POST-SURGICAL NEUROSENSORY DYSFUNCTION OF INFERIOR ALVEOLAR NERVE IN BILATERAL SAGITTAL SPILT OSTEOTOMY OF THE MANDIBLE USING SAW VERSUS PIEZOTOME: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PURPOSE: The purpose of this systematic review was to compare neuro-sensory dysfunction incidence between saw and piezotomes in patients requiring bilateral sagittal split osteotomy. METHODS: Searches were performed electronically in 4 databases (PubMed, LILACS, Cochrane Library, and grey literature) up to September 2020 and manually to identify studies addressing the subject. Randomized and non-randomized clinical trials were included. RESULTS: Six studies met the eligibility criteria with a total number of 284 participants. The risk of bias assessment for randomized clinical trials was high, and for non-randomized clinical trials was critical and serious. Regarding inferior alveolar neuro-sensory dysfunction, the meta-analysis showed no significant difference between saw and piezotome 1 week [RR = 0.99, 95% CI (0.90, 1.08) P = 0.79], and 3 months [RR = 0.39, 95% CI (0.09, 1.75) P = 0.22], post-operatively. CONCLUSIONS: For patients requiring bilateral sagittal split osteotomy, piezotomes seem to offer no advantage over conventional saws regarding the incidence of neurosensory disturbance. Follow-up periods longer than 3 months may reveal faster physiologic regain of sensations. They seem to be safer than conventional saws regarding blood loss. However, proper training for using the device is mandatory, while considering the longer operating time required. Further RCTs are still recommended to improve the level of evidence.

Clinical, volumetric and densitometric evaluation of tissue engineered constructs for secondary alveolar cleft reconstruction: A randomized clinical trial.

The objective of this study was to assess the efficacy of tissue engineered (TE) constructs compared to the standard autogenous anterior iliac crest (AIC) bone graft in secondary maxillary alveolar cleft reconstruction. This clinical trial was registered on (clinical trials.gov); the trial registry number is: NCT03563495. Patients with unilateral alveolar clefts were allocated on the basis of simple randomization. Selected patients were randomly divided into two equal groups: the AIC group (control) received autogenous particulate bone graft from anterior iliac crest, whereas the TE group received tissue engineered construct. Assessment included the newly formed bone volume and density at the grafted cleft sites, which were measured immediately, 6 and 12 months postoperatively on axial computed tomograms. The study population included 10 patients; each group comprised 5 patients. There was no statistically significant difference between the 2 groups regarding the mean volume of the newly formed bone (p = 0.91 at 6 months, p = 0.994 at 1 year) and the mean density of the newly formed bone (p = 0.364 at 6 months, p = 0.073 at 1 year). However, there was a significant increase of TE graft density from 6 months to 1 year (p = 0.048). Within the limitations of the study it seems that the tissue engineered construct (collagen/osteogenically differentiated bone marrow-derived mesenchymal stem cells) might be an alternative to autogenous bone for unilateral secondary alveolar cleftgrafting.

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.

Guided maxillary sinus floor elevation using deproteinized bovine bone versus graftless Schneiderian membrane elevation with simultaneous implant placement: Randomized clinical trial.

OBJECTIVE: The aim of this study is to evaluate the analytical difference between the use of xenograft (control group) and graftless tenting (test group) technique after sinus lift procedure with simultaneous implant placement. MATERIALS AND METHODS: Seventeen patients and 20 sinuses where operated for sinus lift procedures using lateral window approach with simultaneous implant placement. Deproteinized bovine bone (Xenograft) was used as a filling material in control group while nongrafted sinus lifting was performed in the test group. Multislice CT was obtained preoperatively and CBCT were obtained immediately postoperative and 6 months after operation. Osstell readings were taken at the time of implant placement and implant exposure (6 months) RESULTS: Mean bone height gain in the xenograft group was 8.59 ± 0.74 while that of the tenting group was 4.85 ± 0.5 and it was statistically significant (P < .05). Mean bone density values in the xenograft group was 375.59 ± 49.38 while that of the tenting group was 269.08 ± 16.27 and it was statistically significant (P < .05). Mean ISQ values for the xenograft group was 78.3 ± 5.08 while that of the tenting group was 74 ± 3.19 and it was statistically significant (P < .05). CONCLUSIONS: Within the limitation of this study, sinus lift procedures with simultaneous implant placement using xenograft as a filling material or graftless technique are considered reliable procedures, however, the use of xenograft provide better results in all aspects regarding (bone height gain, bone density, and implant stability).

Computer guided sinus floor elevation through lateral window approach with simultaneous implant placement.

BACKGROUND: The introduction of CAD/CAM technology in implant dentistry has marked a new era, allowing various procedures to be carried out with a level of great precision and accuracy. PURPOSE: The aim of the present study is to compare the efficacy of a CAD/CAM generated surgical cutting guide in the reduction of incidence of membrane perforation during maxillary sinus floor elevation in relation to the standard lateral window approach technique. MATERIALS AND METHODS: Twenty cases of maxillary sinus elevation were randomly divided into 2 groups. The first group received computer guided sinus floor elevation through lateral window approach and simultaneous implant placement while the second group received standard sinus elevation procedure through lateral window approach with simultaneous implant placement. RESULTS: In the computer guided group, 3 out of 10 cases presented with sinus septa, only 1 case suffered from membrane perforation during the elevation process. In the non-guided group, 3 cases suffered from membrane perforation, 2 of which were complicated by sinus septa. CONCLUSION: Within the limits of this study, computer guided sinus floor elevation showed promising results in accurately modifying the lateral window osteotomy and presents as a safe alternative to the standard technique.

Midfacial Reconstruction - A Systematic Review.

AIM: Different lesions affecting the midfacial regions require surgical reconstruction. The aim of this study was to assess the different methods used in midfacial reconstruction after maxillectomy procedures. The various reported surgical reconstructive techniques focusing on the esthetic and functional outcomes are to be reviewed in this article. MATERIAL AND METHODS: A thorough PUBMED and hand-search of journals of relevance was performed on related terms and yielded 772 titles of which 45 abstracts were selected and obtained as full articles for further evaluation while the rest were excluded by title/abstract. According to the inclusion criteria; 14 of these studies were used to complete this article. RESULTS: In this review we showed that fibular and radial vascularized grafts were the most commonly reported methods in literature with a few other options. Computer aided design and surgical planning has been also reviewed and seems to be a rapidly evolving option for maxillofacial reconstruction. Lack of RCTs (randomized controlled trials) and large scale case series was noticed in this review making the evidence of poor quality. CONCLUSION: Methods of evaluation of reconstruction options mainly qualitative and subjective made the evaluation of the techniques in this review difficult.

Nongrafted sinus floor elevation with a space-maintaining titanium mesh: case-series study on four patients.

PURPOSE: Numerous materials and techniques have been introduced to augment the maxillary sinus floor for future dental implant placement. Schneiderian membrane tenting above simultaneously placed implants proved to be a successful technique. The present study investigated the use of a titanium micromesh for lateral-window sinus floor elevation without bone grafting. MATERIAL AND METHODS: Four patients indicated for two-stage sinus lifting were included. Through a lateral window, a titanium micromesh was tailored and placed into the sinus to maintain the elevated membrane in place. Immediate and 6-month postoperative cone beam computed tomography (CBCT) was performed to measure the gained bone height. During implant placement, bone core biopsies were retrieved for histomorphometry. RESULTS: The average residual ridge height among the eight sinuses was 3.6 mm ± 1.6 mm. Six months postoperatively, it reached 9.63 mm ± 1.47 mm. Histomorphometry revealed that the average bone volume of the native bone was 30.3% ± 9.1%, while that of the newly formed bone was 55.3% ± 11.4%. CONCLUSION: Within the limitations of this study due to the small sample size, the use of the titanium micromesh as a space-maintaining device after schneiderian membrane elevation is a reliable technique to elevate the floor of the sinus without grafting.

Clinical and radiographic evaluation of a computer-generated guiding device in bilateral sagittal split osteotomies.

The bilateral sagittal split osteotomy (BSSO) is one of the main orthognathic surgery procedures used for managing skeletal mandibular excess, deficiency or asymmetry. It is known to be a technique-sensitive procedure with high reported incidences of inferior alveolar nerve injury, bad splits and post-surgical relapse. With the increasing use of computer-assisted techniques in orthognathic surgery, the accurate transfer of the virtual plan to the operating room is currently a subject of research. This study evaluated the efficacy of computer-generated device at maintaining the planned condylar position and minimizing inferior alveolar nerve injury during BSSO. The device was used in 6 patients who required isolated mandibular surgery for correction of their skeletal deformities. Clinical evaluation showed good recovery of the maximal incisal opening and a reproducible occlusion in 5 of the 6 patients. Radiographic evaluation showed better control of the condyle position in both the vertical and anteroposterior directions than in the mediolateral direction. The degree of accuracy between the planned and achieved screw positions were judged as good to excellent in all cases. Within the limitations of this study and the small sample size, the proposed device design allowed for good transfer of the virtual surgical plan to the operating room.