-supported restorations remains low, primarily due to the high cost of available solutions. To reduce cost and treatment time for patients with an edentulous mandible or failing mandibular dentition, an innovative treatment concept consisting of a standardized framework and time-efficient surgical and restorative protocols was developed. The prefabricated titanium framework is supported on three implants using an adaptive fixation mechanism that compensates for surgical misalignment of the implants to achieve passive fit. The definitive fixed, full-arch mandibular prosthesis can be delivered within 24 hours of implant placement. This patient presentation demonstrates the treatment of a man 82 years of age with complete edentulism. The entire treatment time from surgery to definitive placement was 3 hours over a single business day. After 2 years of function with immediate loading, the patient displayed favorable hard and soft tissue outcomes. Initial results indicate that treatment with this premanufactured device could potentially provide patients with a fixed fullarch implant-supported mandibular restoration with reduced clinical treatment time compared with other implant-supported treatments. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the factors influencing the volume of healthy maxillary sinuses by means of cone beam computed tomography (CBCT). The sinus volumes in bilateral CBCT images of healthy maxillary sinuses of patients aged 18 years or older were evaluated using dedicated 3D volumetric software. Differences in volume based on gender, age, sinus side, and dental status were analyzed statistically. The study included 174 healthy maxillary sinuses in 87 patients (60 women and 27 men) aged between 18 to 82 years with a mean age of 29.5 years. There were 73 dentate sinuses and 101 partially dentate or edentulous sinuses. Males had significantly larger maxillary sinus volumes compared to females. Subjects below the median age of 24.3 years had a significantly larger sinus volume than older subjects. There was no difference in sinus volume between left and right sides. When partially dentate and edentulous cases were pooled together and compared to dentate cases, there was no difference in sinus volume. Gender and age influence healthy maxillary sinus volume, while sinus side and dental status do not. Neither tooth loss nor increasing age could be correlated with ongoing pneumatization of the maxillary sinus in the present population. Thus, the reported increase of the maxillary sinus volume over life and following extraction of posterior teeth in the upper jaw might be considered a misconception. To prove this hypothesis, prospective studies comparing sinus volumes using standardized time intervals before and after tooth extraction in the posterior maxilla are needed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the in vivo accuracy of dental implants placed using a dynamic computer-aided dental implant (CAI) navigation system. The impact of various factors on accuracy was also analyzed. Materials and Methods: A retrospective in vivo study was performed during the period of October 2015 to December 2017. Data were obtained on all implants placed during this time frame. A chart review was conducted to identify the type of flap, number of implants placed, number of patients treated, and factors related to the description of edentulism (partial or complete). To evaluate accuracy outcomes, the preoperative cone beam computed tomography (CBCT) plan was volumetrically registered to a post-implant placement CBCT scan. Deviations between the planned and placed implant positions were analyzed. Data were statistically analyzed for factors that may affect the accuracy during usage. Results: Data were obtained on 231 implants placed in healed ridges using a flapless or minimal flap approach under dynamic guidance by a single surgeon. In the 89 arches operated on, 28 (125 implants) were fully edentulous. For all implants, the mean (SD) discrepancies were: 0.71 (0.40) mm for entry point (lateral) and 1.00 (0.49) mm at the apex (3D). The mean angle discrepancy was 2.26 degrees (1.62 degrees) from actual vs planned implant positions. The accuracy measurements for partially edentulous patients using a thermoplastic stent attachment and for fully edentulous patients using a mini-implant-based attachment were nearly identical. No significant accuracy differences were found between implant positions within the different sextants. Guided insertion of the implant itself reduced angular and apex location deviations. The accuracy of implant placement improved during the study period, with the mean entry point and apex deviation as well as overall angle discrepancy measured for the last 50 implants being better (0.59 mm, 0.85 mm, and 1.98 degrees, respectively) compared with the first 50 implants (0.94 mm, 1.19 mm, and 3.48 degrees, respectively). Conclusion: Dynamic surgical navigation is an accurate method for executing CBCT-based computer-aided implant surgery. In addition, an increased experience level of the surgeon with dynamic navigation appears to improve accuracy outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This 10-year retrospective study aimed to report implant bone changes in completely edentulous patients after a mandibular immediate loading protocol using two ball attachments. Materials and Methods: This study was initially designed as a prospective 1-year cohort study, then extended with a 10-year retrospective evaluation of implant bone change. In the first part of the study, 43 edentulous patients wearing satisfactory maxillary and mandibular dentures for at least 3 months were included. Two interforaminal implants (Brånemark system, Nobel Biocare) were placed symmetrically in the anterior mandible using a surgical template and a torque greater than 40 Ncm. Immediately following surgery, 2.25-mm-diameter ball abutments were screwed to the implants, and their matrices (Dalbo Plus, Cendres et Métaux) were incorporated in the denture base. In an initial 1-year study, clinical recalls were scheduled 3, 6, and 12 months after implant placement with a team of two investigators. The follow-up consisted of a clinical examination and a standardized radiographic assessment of the vertical bone change. Implant stability was then monitored. The patient satisfaction was evaluated with a questionnaire before and 3 months after loading. The second part of the study occurred 10 years after the inclusion, as patients were recalled for an implant bone change monitoring. Results: The included patients were 28 to 80 years of age (mean: 61 ± 11.4 years). Three out of 86 implants failed during the healing phase (survival rate of 96.5% [90.1%, 99.2%]). Implant stability was maintained all along the 1-year follow-up (Δ = 73.33, 95% CI [72.39 to 74.26], P = .032). The mean radiographic bone loss was 0.27 ± 0.35 mm at 3 months after surgery, 0.47 ± 0.42 mm after 1 year, and 0.95 ± 0.98 mm after 10 years. General visual analog scale satisfaction was increased by 25 units with the treatment. No patients were lost to follow-up at 1 year, but five were lost at 10 years. Conclusion: This protocol of immediate loading of two unsplinted mandibular implants in overdenture patients using ball attachments is a clinically viable treatment with a high implant success rate and improved satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the proximal contact alterations between implant-supported restorations and adjacent natural teeth with the passage of time. In addition, potential factors influencing proximal contact loss were also evaluated. Materials and Methods: Patients in need of implant-supported restorations in the posterior region were included. Proximal contact was divided into the following three groups: tight (group T), appropriate (group A), and open (group O). It was judged by dental floss (OralB, Essentialfloss) at restoration insertion and 1-year follow-up. In addition, patients' age, sex, implant sites, restoration type, retention type, and parafunction were recorded. Results: At 1-year follow-up, 74 patients with 144 proximal contacts were included. After 1-year follow-up, the proximal contact loss rate was 24.3%, and 45.1% of proximal contacts did not show any alterations. The proximal contact loss rates in group T at baseline were significantly lower than those in group A at baseline (12.9% and 32.9%, respectively; P = .03). The proximal contact loss rates in the mandible were significantly higher than those in the maxilla (37.2% and 9.1%, respectively; P < .01). Other variables did not show a significant effect on proximal contact loss. Conclusion: Based on the current evidence, the proximal contact loss between implant-supported restorations and the adjacent teeth was frequent in the short term. It is helpful to reduce the proximal contact loss rate in the short term by making the proximal contact slightly tense at restoration insertion. Evaluation of proximal contact should be monitored carefully, especially in the mandible. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this retrospective cohort study was to assess the effects of annual maintenance over a 7-year period on the peri-implant health of patients rehabilitated with overdentures using clinical and radiographic parameters. Materials and Methods: In order to be considered for inclusion in the study, patients had to have been rehabilitated with overdentures that had at least two implants placed in the mandible and four implants in the maxilla. Patients were divided into two groups: group 1 comprised individuals who had undergone annual maintenance over the previous 7 years, and group 2 comprised those who had not attended any dental appointment over the previous 7 years. All patients were submitted to clinical peri-implant examinations and radiographic assessments. Results: Sixty-six patients received 396 implants of the external hexagon type, 132 in the mandible and 264 in the maxilla. Group 1 (44 patients with 264 implants) had a mean probing depth of 2.72 mm, while group 2 (22 patients with 132 implants) had a mean probing depth of 3.10 mm. It can be concluded that the mean of the variable probing depth is influenced by the presence of bleeding (P = .0005) and the implementation of maintenance (P = .0188), whereas plaque and local variables were not otherwise significant (P = .0605 and .0796, respectively). Conclusion: In this study, it was possible to observe better clinical conditions in individuals who had attended annual appointments for maintenance purposes. [ABSTRACT FROM AUTHOR]

Purpose: Real-time surgical navigation has been increasingly applied in implant placement. The initial registration procedures were found to substantially affect the overall accuracy, but the number and distribution of fiducial markers are yet undetermined. This study aimed to determine the minimal number and optimal distribution of fiducial markers to achieve clinically acceptable accuracy in surgical navigation for zygomatic implant placement by systematically analyzing the effects of different setups of fiducial markers on target registration error (TRE). Materials and Methods: A maxillary phantom with bone-anchored fiducial markers was scanned using cone beam computed tomography, followed by data processing on Brainlab, a commercially available navigation system. A total of 10 miniscrews were inserted in the edentulous maxilla for the configuration of the fiducial markers, with another two miniscrews as implant targets to assess the TRE in zygomatic bone. Data were then collected in nine configurations with distinct fiducial numbers and positions. Statistical analyses were performed with SPSS. Results: The accuracy of the surgical navigation system was found to depend on both the number and the position of fiducial markers. No significant difference was observed in accuracy among groups with eight fiducials and with a polygon span distribution (P > .05). When the fiducial number decreased to less than six, the markers inserted in a regular triangle were more precise than those in an inverse triangle configuration. When the number of fiducials was five with a polygonal distribution, a low TRE value of 0.59 mm was detected, which was comparable to the accuracy with more than eight fiducials in this study. Conclusion: A scattered distribution with a polygon span with at least five fiducial markers in the edentulous maxilla for registration seems to achieve acceptable TRE values with high accuracy for navigation in zygomatic implant placement. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic review was to evaluate the outcome of dental implant treatment in fully edentulous patients who underwent Le Fort I osteotomy as a preprosthetic surgical technique. Materials and Methods: A search was conducted of the PubMed (MEDLINE), EMBASE, Scopus, and Cochrane databases to identify records published from 1995 to 2017 dealing with Le Fort I osteotomy procedures for implant placement purposes. The primary outcomes of interest were the survival and success rates. The secondary outcomes consisted of the analysis of intrasurgical and postsurgical complications and the surgical and prosthetic loading protocols. Results: Overall, 20 articles were selected for data analysis. A total of 483 patients accounting for 3,596 implants were analyzed. The cumulative survival rate was 90.22% ± 0.8% at 10 years (mean: 59.20 ± 32.31 months). The cumulative success rate was 89.07% ± 1.3% at 10 years (mean: 62.82 ± 25 months). Higher survival rates were found for implants with a rough surface (P < .001) and for implants loaded with a delayed protocol (P < .001). The fracture of the palatine bone during the downfracture procedure was the main intrasurgical drawback, while sinus pathology and graft resorption were commonly observed during the postoperative healing. Surgical and prosthetic loading protocols were heterogenous. Conclusion: Based on this review, Le Fort I osteotomy might be considered a viable technique to recreate favorable conditions for implant-supported rehabilitations. Caution has to be taken when using machined implants, particularly in the case of a simultaneous approach. [ABSTRACT FROM AUTHOR]

A correction to the article "Denosumab-Related Osteonecrosis of the Jaw After Tooth Extraction and the Effects of a Short Drug Holiday in Cancer Patients: A Multicenter Retrospective Study," published online on July 26, 2023 is presented.

The article explains why osteoporosis patients treated with antiresorptive (AR) drugs are considered like oncology patients regarding their oral health care. It discusses the efficacy of biphosphonates and denosumab in treating osteoporosis. It refers to AR-related osteonecrosis of the jaw (ARONJ) as a complication in AR-treated patients and cites the lack knowledge about differential risks associated with the development of ARONJ between osteoporosis and cancer exposed to oral treatments.

A correction to the article "Evaluation of the survival rate of short implants placed in the posterior atrophic mandible: 5-year clinical study," published in the August 17, 2022 issue is presented.

Temporomandibular Joint Disorders (TMD's) represents a cluster of disorders that include the Temporomandibular Joint (TMJ) and also the masticatory apparatus. Any alteration in its function will have an impact on the overall function of the masticatory apparatus and in turn the stomatognathic system. Though the aetiology, symptoms, and treatment modalities for TMD's have been extensively studied, they remain a subject of prime concern for clinicians as it not only affects the form and function but also negatively affects the overall standard of living of the patient. Symptoms of TMD's such as chronic pain, restriction of function, and psychological effects lead to a lower Quality of Life (QoL) for the patient, which is caused due to various factors such as chronic pain, sleep deprivation, and stress or anxiety. Additionally, personal, professional, and social problems directly or indirectly affect the lifestyle of the patient. Some extra-craniofacial symptoms such as otologic and neurologic symptoms tend to worsen the situation. Majority of patients reporting to an orthodontist present with atleast one symptom of TMD that has affected their QoL. Various questionnaires can be used to assess the patient's QoL, and plan the treatment accordingly. Managing TMD's at an early stage while considering these factors and a multidisciplinary approach may help in improving the QoL of the patient. [ABSTRACT FROM AUTHOR]

Objective: Evaluation of the success and/or survival rates of resin-bonded fixed partial dentures (RBFPDs) reported in the scientific literature with a minimum average observation time of five years. Materials and Methods: Search conducted in Pubmed, Web of Science, and Cochrane databases in free-text format and MESH terms, until May 2021. The random-effects model was used for the estimated survival rate, percentage per year of estimated failure, and existing complications for the meta-analysis. Study heterogeneity was assessed by the inconsistency test (I2) and study quality by the Downs and Black scale. Results: Eleven articles were included, with 687 participants and 783 RBFPDs, with a mean observation time of 8.2 years, with success rates mentioned in three articles and survival rates reported in nine articles. A total of 142 failures were reported for 783 prostheses, the most frequent being debonding. The estimated failure rate was between 0.53% and 5.10% per year. The studies were of sufficient quality. In the meta-analysis, the survival rates showed a significant result (p < 0.001), with moderate heterogeneity (I2 = 58.76%). Conclusions: Within the limitations of this research, mainly related to the heterogeneity of the studies and their quality, it seems possible to conclude that RBFPDs are a viable clinical option for the rehabilitation of patients with single edentulous spaces, mainly when using a single retainer and a zirconia-ceramic prosthesis. [ABSTRACT FROM AUTHOR]

Zygomatic implants imply the use of the zygoma as the implant anchorage and have been proposed as a valuable alternative to the invasive classical procedures in cases of severe maxillary atrophy. Despite the numerous manuscripts published in this field, a quantitative analysis of the research products to infer the trends and the status identification of this specific issue was missing, as well as an objective map of this area. Thus, the present scientometric study analyzed all the research papers published within the interval 1990–2021 that included the keyword "zygomatic implants". Research papers containing the keywords "zygomatic implants" were collected using Web of Science and analyzed with Cytoscape 3.7.2 and Sci software. A total of 654 studies were published between 1990 and 2020, reaching up to 11639 citations in total, with a mean of 17.8 citations per research study. Data show that the number of publications per year is rapidly increasing, as well as the sum of citations per year. While the USA was identified as the most productive country in this field, followed by Italy, Spain, and Brazil, the National Natural Science Foundation of China stands up as the major funding agency, followed by the National Institutes of Health (NIH) in the USA and the United States Department of Health and Human Services. The analysis of the keywords showed that "zygomatic fractures" represents the most common word within this field, with "complications" as the most recent keyword and "screws" as the keyword used for the longest time. The map of science representing the authors and their collaborations highlighted the existence of multiple small-size research groups that contribute to scientific production, forming highly clustered structures that do not collaborate between them. The present scientometric analysis demonstrates the rising interest in using the zygomatic implants technique as an alternative to the classical ones. The obtained data suggest that the scientific community involved in the study of such a field is highly fragmented, emphasizing the lack of communication among the scientists and research groups. [ABSTRACT FROM AUTHOR]

Bone growth requires a balance of minerals such as calcium, phosphorus, and factors of bone biomineralization. The difference between jaws' bones and the rest of the bones is the existence of teeth. Although the development of teeth has no similarities with bones, the biomineralization of both is happening at the same time. Consequently, the disturbances in the metabolism of minerals and peptides which participate in osteogenesis, have an impact on teeth, jaws, periodontal tissues, and oral mucosa. The hereditary and congenial metabolic bone diseases are being analysed and classified based on their genetic profile and oral manifestations. Regarding the categories, there are metabolic bone diseases caused by genetic mutations, like hereditary rickets, and others caused by chromosomal abnormalities, such as Down syndrome. In addition, many disorders are provoked by enzymatic dysfunction, disturbances of creation of polypeptide chain, while others have an unknown explanation. Many oral manifestations are related with problems in the dentition, oral mucosa, periodontal tissues, and jaws. Especially some syndromes present with cleft lip and palate. To conclude, there is a big variety of dental symptoms of these disorders, while the most frequent are the delayed eruption of teeth, oligodontia, a dysplastic enamel and dentine. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to clarify the influence of training with a different kind of lesion on the performance of a target model. Materials and Methods: A total of 310 patients (211 men, 99 women; average age, 47.9±16.1 years) were selected and their panoramic images were used in this study. We created a source model using panoramic radiographs including mandibular radiolucent cyst-like lesions (radicular cyst, dentigerous cyst, odontogenic keratocyst, and ameloblastoma). The model was simulatively transferred and trained on images of Stafne's bone cavity. A learning model was created using a customized DetectNet built in the Digits version 5.0 (NVIDIA, Santa Clara, CA). Two machines (Machines A and B) with identical specifications were used to simulate transfer learning. A source model was created from the data consisting of ameloblastoma, odontogenic keratocyst, dentigerous cyst, and radicular cyst in Machine A. Thereafter, it was transferred to Machine B and trained on additional data of Stafne's bone cavity to create target models. To investigate the effect of the number of cases, we created several target models with different numbers of Stafne's bone cavity cases. Results: When the Stafne's bone cavity data were added to the training, both the detection and classification performances for this pathology improved. Even for lesions other than Stafne's bone cavity, the detection sensitivities tended to increase with the increase in the number of Stafne's bone cavities. Conclusion: This study showed that using different lesions for transfer learning improves the performance of the model. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this retrospective study was to investigate and compare the clinical, radiographic, pathological, pathogenesis, and therapeutic features of simple bone cysts (SBCs) and aneurysmal bone cysts (ABCs) of the jaw. Methods: 35 patients with SBCs and 6 patients with ABCs who received treatment at the Department of Oral and Maxillofacial Surgery, Zhejiang University School of Medicine from 2017 to 2022 were followed up and reviewed retrospectively. Results: The study included 41 patients, accounting for 2.14% of all jaw pathologies, with 35 patients having SBCs and 6 patients having ABCs; their average ages were 26.63 ± 13.62 years and 17.83 ± 7.88 years, respectively. The prevalence of SBC and ABC did not differ significantly by sex. The mandible was the most vulnerable area to be involved. Only 5.71% (2/35) of patients with SBCs and 16.7% (1/6) of patients with ABCs reported histories of previous trauma in the same region of the pseudocysts. A total of 42.86% (15/35) of SBC cases and 66.67% (4/6) of ABC cases had malocclusions. The radiographic features of pseudocysts varied in shape, were associated with the root, and unilocular or multilocular. All patients had curettage with or without bone graft or substitute implantation, and recurrences did not occur in 94.29% (33/35) of SBC patients and 100% (6/6) of ABC patients after a mean follow-up time of 26.23 ± 15.47 months and 21.67 ± 19.75 months, respectively. Conclusions: Pseudocysts, including SBCs and ABCs, are benign osteolytic lesions without an epithelial lining that occur occasionally in the jaw, mostly in adolescents and young adults, and their incidence did not significantly differ by sex. The most vulnerable site of involvement is the mandible, and they are generally not overtly aggressive. Trauma has a less significant role in pseudocysts, but minor trauma, such as malocclusion, has the potential to influence pseudocyst development. The clinical presentation of pseudocysts lacks specificity, and most patients are asymptomatic and found incidentally during radiographs. Dental panoramic radiographs and CBCT cannot accurately distinguish between SBC and ABC, and the final diagnosis depends on pathological diagnosis. Curettage combined with bone grafting is currently the best treatment for both, with a 5.71% (2/35) recurrence rate for SBC and no recurrence found for ABC. [ABSTRACT FROM AUTHOR]

Background: This study aims to detect USP6 translocation in aneurysmal cysts located in the jaw and to give an overview of demographic data. Methods: The present retrospective cohort study includes 10 patients who underwent surgery due to an aneurysmal cyst of the jaw in our hospital between 2002 and 2021. Unstained formalin‐fixed and paraffin‐embedded tissue sections cut at 4 μm thickness were subjected to USP6 FISH testing. Results: All patients underwent surgical treatment. In four of ten patients (40%) USP‐6‐translocations have been found. Conclusion: Based on the study, it is hypothesized that the aneurysmal bone cyst of the jaw bone may be subject to a different pathomechanism than that of the long bones. Therefore, it seems conceivable that the primary cause of aneurysmal bone cysts in the jaw might differ. [ABSTRACT FROM AUTHOR]

This study aimed at presenting a retrospective longitudinal analysis of the pediatric jaw lesions treated at the Oral and Maxillofacial Surgery Clinic in Cluj-Napoca, Romania, over a timeframe of ten years (2012 to 2022). The clinical and radiological characteristics of the jawbone lesions, the treatment outcome, and the recurrence incidence were described. All consecutive patients aged below 18 years, with histologically diagnosed odontogenic tumors (OTs), nonodontogenic tumors (non-OTs), or odontogenic cysts (OCs) were included. Age, dentition type, clinical symptoms, preoperative and postoperative radiological tests, histological diagnosis, treatment, and follow-up information one year following the diagnoses were all examined. Eighty-two cases were included. The ratio of men to women was 1.15:1, with the mandible predominating by 64.4%. Inflammatory radicular cysts predominated in 31.7% of cases. A total of 42.68% of the patients were asymptomatic. Enucleation was the most frequent surgical technique (45.1%), followed by cystectomies (28%) and marsupialization (14.6%). The overall recurrence rate was 7.3%; the most recurrent histopathological lesion was the odontogenic keratocyst. This study sheds new light on the clinical and radiological characteristics, treatment outcomes, and recurrence rate of juvenile jawbone lesions in children and adolescents. The diagnosis and treatment of jawbone lesions in children and adolescents can be enhanced with the use of epidemiological, clinical, and imagistic information. [ABSTRACT FROM AUTHOR]

OBJECTIVE Due to the increased prevalence of antiresorptive drugs in recent years, the risk of medication-related osteonecrosis of the jaws (MRONJ) development after tooth extraction and other dentoalveolar surgical procedures has increased significantly. The aim of this study is to investigate the risk of MRONJ and related factors after routine oral surgical procedures in patients receiving antiresorptive and antiangiogenic drugs therapy. METHODS A retrospective cohort study was carried out in patients receiving antiresorptive and antiangiogenic drugs therapy between 2019 and 2021 at a university's oral and maxillofacial surgery clinic. In all patients, oral surgical procedures were performed according to the guidelines of the American Association of oral and Maxillofacial Surgeons (AAOMS), and the patients were followed for the development of MRONJ. Patients were multidimensionally evaluated for MRONJ risk, including patient-related general-systemic factors, drug-related factors, local anatomical factors, and surgical procedure-related factors. RESULTS A total of 76 patients (60 women and 16 men); mean age (59.23 years) was under antiresorptive (86.8% bisphosphonates, and 6.6% denosumab) or antiangiogenic drug (5.3%) treatment for malignant tumor (21.1%) or osteoporosis (78.9%). The mean duration of drug received was 42 months. Tooth extraction (n=66 patients), cyst enucleation (n=6), and pre-prosthetic surgery (n=4) were atraumatically applied to the patients according to AAOMS recommendations. In all patients in the post-operative period wounds healed uneventfully and osteonecrosis was not observed. CONCLUSION When conducted according to established guidelines, oral surgical operations can be performed safely and predictably in patients undergoing antiresorptive and antiangiogenic medication treatment, even in high-risk patients. [ABSTRACT FROM AUTHOR]

Objectives: To describe the factors related to patient intraoral conditions that impact the scanning accuracy of intraoral scanners (IOSs). A new classification for these influencing factors is proposed to facilitate dental professionals' decision‐making and maximize the accuracy and reliability of intraoral digital scans. Overview: Variables related to intraoral conditions of the patient that can influence the scanning accuracy of IOSs include tooth type, presence of interdental spaces, arch width variations, palate characteristics, wetness, existing restorations, characteristics of the surface being digitized, edentulous areas, interimplant distance, position, angulation, and depth of existing implants, and implant scan body selection. Conclusions: The knowledge and understanding of the patient's intraoral conditions that can impact the scanning accuracy of IOSs is a fundamental element for maximizing the accuracy of IOSs. Clinical Significance: The patient's intraoral conditions, or patient factors, can significantly impact intraoral scanning accuracy. Dental professionals must know and understand these influencing patient factors to maximize the accuracy of IOSs. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of osteonecrosis of the jaw in bisphosphonate users submitted to dental procedures. Methods: This systematic review searched the sources: MEDLINE, EMBASE, Web of Science, Scopus, and Virtual Health Library, with no restriction on language or publication date. Reviewers, in pairs and independently, selected the studies, extracted their data, and assessed the risk of bias. Meta‐analyses were pooled using the DerSimonian and Laird random effects model. Results: A total of 27 studies (5391 participants) were included. The most reported bisphosphonates were zoledronate (n = 17 studies) and alendronate (n = 19) for treating cancers (n = 11) and osteoporosis (n = 16), respectively. Twelve studies were of low methodological quality. The frequency of osteonecrosis was 2.7% (95% CI: 0.9–5.2%) and proved higher for intravenous [6.9% (0.7–17.3%)] than oral [0.2% (0.9–5.2%)] bisphosphonate use. No association between longer treatment duration and greater frequency of osteonecrosis was observed. Conclusions: Higher frequency of osteonecrosis was observed in intravenous bisphosphonate users submitted to dental extraction. Further studies collecting more detailed information on the bisphosphonates used and of greater methodological rigor are warranted to confirm these findings and better inform prescribers, dental surgeons, and other professionals on risks of bisphosphonate use in this patient group. [ABSTRACT FROM AUTHOR]

The authors of this study aimed to compare the treatment outcomes and time efficiency between digital and conventional complete denture restorations and propose suggestions for clinical use. The authors used digital (functionally suitable digital complete denture [FSD]) and conventional complete denture restorations to make 2 dentures each for 10 edentulous patients. All the operations of both techniques before denture delivery were completed in the first 4 visits, and then 2 dentures were delivered successively for the patients. The clinical and laboratory times were recorded to evaluate the time efficiency; treatment outcomes were evaluated via scoring the denture satisfaction of the dentist and patients in a double-blind manner. The satisfaction scores of FSDs (7.6-9.6 [dentist's scores], 8.4-10 [patients' scores]) were higher than those of conventional dentures (7.2-9.7 [dentist's score], 7.4-9.8 [patients' scores]), but there were no significant differences. The clinical and laboratory operation times of the FSD group were less than those of the conventional group, saving an average of 28.0 minutes and 64.3 minutes in the clinic and laboratory, respectively. FSD technology can improve the efficiency of clinical and laboratory operations and shorten the manufacturing cycle of dentures. The occlusion stability of FSDs was statistically better than that of traditional dentures, but there was no statistical difference in other clinical indicators. FSD technology is low cost and easy to operate and has several applications. Compared with conventional complete denture restoration technology, FSDs can save time and have a comparable clinical effect. This clinical trial was registered at the Chinese Clinical Trial Registry. The registration number is ChiCTR1900021722. [ABSTRACT FROM AUTHOR]

Aim: To evaluate bar‐supported maxillary implant overdenture treatment when supported by either four or six implants after 10 years. Materials and Methods: Edentulous subjects with maxillary denture complaints and ample bone volume to facilitate implants in the anterior region of the maxilla were planned for implant overdenture treatment, randomized to receive either four implants (n = 25) or six implants (n = 25) and subsequently evaluated after 10 years of function. Outcome variables included peri‐implant bone‐level changes, implant and overdenture survival, complications, presence of plaque, calculus and bleeding, degree of peri‐implant inflammation, probing depth and patient satisfaction. Differences between the groups and between evaluation periods were tested with a Student's t‐test. Results: Fourteen patients with totally 72 implants were lost to follow‐up. Two patients from the six‐implant group experienced implant loss (four implants), resulting in 96.1% implant survival in this group versus 100% survival in the four‐implant group. Clinical, radiographical and patient‐reported outcome measures did not differ statistically significant between the two groups. Patients from both groups were generally quite satisfied with the result after 10 years. Conclusions: Similar and favourable outcomes are seen in bar‐supported maxillary overdentures on either four or six anteriorly placed implants after a 10‐year evaluation period. [ABSTRACT FROM AUTHOR]

Full-mouth rehabilitation can be challenging due to the complexity of restoring the vertical dimension of occlusion (VDO) and replacing missing teeth. In partially edentulous patients, the concept of a bonded composite resin prototype for increasing the VDO has previously been applied through the use of an overlay removable partial denture (RPD) with acrylic resin covering the existing dentition. Unfortunately, this type of prosthesis does not always accurately model the function and phonetics intended for the definitive prostheses, and the esthetic result often is less than ideal. It would be advantageous if direct bonding could be used with the patient's existing RPD to model the increased VDO, but this approach has not been reported in the literature. This case report describes the direct bonding of an existing RPD to create a prototype for increased VDO in a partially edentulous patient with a skeletal Class II mal-occlusion. The successful outcome has been maintained for more than 1 year. [ABSTRACT FROM AUTHOR]

Background: We investigated whether periodontal diseases contribute to the development of medication‐related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence. Methods: This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data. Results: Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74–3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86–3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41–4.64). Conclusions: The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates. [ABSTRACT FROM AUTHOR]

Bisphosphonates are antiresportive medications used to prevent and treat a wide range of diseases such as osteoporosis, Paget disease of bone, malignancies metastatic to bone, multiple myeloma and hypercalcemia of malignancy. One of the most important complications at the patients who are taking therapy with bisphosphonates is osteonecrosis of the jaw related to bisphosphonates (BRONJ). This review aimed to consider dental implant placement in patients who have been treated with or are currently on bisphosphonate medication, based on research using electronic databases PubMed, Google Scholar and Elsevier, under the following keywords: dental implants, bisphosphonates, ostheonecrosis, BRONJ. We performed a literature review to explore the relation between dental implants and bisphosphonates depending on several factors such as the way of administering (oral or venous), the length of the therapy, the dose of the medicine, other chronic therapies that the patient has taken and which affects the bisphosphonates. The way of administering bisphosphonates is crucial because patient treated with intravenous bisphosphonates seemed to have a higher chance of developing implant-related osteonecrosis of the jaw. The intraorally treated patient group appeared to have more successful results. Benefits that bisphosphonates offer to patients clearly outbalance the risk of potential side effects; however, any patient for whom prolonged bisphosphonate therapy is indicated, should be provided with preventive dental care in order to minimize the risk of developing this severe condition and to have high success rate of dental implants. [ABSTRACT FROM AUTHOR]

A correction notice to the article "Letter to Editor regarding "Why are osteoporosis patients treated with antiresorptive therapies considered like oncology patients regarding their oral health care?", which appeared in the previous issue of the periodical, is presented.

The text highlights the deficiency in UK guidelines for managing patients with medication-related osteonecrosis of the jaw (MRONJ). While there is guidance for preventing MRONJ, there is a lack of information for managing established cases in secondary care settings. The author suggests that clearer guidance is needed, including preliminary staging of MRONJ, non-operative measures, indications for operative intervention, and shared decision-making between clinicians and patients. Improved guidance could help enhance patient management and address the potentially debilitating consequences of anti-resorptive and anti-angiogenic agents. [Extracted from the article]

135 Background: Bone-modifying agents (BMAs) are utilized to reduce the risk of skeletal-related events in patients with bone metastases. Medication-related osteonecrosis of the jaw (MRONJ) is a rare but difficult to treat adverse event of BMAs. There are known patient and treatment related risk factors for development of ONJ, however, little is known on social and geographic risks. In patients with bone metastases and concurrent MRONJ, we seek to describe differences in patient's geographic residence (rural versus urban) with other social factors as secondary outcomes. Methods: We conducted a retrospective chart review of Atrium Health Wake Forest Baptist Comprehensive Cancer Center patients in the date range of 01/01/2013 to 11/01/2023. Included were patients with metastatic breast cancer, metastatic prostate cancer or multiple myeloma who had a diagnosis of MRONJ. We recorded Rural-Urban Commuting Area (RUCA) codes, the Area Deprivation Index (ADI), age, race, ethnicity, smoking status, alcohol use, body mass index, insurance status, type of cancer, type of BMA, and cumulative dosing of BMAs. Patients were defined as rural or urban based on criteria from the health resources and services administration website. Relative socioeconomic advantage versus disadvantage was determined by the patients' ADIs with a decile rank from 1-10 for state ADIs and a percentile rank of 1-100 for national ADIs. SAS software (version 9.4) was used for data analysis (2023, SAS Institute Inc, Cary, NC). Results: A total of 88 patients met inclusion criteria. 64% of patients lived in urban areas and 36% in rural. Demographic features of the identified patients are listed in table 1. MRONJ patients from both urban and rural areas had an above average national and state ADI, with a trend toward higher ADIs in rural locations compared to urban locations; mean of 6.7 vs 5.3 state ADI and mean 70.6 vs 62.0 national ADI, for rural and urban patients respectively. There were no statistically significant differences between rural and urban patients in any of the demographic or health-related characteristics we examined. Conclusions: Patients with bone metastases and MRONJ in our cohort demonstrate relative socioeconomic disadvantage in comparison to national and state averages. In comparing the rural with urban patients, however, we observed relatively similar profiles. Patient characteristics by rural/urban status. Rural (n=32) Urban (n=56) Age in years (mean, sd) 64 (11.3) 65 (10.9) Sex, N (%) Male 19 (59) 29 (52) Female 13 (41) 27 (48) Race, N (%) Non-Hispanic White 30 (93.8) 40 (71.4) Non-Hispanic Black 1 (3.1) 11 (19.6) Hispanic 1 (3.1) 3 (5.4) Non-Hispanic Asian 0 (0.0) 1 (1.8) Other 0 (0.0) 1 (1.8) State ADI (mean, sd) 6.7 (2.4) 5.5 (2.7) National ADI (mean, sd) 70.6 (16.9) 62.0 (23.8) Former/current smoker, N (%) 18 (56.3) 25 (44.6) Medicaid/Medicare, N (%) 16 (50.0) 16 (28.6) Months on BMA (mean, sd) 37.2 (35.5) 40.3 (38.2) [ABSTRACT FROM AUTHOR]

Temporomandibular Joint Disorders (TMD’s) represents a cluster of disorders that include the Temporomandibular Joint (TMJ) and also the masticatory apparatus. Any alteration in its function will have an impact on the overall function of the masticatory apparatus and in turn the stomatognathic system. Though the aetiology, symptoms, and treatment modalities for TMD’s have been extensively studied, they remain a subject of prime concern for clinicians as it not only affects the form and function but also negatively affects the overall standard of living of the patient. Symptoms of TMD’s such as chronic pain, restriction of function, and psychological effects lead to a lower Quality of Life (QoL) for the patient, which is caused due to various factors such as chronic pain, sleep deprivation, and stress or anxiety. Additionally, personal, professional, and social problems directly or indirectly affect the lifestyle of the patient. Some extra-craniofacial symptoms such as otologic and neurologic symptoms tend to worsen the situation. Majority of patients reporting to an orthodontist present with atleast one symptom of TMD that has affected their QoL. Various questionnaires can be used to assess the patient’s QoL, and plan the treatment accordingly. Managing TMD’s at an early stage while considering these factors and a multidisciplinary approach may help in improving the QoL of the patient.

ObjectiveThe aim of this study was to investigate the relationship between type of antiresorptive medication and medication-related osteonecrosis of the jaw (MRONJ) onset and the role of premedication dental evaluation (PMDE) in the prevention of MRONJ.Study designOur database of patients with MRONJ was reviewed. The Kruskal-Wallis test was used to analyze the onset dose of the 3 frequent medication types associated with MRONJ. To evaluate the role of PMDE in the prevention of MRONJ, all patients on antiresorptive and/or antiangiogenic medications seen in the Dental Service of Memorial Sloan Kettering Cancer Center during a 10-year period were subclassified into 2 groups. Group I comprised patients seen for PMDE before the commencement of A/A and group II patients seen after prior exposure to antiresorptive and/or antiangiogenic medications. Fischer's exact test was used to compare the incidence of MRONJ in both groups.ResultsPatients on denosumab developed MRONJ earlier compared with zoledronate and pamidronate (P = .003). Group I had a significantly reduced incidence of MRONJ (0.9%) compared with group II (10.5%) (P

Osteonecrosis is the devitalization of bone and consequent lytic changes. In the jaws, osteonecrosis is a pathologic consequence of prior radiation therapy (osteoradionecrosis) or certain antiresorptive medications. Herein, we review the pathogenesis and clinical manifestations of these lesions, and describe the spectrum of radiologic findings in these conditions, and highlight the similarities and differences between the imaging appearances of these 2 entities.

The article presents a case report of a 71-year-old male with oral mucous membrane pemphigoid (MMP) while under treatment with vildagliptin, a dipeptidyl peptidase-IV inhibitor (DPP4i) used for type 2 diabetes. The report highlights the association between DPP4 inhibitors and autoimmune blistering disorders and suggests substituting the drug or discontinuing it to achieve remission of MMP symptoms.

Purpose: To estimate implant survival and peri-implant bone resorption around long vs normal-length implants in full-arch immediate loading rehabilitation of maxillary arches of low bone quality (D4).Materials and Methods: A total of 45 patients received two mesial normal-length (10 to 15 mm) or longer (18 to 20 mm) implants and two long (18 to 20 mm) distally tilted implants. Differences in bone resorption at 24 months were assessed using the Mann-Whitney U Test.Results: At the 24-month follow-up, no significant differences were found in survival (global cumulative survival rate: 98.9%) or bone resorption (mean: 1.1 mm) between long and normal implants (P = .053).Conclusion: At 24 months, the use of long implants provides favorable survival and bone maintenance results in the immediate loading rehabilitation of low-quality maxillary arches. [ABSTRACT FROM AUTHOR]