Immediate Implant Placement in the Aesthetic Area using Inverted Body-shift Design: A Prospective Clinical Pilot Study.

A prospective clinical pilot study was carried out to evaluate a novel macroimplant design with a 12° angled platform. The implant is placed at the center of the socket, optimizing all the alveolar bone. In addition, the prosthetic emergence should be ideal, as it is corrected and emerges through the cingulate area. Twelve patients were enrolled in an immediate implant placement procedure with immediate aesthetic rehabilitation to replace an anterior maxillary tooth, and were treated with inverted body-shift design with 12° angled neck. Only type I sockets according to the Elian classification were considered eligible for the study. There were no implant failures after one year of loading. Regarding the horizontal and vertical hard tissue changes, there was a statistically significant median overall horizontal change of -0.99 mm at 1 mm and of -0.61 mm at 3 mm. On the other hand, stability was observed at 5 mm, since the result obtained was not statistically significant. The median pink esthetic score (PES) at one year of follow-up was 11.5. This implant may be useful in the immediate tooth replacement treatment of maxillary anterior post-extraction sockets, nevertheless, comparative studies with conventional implants should be carried out.

The Evaluation of Condylar Position Change in the Asymmetric Mandible Following Sagittal Split Osteotomy.

BACKGROUND: The change of condyle position following orthognathic surgery affects the stability of treatments. This study aims to assess the correlation between the amount of condyles' position change and the severity of mandibular asymmetry following BSSO. MATERIALS AND METHODS: This is a cross-sectional study. Subjects with asymmetric mandibular prognathism following BSSO were studied. Subjects were classified into 2 groups: group 1, subjects had mandibular asymmetry without occlusal cant and underwent BSSO. Group 2, subjects had mandibular asymmetry with occlusal cant and underwent BSSO+ Lefort I osteotomy. The condyle position was evaluated using cone-beam computer tomography (CBCT). Pearson's correlation test was used to assess any correlation between the condyle changes and the change in the mandible in sagittal and anterior-posterior directions. RESULTS: A total of 44 subjects were studied. In group 1, the condyle tilted outward in the deviated condyle and inward in the non-deviated condyle immediately after osteotomy. After 12 months, both condyles showed a rotation relative to the original position. In group 2, the condyles of the deviated sides and non-deviated sides moved inferiorly after surgery (condylar sagging), which was more significant in the non-deviated sides. The condyle rotation was similar to group 1. The severity of asymmetry and occlusal cant correlate with the condylar position change in the two groups. CONCLUSION: The severity of mandibular asymmetry correlates with the amount of condyles' position change immediately after BSSO. However, the condyles tend to return to their original position 12 months later.

Influence of Insertion Torques on the Surface Integrity in Different Dental Implants: An Ex Vivo Descriptive Study.

BACKGROUND: The primary objective of this ex vivo study was to assess the influence of increasing insertion torques on three types of dental implants and possible alterations of their microgeometry after the application of three different torque intensities. METHODS: 27 implants of 3 different implant brands (Groups A, B and C) were placed in cow ribs using 30 Ncm, 45 Ncm and 55 Ncm insertion torques. The implants were subsequently removed using trephine burs, and SEM analysis was carried out in order to detect implant surface and connection changes, as compared to the implant controls. RESULTS: Surface deformations were predominantly observed on the third apical part of the implants. The alterations presented with increasing insertion torques, with 45 Ncm being the threshold value. Prosthetic connections were also compromised. CONCLUSIONS: The changes sustained by the implants were proportional to the insertion torque they were subjected to; 45 Ncm and greater insertion torques resulted in more consistent damage, both on the implant surface and the implant connection.

Clinical Evidence on a Novel Macrohybrid Design Dental Implant with 12° Angled Platform: A Systematic Review.

Background: Immediate implant placement with immediate esthetics has become a more common procedure over time, though ensuring good emergence of the axis of the implant has been a challenge. A novel macroimplant design with an angled platform (Co-Axis®) has been developed to ensure exit of the head of the implant in the correct prosthetic position. A systematic literature review was carried to determine the survival rate and marginal bone loss associated with these implants. Material and Methods: An electronic and manual literature search was made in accordance with the PRISMA statement. The search strategy was limited to human studies, retrospective and prospective clinical trials, cross-sectional studies, and cohort studies reporting outcomes of a novel macrohybrid implant with a 12° angled implant connection. Results: Three articles met the inclusion criteria and were reviewed in the analysis. The estimated success rate was 95.9%. The global marginal bone loss was estimated to be -0.17 ± 0.58 mm in an environment characterized by great heterogeneity (I2 = 99%). The estimated mean implant stability was 69.6 ± 0.92 (ISQ). As only two studies provided the required information, it was not possible to determine publication bias. Lastly, mean recession was estimated to be practically zero (0.06 ± 0.23 mm), with great heterogeneity. Conclusions: Within the limitations of this systematic review, it can be affirmed that immediate implant treatment with Co-Axis® implants shows a survival rate of 95.9% at one year of follow-up, with low marginal bone loss values, near-zero soft tissue recession, and favorable papilla index values. Nevertheless, the great heterogeneity of the data requires the findings to be interpreted with caution.

Volumetric changes in alveolar ridge preservation with a compromised buccal wall: a systematic review and meta-analysis

BACKGROUND: Many studies have addressed socket preservation, though fewer publications considering buccal wall loss can be found, since the literature typically considers sockets with four walls. A systematic review was made on the influence of type II buccal bone defects, according to Elian's Classification, in socket grafting materials upon volumetric changes in width and height. MATERIAL AND METHODS: An electronic and manual literature search was conducted in accordance to PRISMA statement. The search strategy was restricted to randomized controlled trials (RCTs) and controlled clinical trials (CCTs) describing post-extraction sockets with loss of buccal wall in which alveolar ridge preservation (ARP) was carried out in the test group and spontaneous healing of the socket (SH) was considered in the control group. RESULTS: The search strategy yielded 7 studies. The meta-analysis showed an additional bone loss of 2.37 mm in width (p > 0.001) and of 1.10 mm in height (p > 0.001) in the absence of ARP. The reconstruction of the vestibular wall was not evaluated in any study. The results also showed moderate to great heterogeneity among the included studies in terms of the changes in width and height. CONCLUSIONS: Despite the heterogeneity of the included studies, the results indicate a benefit of ARP versus SH. Further studies are needed to determine the volumetric changes that occur when performing ARP in the presence of a buccal bone wall defect

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Zygoma Quad Compared With 2 Zygomatic Implants: A Systematic Review and Meta-analysis.

PURPOSE: The aim of this study was to systematically review and compare the survival rates (SRs) of oral rehabilitations performed with 2 zygomatic implants (ZIs) combined with regular implants (RIs) versus 4 ZI. MATERIAL AND METHODS: An electronic search was performed in several databases for articles published in English between 2007 and 2015. Articles reporting human studies were included in this systematic review. RESULTS: The search yielded to a total of 417 studies, of which 6 were included in this study. ZIs SR weighted mean was 98.0% with a 95% confidence interval (CI) of 96.7% to 99.8%. For the control group (2 ZIs + 2 RIs) and the test group (4 ZIs), the implant SR was 98.6% and 97.4%, respectively, with a 95% CI. No statistically significant differences in terms of SRs were obtained between both groups P = 0.286. CONCLUSIONS: The data analysis showed favorable results for treatment with 4 ZIs. The results showed no statistical differences in using 1 or another treatment, in terms of survival and failure rates. The reduction on treatment time and morbidity related to regenerative approaches may be its main advantage. In conclusion, the zygoma quad seems to be the treatment of choice for the rehabilitation of the severely atrophic maxilla.

Planificación tridimensional y utilización de férulas Computer Aided Design/Computed Aided Manufacturing en cirugía ortognática / 3D planning and use of Computer Aided Design/Computed Aided Manufacturing surgical splints in orthognathic surgery

El presente trabajo se centra en explicar las ventajas que aporta la planificación tridimensional (3D) y la confección de férulas quirúrgicas Computer Aided Design/Computed Aided Manufacturing (CAD/CAM) en cirugía ortognática. La digitalización del entorno laboral es una realidad imparable en nuestra sociedad y, en nuestra especialidad, nos proporciona ventajas desde un punto de vista logístico, de precisión diagnóstica y en la confección de férulas quirúrgicas. Las tradicionales férulas quirúrgicas siguen un método de fabricación casi artesanal sometido a errores sistemáticos que se van acumulando a lo largo del proceso. Las férulas CAD/CAM se crean directamente a partir de imágenes que obtenemos de la tomografía computarizada o de la tomografía de haz cónico con lo que acortamos, digitalizamos y estandarizamos el proceso de confección disminuyendo la posibilidad de cometer errores derivados de la confección manual. Las imágenes 3D sobre las que podemos trabajar nos aportan ventajas respecto a la visualización bidimensional (2D) ya que no hay una pérdida de información ni una superposición de estructuras anatómicas. En 3D podemos ver con mayor detalle puntos de referencia difíciles de visualizar en 2D y son imágenes idóneas para el estudio de asimetrías en el plano frontal (AU)

The aim of this work is to present the advantages of 3D planning and CAD/CAM (Computer Aided Design/Computed Aided Manufacturing) surgical splints in orthognathic surgery. Digitalization of the working environment is an unstoppable reality in our society and, in our specialty it gives us advantages from a logistics, accuracy and diagnostic point of view, as well as in the manufacture process of surgical splints. The conventional surgical splints have an artisanal manufacturing process subjective to systematic errors. CAD/CAM surgical splints are built from computed tomography or cone beam computed tomography, which makes manufacturing process shorter, digitalized and standardized, thus decreasing the errors of the hand made manufacture. The 3D images that we can work with, give us advantages compared to two-dimensional (2D) visualization because there is no loss of information or overlapping anatomical structures. More detailed points of references can be seen in 3 D images, which are very difficult to see in two-dimensional images, and are ideal images for the study of frontal plane asymmetry (AU)

3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results - our experience in 16 cases.

The aim of this article is to determine the advantages of 3D planning in predicting postoperative results and manufacturing surgical splints using CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology in orthognathic surgery when the software program Simplant OMS 10.1 (Materialise(®), Leuven, Belgium) was used for the purpose of this study which was carried out on 16 patients. A conventional preoperative treatment plan was devised for each patient following our Centre's standard protocol, and surgical splints were manufactured. These splints were used as study controls. The preoperative treatment plans devised were then transferred to a 3D-virtual environment on a personal computer (PC). Surgery was simulated, the prediction of results on soft and hard tissue produced, and surgical splints manufactured using CAD/CAM technology. In the operating room, both types of surgical splints were compared and the degree of similitude in results obtained in three planes was calculated. The maxillary osteotomy line was taken as the point of reference. The level of concordance was used to compare the surgical splints. Three months after surgery a second set of 3D images were obtained and used to obtain linear and angular measurements on screen. Using the Intraclass Correlation Coefficient these postoperative measurements were compared with the measurements obtained when predicting postoperative results. Results showed that a high degree of correlation in 15 of the 16 cases. A high coefficient of correlation was obtained in the majority of predictions of results in hard tissue, although less precise results were obtained in measurements in soft tissue in the labial area. The study shows that the software program used in the study is reliable for 3D planning and for the manufacture of surgical splints using CAD/CAM technology. Nevertheless, further progress in the development of technologies for the acquisition of 3D images, new versions of software programs, and further studies of objective data are necessary to increase precision in computerised 3D planning.

Primary intraosseous carcinoma and odontogenic cyst. Three new cases and review of the literature.

INTRODUCTION: The Odontogenic Primary Intraosseous Carcinoma (PIOC) are a rare group of malignant tumours with strict clinic and anatomy pathological diagnosis criteria. The different classification suggested for these tumours and the small amount of cases described in literature makes it hard to know exactly how many of the cases published until now are real. MATERIAL AND METHODS: We present three new cases of PIOC originated from a previous cystic lesion that where treated in our Hospital. Two of them in the posterior jaw region where is more frequent, and the third in the upper jaw. We explain the procedure we used in each case and the aesthetic-functional reconstruction used witches are two fibula osteomyocutaneous free flaps and a bone graft of iliac crest and further placing of implants. The classification, the clinical and radiological diagnosis, the treatment and its survival are discussed. RESULTS: In all three cases we were able to see in the anatomy pathological study an epithelial, exclusively without surrounding oral mucosa affectation or tissues near the lesion as well as the lack of tumorous pathology in other parts of the body. One of the patients died because of premature massive cervical recidiva while the other two patients are currently free form illness, for ten years one of them and fifteen months the other. CONCLUSIONS: The anatomy pathological study of all of the lesions of cystic characteristics at jaw level is very important because of the risk of coexisting with carcinomatous cells. The treatment of these tumours consists in practising aggressive surgery and, in some cases, radio and/or chemotherapy post intervention.

Carcinoma primario intraóseo y quiste odontogénico. Tres casos clínicos y revisión de la literatura / Primary intraosseous carcinoma and odontogenic cyst. Three new cases and review of the literature

Introducción: Los Carcinomas Intraóseos Primarios Odontogénicos (PIOC) son un raro grupo de tumores malignos con unos estrictos criterios diagnósticos clínicos y anatomo-patológicos. Las diferentes clasificaciones sugeridas para estos tumores y el escaso número de casos descritos en la literatura hacen difícil conocer con exactitud cuantos son los casos reales publicados hasta el día de hoy. Material y métodos: presentamos tres nuevos casos de PIOC originados a partir de una lesión quística previa que fueron tratadosen nuestro centro. Dos en región posterior mandibular que es el lugar de más frecuente aparición, y un tercero en maxilar superior. Explicamos el tipo de cirugía llevado a cabo en cada caso y la reconstrucción estético-funcional utilizada que son dos injertos osteomiocutáneos de peroné y un injerto de hueso de cresta iliaca con posterior colocación de implantes. Se discute la clasificación, el diagnóstico clinico-radiológico, el tratamiento y su supervivencia.Resultados: en los tres casos se pudo constatar en la anatomía patológica un epitelio celular bien diferenciado acompañando a células carcinomatosas afectando al hueso exclusivamente sin afectación de la mucosa oral circundante ni de tejidos vecinos a la lesión así como ausencia de patología tumoral en otra zona del organismo. Uno de los pacientes falleció por recidiva cervical masiva precoz mientras que los otros dos están libres de enfermedad en la actualidad después de 10 años en uno de ellos y 15 meses en el otro. Conclusiones: es muy importante el análisis anatomo-patológico de todas las lesiones de características quísticas a nivel maxilarpor el riesgo de coexistir con células carcinomatosas. El tratamiento de estos tumores debe ser la práctica de una cirugía agresiva y, en algunos casos, asociados a radio y/o quimioterapia post intervención

Introduction: The Odontogenic Primary Intraosseous Carcinoma (PIOC) are a rare group of malignant tumours with strict clinic and anatomy pathological diagnosis criteria. The different classification suggested for these tumours and the small amount of cases described in literature makes it hard to know exactly how many of the cases published until now are real.Material and methods: We present three new cases of PIOC originated from a previous cystic lesion that where treated in our Hospital. Two of them in the posterior jaw region where is more frequent, and the third in the upper jaw. We explain the procedure we used in each case and the aesthetic-functional reconstruction used witches are two fibula osseomiocutaneousfree flaps and a bone graft of iliac crest and further placing of implants. The classification, the clinical and radiological diagnosis, the treatment and its survival are discussed.Results: in all three cases we were able to see in the anatomy pathological study an epithelial, exclusively without surrounding oral mucosa affectation or tissues near the lesion as well as the lack of tumorous pathology in other parts of the body. One of the patients died because of premature massive cervical recidiva while the other two patients are currently free form illness, for ten years one of them and fifteen months the other.Conclusions: the anatomy pathological study of all of the lesions of cystic characteristics at jaw level is very important because of the risk of coexisting with carcinomatous cells. The treatment of these tumours consists in practising aggressive surgery and, in some cases, radio and/or chemotherapy post intervention