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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]

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: 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]

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]

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]

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: 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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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 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]

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: 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]

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]

Background: To provide a novel classification for all implants in the maxillary retromolar region to simplify surgical design, reduce surgical risks, and guide clinicians in clinical decision-making. Methods: A total of 180 patients with bilateral partial or completely edentulous atrophic posterior maxillae who had received or were scheduled to receive pterygomaxillary implants were included in this study. Cone-beam computed tomography was performed, and the sagittal and coronal images were acquired at 110 kV and 10 mA. The exposure volume was 120 mm in diameter and 80 mm in height. The pterygomaxillary implants were divided into three different types based on the anatomical structures the implants passed through. Results: The average age of the 180 patients was 69 (range: 39–89) years; 99 were men and 81 were women. All the patients exhibited 360 pterygomaxillary implant sites. However, during mimic implantation, 14 implant sites were excluded due to severe resorption of the tuberosity, very small pterygoid plates, or variations in the descending palatal artery configuration. Of the 346 pterygomaxillary implant sites, 24.0% (83/346), 40.7% (141/346), 22.0% (76/346), and 13.3% (46/346) were classified as Types I, IIa, IIb, and III, respectively. Conclusions: Type II pterygomaxillary implants were the most commonly used in the novel classification. Different types of pterygomaxillary implants should follow specific designs and surgical strategies to achieve optimal outcomes. [ABSTRACT FROM AUTHOR]

Medication-Related Osteonecrosis of the Jaw (MRONJ) is characterized by bone exposure in the oral and maxillofacial region for more than eight weeks in patients treated with anti-resorptive agents, immunosuppressants, or anti-angiogenic agents, without prior radiation therapy or metastatic disease to the jaws. Conservative treatments can control infection in mild cases, but surgical intervention is necessary for patients with severe symptoms. A 78-year-old female with a history of bisphosphonate treatment for osteoporosis presented with persistent pain, swelling, and malodor following implant placement in the upper right maxilla. SPECT/CT imaging revealed a high-risk hot spot in the right maxillary region. BIS-guided surgery using the Qray pen-C was performed, selectively removing red fluorescent bone tissue. The defect was grafted with HuBT incorporated with rhBMP-2. Postoperative follow-ups at 4, 7, and 14 months showed successful bone healing, transforming into a corticocancellous complex, and implant placement without MRONJ recurrence. Allogeneic demineralized dentin matrix (DDM) incorporated with rhBMP-2 demonstrates effective bone healing and implant placement following BIS-guided MRONJ surgery. This case supports the use of DDM/rhBMP-2 for tissue regeneration in MRONJ treatment, enabling successful prosthetic restoration without recurrence. [ABSTRACT FROM AUTHOR]

Background: In recent years, the utilization of autogenous vascularized iliac crest flap for repairing jaw defects has seen a significant rise. However, the visual monitoring of iliac bone flaps present challenges, frequently leading to delayed detection of flap loss. Consequently, there's a urgent need to develop effective indicators for monitoring postoperative complications in iliac crest flaps. Methods: A retrospective analysis was conducted on 160 patients who underwent vascularized iliac crest flap transplantation for jawbone reconstruction from January 2020 to December 2022. We investigated the changes in D-dimer levels among patients with or without postoperative complications. Additionally, multivariable logistic regression analysis was performed to explore potential individual risk factors, including surgical duration, age, pathology type, absolute and relative D-dimer levels, and gender, culminating in the development of a nomogram. Results: On the first day following surgery, patients who experienced thrombosis exhibited a substantial increase in plasma D-dimer levels, reaching 3.75 mg/L, 13.84 times higher than the baseline. This difference was statistically significant (P < 0.05) compared to patients without postoperative complications. Furthermore, the nomogram we have developed and validated effectively predicts venous thrombosis, assigning individual risk scores to patients. This predictive tool was assessed in both training and validation cohorts, achieving areas under the curve (AUC) of 0.630 and 0.600, with the 95% confidence intervals of 0.452–0.807 and 0.243–0.957, respectively. Conclusions: Our study illustrates that postoperative plasma D-dimer levels can serve as a sensitive biomarker for monitoring thrombosis-induced flap loss. Moreover, we have developed a novel prediction model that integrates multiple factors, thereby enhancing the accuracy of early identification of patients at risk of thrombosis-associated flap loss. This advancement contributes to improving the overall management and outcomes of such procedures. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the accuracy of full‐arch conventional implant impressions using two different materials (A‐silicone and polyether) to full‐arch digital implant impressions produced from two intraoral scanning devices. Materials and Methods: A master model was fabricated representing an edentulous mandible with four implants with internal connection placed at the sites of canines and first molars. The anterior implants were parallel to the residual ridge, while the two posterior implants had an angulation of 15° to the distal and 15° to the lingual respectively. The conventional technique was performed with open‐tray of non‐splinted impression copings. Two different impression materials were used, A‐silicone and polyether at monophase medium body consistencies. The digital impressions were obtained with the use of two different intraoral scanners, after the connection of scan bodies. A total of 10 impressions were produced for each of the four experimental groups. The conventional models as well as the master model were digitized using a high‐resolution laboratory scanner. The STL files of the models and of the intraoral impressions were imported in a powerful superimposition software, for the conduction of measurements in pairs of files. The software calculated the 3D deviations, as well as the linear and angular displacements among scan bodies at the digital files. For "trueness" measurements every STL file of each experimental group was superimposed to the digital master model, while for "precision" measurements all STL files of each experimental group were superimposed to each other. Results and Conclusions: The accuracy of full arch mandibular implant impressions was influenced both by the impression technique used (conventional vs. digital) and the impression material used (A‐silicone vs. polyether) or the intraoral scanner used (Trios vs. Heron).In terms of "trueness," A‐silicone showed the highest impression accuracy with the lowest deviation values, followed by polyether and Trios, but the differences between the three groups were in the majority not statistically significant. Heron showed statistically lower accuracy results in all measurements compared to the other groups.In terms of "precision", conventional impressions with the use of A‐Silicone or polyether were statistically significantly superior to digital impressions with either scanner. A‐Silicone and polyether showed no statistically significant difference between them. [ABSTRACT FROM AUTHOR]

The main objectives of the present prospective clinical study were to evaluate the survival and success rates of implant-supported zirconia single crowns fabricated with a full digital workflow for the rehabilitation of mono- and bilateral agenesis of maxillary lateral incisors after 2 years of clinical function; biological and technical parameters affecting the prosthetic restorations were recorded, as well as the patient-satisfaction score. Twenty-two patients showing mono- or bilateral agenesis of the maxillary lateral incisors were included in this study, and a total of 30 narrow-diameter implants were inserted. Thirty screw-retained monolithic cubic zirconia single crowns with internal connections were fabricated. Objective outcome evaluations were performed by means of the Functional Implant Prosthodontic Score, whereas the patient-satisfaction score was evaluated using Visual Analog Scales. Descriptive statistics were performed and the Kaplan–Meier analysis was run to analyze time-to-event data. After 2 years of clinical function, the overall FIPS found in the present study was 9.2, whereas the average patient-satisfaction score was 8.7. The Kaplan–Meier analysis at the 2-year follow-up reported a cumulative survival rate of 100% and a cumulative success rate of 93.3%. The implant-prosthetic rehabilitation with a full digital workflow proved to be an effective and reliable procedure for the functional and aesthetic treatment of the agenesis of maxillary lateral incisors in the short-term. Clinical investigations with wider sample populations and longer observational follow-ups could be useful to validate, in the long-term, the clinical outcomes of the present prospective clinical study. [ABSTRACT FROM AUTHOR]

Background: The assessment of hard and soft tissue at edentulous sites is important for subsequent implant treatment design. The aim of the present study was to explore the associations between the keratinized mucosa width (KMW) and the underlying alveolar bone dimensions at partial edentulous molar sites. Methods: In this retrospective study, a total of 110 patients with at least one missing molar were selected. The buccal KMW of the edentulous molar sites was evaluated. Cone-beam computed tomography scans were collected, and the height discrepancy between the alveolar crest and the buccal bone plate (HC−B) as well as the alveolar bone height (ABH) were measured. The KMW was compared among the HC−B and ABH groups at both maxillary and mandibular sites. Linear regression and generalized estimation equations (GEEs) were used to explore the associations between the KMW and alveolar bone dimensions at α = 0.05. Results: Among the 110 patients, 158 edentulous molar sites were analyzed. The average HC−B and ABH were significantly lower at the maxillary sites (1.26 ± 1.62 mm, 11.62 ± 3.94 mm) than at the mandibular sites (3.67 ± 2.85 mm, 14.91 ± 3.01 mm, p < 0.001). The KMW was significantly lower at sites with HC−B > 2 mm than at sites with HC−B ≤ 2 mm both in the maxilla and mandible (p < 0.001). No significant differences were found between the KMW at sites with ABH < 10 mm and sites with ABH ≥ 10 mm (p > 0.05). Linear regression and GEEs analyses revealed that the HC−B was significantly associated with the KMW (B = -0.339, p < 0.001), while the association between the KMW and the ABH was not statistically significant (B = -0.046, p = 0.352). Conclusions: The buccal KMW at edentulous molar sites was significantly associated with the HC−B. Alveolar ridges presenting with a sloped configuration were more prone to possess a narrower band of keratinized mucosa. Both hard and soft tissue augmentation should be considered for implant treatment at these sites. The correlations of dynamic changes between the KMW and alveolar bone dimensions after tooth extraction should be further investigated. [ABSTRACT FROM AUTHOR]

The diagnosis and management of orofacial pain can be challenging, especially when pain of non-odontogenic origin mimics dental pain or is localised intraorally. There is a risk of misdiagnosis as well as unnecessary dental procedures of the supposedly affected tooth or area. Therefore, orofacial pain management should start with referral to an orofacial pain specialist trained to recognise and manage the vast array of disorders that fall under the umbrella of orofacial pain. The choice of pharmacological treatment (e.g. analgesics, anticonvulsants, antidepressants) can vary widely depending on the specific type of orofacial pain. [ABSTRACT FROM AUTHOR]

Background: Surgical ciliated cysts occur mainly in the maxillae after radical maxillary sinus surgery; they rarely develop in the mandible. This study aims to gather information on all the characteristics of patients suffering from mandibular surgical ciliated cysts. This article also reports two new cases. Methods: PubMed, Google Scholar and the International Clinical Trials Registry Platform were explored until 13 December 2022 for articles regarding mandibular surgical ciliated cysts. Maxillary ciliated cysts were excluded. Results: Fourteen original articles were included in a total of 16 cases. Maxillofacial surgeries are the first aetiology (94.4%). Surgical ciliated cysts of the mandibular region show a 1.25:1 male‐to‐female ratio with a protracted time to diagnosis (range: 2–56 years). Most patients are symptomatic (77.8%). Typically, radiology shows a radiolucency lesion (88.9%) and histology describes pseudostratified ciliated columnar epithelium. Enucleation has always been described as the treatment. Discussion: All results were case reports, thus a low level of evidence studies. Mandibular surgical ciliated cysts should be considered in patients presenting a mandibular swelling or radiolucency lesion with a maxillofacial surgery history. Meticulous surgical techniques can aid in the prevention of this lesion. [ABSTRACT FROM AUTHOR]

A detailed and honest social history is vital when piecing together any clinical diagnostic puzzle. This case presentation highlights this, leading to a surprising diagnosis for both patient and clinician. Additionally, access to cone beam computed tomography (CBCT) has vastly widened diagnostic accuracy within the dental field, and this case emphasizes the importance of thorough training to identify, and interpret, incidental findings. CPD/Clinical Relevance: Injuries obtained under the influence of drugs might be missed without in-depth social history and appropriate imaging training. [ABSTRACT FROM AUTHOR]

This case report describes the presentation of a nasopalatine duct cyst in a 27-year-old orthodontic patient. The patient presented with pain in the anterior hard palate and a Class II division 2 occlusion with a complete overbite. The cyst was discovered upon further radiographic investigation. Following discussion at a joint orthognathic clinic, the decision was made to leave the cyst under active monitoring and review the patient clinically and radiographically after 12 months. CPD/Clinical Relevance: Nasopalatine duct cysts are common, therefore awareness of their clinical and radiographic features and treatment options is essential. [ABSTRACT FROM AUTHOR]

Osteoradionecrosis (ORN) of the jaws is the most dangerous long-term side effect of head and neck radiation therapy that can significantly affect the quality of life of the patients. In ORN of the jaw, the bone within the radiation field becomes devitalized and gets exposed via the overlying skin or mucosa, which remains unhealed. Hyperbaric oxygen therapy (HBOT) is used as an adjunctive therapy along with surgical debridement for the management of ORN of the jaws. HBOT promotes angiogenesis, neovascularization, fibroblast and osteoblast proliferation, and collagen production. However, the benefit of HBOT in improving the healing of tissues in patients with ORN remains controversial because of low evidence. The present systematic review aimed to compare the available data on the efficacy of HBOT on the healing of ORN of the jaw. Databases like PubMed, Scopus, Cochrane, Science Direct, Lilac, and Web of Science were searched without any date filter to obtain the relevant articles. A total of six articles met the eligibility criteria and were further processed for data extraction. Two retrospective studies observed that HBOT combined with surgical debridement promoted wound healing in patients with early stages of ORN of the jaws. Similarly, a prospective study reported that prophylactic HBOT reduced the risk of the development of ORN of the jaws following surgery to irradiated jaws. In contrast, three randomized controlled trials (RCTs) reported that HBOT did not improve the healing outcome of patients with advanced lesions of ORN of the jaws. Based on the scope of this review, we concluded that the routine use of HBOT for the prevention or management of ORN of the jaws is not recommended. Adjunctive HBOT may be considered in patients who have failed conservative therapy and subsequent surgical resection and are regarded to be at high risk. [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]

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]

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 effects of injectable platelet-rich fibrin (i-PRF) on implant stability. Materials and Methods: A total of 40 implants (BEGO Semados RS/RSX implants, BEGO Implant System) were surgically placed in 15 patients between the ages of 25 and 67 years who had mandibular edentulous areas. After the implant sockets were prepared with the appropriate protocol, i-PRF was applied to the implant surface and socket with the help of a 5-cc sterile syringe in the study group, and implants were placed without i-PRF in the control group. In the research process, the resonance frequency analysis (RFA) method was used to measure implant stability. The implant stability quotient (ISQ) values were determined during the time of the operation and at the first, second, and fourth weeks. Results: The results obtained after the stability measurement periods showed that the decrease in the mean ISQ values in the control group was statistically significant in the first week. Evaluations made in the following weeks were not statistically significant. The study group showed an increase in ISQ values during the measurement periods, and the increases in the second and fourth weeks were statistically significant. Conclusion: I-PRF had positive effects on early implant stability, and i-PRF can be safely used in dental implant surgery and promotes bone healing around dental implants. [ABSTRACT FROM AUTHOR]

Purpose: To compare the axial and nonaxial retention forces of different milled bar attachment designs for maxillary implant overdentures. Materials and Methods: Four implants were placed in the canine and second premolar areas of an edentulous maxillary ridge model and connected to a cobalt-chromium milled bar either with or without Locator attachments. According to the type of bar and overlying housing, the following groups (n = 10 each) were investigated: group 1 (MWM) = milled bar without attachments and metal housing; group 2 (MWP) = milled bar without attachments and PEEK housing; group 3 (MAM) = milled bar with Locator attachments and metal housing; and group 4 (MAP) = milled bar with Locator attachments and PEEK housing. Axial and nonaxial (anterior, posterior, and lateral) retention forces were measured both at baseline and after wear simulation, then compared between groups and dislodging directions. Results: MAM showed the highest axial (53.20 ± 2.28 N) and nonaxial (anterior [33.80 ± 1.48 N], posterior [37.60 ± 2.07 N], and lateral [34.40 ± 1.67 N]) retention forces at baseline, followed by MAP, then MWM, and MWP (P < .001). MAP showed the highest axial (42.80 ± 2.28 N) and nonaxial (anterior [24.00 ± 1.58 N], posterior [29.40 ± 2.07 N], and lateral [27.80 ± 1.64 N]) retention forces after wear simulation, followed by MAM, then MWP, and finally MWM (P < .001). MAM showed the highest axial (25.25 ± 2.45 N) and nonaxial (anterior [28.29 ± 4.03 N], posterior [24.40 ± 3.25 N], and lateral [25.55 ± 1.65 N]) retention loss, followed by MWM, then MAP, and finally MWP (P < .001). For all groups, the highest retention forces were noted with axial dislodging, followed by posterior dislodging, then lateral dislodging, and finally vertical dislodging (P < .001). Conclusion: Milled bars with PEEK housings and Locator attachments for maxillary implant overdentures were associated with the highest axial and nonaxial retention forces after wear simulation, while milled bars with metal housing and no attachments showed the lowest forces. Milled bars with metal housing and attachments showed the highest retention loss, while milled bars with PEEK housing with no attachments showed retention gain. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to describe the facially oriented crestal incision (FOCIS) and assess the incidence of flap dehiscence and its efficacy in simultaneous and staged guided bone regeneration (GBR) procedures. The data of 41 patients treated with FOCIS GBR were analyzed. The primary outcome analyzed was the rate of initial wound closure. Secondary outcomes were related clinical parameters, including mean resolution of dehiscences and fenestrations, crestal buccal bone thickness (BBT), and bone width (BW) increase. A total of 53 implants were placed. The initial wound closure rate was 92.7% (38/41) and 94.3% (50/53) at the patient and implant levels, respectively. The complete dehiscence resolution rate was 79.31%, and the mean dehiscence reduction was 3.12 ± 2.46 mm (95% CI: 2.19 to 4.06 mm). BBT had a mean increase of 1.22 ± 1.07 mm (95% CI: 0.86 to 1.59 mm), and the final BBT was an average of 1.56 ± 0.79 mm (95% CI: 1.32 to 1.80 mm). Lastly, BW increase averaged 3.38 ± 1.49 mm (95% CI: 2.58 to 4.17 mm) for the staged cases. Utilizing FOCIS at partially edentulous sites can help achieve and maintain wound closure in horizontal GBR procedures. [ABSTRACT FROM AUTHOR]

This retrospective cohort study aimed to evaluate the efficiency of supportive periodontal treatment (SPT) on peri-implant disease prevention. A total of 63 rehabilitated patients with 504 implants were selected with both maxillary and mandibular Brånemark-type protocols (all-on-four system) placed between 2004 and 2014 in a private practice with 5 to 15 years of follow-up. Study participants were divided into those who adhered to SPT with regular intervals of two or more times a year (Group 1) and those with irregular intervals with more than 1 year without attending SPT (Group 2). The implants placed were evaluated clinically and radiographically to assess peri-implant diseases. The prevalence of mucositis and peri-implantitis in the total population was 64.7% (326 implants) and 3.7% (19 implants), respectively. Group 2 had higher rates of mucositis (181 implants) and peri-implantitis (16 implants) than Group 1 (145 and 3 implants, respectively) (P < .05). The odds ratio for periimplantitis in Group 2 was 7.1. The results suggest that patients who regularly received SPT had lower chances of developing peri-implant diseases. [ABSTRACT FROM AUTHOR]