Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial.

PURPOSE: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. MATERIALS AND METHODS: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. RESULTS: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). CONCLUSIONS: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. CLINICAL RELEVANCE: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. TRIAL REGISTRATION: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).

Patient-specific PEEK implant for treatment of temporal myositis ossificans (five years follow-up): A case report.

Myositis ossificans of the temporalis muscle results in a cosmetic problem both before and after treatment because of the preoperative swelling and the postoperative defect respectively. The authors hypothesized that a patient-specific Polyether-ether ketone implant can be appropriate for immediate obliteration and reconstruction of such defect benefiting from the accuracy of CAD/CAM technology and computer-guided maxillofacial surgery. A Forty-year-old male patient with myositis ossificans affecting the left temporalis muscle was treated with a computer-guided surgical approach, a patient-specific implant was fabricated to obliterate the defect and avoid temporal hollowing using PEEK material. The functional and cosmetic results were satisfactory both immediately and at the 5-year follow-up, except that the skin over the implant was noticed to be stretched after 5 years. Hence, it can be concluded that virtual surgical planning and PEEK patient-specific implants are reliable in the immediate reconstruction of post-surgical temporal hollowing.

The Virtual Surgical Management of Facial Fibrous Dysplasia.

PURPOSE: Fibrous dysplasia (FD) is a benign condition, which is characterized by the replacement of normal bone with fibrous tissue and the deposition of woven bone in an irregular manner. Surgical resection, careful corrective osteotomies as debulking, and recontouring procedures are frequently performed, but can be complicated by postoperative regrowth of the lesion. The main aim of this study was to introduce a computer-guided technique for a predetermined technique of bone contouring of craniofacial FD involving the facial bones. METHODS: This case report was conducted on an 18-year-old girl complaining of unilateral craniofacial dysplasia. Upon clinical examination and radiographic examination, a customized computer-generated bone contouring guide was designed using virtual surgical software for accurate contouring of excess bone in the cranial vault and frontal bone. This guide was virtually designed after importing the multislice computerized tomography scans into the virtual surgical planning software. It was generated based on the mirroring option of the unaffected normal side along the median sagittal plane. In the surgery, the guide was seated in place and 5 mm implant drills were inserted through the guide depth holes. Bone removal was made using surgical burs connecting the guiding depth holes. RESULTS: At the end of the follow-up, the patient showed acceptance of her external appearance with no signs of infection or dehiscence. CONCLUSION: This patient-specific cutting guide shows a promising solution for preplanned bone removal in cases with unilateral craniofacial FD.

Accuracy of patient-specific temporal implants using PEKK.

The main aim of this study was to evaluate the accuracy of immediate CAD/CAM reconstruction of the temporal hollowing following temporalis muscle surgery, using a patient-specific implant (PSI) PEKK model. This case series included ten patients who underwent maxillofacial reconstruction using temporalis muscle flap (TMF). The study involved the preoperative planning and fabrication of the temporal implant using virtual surgical planning software. The planning was based on multislice CT scans, from which DICOM files were used to fabricate a 3D model of the temporalis muscle using polyetherketoneketone (PEKK). The patients were followed up for 12 months, to check for any signs of infection or mobilization, and to assess accuracy. At the end of the follow-up period, all the patients showed acceptance of the external appearance, with no signs of infection or rejection. These customized implants were measured and compared with their original 3D preoperative planning using a point-based analysis. This revealed a mean difference (±SD) of 0.0373 (±0.3036) mm and a median difference (Q1 to Q3) of 0.0809 (-0.2108 to 0.2769) mm. The study demonstrated that a highly accurate duplication of PSIs can be achieved using this template-molding workflow. The use of PEKK PSIs resulted in uneventful healing and esthetic acceptance by the patients and, therefore, is a relevant treatment option when temporal hollowing has to be corrected.

Assessment of bone density and stability with immediately loaded dental implants with the All-on-Four technique in free vascularized fibular grafts used for mandibular reconstruction.

BACKGROUND: Following free fibula flaps (FFF) reconstruction of mandibular defects the patients need an early dental rehabilitation to regain their masticatory function and enhance their feeding and nutrition. METHODS: This study included 10 patients, with mandibular defects previously reconstructed with FFF that span the area between the two mandibular angles. They received a full arch fixed restoration supported by four implants using a pilot drilling guide to perform a flapless operation. The stability of the placed dental implants was assessed along with the changes in bone density. RESULTS: There was a statistically significant increase in stability after 3 and 6 months, and there was a decrease in density after 6 months. The patient satisfaction improved over the follow-up period. CONCLUSION: The All-on-Four technique is reliable and economic for early functional rehabilitation of resected jaws reconstructed with FFF; however, further studies are needed to investigate the changes in fibula bone density over time and with function.

Oropharyngeal Administration of Mother's Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial.

BACKGROUND: Oropharyngeal administration of mother's colostrum in early days has an immunoprotective effect in preterm infants. OBJECTIVES: Our aim was to study the effect of oropharyngeal administration of mother's milk (OPAMM) on decreasing the incidence of nosocomial sepsis. METHODS: In a pilot prospective randomized study on preterm (<32 weeks gestation and 1500 g weight) infants, we compared OPAMM practice (applying 0.2 mL of mother's colostrum or milk prior to gavage feeding until full oral feeding is reached) with regular gavage feeding. The primary outcome was incidence of culture-proven nosocomial sepsis. Secondary outcomes included bacterial colonization of the gastrointestinal tract, feeding intolerance, time to reach full feeding, incidence of necrotizing enterocolitis, ventilator-associated pneumonia, duration of respiratory support, incidence of bronchopulmonary dysplasia (BPD), length of hospital stay, and neonatal mortality. RESULTS: The outcomes of 200 neonates (100 in each group) were analyzed. OPAMM practice did not significantly reduce the incidence of culture proven nosocomial sepsis (8% vs 13%, P = 0.35). Infants in the OPAMM group had a significantly lower growth of Klebsiella species in the oropharyngeal pouch, borderline lower incidence of ventilator-associated pneumonia, shorter duration of oxygen therapy, less episodes of feeding intolerance, reached full feeding earlier, and had a shorter length of hospital stay. OPAMM practice did not affect the incidence of necrotizing enterocolitis, BPD, or neonatal mortality. CONCLUSION: OPAMM prior to gavage feeding does not reduce the incidence of nosocomial sepsis but had beneficial effects on early achievement of feeding, and early hospital discharge in preterm very low-birth-weight infants.

Histomorphometric evaluation of a nano-sized eggshell-containing supplement as a natural alloplast: An animal study.

BACKGROUND: Limitations of autogenous grafts have dictated the need for development of new biomaterials that can serve as allografts. A paradigm shift directed manufacturers to revert to nature in the search for such allografts. This study aimed to evaluate an eggshell-based supplement, Membrell's® BONEhealth Plus D3 & K2, indicated to support bone mineral density, as a natural bone graft material. METHODS: Twelve 5 × 10 × 1 mm full-thickness cranial bone defects were created in six adult male New Zealand rabbits. Six defects were filled with Membrell's® BONEhealth™ Plus D3 & K2, and the others were left empty as control. The animals were sacrificed 14 days postoperatively. The defects were dissected and prepared for histological assessment. Bone formation was compared both qualitatively and quantitatively. The area percent of newly-formed bone was evaluated in five successive regions using image analysis. Statistical analysis was performed using unpaired t-test. Differences between the two groups were considered significant at p ≤ 0.05. RESULTS: Cranial bone defects filled with the nano-sized eggshell powder "Membrell's® BONEhealth™ Plus D3 & K2" revealed significantly higher levels of osteoid, newly-formed, regularly-arranged bone trabeculae in the center of the defects (47.37% ± 1.12) compared to the control defects (21.6% ± 4.92), which revealed no bone formation. A rapid rate of resorption of the nano-sized eggshell powder and consequently a rapid osteogenic effect was evident. CONCLUSIONS: The eggshell-based graft powder, Membrell's® BONEhealth™ Plus D3 & K2, is a biocompatible material which has the potential to enhance new bone formation.

Sustained lung inflation at birth for preterm infants at risk of respiratory distress syndrome: The proper pressure and duration.

BACKGROUND: Variations exist among the administered pressure and duration of sustained lung inflation (SLI) in the delivery room (DR). We aimed to evaluate the appropriate pressure and duration needed for SLI in preterm infants with respiratory distress syndrome. METHODS: We prospectively randomized 100 preterm (<32 weeks) infants to receive either conventional therapy of continuous positive airway pressure (CPAP) at 5 cm H2O, or four groups of CPAP plus a single maneuver of SLI at four regimens based on administered pressures and durations; P20D20 (Pressure of 20 cm H2O for a duration of 20 seconds), P20D10 (20 cm H2O for 10 seconds), P15D20 (15 cm H2O for 20 seconds), and P15D10 (15 cm H2O for 10 seconds) using a T-piece ventilator. The primary outcome was the need for endotracheal intubation (ETT) in the DR. Broncho-alveolar lavage (BAL) was obtained from intubated infants for interleukin-10 (IL-10) assessment. RESULTS: SLI decreased the need for ETT in the DR (21% versus 55%, p < 0.01) compared to conventional therapy. ETT requirement was significantly lower in P20D10 (20%), P15D20 (20%), and P15D10 (20%) groups, but not P20D20 (25%) compared to the conventional group (55%, p < 0.05). Group P20D20 had significant higher BAL levels of IL-10 [713.8 (IQR 611-874) versus 535.4 (IQR 480-563) pg/ml, p < 0.05] compared to the conventional group, and to other SLI groups. Pneumothorax was not significantly different among studied groups. CONCLUSION: SLI for a pressure and duration ≥20 cm H2O for 20 seconds is not superior to lower pressures for shorter duration and may be injurious to lungs.