Titanium and polyether ether ketone (PEEK) patient-specific sub-periosteal implants: two novel approaches for rehabilitation of the severely atrophic anterior maxillary ridge.

The aim of this study was to assess two new protocols for single-stage rehabilitation of the severely atrophic maxillary ridge using customized porous titanium or polyether ether ketone (PEEK) sub-periosteal implants. Ten patients with a severely atrophic anterior maxillary alveolar ridge were divided randomly into two groups (five patients in each) to receive customized sub-periosteal implants fabricated via CAD/CAM technology: group 1, porous titanium implants; group 2, PEEK implants. Prosthetic loading with fixed acrylic bridges was performed 1 month postoperative. The implants were followed-up for 12 months and evaluated for the presence of any sign of radiographic bone resorption, mobility, infection, prosthetic fracture, or implant exposure. The immediate postoperative period was uneventful except for one case complicated by wound dehiscence in group 1. At 12 months, all implants were functionally stable and the patients were comfortable with the prostheses. No signs of radiographic bone resorption, mobility, infection, or prosthetic fracture were observed. Within the limitations of this study, the application of customized porous titanium and PEEK sub-periosteal implants produced through CAD/CAM technology appears to be an acceptable method for single-stage prosthetic rehabilitation of the severely atrophic edentulous anterior maxilla. This study was awarded the best case study at the academy of osseintegration annual meeting 2017, Orlando, Florida.

Botulinum toxin injection for management of temporomandibular joint clicking.

The aim of the present study was to investigate the effect of botulinum toxin type A (BTX-A) injection in the lateral pterygoid (LP) muscle on temporomandibular joint (TMJ) clicking. The study enrolled seven patients with a total of 11 joints; all patients were stage I or II of Wilke's staging for internal derangement. BTX-A was injected in the ipsilateral LP muscle with electromyogram (EMG) guidance and the subjects were assessed for 4 months. Maximum inter-incisal opening, range of lateral movement, and the presence of a click were recorded throughout the follow-up period, and magnetic resonance imaging (MRI) was ordered at the end of the 4 months. The results showed that the decrease in inter-incisal opening and side to side movement immediately postoperative was statistically significant, while the difference by the end of the follow-up period was insignificant. MRI showed a marked improvement in disc position postoperatively. It may be concluded that BTX injection in the LP muscle leads to the disappearance of joint clicking clinically and a significant improvement in disc position as shown on MRI.