Impacted Mandibular "Double" Third Molar: Fusion or Gemination? A Case Report.

Dental fusion is defined as an abnormality in tooth shape caused by developmental tooth disturbances that produce an intimate union of dental tissues. This case report discusses treatment of a mandibular impacted "double" third molar in a 21-year-old patient that could have been related to either gemination or tooth fusion. Radiological examination allowed for careful analysis of the tooth's shape and root development, relation to the inferior alveolar nerve, and 3-dimensional position. After evaluation of therapeutic options and risks, and with the patient's consent, the authors opted to extract the tooth in question. Such favorable conditions as the incomplete development of the roots and the relatively young age of the patient, combined with the use of an antibiotic and antiseptic prophylaxis as well as a standard surgical approach, enabled a successful result to be achieved with no related complications.

Autogenous graft versus collagen matrices for peri-implant soft tissue augmentation. A systematic review and network meta-analysis.

OBJECTIVE: The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of matrices (acellular dermal matrix-ADM, xenograft collagen matrix-XCM, volume-stable collagen matrix-VCMX) used to increase peri-implant soft tissues. MATERIALS AND METHODS: A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements. RESULTS: A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days. CONCLUSIONS: While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients' morbidity. LIMITATIONS: The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups). CLINICAL RELEVANCE: Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.

Detection and sensing of oral xenobiotics in edentulous patients rehabilitated with titanium dental implants: Insights from a scoping review.

STATEMENT OF PROBLEM: Titanium has been considered the standard element in implant manufacturing. Recent studies have evaluated the role of titanium as a biological modulator of oral health. However, evidence regarding the association between the release of metal particles and peri-implantitis is lacking. PURPOSE: The purpose of this scoping review was to evaluate the literature regarding the release of metal particles in peri-implant tissues correlated with the methods of detection and the local and systemic implications. MATERIAL AND METHODS: The study was performed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and was registered with the National Institute for Health Research PROSPERO (Submission No. 275576; ID: CRD42021275576). A systematic search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE via PubMed, Scopus, and Web of Science bibliographic databases, complemented by a manual evaluation. Only in vivo human studies written in the English language and published between January 2000 and June 2022 were included. RESULTS: In total, 10 studies were included according to eligibility criteria. Different tissues and analytic techniques were reported: the characterization technique most used was inductively coupled plasma mass spectrometry. All 10 studies analyzed the release of metal particles in patients with dental implants, continuously detecting titanium. None of the studies reported a significant association between metal particles and biological effects. CONCLUSIONS: Titanium is still considered the material of choice in implant dentistry, despite the detection of metal particles in peri-implant tissues. Further studies are necessary to evaluate the association between analytes and local health or inflammatory status.

Tooth Germ Autotransplantation With 24 Months of Follow-up: A Case Report.

The autotransplantation of a third molar represents an alternative treatment solution for filling an edentulous space that may exist because of traumatic avulsion, agenesis, large carious processes, or other reasons, particularly in young patients. Autotransplantation can offer many benefits, including maintenance of a normally functioning periodontium, preservation of pulp vitality, and completion of root formation. This case report describes a successful autotransplantation of an open-apex maxillary third molar germ to replace a hopeless mandibular first molar in a growing patient. After 24 months of follow-up, the donor tooth showed physiological mobility, absence of infection and ankylosis, positive pulp vitality, and fully formed periodontal integration. Radiographic examination confirmed a remarkable radicular edification.