Randomized clinical trial comparing PEG-based synthetic to porcine-derived collagen membrane in the preservation of alveolar bone following tooth extraction in anterior maxilla.

OBJECTIVES: The objective of this randomized controlled trial was to compare alveolar ridge preservation using a bone substitute material and covered with a synthetic or porcine collagen membrane. MATERIALS AND METHODS: Thirty-two sockets in the aesthetic maxillary region of 30 patients were randomized into two groups. Randomization was stratified according to bone wall defect. Flapless technique was used, and sockets were grafted with bi-phasic calcium phosphate particulate bone substitute and covered by synthetic polyethylene glycol (PEG; test group) or porcine-derived collagen membrane (CM; control group). No primary closure was attempted. A cone beam computed tomography (CBCT) scan was performed immediately after the surgical procedure and repeated 22 weeks later. OnDemand3D was used to superimpose scan images and assess changes. The mean vertical and horizontal percentage bone loss were calculated and implants placed after 6 months with or without additional augmentation. RESULTS: There were no baseline differences between groups or dropouts. The mean percentage loss at the labial plate and at the coronal part of the sockets was statistically significantly lower in the test group compared with controls (-2.86% [SD = 13.48] versus 7.42% [SD = 11.95]; 13.45% [SD = 11.97] versus 28.59% [SD = 16.97]). Implants were placed after 6 months, and there was no difference in need for further augmentation between PEG (n = 5) or CM (n = 4). CONCLUSION: Sites treated with PEG membrane showed less percentage loss in horizontal and vertical measurements in this trial.

Prosthetic Rehabilitation of a Patient Diagnosed With Sarcoidosis Using Dental Implants: A Clinical Case Report.

No previously published studies have reported on the placement and restoration of dental implants in a patient diagnosed with sarcoidosis. Patients with sarcoidosis may develop periodontitis as a manifestation of systemic disease and are therefore at increased risk of tooth loss. These patients are likely to want fixed dental prostheses, which may need to be supported by dental implants. The case presented is that of a 31-year-old female patient presenting with a missing maxillary central incisor and a sarcoidal process affecting the anterior maxilla, which had severely compromised the periodontium of the adjacent lateral incisor. The patient was successfully rehabilitated with an implant-retained prosthesis following a staged horizontal and vertical bone augmentation procedure. At the 4-year review, the implant restoration performed well with stable peri-implant bone levels. We conclude that dental implant rehabilitation in patients with sarcoidosis may be a predictable treatment option, depending on disease stability and concurrent systemic therapy, but these patients will require additional maintenance because of the possibility of an increased risk of peri-implantitis. The effects of sarcoidosis and its management on the success of dental implants are discussed to aid treatment planning for such patients.

Replicating a discolored tooth preparation: A technique for effective laboratory communication.

Fabricating a ceramic restoration for a discolored anterior tooth presents a clinical challenge. The dental technician is often hampered by being unaware of the shade of the discolored tooth preparation, which influences the color of the overlying ceramic restoration. A definitive cast that replicates the shade of the prepared tooth helps the ceramist to fabricate a restoration that masks the discoloration appropriately and still achieves the desired optical properties. This report demonstrates the use of a technique of recording and communicating the shade of a prepared tooth to the dental laboratory technician.

Management of severe mandibular deviation following partial mandibular resection: a case report.

Extensive mandibular resection commonly leads to a deviation of the mandible, facial disfigurement, and difficulty with speech and mastication. The rehabilitation of these patients is a prosthodontic challenge. This article presents the case of a 60-year-old man who sought prosthetic rehabilitation after a right segmental mandibulectomy. The prosthetic rehabilitation was planned in 2 phases. A palatal ramp was constructed, followed by a mandibular guiding flange. After 4 months, the patient's chewing ability, tongue movement, and facial esthetics were improved.

Evaluation of experimental coating to improve the zirconia-veneering ceramic bond strength.

PURPOSE: To evaluate the shear bond strength (SBS) between zirconia and veneering ceramic following different surface treatments of zirconia. The efficacy of an experimental zirconia coating to improve the bond strength was also evaluated. MATERIALS AND METHODS: Zirconia strips were fabricated and were divided into four groups as per their surface treatment: polished (control), airborne-particle abrasion, laser irradiation, and application of the experimental coating. The surface roughness and the residual monoclinic content were evaluated before and after the respective surface treatments. A scanning electron microscope (SEM) analysis of the experimental surfaces was performed. All specimens were subjected to shear force in a universal testing machine. The SBS values were analyzed with one-way ANOVA followed by Bonferroni post hoc for groupwise comparisons. The fractured specimens were examined to observe the failure mode. RESULTS: The SBS (29.17 MPa) and roughness values (0.80) of the experimental coating group were the highest among the groups. The residual monoclinic content was minimal (0.32) when compared to the remaining test groups. SEM analysis revealed a homogenous surface well adhered to an undamaged zirconia base. The other test groups showed destruction of the zirconia surface. The analysis of failure following bond strength testing showed entirely cohesive failures in the veneering ceramic in all study groups. CONCLUSION: The experimental zirconia surface coating is a simple technique to increase the microroughness of the zirconia surface, and thereby improve the SBS to the veneering ceramic. It results in the least monoclinic content and produces no structural damage to the zirconia substructure.

The Anatomic Inter Relationship of the Neurovascular Structures Within the Inferior Alveolar Canal: A Cadaveric and Histological Study.

OBJECTIVE: The location and inter relationship of the structures of the inferior alveolar neurovascular bundle within the mandibular canal has not been clearly defined. The knowledge of the same is important while planning surgeries in the posterior mandible. METHODS: Eight cadaveric mandibles were dissected and sections were made at the distal aspect of every tooth. The inferior alveolar neurovascular bundle was identified and examined for the location of the inferior alveolar artery, vein and nerve. Hematoxylin and Eosin sections were made for each specimen to confirm the position of these structures. RESULTS: All the sections in all the specimens confirmed that a blood vessel lies superior to the nerve. This position appeared consistent in all the positions relative to all the posterior teeth. There was a variation in the bucco-lingual positioning of these structures relative to each other for the various mandibles. CONCLUSION: A blood vessel is found to always lie superior to the inferior alveolar nerve within the mandibular canal. Variations in the inter relationship of the structures is present. SIGNIFICANCE: This cadaveric study proves that all along the course of the neurovascular bundle, at various cross-sections studied, the inferior nerve is always inferior to a blood vessel. There can be great variations to the positioning of the structures within the neurovascular bundle in the bucco-lingual dimension and also in the exit of the nerve in various mandibles. Knowledge of the location of the structures is of importance during surgical procedures carried out in the vicinity of these structures.

Easy Accurate Transfer of the Sculpted Soft Tissue Contours to the Working Cast: A Clinical Tip.

Tooth replacement in the esthetic zone presents a myriad of challenges for the clinician. An ovate pontic accurately duplicates the emergence profile of the natural tooth it replaces in order to provide an esthetic, yet cleansable prosthesis. The accurate transfer of this sculpted tissue beneath the pontic of the provisional restoration is critical to provide the dental laboratory technician with the necessary information to fabricate a definitive restoration with an appropriate emergence profile. This article presents an innovative, simple and convenient impression technique for easy and accurate transfer of the tissue contours to the working cast, avoiding tissue collapse and tissue compression produced due to the impression material.