Vascular Delay Soft Tissue Technique in Oral/Maxillary Bone Reconstructive Surgery: A Technical Note.

PURPOSE: The present study describes a new presurgical soft tissue technique in oral/maxillary bone reconstructive surgery for reducing the risk of soft tissue dehiscence and its related complications. MATERIALS AND METHODS: Ten consecutive patients with Cawood and Howell type V atrophy were scheduled for CAD/CAM titanium mesh bone reconstructive surgery after applying the vascular delay technique 21 days before regenerative surgery. The surgical and healing complications were clinically assessed at nine time points, ranging from the time of bone regenerative surgery to 9 months after surgery. Surgical complications included flap damage and neurologic and vascular complications. Healing complications were subdivided into four classes. These classes comprised Class I: small membrane exposure (≤ 3 mm) without purulent exudate; Class II: large membrane exposure (> 3 mm) without purulent exudate; Class III: membrane exposure with purulent exudate; and Class IV: abscess formation without membrane. RESULTS: The study sample included seven men and three women (mean age: 48.2 ± 3.5 years) with seven mandibular cases and three maxillary cases. The defect length ranged from three to six teeth, with a mean mesiodistal distance of 29.9 ± 8.5 mm and a mean volume augmentation of 2.03 ± 0.9 cm3. There were no surgical complications. One patient presented a Class I healing complication that did not affect the regeneration outcome. CONCLUSIONS: The vascular delay technique appears to reduce the risk of soft tissue dehiscence and exposure in bone regenerative surgery, though randomized studies involving larger samples and longer follow-up periods are needed in order to draw firm conclusions.

Three-Dimensional Evaluation of the Accuracy of Zygomatic Implant Placement Through an In-House Fully Guided Approach.

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.

Extramaxillary Zygomatic Implant Coverage with a Pedicled Buccal Fat Pad Flap Through a Tunnel Approach: A Prospective Case Series.

PURPOSE: To describe the benefits of covering the extrasinusal length of extramaxillary zygomatic implants with a pedicled buccal fat pad flap through a tunnel approach. MATERIALS AND METHODS: Four extramaxillary zygomatic implants were placed in 10 patients and loaded immediately with an acrylic provisional fixed prosthesis. The extrasinusal length of every implant was covered with a pedicled buccal fat pad flap. Study variables were implant survival rate, peri-implant soft tissue recession (PISTR), peri-implant soft tissue condition (PISTC), modified Bleeding Index (mBI), and suppuration. The statistical analysis comprised the Brunner-Langer model of longitudinal data for each variable and the analysis of variance to assess main effects and interactions. RESULTS: All the zygomatic implants showed osseointegration, resulting in a survival rate of 100%. The PISTR was evaluated after surgery (T0) and after 12 months (T1), statistically significant differences being observed (P = .014). Recession also depended on specific implant positioning; zygomatic implants in the anterior were found to have a higher risk of recession vs implants in the posterior (P = .065). The PISTC was assessed at T0 and T1, and no statistically significant changes were observed (P = .718). Bleeding on probing was present in 10% of the implants at T0 and in 15% at T1, the difference being nonsignificant (P = .317). CONCLUSION: The use of a pedicled buccal fat pad flap to cover the extrasinusal length of extramaxillary zygomatic implants appears to reduce the risk of soft tissue recession and exposure of the implant surface to the oral cavity.

Fiabilidad del uso de la tomografía computarizada de haz cónico en la localización y medida del conducto mandibular en la planificación de técnicas quirúrgicas en el cuerpo mandibular / Reliability of cone beam computed tomography in locating and measuring the mandibular canal for planning of surgical techniques in the mandibular body

Objetivo. El objetivo de nuestro estudio fue determinar la fiabilidad del estudio tomográfico para localizar el conducto mandibular y tomar mediciones exactas del diámetro de dicho conducto y de la pared ósea vestibular, como mediciones principales en la planificación de la toma de injerto óseo de cuerpo mandibular. Material y método. Se estudiaron 11 mandíbulas (22 hemimandíbulas) de cadáver fresco, la mitad de ellas dentadas, a las cuales se les realizaron una CBTC y un procedimiento quirúrgico de lateralización del nervio dentario inferior con el objetivo de medir el grosor de la tabla vestibular y el grosor del conducto mandibular o dentario inferior (CDI) a los 5, 15 y 25 mm de la parte más posterior del agujero mentoniano. Resultados. Los resultados obtenidos por nuestro estudio indican que el CBTC, siendo el mejor método diagnóstico disponible en la actualidad, aún presenta diferencias respecto a la realidad. Esta discrepancia es de 1,15 mm de media con relación al grosor de la tabla ósea vestibular que lo recubre y de 0,3 m de media con relación al grosor del CDI. Discusión. Conocer y valorar estas discrepancias es importante dada la multitud de procedimientos quirúrgicos que se pueden realizar en esta zona, y la vecindad con el nervio dentario inferior (AU)

Aim. The aim of this study was to determine the reliability of cone beam computed tomography to locate and take measurements of the mandibular canal, as well as the vestibular bone wall, in the planning of the bone graft surgery in the mandibular body. Material and methods. A total of 11 mandibles from fresh cadavers were studied (22 hemi-mandibles, half of them with teeth). A CBTC and a surgical procedure for the lateralization of the lower dental nerve were performed with the aim of measuring the thickness of the vestibular table and the mandibular canal (MC) or lower dental nerve at 5, 15, and 25 mm from the most posterior position of the mentonian hole. Results. The results obtained in the study indicate that CBTC, being the best diagnostic tool currently available, still appears to be unreliable when compared to actual resultshas. This discrepancy is a mean of 1.15 mm as regards the thickness of the vestibular bone wall that covers the MC, and a mean of 0.3 mm in relation to the thickness of the lower dental nerve. Discussion. It is important to know and assess these discrepancies in view of the multitude of surgical procedures that can be performed in this area, and in the vicinity of the lower dental nerve (AU)