Comparative evaluation of hard and soft tissue parameters by using short implants and standard long implants with sinus lift for prosthetic rehabilitation of posterior maxilla.

Objective: The objective is to compare and evaluate the hard and soft tissue parameters by using short and standard long implants with sinus lifting in the posterior maxilla. Materials and Methods: Eleven patients with complaints of missing upper back teeth were enrolled in the study for implant-supported rehabilitation and were categorized into two groups: Group long (GL): longer implant (>8 mm) placement, preceded by Sinus Augmentation. Group short (GS): short implant (≤8 mm) placement, without sinus augmentation. The primary outcome measured was cumulative survival rate (CSR) in the compromised partial edentulous posterior maxilla. Secondary outcomes measured were implant stability (IS), marginal bone level alterations (MBL), pocket probing depth (PPD), crown-to-implant ratio, and any complications. Results: The difference in CSR between the groups was not statistically significant (P = 0.317). High stability was achieved immediately after the placement of the implants, in both groups (GS: 64 ± 4.07, GL: 65.58 ± 9.75); this difference in the mean ISQ (IS quotients) values was not found to be statistically significant at implant placement (P = 0.7). The mean MBL reported in the study at the end of 12 months of prosthesis function was - 0.762 ± 0.48 mm and - 0.7 ± 0.34 mm for GS and GL, respectively. The mean PPD measurements in GS and GL groups were 1.917 ± 0.68 mm and 1.833 ± 0.38 mm, respectively, and it was not statistically significant (P = 0.8). Conclusion: Within the limitations of the present study, the obtained results indicate that short implants provided a similar clinical and radiographic performance compared to long implants placed in combination with a sinus augmentation procedure (lateral window) up to 12 months after prosthetic loading.

Comparative evaluation of mucin and total protein in periodontal disease before and after nonsurgical periodontal therapy.

Background: Periodontal ailments cause a quantum leap in the biomarker profile of the saliva. This profile is, in fact, the epiphany of the scale and extent of the disease. Both gingivitis and periodontitis are chronic inflammatory diseases with a step-grade progression. The study aimed to determine the response of the host in these conditions by analyzing concentrations of salivary mucin and total protein activity, before and after nonsurgical periodontal therapy (NSPT). Materials and Methods: Sixty adult subjects were clinically examined and divided into three groups (n = 20) according to the clinical assessment and categorized as Group I (healthy), Group II (gingivitis), and Group III (chronic periodontitis). Whole saliva was collected, and salivary mucin and total protein levels were quantitatively measured at baseline in all the groups and additionally after NSPT in Groups II and III. Results: Levels of mucin and total protein increased in patients with gingivitis and periodontitis. There was a slight decline in mucin levels in periodontitis patients in comparison with the gingivitis group. A positive correlation was found between the respective clinical parameters of both the groups along with their levels of salivary mucin and total protein. It indicated that the response of salivary glands to increase their protective potential caused the change among the groups. Conclusion: Periodontal diseases induce an increase in the levels of mucins and proteins, which is believed as the action of the salivary glands to protect the oral cavity and put off the chaos caused by the microorganisms.

Palatal bone block: A predictable bone augmentation technique for restricted maxillary defect.

Bone grafting for implant dentistry depends on bone quality, quantity, and biological principles for good outcome. Autogenous bone as donor remains the gold standard among all the available materials. However, it carries unpredictable morbidity and need for different surgical sites. In our report, we describe a simplified approach in bone augmentation for restricted maxillary atrophic defect within the same surgical site as a harvesting site. The method can be an alternative for different intraoral surgical harvesting sites. The patient's left maxillary central incisor before treatment had a large bony defect which was reconstructed though single site approach of augmentation. The implant-supported restoration with healthy periodontium around even after 2 years of review looks promising. The approach can be an alternative for different intraoral surgical sites.

Comparison between all-on-four and all-on-six treatment concepts on stress distribution for full-mouth rehabilitation using three-dimensional finite element analysis: A biomechanical study.

Purpose: The current study intended to provide a comparison of biomechanical behaviors of two different treatment concepts for full-mouth rehabilitation with dental implants placed according to the "All-on-four" concept and "All-on-six" concept with analysis of the stress patterns of the implant support system using three-dimensional finite element analysis (FEA). Materials and Methods: The edentulous mandible was treated with two different implant designs. "All-on-Four" implant placement concept was used in Model 1 with two central axial implants and two distally tilted implants at 17° and in Model 2, "All-on-Six" concept was applied with six vertically placed implants. Individual vertical and horizontal load of 100 N and oblique load of 141 N at 45° was applied to all implants. To evaluate and compare the results in terms of maximum principal stress, we used FEA. Results: All-on-six showed smaller maximum principal stress values on the cortical bone and implants. However, maximum principal stress values obtained on trabecular bone was smaller in the All-on-four design for vertical and horizontal loading conditions. Conclusions: The All-on-six approach showed more favorable biomechanical behavior.

Tent screws: Predictable guided bone regeneration.

Bone regeneration of large maxillary and mandibular alveolar ridge defects is clinically challenging. Various techniques have been described for the reconstruction of these deficiencies before implant placement. The tent screw-pole technique is one of the effective methods available for clinicians to perform the predictable functional and esthetic reconstruction. The aim of this prospective report was to evaluate clinical and three-dimensional radiographic analyses of two patients treated with xenograft and particulate autogenous bone using tenting screws for regeneration of compromised partial edentulous ridges.

Pink gingival restoration: An acceptable treatment for complex ridge defects.

Complex implant prosthetic reconstruction poses several challenges. The lost anatomy of periodontium due to trauma or long-standing missing teeth, especially in esthetic area, requires several surgical visits for recovery. The augmentation procedures are technique sensitive and unpredictable and need long commitment from the patient. They are time-consuming and expensive, and patients are often unwilling. The alternative for anatomically deficient partial edentulous sites could be prosthetic gingival restoration. They help in re-establishing natural contours, interproximal papilla, and further eliminating complex procedures. The other advantage is perfect horizontal and vertical transition between the prosthesis and adjacent tissues. This article describes two cases of completed gingival prosthetic prosthesis which corrected the missing architectures around lost teeth. It was well accepted by the patients and can be an alternative for unpredictable regenerative procedures.

Mango-shaped Bi-paddled pectoralis major myocutaneous flap reconstruction for large full-thickness defects post resection of squamous cell carcinoma of oral cavity: An analysis of 232 cases.

Objectives: The objective of the study was to examine the feasibility of bi-paddled pectoralis major myocutaneous (PMMC) flap reconstruction in patient undergoing full thickness composite resection. Materials and Methods: Inclusion criteria: The subjects chosen were patients with clinically T4A squamous cell carcinoma of buccal mucosa, lower alveolus, and maxilla in with skin involvement. Patients required a full-thickness composite resection of intraoral lesion, bone (mandibular segment and/or maxilla), and overlying involved skin and had modified radical neck dissection. Exclusion criteria: Patients not requiring full thickness composite resection including skin. Patients were observed postoperatively for early and late postoperative complications, starting of oral feeding, post-operative trismus, and dysphagia during subsequent follow-up and cosmetic outcome. Results: Overall, the complication rate was 33.8% out of which only 7.8% required major re-surgery with second flap reconstruction. This is comparable with other large series of PMMC flap. Clavien-Dindo Grade I complications were seen in 9.5%, Grade II in 69.7%, Grade IIIA in 13.4%, and Grade IIIB in 7.45% of patients. Full-thickness partial flap necrosis included necrosis of either the external or the internal skin paddle. There were 15 cases - 6.5% of full thickness external paddle necrosis. These were mostly in patients with bite composite resections and having a larger random fasciocutaneous distal component of the flap without underlying muscle. Furthermore, 40% of these patients were females. In females, the flap necrosis comprised 4 of the 12 patients (33.33%). Conclusion: Pectoralis major mycocutaneous flap has been a boon to reconstruction of the oral cavity post its inception. In case of locally advanced squamous cell carcinomas of the oral cavity, in many instances, there is a clinically significant cervical lymph nodal spread vessels post mandating a comprehensive lymph node dissection. PMMC flap provides a robust well vascularized muscular cover to the cervical vessels poststernocleidomastoid excision.

Natural teeth and implant-retained prosthesis in treated periodontitis subjects.

History of periodontal disease is a risk factor for the development of peri-implantitis. Implant treatment in susceptible patients should be followed by adequate periodontal treatment and stringent supportive programs. The assessment of the patient needs to be carefully evaluated before the procedure for implants. The risk associated with the sites to be treated requires evaluation with regular visits. The completion of treatment will still require committed follow-up visits with checks for pockets, bone loss, and plaque scores around implant-retained prosthesis as well as complete dentition. In our report, we describe in detail the reconstruction of lost dentition with implants in treated periodontitis subjects. The patients are still being followed with regular recall programs.

An interdisciplinary approach for reconstruction of worn dentition.

Complete tooth wear dentition is multifactorial and has challenges with diagnosis and etiology. Their rehabilitation often requires orthognathic surgery, orthodontics, periodontal surgery, and prosthodontic guidelines for occlusion with harmonious facial and dental esthetics. A patient needs a multidisciplinary approach with systematic analysis to formulate evidence-based approach to improve function and esthetics. Contemporary periodontal therapy also encompasses esthetic treatment where needs are frequently associated with changes in tooth size, shape, proportion, and balance that can adversely affect smile appearance. The article provides an evidence-based guideline for reconstruction of a worn dentition. The completed work includes crown lengthening, provisionalization, socket shield technique, oral implants, and gain in lost vertical dimension with occlusion correction and minimally invasive prosthetic restorations.

En Block Versus Separate Management of Cervical Nodes in Tongue and Floor of the Mouth Cancers- Is There a Difference? An Analysis of 85 Cases in a Tertiary Care Institute.

To evaluate difference in local recurrence, regional (neck) recurrence as well as distant metastases between cases operated with en-block excision of primary cancer and neck nodes versus their separate removal, in squamous cell carcinomas of anterior 2/3 of tongue and floor of the mouth. A total 85 patients of cT1-T4a N0-N2b of carcinoma anterior 2/3 of tongue and floor of mouth were evaluated. Amongst these patients 39 cases of in-continuity en-block neck dissection and 46 cases of discontinuous neck dissection were evaluated for post-operative complications as well as oncological outcome for a follow up period of 3 years. Patient population was similar in both groups with tongue cancers being the commonest site and tobacco being the most common addiction. Primary site hematoma was seen more in the in-continuity en-block neck dissection group with a p-value of 0.0276, which was statistically significant. Post-operative oro-cutaneous fistula occurred more in in-continuity enblock neck dissection as compared to discontinuous neck dissection, but the difference was not statistically significant. Local recurrence rate was significantly more in cases of discontinuous neck dissection (19.565) as compared to in-continuity en-block neck dissection (5.12%) with a p-Value 0.0481. A statistically non-significant but higher loco-regional recurrence was observed in cases of discontinuous neck dissection as compared to cases of in-continuity en-block neck dissection (10.56% vs 2.56). In the present study recurrence-free survival RFS 3 year in cases of en-block in-continuity neck dissection (84.06%) cases as compared to discontinuous neck dissection cases (63.04%) with p Value 0.025698. In-continuity en-block in continuity neck dissection has lower loco-regional recurrence and may impact overall distant metastases. Though early postoperative complications are more in in-continuity en-block in continuity neck dissection as compared to discontinuous neck dissection, most are managed conservatively. Further studies with a larger sample size are needed to evaluate its outcome in a comprehensive manner.

Soft-tissues stabilization after immediate implant; platform switch with supraperiosteal augmentation.

The architecture around an oral implant pushes the clinicians for an equalization of biological and physiological requirements. An esthetic implant-supported restoration needs plethora of knowledge and expertise. Surgeon skills can be of use for correct tridimensional position of implant in the extraction socket, shaped abutment contours, and anatomical final crown. An immediate implant placement for a fresh socket requires existing oral parameters judgment and evidence-based treatment plan. They are hard- and soft-tissue relationship, gingival biotype, and the tooth position. In this article, we describe a case of immediate implant placement, provisional crown, bovine bone contraction, soft-tissue collapse, and its management.

One-piece implants: Careful approach for complex rehabilitation.

It is understood that one-piece implant design is a stronger concept as there is no connection between implant and abutment. The absence of a microgap can lead to minimal peri-implant bone loss. Furthermore, there is a reduction of mechanical complications such as screw loosening and abutment fractures. These implants can be immediately placed and can be put through instant function because of their high cortical stabilization. This immediate function protocol has advantages over two-stage surgical placement. Other benefits are fewer surgical appointments, reduced treatment time, and minimal trauma. It is suggested that one-piece implant can be an alternative to conventional implants for edentulous arches where there is a resorbed bone in width and height. Initially, one-piece implants were used as transitional or provisional implants. However, because of biological osseointegration, their removal often became difficult. Several manufacturers obtained approval for its use in defined situations. Proper treatment planning avoided comorbidity associated with augmentation procedures and acceptable esthetic result was achieved.

Terminal dentition to functional esthetic full-mouth implant reconstruction: Evidence-based approach.

Implant-supported fixed dental prosthesis is a well-accepted treatment option for edentulism. Loss of teeth due to extensive caries or severe periodontitis presents a challenge to the clinicians. Young age disability with either of these problems can further make full-mouth rehabilitation on implants a complex procedure. The outcome of implant surgery with periapical infections and periodontal inflammation is unpredictable and often delays the placement of dental implants. Here, we describe a case of full-mouth reconstruction with implant-supported prosthesis in a young individual who lost all her teeth due to extensive caries. The journey from terminal dentition to functional esthetic rehabilitation was uneventful.

Socket shield: An esthetic success?

Dental implants require adequate bone, three dimensionally, for successful osseointegration. The extraction socket changes in the dimension had been described in several studies. Implant in extraction socket cannot prevent resorption of the surrounding tissues. The bony alterations make oral esthetic implant reconstruction difficult without hard- and soft-tissue augmentation. Placement of bone substitute material and immediate implant were not able to completely establish an esthetic outcome. A novel technique of retaining the buccal aspect of the tooth root during implant placement has shown preservation of esthetics. Hard and soft tissues were preserved in their original form around the replaced tooth. The retained root on the buccal aspect of an oral implant is observed to have formed cementum and to some aspects of osseointegration with the surrounding tissues. It is called socket-shield technique and if completed meticulously can be an alternative for regenerative materials and soft-tissue grafting. In our report, we completed 14 cases of the said technique with 5-year follow-up. The results looked promising as none of the cases required guided bone regeneration procedures. This may become the future noninvasive method for the preservation of hard and soft tissues around an oral implant in esthetic areas.

Evaluation and comparison of stress distribution around periodontally compromised mobile teeth splinted with different materials: Three-dimensional finite element analysis.

BACKGROUND: Progressive attachment loss around the teeth because of periodontal disease can result in increased tooth mobility. This adversely affects patient's comfort, function, and esthetics. Periodontal splinting helps in accomplishing stability by redistributing the functional and parafunctional forces. There are various materials that have been used for periodontal splinting. Fiber-reinforced composite, composite resin, and metal-reinforced composite are often used as splinting materials for periodontally compromised teeth. In our study, a comparison was done among these materials for their ability to distribute the stresses at different bone levels in mobile lower incisors splinted together with canines. MATERIALS AND METHODS: Five patients of age group 25-50 years with Grade 2 and 3 mobile incisors having 40% or more bone loss and firm canines with optimal bone support were selected. From the computed tomography scan of each patient, three models were developed demonstrating splinting of mandibular incisors and canines with metal-reinforced composite, fiber-reinforced composite, and composite resin. So in total, 15 models were developed and each one of them was subjected to vertical and transverse loads of 150 N. Pattern of stress distribution was observed in these models using three-dimensional finite element analysis. RESULTS: After splinting, the stress on the canine increased when bone levels around incisors decreased while stress on incisors reduced. CONCLUSION: Tested splinting materials were successful in stress distribution, and metal-reinforced composite was found to be better than the other splinting materials.

Implant therapy in patients with chronic periodontitis: A short follow-up with a successful outcome.

Chronic periodontitis is a progressive disease with loss of several teeth. Implant therapy in these patients can be a successful outcome as long as the tissues are kept healthy from a microbiologic viewpoint. Regular follow-up visits after complex reconstruction is the key for long-term success. In our report, recall visits were kept on short intervals for ten years. The results showed that implants were very good prosthetic replacements in chronic sufferers of the disease but regular followups are the gold standard.

Myeloperoxidase level around dental implants as an indicator of an inflammatory process.

AIM: Myeloperoxidase (MPO) has been widely used as an inflammatory marker of both acute and chronic conditions. The aim of the present study was to analyze MPO found in the peri-implant sulcus fluid of implants (PISF) and gingival cervicular fluid (GCF) of natural teeth in healthy or diseased states. MATERIAL AND METHODS: A total of 107 dental implant sites, either healthy/noninflamed, inflamed or affected by periodontitis, were classified and GCF/PISF samples were obtained. GCF/PISF MPO was spectrophotometrically determined. RESULTS: Both the GCF and the PISF volumes exhibited a gradual increase with gingival inflammation (P < 0.05). PISF from inflamed sites (P = 0.0001) and GCF from the gingivitis and periodontitis sites showed significantly higher total MPO levels (P < 0.05) in comparison with the noninflamed sites. The volumetric similarities of PISF and GCF in terms of response to inflammation were seen in the present study. However, some differences in PISF and GCF were observed. CONCLUSION: PISF may be suggested to have a considerable diagnostic potential as it exhibits the biologic changes around load-bearing endosseous dental implants.

Microsurgical aesthetic treatment of gingival fenestration by a coronally repositioned partial thickness graft: a case report.

Gingival fenestration is a rare pathological entity, scarcely described in the literature. The present paper has reported a case of a 22-year-old male patient with a "Gingival fenestration" in the lower left central incisor. The lesion was successfully treated using a coronally positioned partial thickness graft under 4 X magnification, with excellent aesthetic results.

Isolated Hypoglossal Nerve Palsy due to Infected Impacted Tooth.

Case of isolated hypoglossal nerve palsy is an extremely rare condition. There are several causes that can be attributed to it. We present a case where a patient presented herself with swelling on the right side of her cheek extending to the floor of the mouth, with unilateral right hypoglossal nerve palsy. Removal of the impacted tooth resulted in the improvement of function of the hypoglossal nerve. The transient isolated hypoglossal nerve palsy could have been due to the infected impacted tooth. Therefore, the dentist or doctors coming across with isolated hypoglossal nerve palsy should consider the infected impacted tooth as the differential diagnosis.

Intraosseous follicular adenomatoid odontogenic tumour-a case report.

The adenomatoid odontogenic tumour is a relatively uncommon lesion which mainly affects females in their second decade of life. It exhibits a predilection for the anterior region of the maxilla. The lesion is usually associated with the crown of an embedded tooth, most commonly the maxillary canine. In this paper, we present a case of adenomatoid odontogenic tumor affecting the left maxillary region in a 24-year-old female. The authors also discuss clinical, radiographic, histopathologic, and therapeutic features of the case.