Mathematical equations for dental implant stability patterns during the osseointegration period, based on previous resonance frequency analysis studies.

BACKGROUND: Total stability of dental implant can be obtained from resonance frequency analysis (RFA) device, but without primary and secondary stability values. PURPOSE: To formulate mathematical equations for dental implant stability patterns during the osseointegration period. MATERIALS AND METHODS: An online systematically search of the literature between January 1996 and December 2017 was performed for all prospective clinical trials that measured implant stability using RFA device during the osseointegration period. Initial mathematical function with adjustable parameters were created. Then curve-fitting was performed using a computerized program to formulate mathematical equations stability patterns. RESULTS: Nine publications (24 study groups) were included in the mathematical analysis. Curve fitting with low sum of squared errors could be applied in all studies, except one. The stability has been divided into high, medium, and low stability. The curve fitting showed stability dip areas and intersection point which predict the returning of the stability to reach the primary stability. The study groups with low primary stability showed the poorest results, the high and medium stability group showed the stability pattern following the assumed primary stability pattern according to the mathematic equations. CONCLUSIONS: The model of primary and secondary stability could be predicted from the proposed equations.

Implants in patients with oral manifestations of autoimmune or muco-cutaneous diseases - A systematic review

Background: To give an overview on implant survival rates in patients with oral manifestations of systemic autoimmune (oral Lichen planus (oLp), Pemphigus (Pe)), muco-cutaneous (Epidermolysis bullosa (EB)), autoimmune multisystemic rheumatic diseases (Sjögren's syndrome (SjS), systemic Lupus erythematosus (sLE), or systemic Sclerosis (sSc)). Material and Methods: Systematic literature review (PubMed/Medline, Embase) using MESH and search term combinations, published between 1980 and August 2018 in English language reporting on dental implant-prosthetic rehabilitation of patients with oLp, Pe, EB, SjS, sLE, sSc, study design, age, gender, follow-up period (≥ 12 months), implant survival rate. Implant-related weighed mean values of implant survival rate (wmSR) were calculated. Results: After a mean follow-up period (mfp) of 44.6 months, a wmSR of 98.3 % was calculated from data published for patients with oLp (100 patients with 302 implants). Data of 27 patients (152 implants) with EB revealed wmSR of 98.7 % following mfp of 32.6 months. For 71 patients (272 implants) with SjS, wmSR was 94.2 % following a mfp of 45.2 months, and for 6 patients (44 implants) with sSc, wmSR was 97.7 % after mfp of 37.5 months. One case report on one patient each with Pe (two implants) as well as sLE (6 implants) showed 100 % SR following at least 24 months. Conclusions: Guidelines regarding implant treatment of patients with oLp, Pe, EB, SjS, sLE or sSc do not exist nor are contraindicating conditions defined. Implant survival rates of patients affected are comparable to those of healthy patients. For implant-prosthetic rehabilitation of patients with Pe and sLE no conclusions can be drawn due to lack of sufficient clinical data. Implant-prosthetic treatment guidelines regarding healthy patients should be strictly followed, but frequent recall is recommended in patients affected with oLp, SjS, EB, SSc, Pe or sLE

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Comparative Clinical Study of Conventional Dental Implants and Mini Dental Implants for Mandibular Overdentures: A Randomized Clinical Trial.

BACKGROUND: Dental implant-retained overdentures have been chosen as the treatment of choice for complete mandibular removable dentures. Dental implants, such as mini dental implants, and components for retaining overdentures, are commercially available. However, comparative clinical studies comparing mini dental implants and conventional dental implants using different attachment for implant-retained overdentures have not been well documented. PURPOSE: To compare the clinical outcomes of using two mini dental implants with Equator® attachments, four mini dental implants with Equator attachments, or two conventional dental implants with ball attachments, by means of a randomized clinical trial. MATERIALS AND METHODS: Sixty patients received implant-retained mandibular overdentures in the interforaminal region. The patients were divided into three groups. In Groups 1 and 2, two and four mini dental implants, respectively, were placed and immediately loaded by overdentures, using Equator® attachments. In Group 3, conventional implants were placed. After osseointegration, the implants were loaded by overdentures, using ball attachments. The study distribution was randomized and double-blinded. Outcome measures included changes in radiological peri-implant bone level from surgery to 12 months postinsertion, prosthodontic complications and patient satisfaction. RESULTS: The cumulative survival rate in the three clinical groups after one year was 100%. There was no significant difference (p < 0.05) in clinical results regarding the number (two or four) of mini dental implants with Equator attachments. However, there was a significant difference in marginal bone loss and patient satisfaction between those receiving mini dental implants with Equator attachments and conventional dental implants with ball attachments. The marginal bone resorption in Group 3 was significantly higher than in Groups 1 and 2 (p < 0.05); there were no significant differences between Groups 1 and 2. There was no significant difference in patient satisfaction between Groups 1 and 2 but it was significantly higher than that in Group3 (p < 0.05). CONCLUSIONS: Two and four mini dental implants can be immediately used successfully for retaining lower complete dentures, as shown after a 1-year follow up.

Relation between the stability of dental implants and two biological markers during the healing period: a prospective clinical study.

OBJECTIVES: The purposes of this study were to examine the correlation between the stability of dental implants and bone formation markers during the healing period and to monitor the stability of dental implants using the resonance frequency analysis (RFA) method. The null hypothesis of the study is no correlation between the stability of dental implant and bone formation markers. METHODS: The study is a prospective clinical study during the 3-month healing period of implant. At implant placement (PW Plus, Nakhon Pathom, Thailand) and after 1, 2, 3, 4, 6, 8, 10, and 12 weeks, RFA assessments were performed and gingival (GCF)/peri-implant crevicular fluids (PICF) were collected from ten patients. The level of osteocalcin (OC) was measured by using ELISA kits, and the level of alkaline phosphatase (ALP) activity was measured by colorimetric analysis. Repeated measures analysis of variance, the Friedman test, the Mann-Whitney U test, and the Pearson correlation were performed for data analysis. RESULTS: There was a statistical decrease in the mean implant stability quotient (ISQ) values between 1 and 3 weeks (P < 0.05). The ISQ values recovered to the initial values at 4 weeks. There was no statistical difference in the ALP level at each measurement, while there was a statistical increase in the OC level at 6, 8, 10, and 12 weeks when compared with 1 week (P < 0.05). There was a significant correlation between ALP levels and ISQ values (r = 0.226, P < 0.05). There was a statistically significant correlation between OC levels and ISQ values at 1-12 weeks (r = 0.245, P < 0.05). CONCLUSIONS: The ISQ values were weakly correlated with both ALP and OC. The three-thread-design implant showed a high stability through healing period.

The adenomatoid odontogenic tumour: an update of selected issues.

The aim of this update was to present the recent notable progress within remaining questions relating to the adenomatoid odontogenic tumour (AOT). Selected issues that were studied included the following: (i) AOT history and terminology, (ii) the so-called peripheral AOT, (iii) AOT and the gubernaculum dentis and (iv) the so-called adenomatoid odontogenic cyst (AOC). The earliest irrefutable European case of AOT was described in 1915 by Harbitz as 'cystic adamantoma'. Recently, Ide et al. have traced two Japanese cases with irrefutable proof described by Nakayama in 1903. The so-called peripheral (gingival) variant of AOT seems to cover a dual pathogenesis, both an 'erupted intraosseous' and an 'extraosseous' (gingival) one. In 1992, we theorized that the generally unnoticed gubernaculum dentis (cord and canal) seems to be involved in the development of AOT. Ide et al. have concluded that the dental lamina in the gubernacular cord seems to be an embryonic source of the vast majority of AOTs. The suggestion by Marx and Stern to change the nomenclature of AOT to adenomatoid odontogenic cyst (AOC) is critically discussed. The present authors agree on the background of the work of several groups of researchers and WHO/IARC classifications that the biology of the follicular variant of AOT is already fully explained and does not make room for any change in diagnostic terms. Further, there is no reason to change terminology in this case where improvements or conditions to better clinical management are not an issue.

Ebola virus disease: any risk for oral and maxillo-facial surgery? An overview.

The 2014-2015 outbreak of the Ebola virus disease (EVD) in West Africa has been considered a major global health emergency by the WHO. Implications for health care providers including oral and maxillo-facial surgeons have been published by the WHO, the Centers for Disease Control and Prevention (USA), and other medical societies and public health organizations. While the risk of infection with the Ebola virus seems to be rather small in Europe, maxillo-facial and plastic surgeons often travel to Africa to treat patients with facial burns, cleft-lip and palate, and noma. The likelihood of an encounter with patients infected by Ebola virus in subsaharan and West Africa, therefore, has increased during the last 2 years. The purpose of this short overview was to summarize the virology of the Ebola virus, transmission, epidemiology, clinical features, oral manifestations, treatment, and possible implications for maxillo-facial surgeons of EDV.

Case Presentation of Concomitant and Contiguous Adenomatoid Odontogenic Tumor and Focal Cemento-Ossifying Dysplasia.

A 24 year-old male was presented for the diagnosis of an asymptomatic bony expansion in relation to the right maxillary canine and first premolar. The unilocular radiolucent lesion with central foci of calcification had caused divergence of canine and first premolar roots without any resorption. This case report details a diagnosis of two distinct disease processes of different cellular origin namely, focal cemento-ossifying dysplasia and adenomatoid odontogenic tumor in a previously unreported concomitant and contiguous relationship. The diagnosis was determined by a combination of clinical, radiographic, histopathological and surgical evidence. This case highlights two points, first the need to examine all mixed radiolucent-radiopaque lesions with advanced imaging techniques to assess the number and extent of the lesions prior to treatment planning. Second a likely role of periodontal ligament as the tissue source for odontogenic epithelial cells and mesenchymal stem cells required for the development of odontogenic tumors and cemento-osseous dysplasias.

Comparison between Radiographic (2-dimensional and 3-dimensional) and Histologic Findings of Periapical Lesions Treated with Apical Surgery.

INTRODUCTION: The aim of this study was to evaluate the concordance of 2- and 3-dimensional radiography and histopathology in the diagnosis of periapical lesions. METHODS: Patients were consecutively enrolled in this study provided that preoperative periapical radiography (PR) and cone-beam computed tomographic imaging of the tooth to be treated with apical surgery were performed. The periapical lesional tissue was histologically analyzed by 2 blinded examiners. The final histologic diagnosis was compared with the radiographic assessments of 4 blinded observers. The initial study material included 62 teeth in the same number of patients. RESULTS: Four lesions had to be excluded during processing, resulting in a final number of 58 evaluated cases (31 women and 27 men, mean age = 55 years). The final histologic diagnosis of the periapical lesions included 55 granulomas (94.8%) and 3 cysts (5.2%). Histologic analysis of the tissue samples from the apical lesions exhibited an almost perfect agreement between the 2 experienced investigators with an overall agreement of 94.83% (kappa = 0.8011). Radiographic assessment overestimated cysts by 28.4% (cone-beam computed tomographic imaging) and 20.7% (periapical radiography), respectively. Comparing the correlation of the radiographic diagnosis of 4 observers with the final histologic diagnosis, 2-dimensional (kappa = 0.104) and 3-dimensional imaging (kappa = 0.111) provided only minimum agreement. CONCLUSIONS: To establish a final diagnosis of an apical radiolucency, the tissue specimen should be evaluated histologically and specified as a granuloma (with/without epithelium) or a cyst. Analysis of 2-dimensional and 3-dimensional radiographic images alike results only in a tentative diagnosis that should be confirmed with biopsy.

Radiographic volume analysis as a novel tool to determine nasopalatine duct cyst dimensions and its association with presenting symptoms and postoperative complications.

OBJECTIVES: The aims of the study were to use cone beam computed tomography (CBCT) images of nasopalatine duct cysts (NPDC) and to calculate the diameter, surface area, and 3D-volume using a custom-made software program. Furthermore, any associations of dimensions of NPDC with age, gender, presence/absence of maxillary incisors/canines (MI/MC), endodontic treatment of MI/MC, presenting symptoms, and postoperative complications were evaluated. MATERIAL AND METHODS: The study comprised 40 patients with a histopathologically confirmed NPDC. On preoperative CBCT scans, curves delineating the cystic borders were drawn in all planes and the widest diameter (in millimeter), surface area (in square millimeter), and volume (in cubic millimeter) were calculated. RESULTS: The overall mean cyst diameter was 15 mm (range 7-47 mm), the mean cyst surface area 566 mm(2) (84-4,516 mm(2)), and the mean cyst volume 1,735 mm(3) (65-25,350 mm(3)). For 22 randomly allocated cases, a second measurement resulted in a mean absolute aberration of ±4.2 % for the volume, ±2.8 % for the surface, and ±4.9 % for the diameter. A statistically significant association was found for the CBCT determined cyst measurements and the need for preoperative endodontic treatment to MI/MC and for postoperative complications. CONCLUSION: In the hands of a single experienced operator, the novel software exhibited high repeatability for measurements of cyst dimensions. Further studies are needed to assess the application of this tool for dimensional analysis of different jaw cysts and lesions including treatment planning. CLINICAL RELEVANCE: Accurate radiographic information of the bone volume lost (osteolysis) due to expansion of a cystic lesion in three dimensions could help in personalized treatment planning.

Bilateral necrotizing sialometaplasia of the hard palate in a patient with bulimia: a case report and review of the literature.

Necrotizing sialometaplasia (NS) is a rare and benign lesion that mostly affects the posterior hard palate. Its importance resides in its clinical and microscopic characteristics, which can closely mimic malignant neoplasias, in particular oral squamous cell carcinoma and mucoepidermoid carcinoma. Accurate histopathologic evaluation of an incisional biopsy is considered as the diagnostic gold standard. NS lesions heal spontaneously within weeks, and no further treatment is necessary. We report a case of a bilateral palatal NS in a 22-yearold woman with bulimia, where an incisional biopsy confirmed the clinical diagnosis. The different clinical stages of the lesions from onset to resolution and the possible etiologic factors are described in detail, as well as a discussion of the differential diagnoses of palatal ulcers. When taking a biopsy from suspicious oral lesions, care has to be taken that an appropriate tissue sample is harvested, and the histopathologic analysis is performed by an experienced pathologist to establish a correct diagnosis.

Diagnosis and interdisciplinary treatment of a botryoid odontogenic cyst in the posterior mandible: report of a case.

Botryoid odontogenic cysts (BOC) are considered to be rare polycystic variants of lateral periodontal cysts characterized by a multilocular growth pattern. The most frequent location of BOC is the mandible, predominantly the premolar-canine area, followed by the anterior region of the maxilla. The cyst shows a slight female predilection. This case report of a BOC demonstrates a treatment with initial fenestration and decompression of the cyst in order to prevent damage to adjacent structures such as the inferior alveolar nerve. The present case report emphasizes the importance of accurate clinical, radiographic, and histologic diagnostic procedures of unspecific radiolucent lesions in the jaws to establish a firm diagnosis and avoid inappropriate treatment strategies.

Intraoral hyperplastic Fordyce granule with destruction of bone: a case presentation.

Fordyce granules of the oral mucosa are often discovered during routine dental examinations. They are considered anatomic variations and are typically seen on the labial and buccal mucosa in adults. The present case report describes for the first time in the literature an atypical location of an enlarged Fordyce granule with local bone destruction. The diagnostic process, surgical treatment, and follow-up are presented and discussed.

Assessment of smoking behaviour in a dental setting: a 1-year follow-up study using self-reported questionnaire data and exhaled carbon monoxide levels.

OBJECTIVES: This study analyses the changes in smoking habits over the course of 1 year in a group of patients referred to an oral medicine unit. MATERIALS AND METHODS: Smoking history and behaviour were analysed at baseline and after 1 year based on a self-reported questionnaire and on exhaled carbon monoxide levels [in parts per million (ppm)]. During the initial examination, all smokers underwent tobacco use prevention and cessation counselling. RESULTS: Of the initial group of 121 patients, 98 were examined at the follow-up visit. At the baseline examination, 33 patients (33.67 %) indicated that they were current smokers. One year later, 14 patients (42.24 % out of the 33 smokers of the initial examination) indicated that they had attempted to stop smoking at least once over the follow-up period and 15.15 % (5 patients) had quit smoking. The mean number of cigarettes smoked per day by current smokers decreased from 13.10 to 12.18 (p = 0.04). The exhaled CO level measurements showed very good correlation with a Spearman's coefficient 0.9880 for the initial visit, and 0.9909 for the follow-up examination. For current smokers, the consumption of one additional cigarette per day elevated the CO measurements by 0.77 ppm (p < 0.0001) at the baseline examination and by 0.84 ppm (p < 0.0001) at the 1-year follow-up. CONCLUSIONS: In oral health care, where smoking cessation is an important aspect of the treatment strategy, the measurement of exhaled carbon monoxide shows a very good correlation with a self-reported smoking habit. CLINICAL RELEVANCE: Measurement of exhaled carbon monoxide is a non-invasive, simple and objective measurement technique for documenting and monitoring smoking cessation and reduction.

Management of children with autism spectrum disorder in the dental setting: Concerns, behavioural approaches and recommendations

Objectives: This article reviews the present literature on the issues encountered while coping with children with autistic spectrum disorder from the dental perspective. The autistic patient profile and external factors affecting the oral health status of this patient population are discussed upon the existing body of evidence. Material and Methods: The MEDLINE database was searched using the terms ‘Autistic Disorder’, ‘Behaviour Control/methods’, ‘Child’, ‘Dental care for disabled’, ‘Education’, ‘Oral Health’, and ‘Pediatric Dentistry’ to locate related articles published up to January 2013.Results: Most of the relevant studies indicate poor oral hygiene whereas they are inconclusive regarding the caries incidence in autistic individuals. Undergraduate dental education appears to determine the competence of dental professionals to treat developmentally disabled children and account partly for compromised access to dental care. Dental management of an autistic child requires in-depth understanding of the background of the autism and available behavioural guidance theories. The dental professional should be flexible to modify the treatment approach according to the individual patient needs (AU)

Management of children with autism spectrum disorder in the dental setting: concerns, behavioural approaches and recommendations.

OBJECTIVES: This article reviews the present literature on the issues encountered while coping with children with autistic spectrum disorder from the dental perspective. The autistic patient profile and external factors affecting the oral health status of this patient population are discussed upon the existing body of evidence. MATERIAL AND METHODS: The MEDLINE database was searched using the terms 'Autistic Disorder', 'Behaviour Control/methods', 'Child', 'Dental care for disabled', 'Education', 'Oral Health', and 'Pediatric Dentistry' to locate related articles published up to January 2013. RESULTS: Most of the relevant studies indicate poor oral hygiene whereas they are inconclusive regarding the caries incidence in autistic individuals. Undergraduate dental education appears to determine the competence of dental professionals to treat developmentally disabled children and account partly for compromised access to dental care. Dental management of an autistic child requires in-depth understanding of the background of the autism and available behavioural guidance theories. The dental professional should be flexible to modify the treatment approach according to the individual patient needs.

[Prevention of the eruption of an upper later incisor by a compound odontoma. Case report]. / Durchbruchsbehinderung eines lateralen Inzisiven im Oberkiefer aufgrund eines zusammengesetzten Odontoms. Ein Fallbericht.

Odontomas are the most common odontogenic tumours. They are considered as hamartomas - a local tissue malformation without autonomous growth potential - and are non-neoplastic. Clinically and histopathologically, compound and complex odontomas can be differentiated. Compound odontomas consist of a varying number of tooth-like structures and histology show dental tissues in an orderly pattern. Most often compound odontomas are diagnosed in young patients in the anterior maxilla. Patients are rarely complaining of symptoms and they are usually diagnosed during routine radiographic examinations or due to late eruption of permanent or persistence of deciduous teeth. The following case report presents a disturbed eruption of a lateral right incisor of the maxilla in a 8-year old female patient. Clinical, radiological and histopathological characteristics of this lesion will be discussed as well as therapy and follow-up.

Intraoral foreign bodies detected 40 years after a car accident using cone beam computed tomography.

Foreign bodies are common findings in the maxillofacial region, most commonly the result of accidents and physical aggression. Among the objects frequently found in the orofacial tissues are fragments of metal, plastic, wood, and glass. Visualization and exact identification of the location of these objects can be challenging but is of major importance prior to surgical removal. The present case report describes the use of cone beam computed tomography to locate, visualize, and surgically remove glass particles in the oral cavity.

Oral lichenoid contact lesions induced by areca nut and betel quid chewing: a mini review.

Betel quid (BQ) and areca nut chewing is widely prevalent in many parts of Asia and Asian-migrant communities throughout the world. Global reports estimate 600 million users. Sufficient evidence of carcinogenicity has been found for BQ and its main ingredient, areca nut. BQ areca nut users have an increased risk of potentially malignant disorders. Among chewers, BQ remains in contact with the oral mucosa for prolonged periods. This review examines the clinical and pathological aspects of lichenoid lesions caused by areca nut and BQ, a condition that has received little attention in the published literature.

Does a pulsed mode offer advantages over a continuous wave mode for excisional biopsies performed using a carbon dioxide laser?

PURPOSE: Animal studies of excisional biopsies have shown less thermal damage when a carbon dioxide (CO(2)) laser (10.6 µm) is used in a char-free (CF) mode than in a continuous-wave (CW) mode. The authors' aim was to evaluate and compare clinical and histopathologic findings of excisional biopsies performed with CW and CF CO(2) laser (10.6 µm) modes. MATERIALS AND METHODS: This prospective randomized controlled clinical trial included 60 patients with similar fibrous hyperplasias of the buccal plane willing to undergo excisional CO(2) laser biopsy. Patients were randomly allocated to the CW (5 W) or CF (140 Hz, 400 µs, 33 mJ) group. Duration of surgery, intra- and postoperative complications, and the width (micrometers) of the histopathologic collateral thermal damage zone were registered as primary outcome variables. Secondary outcome variables were pain (patients filled in a visual analog scale [VAS]) and analgesic intake (recorded by patients). RESULTS: The study group consisted of 36 women and 24 men with a median age of 50.5 years. Median durations of surgery were 74.5 seconds in the CW group and 83.5 seconds in the CF group. Intraoperative venous bleeding occurred in 16.7% of patients in the CW group and in 13.3% of patients in the CF group. Median areas of histopathologic collateral damage zones were similar in the CW group (166.5 µm) and the CF group (162.5 µm). There was no statistically significant difference between the VAS values of the 2 groups. Analgesic intake was recorded by 16.7% of patients in the CW group and by 6.7% of patients in the CF group (P = .23, not significant). No statistically significant correlation was found between areas of thermal damage zones and postoperative VAS scores. CONCLUSIONS: In contrast to previous animal studies, no significant difference was found in the widths of thermal damage zones between the CW and CF groups. The VAS values and analgesic intake were low in the 2 groups. The 2 CO(2) laser modes are appropriate for the excision of intraoral mucosal lesions. A safety border of at least 1 mm is recommended regardless of the laser mode used.