Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial.

PURPOSE: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. MATERIALS AND METHODS: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. RESULTS: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). CONCLUSIONS: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. CLINICAL RELEVANCE: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. TRIAL REGISTRATION: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).

Early Surgical Management of Displaced Orbital Roof Fractures: Prospective Observational Study.

This study aimed to evaluate the clinical, radiological and functional outcome of early (within 24 h) surgical intervention of displaced orbital roof fractures. This is a prospective observational study for patients with displaced orbital roof fractures. Six patients underwent early surgical management within hours of admission. The primary outcome variables were functional and aesthetic (evaluated through clinical and radiological assessments). The rate of immediate and delayed complications over a 6-months minimum follow-up period was recorded. All patients were males. The median age at the time of presentation was 23.5 years ranging from 4 to 40 years. The etiology was a high impact traffic accident in all patients. In three patients, the orbital roof fractures were unilateral, and in the other three patients, the fractures were bilateral. All patients were treated via transcranial approach at the same time as the neurosurgery. The median follow-up period was 10 months ranging from 6 to 15 months. During the follow-up period, there were no signs of meningitis, cerebrospinal fluid leakage, facial asymmetry, enophthalmos, exophthalmos, restriction of ocular motility, or blindness. Traumatic optic neuropathy was present in two patients (one unilateral and the other bilateral), of whom, one patient achieved full visual acuity recovery, while the other patient showed a mild decrease in visual acuity which improved within 6 months (OD;20/30, OS;20/25). One patient had mild ptosis and recovered spontaneously within 3 months after surgery. Postoperative CT scans showed a good anatomical reconstruction of orbital roof fracture in all cases. Early definite management of displaced orbital roof fractures secures reliable functional and cosmetic results and reduces the incidences of intracranial and ocular complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04056-x.

Horizontal Ridge Reconstruction of Atrophic Anterior Maxillary Ridges Using Customized Xenograft Bone Shell with 1:1 Mixture of Autogenous and Xenograft Bone Particulate (A Case Series Study).

INTRODUCTION: Different surgical procedures have been proposed to achieve successful horizontal ridge reconstruction of the anterior maxilla, most of these procedures require complex surgical stages with morbidity and are time-consuming. AIM: The purpose of this study is to evaluate the efficacy of using a customized xenograft shell with a 1:1 mixture of particulates xenograft and autogenous bone for the reconstruction of horizontally deficient anterior maxillary alveolar ridges. METHODS: Cone beam computed tomography (CBCT) images of the atrophic maxilla of eight patients were acquired and generated into 3D models. The data were transferred to a 3D printer and solid models were fabricated. During the surgery, the xenograft blocks were manually sliced and customized on the 3D printed models and fixed then the gap was augmented with a 1:1 xenograft autograft mixture. RESULTS: Clinical assessment showed no adverse effects. However, one patient exhibited wound dehiscence. The mean difference between the preoperative and the six months postoperative showed a net average bone gain by 4.06 mm at 2 mm from the crest and 4.34 mm at 5 mm from the crest, which was statistically significant. On the other hand, a statistically significant graft resorption by 1.41 mm and 2.19 mm at 2 and 5 mm from the crest was found when the mean difference between the immediate and the six months postoperative was calculated. CONCLUSIONS: Within the limitations of the study, the use of xenograft shells as a barrier for maxillary alveolar ridge reconstruction is predictable technique however, further investigations regarding the required time for graft consolidation is required.

Comparative study between patient specific titanium plates versus conventional miniplates for treatment of mandibular fractures: Randomized clinical trial.

The aim of the study was to evaluate and assess the clinical stability and efficacy of three-dimensional patient-specific computer-guided titanium plates versus conventional mini plates when used for the treatment of mandibular fractures. Patients with isolated mandibular body fractures were assigned randomly into two equal groups. Group I was treated with patient-specific 3D titanium plates and Group II was treated with conventional mini plates. Outcome measurements included patient satisfaction, pain, occlusion, occlusal bite force and fracture gap distance. All parameters were evaluated at one-week and three-month intervals. The operating time was measured during the surgery. A total of 20 patients were included in the study. Group I (n=10) showed higher values of patient satisfaction and lower pain values than Group II (n=10) at both follow-up intervals. The degree of occlusal derangement showed no statistically significant difference between both groups at one week postoperatively, while both groups showed normal occlusion after 3 months. Occlusal bite forces in Group I were significantly higher than Group II at both follow up intervals. The fracture gap distance was statistically insignificant between both groups at both follow up intervals. The operating time was significantly lower for Group I. Within the limitations of the study, it seems that in the treatment of mandibular body fractures patient-specific plates are preferred over conventional mini plates as they provide more stability, higher biting forces and shorter operating time with highly acceptable outcomes and promising results.

Assessment of absorbable gelatin sponge for maxillary sinus floor elevation versus anorganic bovine bone minerals: a randomized clinical trial.

PURPOSE: The present study compared the absorbable gelatin sponge as a space-filling material versus anorganic bone bovine mineral (ABBM) in maxillary sinus augmentation with simultaneous endosseous dental implant placement. METHODS: Eighteen maxillary sinus floor elevation cases were randomly allocated into two groups. The first group received ABBM, while the second group received an absorbable gelatin sponge as a space-filling material. For both groups, CBCT scans were obtained immediately postoperatively and six months later to calculate the difference in sinus floor bone gain. Osstell readings were recorded both at the time of implant placement and implant exposure with a total of twenty-three dental implant placements in relation to the eighteen elevated sinus floors. RESULTS: The mean radiographic sinus floor gain in the ABBM group was 10.2 mm (± 2.5), while in the absorbable gelatin sponge group was 5.4 mm (± 2.0), with a mean difference of 4.8, which was statistically significant (p < 0.001). The mean implant stability for the ABBM was 77.3 (± 4.9), while in the absorbable gelatin sponge group was 74.2 (± 3.0), with a mean difference of 3.1, which was statistically insignificant (p = 0.1610). CONCLUSION: The ABBM showed superior results regarding the amount of radiographic sinus floor bone gain. However, the implant stability was invariable between both groups.

Ridge augmentation using autologous concentrated growth factors enriched bone graft matrix versus guided bone regeneration using native collagen membrane in horizontally deficient maxilla: A randomized clinical trial.

BACKGROUND: Facial resorption of maxillary alveolar ridges is a challenging situation for implant rehabilitation, which mandates a preparatory surgery of bone augmentation. Guided bone regeneration using a 1:1 mixture of autogenous particulate and anorganic bovine bone mineral (ABBM) showed reliable outcomes in treating horizontally deficient ridges. METHODS: Twenty-eight patients were randomly assigned into two groups; in the control group, the 1:1 mixture of particulate autogenous bone and ABBM was covered with native collagen membrane, while in the study group, it was mixed with autologous fibrin glue (AFG) to make a sticky bone that was covered by concentrated growth factor (CGF) membrane. For each proposed implant site, the average bone width gain was calculated preoperatively, immediately after augmentation and after 6 months. Implants were placed after 6 months and the implant stability quotient (ISQ) was measured after insertion and after 6 more months. RESULTS: The graft consolidation period went uneventful in both groups; however, two cases in the sticky bone group showed total resorption of the graft upon re-entry. The mean horizontal bone width after 6 months was 9 mm ± 0.71 in the guided bone regeneration (GBR) group which was higher than 7.9 mm ± 0.92 for the sticky bone group. The mean primary stability was higher in the GBR group; 67.19 ± 2.23 compared to 66.7 ± 3.22 for the sticky bone group, while the mean secondary stability was higher in the sticky bone group; 72 ± 2.15 compared to 71.7 ± 2.27 for the GBR group. Results of Shapiro-Wilk's for bone width data and model residuals were both statistically not significant (p > 0.05). CONCLUSION: Comparing CGF membrane versus native collagen membrane as barriers for GBR showed no statistically significant difference regarding bone gain. However, from a clinical point of view, CGF membrane is not a predictable barrier for guided bone regeneration.

The formation of starch-lipid complexes by microwave heating.

This study investigated the impact of microwave treatment on the formation of starch-lipid complexes, and physicochemical properties of wheat starch (WS) fortified with lipids, such as lauric acid (LA), glycerol monolaurate (GML), and stearic acid (SA). Specimens were prepared using a conventional water bath and microwave heating and evaluated using macrostructural and microstructural analyses. Iodine staining and scanning electron microscopy revealed interplay between WS and LA. Diffraction peaks around 7.5°, 13°, and 20° and the absence of the absorption band in the 2850 cm-1 were observed in microwave treated WS-lipid samples than conventional water bath samples. Further, more type I complexes were formed in WS-LA microwave-assisted samples, as demonstrated by differential scanning calorimetry. Additionally, more resistant starch was formed in specimens treated by microwave than water bath treated counterparts, the finding that was proved by in vitro enzymatic hydrolysis. In short, the current study may suggest the applications of microwave treatment in foods for hypoglycemia.

Combretastatin A4-loaded Poly (Lactic-co-glycolic Acid)/Soybean Lecithin Nanoparticles with Enhanced Drug Dissolution Rate and Antiproliferation Activity.

OBJECTIVE: This study aimed to prepare combretastatin A4 (CA4)-loaded nanoparticles (CA4 NPs) using poly(lactic-co-glycolic acid) (PLGA) and soybean lecithin (Lipoid S100) as carriers, and further evaluate the physicochemical properties and cytotoxicities of CA4 NPs against cancer cells. METHODS: CA4 NPs were prepared using a solvent evaporation technique. The effects of formulations on CA4 NPs were investigated in terms of particle size, zeta potential, encapsulation efficacy, and drug loading. The physicochemical properties of CA4 NPs were characterized using transmission electron microscopy, X-ray powder diffraction, differential scanning calorimetry, and Fourier transform infrared spectra. The drug release from CA4NPs was performed using a dialysis method. In addition, the cytotoxicity of CA4NPs against human alveolar basal epithelial (A549) cells was also evaluated. RESULTS: CA4 NPs prepared with a low organic/water phase ratio (1:20) and high drug/PLGA mass ratio (1:2.5) exhibited a uniform hydrodynamic particle size of 142 nm, the zeta potential of -1.66 mV, and encapsulation efficacy and drug loading of 92.1% and 28.3%, respectively. CA4 NPs showed a significantly higher release rate than pure CA4 in pH 7.4 phosphate-buffered solution with 0.5% Tween 80. It was found that the drug molecules could change from the crystal state to an amorphous form when loaded into the PLGA/Lipoid S100 matrix, and some molecular interactions could also occur between the drug and PLGA. Importantly, CA4 NPs showed a remarkably higher antiproliferation activity against A549 cancer cells compared to pure CA4. CONCLUSION: These results suggested the promising potential of PLGA/Lipoid S100 nanoparticles as the drug delivery system of CA4 for effective cancer therapy.

Formulation Optimization and In Vitro Characterization of Granisetronloaded Polylactic-co-glycolic Acid Microspheres Prepared by a Dropping-in-liquid Emulsification Technique.

PURPOSE: Traditional dosage forms of granisetron (GRN) decrease patient compliance associated with repeated drug administration because of the short half-life of the drug. METHODS: In this study, novel GRN-loaded Polylactic-co-glycolic Acid (PLGA) sustained-release microspheres were prepared for the first time via a dropping-in-liquid emulsification technique. The effects of various factors, such as pH of the outer phase, Tween 80, Polyvinyl Alcohol (PVA) concentrations, and hardening process, on the Encapsulation Efficiency (EE), Drug Loading (DL), and particle size of microspheres were extensively studied. The physicochemical properties, including drug release, surface morphology, crystallinity, thermal changes, and molecular interactions, were also studied. RESULTS: GRN has a pH-dependent solubility and it exhibits a remarkably high solubility under acidic condition. The EE of the alkaline medium (pH 8) was higher than that of the acidic medium (pH 4.0). EE and DL decreased in the presence of Tween 80 in the outer phase, whereas EE significantly increased during hardening. The particle size of microspheres was not affected by PVA and Tween 80 concentrations, but it was influenced by PVA volume and hardening. X-ray diffraction and differential scanning calorimetry results showed that the physical state of the drug changed from a crystalline form to an amorphous form, thereby confirming that the drug was encapsulated into the PLGA matrix. Fourier transform-infrared spectroscopy confirmed that some molecular interactions occurred between the drug and the polymer. GRN-loaded PLGA microspheres showed sustained release profiles of over 90% on week 3. CONCLUSION: GRN-loaded PLGA microspheres with sustained-release were successfully prepared, and they exhibited a relatively high EE without Tween 80 as an emulsifier and with the hardening process.

Polyetheretherketone patient-specific implants (PPSI) for the reconstruction of two different mandibular contour deformities.

BACKGROUND: This study aims to prospect the soft and hard tissue changes after augmentation of two different local mandibular contour defects using polyetheretherketone (PEEK) patient-specific onlay implants. METHODS: Six patients with disfiguring local mandibular deformities were included in this study (five males and one female) and received seven PEEK patient-specific implants (PSI), virtually designed and surgically settled to augment seven mandibular defects, three deficient chins, and four mandibular angels. The analysis of the soft and hard tissue changes utilized the superimposition of the preoperative and the 6-month postoperative sagittal and coronal CT views, after standardizing the radiographic interpretation. RESULTS: The soft tissue gain for the chin was 6.8 mm ± 0.98 with a 45.8% increase versus 4.42 mm ± 0.41 with a 22.9% increase for the angle. The difference in the soft tissue gain between the two groups was statistically significant (P = 0.0001). Comparing the soft tissue gain to the planned implant thickness, the percentage of the soft tissue gain for the chin recorded 109.2% versus 65.57% for the angle. The difference between the two groups was also statistically significant (P < 0.0001). CONCLUSION: PEEK patient-specific onlay implants represented an efficient and straightforward modality to augment local mandibular contour deformities with favorable esthetic outcomes; the total soft tissue profile gain of the chin region markedly exceeded that of the mandibular angle.

Evaluation of the effect of the lateralized inferior alveolar nerve isolation and bone grafting on the nerve function and implant stability. (Randomized Clinical Trial).

BACKGROUND: The inferior alveolar nerve lateralization (IANL), although allows for an implant full-length mandibular height engagement, coincides with depleting the buccal bone support and sensory deficits. PURPOSE: This study aims to assess whether interposing a bone graft coupled with securing a collagen membrane separation between the inferior alveolar nerve (IAN) and the underlying dental implants would preserve the nerve function, enhance the implant stability, and minimize the radiographic marginal bone loss. MATERIAL AND METHODS: Eighteen patients with 30 atrophic mandibular edentulous ridges were subjected to IANL after being randomly assigned to two treatment modalities which consisted of 15 patients each. The (control group) utilized conventional IANL in direct contact with 20 implants. The (test group) implemented the IAN collagen-membrane wrapping and interposing bone graft to overlay 23 implants. The neural function, the radiographic marginal bone loss, and the implant stability quotient were assessed and compared 6 months postoperatively. RESULTS: All the patients regained their full neurosensory function after 6 months, with statistically nonsignificant differences between both groups throughout the follow-up period. The mean marginal bone loss in the test group was (0.42 ± 0.09) mm versus (0.38 ± 0.14) mm for the control group, which was statistically similar (P = 0.401). The 6-month postoperative mean implant stability quotient values of the test group recorded (74.73 ± 2.68) versus (74.73 ± 1.79) for the control group, which was statistically nonsignificant with a value of P = 0.626. CONCLUSION: The interposed bone graft, coupled with the collagen membrane isolation, neither subsided the neural disturbances nor enhanced the secondary implant stability and marginal bone loss.

CD44 Targeted Nanomaterials for Treatment of Triple-Negative Breast Cancer.

Identified as the second leading cause of cancer-related deaths among American women after lung cancer, breast cancer of all types has been the focus of numerous research studies. Even though triple-negative breast cancer (TNBC) represents 15-20% of the number of breast cancer cases worldwide, its existing therapeutic options are fairly limited. Due to the pivotal role of the presence/absence of specific receptors to luminal A, luminal B, HER-2+, and TNBC in the molecular classification of breast cancer, the lack of these receptors has accounted for the aforementioned limitation. Thereupon, in an attempt to participate in the ongoing research endeavors to overcome such a limitation, the conducted study adopts a combination strategy as a therapeutic paradigm for TNBC, which has proven notable results with respect to both: improving patient outcomes and survivability rates. The study hinges upon an investigation of a promising NPs platform for CD44 mediated theranostic that can be combined with JAK/STAT inhibitors for the treatment of TNBC. The ability of momelotinib (MMB), which is a JAK/STAT inhibitor, to sensitize the TNBC to apoptosis inducer (CFM-4.16) has been evaluated in MDA-MB-231 and MDA-MB-468. MMB + CFM-4.16 combination with a combination index (CI) ≤0.5, has been selected for in vitro and in vivo studies. MMB has been combined with CD44 directed polymeric nanoparticles (PNPs) loaded with CFM-4.16, namely CD44-T-PNPs, which selectively delivered the payload to CD44 overexpressing TNBC with a significant decrease in cell viability associated with a high dose reduction index (DRI). The mechanism underlying their synergism is based on the simultaneous downregulation of P-STAT3 and the up-regulation of CARP-1, which has induced ROS-dependent apoptosis leading to caspase 3/7 elevation, cell shrinkage, DNA damage, and suppressed migration. CD44-T-PNPs showed a remarkable cellular internalization, demonstrated by uptake of a Rhodamine B dye in vitro and S0456 (NIR dye) in vivo. S0456 was conjugated to PNPs to form CD44-T-PNPs/S0456 that simultaneously delivered CFM-4.16 and S0456 parenterally with selective tumor targeting, prolonged circulation, minimized off-target distribution.

A single-stage computer-guided gap arthroplasty with simultaneous patient-specific total joint replacement with a novel flat fossa design: A case report.

INTRODUCTION AND IMPORTANCE: The computer-guided approach for the patient-specific TMJ replacement is considered an ultimate reliable option in advanced cases. However, dislocation of the condylar head could happen with the concave fossa design. A flat design was described and used in this case. CASE PRESENTATION: A 15 years old male patient with mandibular asymmetry and class IV recurrent ankylosis of the right TMJ received a patient-specific artificial joint with computer-guided gap arthroplasty and orthognathic corrective mandibular surgery for the left side. The fossa component was made entirely flat, and the patient was followed up over the next year. CLINICAL DISCUSSION: Customized TMJ prosthetic solutions are reliable in advanced cases, especially when facial corrections are indicated; however, the commonly used concave design showed reported dislocations requiring some design modifications as proposed in the presented case. CONCLUSION: The flat fossa design of the artificial TMJ secures the same results as the anatomical fossa design without the incidence of dislocation.

The assessment of the effect of the size of lateral-antrostomy in graftless balloon elevation of the maxillary sinus membrane with simultaneous implant placement (a randomized controlled clinical trial).

BACKGROUND: The overlying maxillary sinus frequently restrains the height of the posterior maxillary bones. PURPOSE: Evaluating the effect of downsizing the antrostomy side-window on the stability of the installed implants and vertical bone gain, after employing a graftless antral membrane balloon elevation (AMBE). MATERIALS AND METHODS: The study is a randomized controlled clinical trial conducted on 20 patients with 30 deficient maxillary alveolar ridges underwent graftless (AMBE) after being allocated into a (5 mm) entry antrostomy group (the test group) and a (10 mm) entry antrostomy group (the control group) implementing a radiographic linear bone height and implant stability quotations (ISQ) comparison among both groups immediately after the placement of 38 Implants and 6 months after. RESULTS: Radiographic bone gain of the test group (5.55 ± 0.93 mm) was significantly higher than the control group (2.86 ± 0.60 mm) (p <0.001). There was no significant difference in primary stability between the test (65 ± 5.32) and control groups (62.67 ± 4.46) (p = 0.202); while the test group (73.43 ± 4.39) showed significantly higher secondary stability than the control group (64.83 ± 6.05) (p <0.001). ISQ values recorded at 6 months were significantly higher than those recorded at insertion in the test group (p <0.001), while they were insignificant in the control group (p = 0.148). CONCLUSION: Undersizing the antrostomy window deemed beneficial concerning the vertical bone gain and the simultaneously placed root form dental implants' secondary stability.

Collagenase IV and clusterin-modified polycaprolactone-polyethylene glycol nanoparticles for penetrating dense tumor tissues.

Purpose: Novel collagenase IV (ColIV) and clusterin (CLU)-modified polycaprolactone-polyethylene glycol (PCL-PEG) nanoparticles that load doxorubicin (DOX) were designed and fully evaluated in vitro and in vivo. Methods: PCL-PEG-ColIV was synthesized by linking PCL-PEG and ColIV through a carbodiimide method. DOX-loaded nanoparticles (DOX-PCL-PEG-ColIV) were self-assembly prepared, followed by noncovalently adsorbing CLU on the DOX-PCL-PEG-ColIV surface to obtain DOX-PCL-PEG-ColIV /CLU nanoparticles, which can penetrate through the tumor extracellular matrix (ECM) and inhibit phagocytosis by macrophage. The physicochemical properties of nanoparticles were characterized. The cellular uptake and antiphagocytosis ability of nanoparticles in MCF-7 tumor cells and RAW264.7 cells were investigated. The penetration ability of nanoparticles was individually evaluated in the two-dimensional (2D) and three-dimensional (3D) ECM models. The tissue distribution and antitumor effect of nanoparticles were evaluated in MCF-7 cell-bearing nude mice. Results: Compared with DOX-PCL-PEG-COOH nanoparticles, DOX-PCL-PEG-ColIV/CLU nanoparticles could effectively overcome the phagocytosis by RAW264.7 and showed excellent cellular uptake in MCF-7 cells. In addition, they showed remarkable penetration ability through the 2D and 3D ECM models. DOX-PCL-PEG-ColIV/CLU nanoparticles significantly reduced the drug distribution in the liver and spleen and enhanced the drug accumulation in tumor tissue compared with DOX-PCL-PEG-COOH or DOX-PCL-PEG-ColIV nanoparticles. DOX-PCL-PEG-ColIV/CLU nanoparticles showed remarkable antitumor effect but did not cause severe pathological damages in the main tissues, including the heart, liver, spleen, lung, and kidney. Conclusion: Novel ColIV and CLU-modified PCL-PEG nanoparticles showed excellent cellular uptake, ECM penetration, antiphagocytosis, and antitumor effects both in vitro and in vivo.

Rough approximation models via graphs based on neighborhood systems.

Neighborhood systems are used to approximate graphs as finite topological structures. Throughout this article, we construct new types of eight neighborhoods for vertices of an arbitrary graph, say, j-adhesion neighborhoods. Both notions of Allam et al. and Yao will be extended via j-adhesion neighborhoods. We investigate new types of j-lower approximations and j-upper approximations for any subgraph of a given graph. Then, the accuracy of these approximations will be calculated. Moreover, a comparison between accuracy measures and boundary regions for different kinds of approximations will be discussed. To generate j-adhesion neighborhoods and rough sets on graphs, some algorithms will be introduced. Finally, a sample of a chemical example for Walczak will be introduced to illustrate our proposed methods.

Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial.

BACKGROUND: Alveolar bone resorption and labial bone plate reduction follow teeth extraction due to the deficiency of blood supply, derived from the loss of periodontal ligaments, and hence the socket shield technique was introduced to preserve the periodontal ligaments related perfusion. PURPOSE: The study aimed to compare the vertical and horizontal changes of the buccal cortical bone plates, encountered after utilizing the socket shield technique with immediate temporization vs an immediate implant placement with immediate temporization, and analyzing the differences of the implant stability and pink esthetic score evaluation between both techniques. MATERIALS AND METHODS: A total of 40 dental implants were placed in the maxillary esthetic zone, 20 implants were placed using the socket shield technique with immediate temporization; the study group and 20 implants were placed immediately with immediate temporization; the control group. All patients received immediate and 6 months postoperative CBCT to assess the dimensional changes in the labial bone plates. Implant stability quotients (ISQs) and pink esthetic scores were measured at the time of implant placement and 6 months postoperatively. RESULTS: The horizontal bone loss; ranged from 0 to0.26 (0.15) mm and 0.03 to0.44 (0.32) mm for the study and control groups, respectively. The vertical bone loss; ranged from 0.11 to 0.55 (0.31) mm and 0.25 to 1.51 (0.7) mm for the study and control groups, respectively. The ISQ for the study group increased from 68.6 ± 3.81 to 76.7 ± 3.49, while in the control group it increased from 66.4 ± 5.64 to 75 ± 4.4. PES for the study group increased from 11 to 12, while in the control group it decreased from 13 to 9. CONCLUSION: The socket shield technique with immediate temporization is a reliable method to reduce the labial bone loss following teeth extraction. However, further studies are required to investigate the effect of grafting the jumping gaps, to evaluate the graft contribution in further reduction of the bone loss.

Horizontal ridge augmentation using native collagen membrane vs titanium mesh in atrophic maxillary ridges: Randomized clinical trial.

BACKGROUND: Several techniques have been proposed to reconstruct deficient alveolar ridges including bone blocks, ridge splitting and guided bone regeneration (GBR). GBR has been successfully established in restoring horizontal bone deficiency. However, yet still there is a debate regarding the ideal barrier for GBR. PURPOSE: To evaluate the quantity and the quality of the bone gained using collagen membrane with 1:1 mixture of autogenous and anoraganic bovine bone mineral compared to titanium mesh with the same mixture of bone for GBR of horizontally deficient maxillary ridges. MATERIALS AND METHODS: Two different grafting techniques were evaluated, 10 patients receiving GBR using native collagen membrane using 1:1 autogenous and anorganic bovine bone mineral (ABBM) bone mixture, and 10 patients receiving GBR using titanium mesh with same mixture of bone. RESULTS: Statistical analysis showed a significant increase in alveolar bone width in both techniques with a mean bone gain of 4.0 mm for Collagen group and 3.7 mm for titanium mesh group. Bone area percent was almost 28% for both groups. For Ti-mesh group, six sites soft tissue healing was uneventfully with no signs of wound dehiscence. However, four cases showed mesh exposure first 3 patients showed this exposure 3 weeks postoperatively while the fourth patient showed exposure 4 months postoperatively. The mean graft resorption in the Collagen and mesh group 6 months postoperative was considered nonsignificant. CONCLUSIONS: GBR with both collagen membrane and titanium mesh using a 1:1 mixture of autogenous and ABBM is a viable technique for horizontal augmentation of deficient maxillary alveolar ridges. Titanium mesh is a more technique sensitive compared to collagen membrane. Soft tissue dehiscence and difficulty during second stage removal should limit its use in augmentation of horizontally deficient maxillary ridges.

Maxillary sinus floor elevation using hydroxyapatite nano particles vs tenting technique with simultaneous implant placement: A randomized clinical trial.

PURPOSE: The present study was conducted to evaluate the amount of bone height gain, density values, and implant stability after maxillary sinus floor elevation using graftless tenting technique or the use of Hydroxyapatite Nanoparticles bone substitute for augmentation with simultaneous implant placement. MATERIALS AND METHODS: A total of 20 sinuses with a residual alveolar bone height ranging from 4-6 mm were divided into two groups and underwent sinus augmentation using nano hydroxyapatite bone substitute material and the graftless tenting technique with simultaneous implant placement. Computed tomography CT scans and ISQ measurements were conducted to evaluate bone quality, quantity, and implant stability. RESULTS: Radiographic analysis revealed that the mean bone height gain of the nano group was (7.0 ± 0.8 mm) compared to (5.0 ± 1.5 mm) in the tent group, which was statistically significant (P = .002) being higher in the nano group. The mean bone density value of the nano group was (548 ± 25 HU) compared to (420 ± 23 HU) in the tent group, which was statistically significant (P < .001) being higher in the nano group. The mean ISQ value after 6 months in the nano group was (78 ± 5) compared to (77 ± 5) in the tent group, which was statistically nonsignificant (P = .901). CONCLUSION: Nano hydroxyapatite bone graft offered superior results in terms of the bone height gain and the relative bone density as compared to graftless tenting technique. However, both techniques showed accepted results regarding implant stability.

Autogenous interpositional block graft vs onlay graft for horizontal ridge augmentation in the mandible.

BACKGROUND: Interpositional block graft revealed promising results in vertical ridge augmentation in the mandible, while scarce evidence is available regarding the use of interpositional block graft for horizontal ridge augmentation in the mandible. PURPOSE: To compare the efficacy of autogenous block interpositional graft vs onlay graft in terms of horizontal ridge augmentation in the mandible. MATERIALS AND METHODS: Twenty patients were randomly divided in two groups interpositional and onlay groups, using autogenous blocks harvested from the mandibular symphysis as the donor site. For the interpositional group, the mandibular ridge was split and the harvested block was inserted in the created space and fixated using titanium screws. For the onlay group, the defect site was decorticated and the harvested block was firmly fixated buccally using titanium screws. Immediate and 4 months postoperative cone beam computed tomography scans were taken for assessment. RESULTS: In the interpositional group, the mean preoperative bone width was 3.85 ± 0.6 mm, after 4 months, the mean bone width was 8.84 ± 0.54 mm. While in the onlay group, the mean preoperative bone width was 3.74 ± 0.83 mm while after 4 months the mean bone width was 7.37 ± 1.98 mm. this was statistically significant. CONCLUSION: Within the limits of this study, interpositional block graft appears to be a viable treatment option for horizontal ridge augmentation in the mandible.