The effect on the performance of a dynamic navigation system of superimposing a standard tessellation language (STL) file obtained with an intraoral scan on a cone beam computer tomograph (CBCT). An experimental in vitro study.

OBJECTIVES: To compare the accuracy and operative time of implant placement using a dynamic computer assisted implant surgery (dCAIS) system based on a cone beam computer tomography (CBCT) image, with and without superimposing a standard tessellation language (STL) file of an intraoral scan of the patient. METHODS: Ten identical resin models simulating an upper maxilla with posterior edentulism were assigned to two groups. In the CBCT+STL group, a CBCT file and an intraoral STL file were superimposed and used for registration; in the CBCT group, registration was performed using CBCT images. Six implants were placed in each model using the Navident® dynamic navigation system. Anatomy registration was performed by tracing fiducial points on the CBCT or STL image, depending on the group. Preoperative and postoperative CBCT images were overlaid to assess implant placement accuracy. RESULTS: Sixty implants were analyzed (30 implants in each group). 3D platform deviation was significantly lower (mean difference (MD): 0.17 mm; 95 % confidence interval (CI): 0.01 to 0.23; P = 0.039) in the CBCT+STL group (mean: 0.71 mm; standard deviation (SD): 0.29) than in the CBCT group (mean: 0.88 mm; SD: 0.39). The remaining accuracy outcome variables (angular deviation MD: -0.01; platform lateral deviation MD: 0.08 mm; apex global MD: 0.01 mm; apex depth MD: 0.33 mm) and surgery time (MD: 3.383 min.) were similar in both groups (p > 0.05). CONCLUSIONS: The introduction of an intraoral scan (STL) seems to reduce deviations slightly in dental implant placement with dCAIS systems. However, the clinical repercussion of this improvement is questionable. CLINICAL SIGNIFICANCE: Superimposing an intraoral scan on the CBCT image does not seem to increase the accuracy of dCAIS systems but can be useful when radiographic artifacts are present.

Histological assessment of a novel de-epithelialization method for connective tissue grafts harvested from the palate. An experimental study in cadavers.

OBJECTIVES: This study aims to compare the histological outcomes of three distinct de-epithelialization methods used in (connective tissue grafts) CTG harvested from the palate. MATERIALS AND METHODS: An experimental study using nine cadaver head specimens was carried out to compare 3 different de-epithelialization techniques for CTG. Eighteen samples were randomly allocated to three study groups: bone scraper, diamond bur and extraoral removal with a scalpel. The main outcome variable was the graft surface percentage without epithelium remains. Additionally, the time employed, and the graft thickness were also measured. RESULTS: Sixteen CTGs were analyzed. The extraoral scalpel group presented a total surface area with no epithelium of 58.84% (22.68) and a mean de-epithelialization time of 3.7 min; the intraoral diamond bur group had 88.24% (41.3) of the surface with no epithelium and took 1.455 min, and the intraoral bone scraper showed 97.98% (5.99) of surface without epithelium and a mean time of 0.815 min (P < 0.05). Histological analysis showed significant differences between the bone scraper and the extraoral group (P = 0.009). CONCLUSION: The de-epithelialization technique with a bone scraper seems to be the most effective and fastest de-epithelialization technique for CTG. These findings need to be confirmed in future clinical studies with larger samples. CLINICAL RELEVANCE: The use of bone scrapers, could be a simple, effective and fast technique to de-epithelialize connective tissue grafts harvested from the palatal area for both novice and experienced surgeons.

The influence of radiographic marker registration versus a markerless trace registration method on the implant placement accuracy achieved by dynamic computer-assisted implant surgery. An in-vitro study.

OBJECTIVES: This study aimed to compare the effect the radiographic marker registration (RMR) and markerless tracing registration (MTR) on implant placement accuracy using a dynamic computer-assisted implant surgery system (dCAIS). Additionally, this study aimed to assess the surgical time and whether the implant location influences the accuracy of the two registration methods. METHODS: 136 dental implants were randomly allocated to the RMR or MTR group and were placed with a dCAIS in resin models. Preoperative and postoperative Cone Beam Computer Tomograms (CBCT) were overlaid and implant placement accuracy was assessed. Descriptive and multivariate analysis of the data was performed. RESULTS: Significant differences (P < 0.001) were found for all accuracy variables except angular deviation (RMR:4.30° (SD:4.37°); MTR:3.89° (SD:3.32°)). The RMR had a mean 3D platform deviation of 1.53 mm (SD:0.98 mm) and mean apex 3D deviation of 1.63 mm (SD:1.05 mm) while the MTR had lower values (0.83 mm (SD:0.67 mm) and 1.07 mm (SD:0.86 mm), respectively). In the MTR group, implant placement in the anterior mandible was more accurate (p < 0.05). Additionally, MTR did not significantly increase the surgical time compared with RMR (P = 0.489). CONCLUSIONS: MTR seems to increase the accuracy of implant placement using dCAIS in comparison with the RMR method, without increasing the surgical time. The operated area seems to be relevant and might influence the implant deviations. CLINICAL SIGNIFICANCE: Considering the limitations of this in-vitro study, MTR seems to provide a higher accuracy in implant placement using dCAIS without increasing the surgical time. Furthermore, this method does not require radiographic markers and allows re-registration during surgery.

Hamular bursitis as a cause of orofacial pain. A case report.

Pterygoid hamular bursitis is an infrequent cause of orofacial pain due to a hypertrophic pterygoid hamulus. The pain is often referred to the pharynx, temporomandibular region and facial zone, and requires a differential diagnosis with other craniofacial entities. This paper describes a patient with pterygoid hamular bursitis that presented pain of neuropathic characteristics in the left retromolar region, associated with odynophagia and temporomandibular joint disorders. Based on the clinical and radiological findings, a surgical resection of the pterygoid hamulus was decided. After the surgical procedure the patient still reported symptoms so additional specific treatments such as peripheral nerve block and infiltration were performed. Four months later, the patient developed a squamous cell carcinoma on the left margin of the tongue, which was surgically treated. At present (thirty months follow-up), the patient has no pain or signs of tumor relapse. Key words:Pterygoid hamular bursitis, orofacial pain, oral carcinoma, temporomandibular joint disorders, radiofrequency, neuropathic pain.

Accuracy of dental implant placement with or without the use of a dynamic navigation assisted system: A randomized clinical trial.

OBJECTIVES: To assess dental implant placement accuracy with a dynamic computer-assisted implant surgery (dCAIS) system and a freehand approach. Secondarily, to compare the patients' perception and quality of life (QoL) with the two approaches. METHODS: A double-arm randomized clinical trial was conducted. Consecutive partially edentulous patients were randomly allocated to the dCAIS or standard freehand approach groups. Implant placement accuracy was evaluated by overlapping the preoperative and postoperative Cone Beam Computer Tomographs (CBCT) and recording linear deviations at the implant apex and platform (in mm) and angular deviations (in degrees). Questionnaires recorded self-reported satisfaction, pain and QoL during surgery and postoperatively. RESULTS: Thirty patients (22 implants) were enrolled in each group. One patient was lost to follow-up. A significant difference (p < .001) in mean angular deviation was found between the dCAIS (4.02°; 95% CI: 2.85 to 5.19) and the FH (7.97°; 95% CI: 5.36 to 10.58) groups. Linear deviations were significantly lower in the dCAIS group, except for the apex vertical deviation, where no differences were found. Although dCAIS took 14 min longer (95% CI: 6.43 to 21.24; p < .001), patients in both groups considered the surgical time acceptable. Postoperative pain and analgesic consumption during the first postoperative week were similar between groups and self-reported satisfaction was very high. CONCLUSION: dCAIS systems significantly increase the accuracy of implant placement in partially edentulous patients in comparison with the conventional freehand approach. However, they increase the surgical time significantly and do not seem to improve patient satisfaction or reduce postoperative pain.

Blood spatter in oral surgery: Prevalence and risk factors.

BACKGROUND: Oral surgeons are exposed to blood spatter. The authors evaluated the prevalence of and risk factors for blood spatter in facial masks during oral surgery procedures. METHODS: The authors evaluated facial masks and caps of oral surgeons and assistants for blood spatter using the Kastle-Meyer test after different oral surgery procedures. The authors correlated the presence of blood spatter to the clinician, type of surgery, surgery time, and self-awareness of blood spatter, using χ2 and t tests. RESULTS: The authors analyzed a total of 202 samples and detected blood particles in 46% of the samples in both operators and assistants. The authors observed blood contamination in all types of procedures, and in 4% of the cases, the internal part of the visor was also affected. Clinicians were unaware of the presence of blood spatter in 40% of the cases. CONCLUSIONS: The risk of clinician contamination with blood during tooth extraction and implant placement was 46%. The risk increased with the use of high-speed instruments and longer surgery time. PRACTICAL IMPLICATIONS: The use of facial protective devices should be mandatory during oral surgery procedures to avoid blood contamination, especially when rotary devices are used. In many cases, imperceptible blood spatter is present.

Dental implants after the use of bichat's buccal fat pad for the sealing of oro-antral communications. A case report and literature review.

Oro-antral communications are frequent complications in oral surgery, and generally occur after molar extractions, maxillary sinus elevations or dental implant procedures. The presence of these defects may increase the morbidity and often need a surgical approach. The present report describes an oro-antral communication in a 52-year-old female who presented a 2 week-course of painless nasal obstruction and rhinorrea after a right maxillary sinus floor elevationwith simultaneous dental implant placement. Based on the anamnesis, clinical examination and a computed tomographyof the paranasal sinuses, a diagnosis of odontogenic rhinosinusitis associated with a 1.5 cm diameter oro-antral communicationwas establishedand its surgical closure using Bichat's buccal fat pad was planned.After 15 months, the patient was successfully rehabilitated with an implant-supported 3 unit fixed partial denture. Key words:Dental implants, buccal fat pad, oro-antral communications.

Lipoescultura facial: técnica quirúrgica y revisión bibliográfica / Facial liposculpture: surgical technique and literature review

Esta revisión presenta la infiltración de grasa autóloga como un procedimiento de gran utilidad para el relleno de las partes blandas faciales con objetivos estéticos o reconstructivos. Se ha realizado una revisión sobre los procedimientos de lipoescultura de la literatura publicada en PubMed. Se describen la técnica de Coleman, la técnica subdérmica, y la infiltración intramuscular, así como sus principales modificaciones, y los agentes estudiados y usados para incrementar la tasa de mantenimiento del injerto graso(AU)

This review shows that autologous fat grafting is useful for filling the soft tissues of the face for cosmetic and reconstructive purposes. The literature on liposculpture techniques published on PubMed was reviewed. The Coleman technique, subdermal technique, and intramuscular infiltration are described, in addition to their primary modifications, and the agents used to improve fat graft maintenance were studied(AU)