Accuracy of Edentulous Computer-Aided Implant Surgery as Compared to Virtual Planning: A Retrospective Multicenter Study.

PURPOSE: To evaluate the accuracy of computer-aided dental implant positions obtained with mucosal-supported templates as compared to Three-Dimensional (3D) planning. MATERIALS AND METHODS: One-hundred implants were inserted into 14 edentulous patients using the All-on-4/6 protocol after surgical virtual planning with RealGUIDE, 3DIEMME, and Geomagic software. After 6 months, three-dimensional neck (V) and apex (S) spatial coordinates of implants and angle inclination displacements as compared to virtual plans were evaluated. RESULTS: The S maxilla coordinates revealed a significant discrepancy between clinical and virtual implant positions (p-value = 0.091). The V coordinates showed no significant differences (p-value = 0.71). The S (p-value = 0.017) and V (p-value = 0.038) mandible coordinates showed significant discrepancies between the clinical and virtual positions of the screws. Implant evaluation showed a 1-mm of the horizontal deviation in the V point and a 1.6-mm deviation in the S point. A mean 5° angular global deviation was detected. The multivariate permutation test of the S (p-value = 0.02) confirmed the difference. Greater errors in the mandible were detected as compared to the maxilla, and a higher S discrepancy was found in the posterior jaw compared to the anterior section of both the mandible and maxilla. CONCLUSIONS: Computer-aided surgery with mucosal-supported templates is a predictable procedure for implant placement. Data showed a discrepancy between the actual dental implant position as compared to the virtual plan, but this was not statistically significant. However, the horizontal and angle deviations detected indicated that flap surgery should be used to prevent implant positioning errors due to poor sensitivity and accuracy in cases of severe jaw atrophy.

Reduction of gingival recession following orthodontic intrusion in periodontally compromised patients.

OBJECTIVES: To evaluate the role of orthodontic intrusion and alignment in the reduction of gingival recession (REC) around maxillary incisors of adult periodontal patients. Design - Prospective clinical study. SETTING AND SAMPLE POPULATION: Twenty-eight consecutively treated adult patients, suffering from severe chronic periodontitis and with one upper central incisor extruded and infrabony defect on its mesial site. All patients were seen in a private practice in Turin, Italy. At baseline, all patients presented with REC on the buccal and mesial aspects of the treated teeth. MEASUREMENTS AND RESULTS: For each patient probing pocket depth (PPD) and REC were assessed at baseline, at the end of treatment and 1-year after the end of treatment. REC was also evaluated independently in patients with narrow (NPB) or wide periodontal biotype (WPB). All parameters showed improvement between initial and final measurements statistically, and showed no changes between final and follow-up measurements. Mean mesial PPD decrease was 4.29 mm, with a residual PPD of 2.50 mm. Mean REC reduction was 0.96 mm on the buccal sites and 1.71 mm on the mesial. No statistical difference was recorded on REC values between groups NPB and WPB. CONCLUSION: The presented clinical protocol resulted in improvement of all parameters examined. At the end of orthodontic treatment a predictable reduction of REC was reported, both in patients with thin or wide gingiva.

Intrusion of migrated incisors with infrabony defects in adult periodontal patients.

This report describes the orthodontic treatment of 10 adult patients who had severe periodontal disease, with migration and radiological evidence of an infrabony defect on a maxillary central incisor. Orthodontic tooth movement, using light and continuous forces, was initiated 7 to 10 days after periodontal surgical therapy. Mean orthodontic treatment time was 10 months. Before surgery and at the end of orthodontic treatment, the following parameters were registered clinically and with standardized intraoral radiographs: probing depth, clinical crown length, marginal bone level, bone defect radiological dimension, and root length. Comparison of pre- and posttreatment values showed a statistically significant improvement for all parameters without a remarkable decrease of root length. The mean residual probing depth was 2.80 mm, and the mean intrusion of the incisors was 2.05 mm. Moreover, radiographs showed a reduction of the infrabony defects. These results show the efficacy of a combined orthodontic-periodontal approach. Intrusive movement, after proper periodontal surgical therapy, can positively modify both the alveolar bone and the soft periodontal tissues.

Bodily tooth movement through the maxillary sinus with implant anchorage for single tooth replacement.

Movement of teeth through anatomic limitations, such as the maxillary sinus, can be a reliable therapeutic protocol if suitable force systems are used. We report here the outcome of a treatment based on this concept. The patient exhibited pneumatization of the maxillary sinus resulting from earlier extractions. She was treated using an endosseous implant inserted in the retromolar region to serve as orthodontic anchorage and a T-loop appliance fabricated from TMA wire to bodily move an upper second premolar through the sinus. After 6 months, at the end of the displacement, a titanium implant was inserted in the alveolus of the moved tooth and a single crown restoration was placed. The premolar moved through the sinus maintaining its support apparatus and bone. At the end of treatment the implant used for anchorage was still osseointegrated.

Orthodontic treatment in periodontally compromised patients: 12-year report.

This work describes the therapeutic protocol of combined orthodontic-periodontal treatment and evaluates the effectiveness of surgical and nonsurgical periodontal therapy in the maintenance of a healthy periodontal status after the orthodontic treatment. Surgical periodontal treatment was performed in 267 patients affected by severe periodontal disease, and 128 patients had nonsurgical treatment. For each patient the mean value of probing depth (mPPD) and the rate of positive bleeding on probing (%BoP) of the teeth involved in the orthodontic movement were registered before the start of the periodontal treatment, at the end of the orthodontic treatment, and 2, 4, 6, 10, and 12 years after the end of the orthodontic treatment. Comparison between pretreatment and posttreatment values and between pretreatment and follow-up values showed a decrease in mPPD and %BoP that was of statistical significance. The difference between posttreatment and follow-up values was not statistically significant. These results suggest that orthodontic treatment is no longer a contraindication in the therapy of severe adult periodontitis. In these cases orthodontics improve the possibilities of saving and restoring a deteriorated dentition.

Long-term evaluation of osseointegrated implants in regenerated and nonregenerated bone.

This investigation evaluated the predictability of dental implants subjected to bone regeneration procedures at the time of insertion. Fifty-two test implants were inserted into sites with periimplant bone defects. A calcium carbonate allograft material with or without a fibrin-fibronectin sealing system was used to fill the defects. Sixty control implants were inserted into an adequate volume of nonaugmented bone. Each of the 29 study patients received at least one test implant and one control implant. At the second-stage surgery, fill of the bone defect was assessed as complete or incomplete. The cumulative success rate was 91.7% (mean follow-up 55 mo) for the test implants and 93.2% (mean follow-up 59 mo) for the control implants. Within the test group, implants with complete bone fill achieved 97.6% success versus 59.1% success for implants with incomplete bone fill. These preliminary results suggest that implants placed with simultaneous bone regeneration procedures achieve long-term predictability that is comparable to that of implants placed in an adequate volume of bone, provided that complete bone fill of the periimplant defect is achieved. Long-term studies with other augmentation materials are needed to fully validate these findings.

Resin-bonded fixed partial dentures and splints in periodontally compromised patients: a 10-year follow-up.

In the present study, 139 periodontally compromised patients received a complete periodontal treatment; in 104 cases this was followed by orthodontic treatment. At the end of the entire therapy, a total of 150 Maryland restorations (69 resin-bonded fixed partial dentures and 81 resin-bonded splints) was placed and then followed for a period of up to 10 years (mean 6.7 y). Thirteen fixed partial dentures and 16 splints failed during the observation period; the 10-year cumulative survival rate from lifetable analysis was 76.2% (70.6% for fixed partial dentures and 80.7% for splints).

Supracrestal bone regeneration around dental implants using a calcium carbonate and a fibrin-fibronectin sealing system: clinical and histologic evidence.

This study evaluated a new surgical technique for the treatment of an alveolar ridge deficiency in 11 patients. Twenty-two implants were placed, 15 of which presented with a combination of supracrestal and dehiscence kinds of defects, and seven presented only supracrestal bone loss. Surgical procedures were performed utilizing a combination of the resorbable space-making material calcium carbonate stabilized with a fibrin-fibronectin sealing system and the immediate placement of titanium dental implants. After implant placement, the mean height for supracrestal and dehiscence defects measured 2.57 +/- 1.41 mm and 2.47 +/- 1.54 mm, respectively. The defects were filled with calcium carbonate and a fibrin-fibronectin sealing system, and the flaps were sutured, avoiding any compression of the treated area. Healing was uneventful in all instances. At second-stage surgery at 6 months, a hard bone-like tissue was detectable at the defect sites. Histologic examination of four defects confirmed the presence of newly formed bone and revealed residual particles of calcium carbonate. There was a mean gain of 2.05 +/- 1.47 mm in the supracrestal defects and of 2.23 +/- 1.62 mm in the dehiscences. The results indicated that calcium carbonate, combined with a fibrin-fibronectin sealing system, is a viable alternative in the treatment of supracrestal and dehiscence bony defects.

Bilateral disc edema in retinitis pigmentosa.

Retinitis pigmentosa (RP), one of the most common forms of hereditary retinal degeneration, is characterized by night blindness and constricted visual fields. In addition to bone spicule pigmentation, other ocular findings may include posterior subcapsular cataracts, cystoid macular edema, and hyaline bodies or drusen of the optic nerve. Rarely, optic nerve head (ONH) edema has been reported to be associated with RP. A 44-year-old white male with RP and neurosensory hearing loss (Usher's syndrome type II) presented to our clinic for routine examination. A dilated fundus examination revealed bone spicule pigmentation, vessel attenuation, several flame hemorrhages on or adjacent to the nerves, and ONH edema in the right eye. B-scan ultrasonography revealed drusen of the right ONH but not of the left. Late stage fluorescein angiography showed hyperfluorescence and dye leakage from both optic discs which was more pronounced in the right eye than the left. Computed tomography (CT) of the head and orbits and cerebrospinal fluid (CSF) examination by lumbar puncture were normal. The differential diagnosis of bilateral ONH edema in this case included ONH drusen or papilledema secondary to increased intracranial pressure. This patient was found to have RP with asymmetric, bilateral ONH edema of unknown cause. One theory regarding the cause of the ONH edema is disc vessel leakage secondary to an inflammatory reaction caused by rapid photoreceptor and retinal pigment epithelium (RPE) degeneration.

Choroidal metastases resulting from carcinoma of the lung.

BACKGROUND: Choroidal metastases, the most commonly observed tumors of the choroid, are a frequent sequela of lung cancer. Carcinoma of the lung is the most common cancer. Choroidal metastatic tumors can be observed before or after the definitive diagnosis of a lung carcinoma. METHODS: A 42-year-old man, examined 1 month after reporting an ache and blurry vision in his left eye, was found to have an elevated, irregular-shaped choroidal lesion in the eye. The second patient, a 53-year-old man, was examined 1 week after reporting dim vision in the left eye. Diagnosed with non-small-cell lung carcinoma 5 months earlier, he was found to have bilateral choroidal lesions. RESULTS: The first patient was diagnosed with choroidal metastasis from adenocarcinoma of the lung 8 months after the initial presentation, confirmed after a fine-needle aspiration biopsy. The second patient had bilateral choroidal metastases from disseminated lung carcinoma. CONCLUSIONS: Metastases to the eye or orbit develop in approximately 0.7% to 12% of patients with lung cancer. Treatment regimens depend on the size and extent of the choroidal tumor, number of tumors, laterality, the visual status of the affected or nonaffected eye, the stage of cancer, and the age and general health of the patient. Prognosis is contingent on vital organ involvement and response to therapy. Preserving the patient's visual status may enhance the quality of remaining life.