Clinical protocol selection for alveolar ridge augmentation at sites exhibiting slight, moderate, and severe horizontal ridge deficiencies.

FOCUSED CLINICAL QUESTION: What factors identify the optimal bone augmentation techniques for managing slight, moderate, and severe horizontal alveolar ridge deficiency (ARD) at dental implant sites? SUMMARY: Horizontal ARD is a concern at a high proportion of sites receiving dental implants, and clinicians have developed a variety of surgical procedures to address such defects. In a particular case, selection of the optimal treatment may depend predominantly on defect severity, location (anterior versus posterior), and configuration (contained versus noncontained). This report provides a framework for selecting an augmentation method when presented with a slight, moderate, or severe horizontal ARD at a site requiring dental implant placement. CONCLUSION: Multiple treatment options are available for planned implant sites exhibiting horizontal ARD; severe posterior and slight anterior defects intuitively call for different approaches. Although rigid guidelines for selecting the optimal augmentation method do not exist, some techniques are poorly suited for esthetically demanding sites. A framework considering defect severity, location, and configuration may help guide clinical decisions on this topic.

Dental implants at sites of focal high and mixed density osseous lesions: Treatment strategies.

FOCUSED CLINICAL QUESTION: Under what circumstances may a clinician consider dental implant placement at a site exhibiting a focal high or mixed density (HMD) osseous lesion radiologically? SUMMARY: Some conditions and pathologic entities exhibiting high and mixed density radiological appearance pose low risk for dental implant failure or complications following implant surgery. However, other lesions represent contraindications to implant placement, and implant surgery at such sites can result in severe morbidity. CONCLUSION: Potential implant sites exhibiting focal HMD osseous lesions/conditions present varying levels of risk. In most cases, optimal management will include advanced imaging of the site, multidisciplinary consultations, and detailed informed consent to assure full understanding of procedural risks, benefits, and complications. Currently, clinical recommendations rely on case reports, opinion, and usual practice (level 3 evidence). The strength of each recommendation provided in this report is categorized as level C.

Guided protocol for indirect fabrication of a custom provisional restoration prior to immediate implant surgery in the esthetic zone.

BACKGROUND: Delivery of a high-quality provisional restoration at a maxillary anterior immediate implant site enhances patient-centered outcomes and promotes development of favorable hard and soft tissue architecture. The purpose of this report is to present a protocol relying upon compatible guided surgery and laboratory systems for fabrication of a custom provisional crown prior to immediate implant surgery in the esthetic zone. METHODS AND RESULTS: A female patient, aged 33 years, presented to the Army Postgraduate Dental School, Fort Gordon, Georgia, with an unfavorable prognosis for tooth #9. The patient elected extraction with immediate implant placement. Prior to the surgery, we utilized a cone-beam computed tomography volume, stone models, implant planning software, and an implant indexing system to fabricate a custom provisional crown. Following extraction of tooth #9 and immediate implant placement, the provisional crown exhibited excellent fit and finish, requiring virtually no chairside adjustment. We noted minimal change in baseline mucosal contours throughout the healing phase. CONCLUSION: The clinical/restorative protocol described in this report assured accurate three-dimensional implant positioning and permitted indirect fabrication of a high-quality custom provisional crown in advance of surgery. The laboratory workflow-which dental technicians/auxiliaries can master-has the potential to shorten surgery, enhance treatment outcomes, and increase patient satisfaction. KEY POINTS: Why is this case new information? This report provides a stepwise workflow guiding indirect fabrication of a custom provisional crown prior to immediate implant placement. What are the keys to successful management of this case? The described technique requires compatible laboratory and guided surgery systems to assure that the restoration accounts for the three-dimensional position and timing of the implant. What are the primary limitations to success in this case? Dental technicians/auxiliaries can master this protocol and independently produce high-quality provisional implant restorations under supervision, potentially enhancing practice efficiency. However, practitioners should provide adequate staff training to optimize reliability and quality.

The Triangle Suture for Membrane Fixation in Guided Bone Regeneration Procedures: A Report of Two Cases.

INTRODUCTION: Existing evidence supports superior treatment outcomes in guided bone regeneration (GBR) procedures employing membrane fixation. The purpose of this report is to present a specific flap design and suturing method for stabilizing GBR barrier membranes. CASE PRESENTATION: Two generally healthy patients received GBR using native collagen membranes stabilized with absorbable sutures. In both cases, we fixed barrier membranes apically using "triangle" sutures. Sling sutures (Case 1) or triangle sutures (Case 2) secured the crestal and palatal aspects of the membranes. No postoperative complications occurred, and both sites exhibited favorable alveolar ridge volume for implant placement. CONCLUSIONS: The described triangle suture technique reliably stabilized GBR barrier membranes without the need for fixation hardware. Compared with suturing methods that limit graft volume and apply pressure over the grafted area, the triangle suture may offer clinical advantages.

Neodymium-Doped Yttrium Aluminum Garnet Laser Photobiomodulation May Improve Neurosensory Function after Surgical Injury to Cranial Nerve V: A Report of Three Consecutive Cases.

OBJECTIVE: The purpose of this report was to document clinical responses to Nd:YAG laser energy in patients with surgical injury to terminal branches of the trigeminal nerve. BACKGROUND: Limited evidence from in vitro, animal, and human studies suggests infrared laser energy may positively influence recovery after peripheral or cranial nerve injury, although clinical effects of neodymiumdoped yttrium aluminum garnet (Nd:YAG) lasers remain unstudied in this context. METHODS: We applied Nd:YAG laser energy in the treatment of three consecutive patients presenting with altered neurosensory function following various oral and maxillofacial procedures. The time interval between surgical injury and laser photobiomodulation ranged from one week to two years. RESULTS: All patients exhibited reduction in the area of diminished sensation and partial recovery of normal neurosensory function. The two patients with long-standing neurosensory deficiency experienced near complete recovery of intraoral sensation, with residual zones of diminished sensation from the perioral skin. CONCLUSIONS: Although all patients in this case series demonstrated clinical improvements compared with baseline, controlled studies are needed to determine whether Nd:YAG laser energy accelerates or enhances recovery of neurosensory function after surgical nerve injury. Studies establishing the relative efficacies of Nd:YAG and diode lasers appear warranted.

Global phylogeography of the critically endangered hawksbill turtle (Eretmochelys imbricata).

The hawksbill turtle is a broadly distributed, highly migratory and critically endangered sea turtle species. The paucity of studies restricts the comprehension of its behavior and life history. In this work, we performed a global phylogeographic analysis using a compilation of previously published mitochondrial haplotype data to understand the dynamics and diversity of hawksbill populations worldwide. Our results revealed a complex demographic pattern associated to hawksbill phylogeography since the Pliocene. Isolation by distance is not enough to explain distinct demographic units of hawksbill turtles, which are also influenced by other factors as oceanic currents, coral reef distribution and nesting timing. The foraging aggregations are typically mixed stocks of individuals originating from multiple nesting areas, but there is also a trend of foragers coming from nearby natal beaches. Phylogenetic analysis indicates two highly divergent major lineages split between Atlantic and Indo-Pacific rookeries, but there is also a more recent Atlantic Ocean colonization from the Indo-Pacific Ocean. Long-distance dispersal events are likely responsible for homogenization between distant populations within oceans. Our findings provided new insights about population connectivity, identified gaps that should be prioritized in future research and highlighted the need for international efforts aiming at hawksbill's conservation.

Phylogeography, Genetic Diversity, and Management Units of Hawksbill Turtles in the Indo-Pacific.

Hawksbill turtle (Eretmochelys imbricata) populations have experienced global decline because of a history of intense commercial exploitation for shell and stuffed taxidermied whole animals, and harvest for eggs and meat. Improved understanding of genetic diversity and phylogeography is needed to aid conservation. In this study, we analyzed the most geographically comprehensive sample of hawksbill turtles from the Indo-Pacific Ocean, sequencing 766 bp of the mitochondrial control region from 13 locations (plus Aldabra, n = 4) spanning over 13500 km. Our analysis of 492 samples revealed 52 haplotypes distributed in 5 divergent clades. Diversification times differed between the Indo-Pacific and Atlantic lineages and appear to be related to the sea-level changes that occurred during the Last Glacial Maximum. We found signals of demographic expansion only for turtles from the Persian Gulf region, which can be tied to a more recent colonization event. Our analyses revealed evidence of transoceanic migration, including connections between feeding grounds from the Atlantic Ocean and Indo-Pacific rookeries. Hawksbill turtles appear to have a complex pattern of phylogeography, showing a weak isolation by distance and evidence of multiple colonization events. Our novel dataset will allow mixed-stock analyses of hawksbill turtle feeding grounds in the Indo-Pacific by providing baseline data needed for conservation efforts in the region. Eight management units are proposed in our study for the Indo-Pacific region that can be incorporated in conservation plans of this critically endangered species.

Nuclear markers reveal a complex introgression pattern among marine turtle species on the Brazilian coast.

Surprisingly, a high frequency of interspecific sea turtle hybrids has been previously recorded in a nesting site along a short stretch of the Brazilian coast. Mitochondrial DNA data indicated that as much as 43% of the females identified as Eretmochelys imbricata are hybrids in this area (Bahia State of Brazil). It is a remarkable find, because most of the nesting sites surveyed worldwide, including some in northern Brazil, presents no hybrids, and rare Caribbean sites present no more than 2% of hybrids. Thus, a detailed understanding of the hybridization process is needed to evaluate natural or anthropogenic causes of this regional phenomenon in Brazil, which could be an important factor affecting the conservation of this population. We analysed a set of 12 nuclear markers to investigate the pattern of hybridization involving three species of sea turtles: hawksbill (E. imbricata), loggerhead (Caretta caretta) and olive ridley (Lepidochelys olivacea). Our data indicate that most of the individuals in the crossings L. olivacea × E. imbricata and L. olivacea × C. caretta are F1 hybrids, whereas C. caretta × E. imbricata crossings present F1 and backcrosses with both parental species. In addition, the C. caretta × E. imbricata hybridization seems to be gender and species biased, and we also found one individual with evidence of multispecies hybridization among C. caretta × E. imbricata × Chelonia mydas. The overall results also indicate that hybridization in this area is a recent phenomenon, spanning at least two generations or ~40 years.

DNA barcoding of Brazilian sea turtles (Testudines).

Five out of the seven recognized species of sea turtles (Testudines) occur on the Brazilian coast. The Barcode Initiative is an effort to undertake a molecular inventory of Earth biodiversity. Cytochrome Oxidase c subunit I (COI) molecular tags for sea turtle species have not yet been described. In this study, COI sequences for the five species of sea turtles that occur in Brazil were generated. These presented widely divergent haplotypes. All observed values were on the same range as those already described for other animal groups: the overall mean distance was 8.2%, the mean distance between families (Dermochelyidae and Cheloniidae) 11.7%, the mean intraspecific divergence 0.34%, and the mean distance within Cheloniidae 6.4%, this being 19-fold higher than the mean divergence observed within species. We obtained species-specific COI barcode tags that can be used for identifying each of the marine turtle species studied.

DNA barcoding of Brazilian sea turtles (Testudines)

Five out of the seven recognized species of sea turtles (Testudines) occur on the Brazilian coast. The Barcode Initiative is an effort to undertake a molecular inventory of Earth biodiversity. Cytochrome Oxidase c subunit I (COI) molecular tags for sea turtle species have not yet been described. In this study, COI sequences for the five species of sea turtles that occur in Brazil were generated. These presented widely divergent haplotypes. All observed values were on the same range as those already described for other animal groups: the overall mean distance was 8.2 percent, the mean distance between families (Dermochelyidae and Cheloniidae) 11.7 percent, the mean intraspecific divergence 0.34 percent, and the mean distance within Cheloniidae 6.4 percent, this being 19-fold higher than the mean divergence observed within species. We obtained species-specific COI barcode tags that can be used for identifying each of the marine turtle species studied.

Genetic diversity and origin of leatherback turtles (Dermochelys coriacea) from the Brazilian coast.

The leatherback sea turtle (Dermochelys coriacea) population that nests in Brazil is restricted to a few individuals, but high densities of pelagic individuals are observed along the southern and southeastern Brazilian coast. We investigated the diversity of the mitochondrial DNA (mtDNA) control region in order to understand the relationship between nesting and pelagic leatherbacks from Brazil and elsewhere. High-quality 711-bp sequences were generated, analyzed, and compared with published data from worldwide populations. We detected the presence of shared haplotypes between nesting and pelagic aggregates from Brazil, as well as haplotypes shared with other nesting areas from the Atlantic and Pacific. Furthermore, the use of longer control region sequences allowed the subdivision of the common Atlantic haplotype A into 3 different haplotypes (A1, A3, and A4), thus improving the resolution of mtDNA-based leatherback phylogeography. The use of longer sequences partially supported a closer association between nesting and pelagic individuals from Brazil and pointed to a complex origin for the pelagic individuals in the Brazilian coast.