Innovative Strategies in Microvascular Head and Neck Reconstruction.

The field of reconstructive microsurgery has witnessed considerable advancements over the years, driven by improvements in technology, imaging, surgical instruments, increased understanding of perforator anatomy, and experience with microsurgery. However, within the subset of microvascular head and neck reconstruction, novel strategies are needed to improve and optimize both patient aesthetics and post-operative function. Given the disfiguring defects that are encountered following trauma or oncologic resections, the reconstructive microsurgeon must always aim to innovate new approaches, reject historic premises, and challenge established paradigms to further achieve improvement in both aesthetic and functional outcomes. The authors aim to provide an up-to-date review of innovations in head and neck reconstruction for oncologic defects.

Rehabilitation of long-term mandibular defects by whole-process digital fibula flap combining with implants: A case report.

Currently, the gold standard and workhorse in mandibular reconstruction is the free vascularized fibula flap. Particularly for patients who have had mandibulectomy for a long time, it is still difficult to precisely reconstruct the mandibular contour and successfully restore the patient's chewing function and esthetics. For the restoration and rehabilitation of long-term mandibular abnormalities, three-dimensional (3D) virtual surgical planning (VSP) and 3D-printed surgical guides are essential. Digital design and manufacturing were used to improve the accuracy of prostheses and facilitate occlusal reconstruction. Therefore, equipped with the methods of 3D VSP, 3D-printed surgical guides, free vascularized fibular flap, and immediate dental implants, this clinical report provides a feasible solution for mandibular reconstruction.

Immediate loading of a fully tapered implant with deep apical threads placed in healed alveolar ridges vs. immediate extraction sockets.

OBJECTIVES: Immediate implant placement and loading is a practice that continues to gain traction in implant dentistry because it reduces treatment time and improves satisfaction. Novel implant designs that facilitate increased primary stability, while not compromising osseointegration and long-term survival are important to offer immediate solutions for missing teeth. Here, we hypothesize that fully tapered implants can obtain successful osseointegration with high survival rates after immediate loading in fresh extraction sockets and healed sites. MATERIALS AND METHODS: A total of 13 swine with 73 implants were evaluated. Fully tapered or apically tapered implants were placed in extraction sockets and healed sites. Insertion torque and resonance frequency analysis were determined at placement and euthanasia. Animals were evaluated at: placement, and 1-week and 12-weeks after placement. Bone to Implant Contact (BIC), Bone Area/Total Area (BA/TA), and first BIC (fBIC) analyses were conducted. RESULTS: The fully tapered implant achieved similar primary stability with lower insertion torque at placement. Apically and fully tapered implants had comparable BIC (50.1% vs 59.4%) and ISQ (82.5 vs 80.3) values by 12 weeks in healed sites. In extraction sockets, BIC and ISQ for the apically tapered implant was 35.8% and 73.2 and 37.8% and 79.2 for the fully tapered implants, respectively. CONCLUSIONS: In this short-term study, immediately loaded fully tapered implants obtained high survival with similar osseointegration ability as apically tapered implants when placed in healed sites and fresh extraction sockets. Fully tapered implants show promise for use in immediate loading and immediate placement.

Confirmation of Calcium Phosphate Cement Biodegradation after Jawbone Augmentation around Dental Implants Using Three-Dimensional Visualization and Segmentation Software.

The use of autologous bone graft for oral rehabilitation of bone atrophy is considered the gold standard. However, the available grafts do not allow a fast loading of dental implants, as they require a long healing time before full functionality. Innovative bioactive materials provide an easy-to-use solution to this problem. The current study shows the feasibility of calcium phosphate cement paste (Paste-CPC) in the sinus. Long implants were placed simultaneously with the cement paste, and provisional prosthetics were also mounted in the same sessions. Final prosthetics and the full loading took place within the same week. Furthermore, the study shows for the first time the possibility to monitor not only healing progression using Cone Beam Computer tomography (CBCT) but also material retention, over two years, on a case study example. The segmented images showed a 30% reduction of the cement size and an increased mineralized tissue in the sinus. Mechanical testing was performed qualitatively using reverse torque after insertion and cement solidification to indicate clinical feasibility. Both functional and esthetic satisfaction remain unchanged after one year. This flowable paste encourages the augmentation procedure with less invasive measure through socket of removed implants. However, this limitation can be addressed in future studies.

Fatores determinantes para a otimização da estética na instalação de implantes e provisórios imediatos / Determinant factors for esthetic optimization in immediate implant placement and immediate provisionalization

A instalação de implantes e provisórios imediatos em áreas anteriores é uma técnica viável pela previsibilidade estética, redução do tempo de tratamento e conforto pós-operatório oferecido ao paciente. Independentemente do protocolo utilizado, sempre haverá um processo fisiológico de remodelação dos tecidos ao redor do dente que foi extraído. Mas, a técnica imediata mostrou redução desse processo e manutenção dos tecidos peri-implantares. A confecção de uma coroa provisória com um aspecto natural é fundamental, pois moldará todos os tecidos circundantes para receber a coroa definitiva. Apesar de ser considerado um procedimento previsível, sua indicação depende de um planejamento criterioso.

Immmediate implant placement and provisionalization in esthetic areas is a viable technique for predictability, reduced treatment time and postoperative patient comfort. Regardless of the applied protocol, a physiologic remodeling process around the extracted tooth will always be found. However, the immediate technique can reduce this process and still maintain the peri-implant tissue response. The fabrication of a provisional crown with natural aspect is mandatory, because it will shape the surrounding tissues for the defi nitive restoration. Although been considered a predictable procedure, its indication depends on a judicious treatment planning proposal.

Instalação imediata de implante após exodontia e provisório imediato em área estética: relato de caso clínico com um ano de acompanhamento pós-cirúrgico / Immediate post extraction implant placement in aesthetic area and provisional immediate installation: one year follow-up ­ a case report

As fraturas radiculares em dentes anteriores são bastante frequentes no consultório odontológico, sendo muitas vezes necessárias a remoção da raiz e a instalação de implantes. Os implantes podem ser instalados após a exodontia ou após o período de cicatrização do alvéolo. O presente relato de caso mostra uma fratura radicular do dente 11 com exodontia, instalação imediata do implante, confecção e instalação de provisório imediato. No caso clínico relatado neste artigo, a técnica de instalação imediata de implante após exodontia e instalação de provisório imediato mostrou-se previsível, tanto no que se refere à osseointegração quanto do ponto de vista estético.

Root fractures at anterior teeth are quite common in the office and the need for root removal and implant placement often is necessary. The dental implants may be installed immediately after the extraction or after the healing process. This case report shows a root fracture of tooth 11 with extraction, immediate implant placement, manufacture and installation of an immediate provisional tooth. According to the case reported in this article, in this case, immediate implant installation technique after the extraction, and immediate provisional tooth installation showed to be a predictable procedure to reach osseointegration and aesthetic outcome.

Comparative study of immediately inserted dental implants in sinus lift: 24 months of follow-up.

OBJECTIVES: The primary aim of this study is to evaluate the success rate of immediately inserted dental implants in sinus lift and the secondary aim is to assess the reliability of performing simultaneous surgery for sinus lift, grafting and implant placement in situations of very low residual bone heights (<4 mm) in the posterior maxillae. MATERIALS AND METHODS: A series of consecutive patients who sought dental implant rehabilitation were included in this study. The sinus lift cases were selected and divided into two groups based on the maxillary alveolar height, ≥4 mm of radiographically measurable bone height (Group 1) and < 4 mm of bone height (Group 2). RESULTS: A total of 13 implants were installed in Group 1, whereas 8 implants were installed in Group 2. The success rate for dental implants in the sinus lifts reached 95.2% after a period of 24 months of evaluation, at 100% for Group 1 (bone height ≥ 4 mm) and 87.5% for Group 2 (bone height with < 4 mm). Besides the differences between the percentages of success, statistical differences were not reached when the groups were compared (Fisher's exact test, P = 0.38). CONCLUSIONS: Despite the limitations of this study, including its low number of participants, the results indicate that simultaneous surgery for sinus lifting, grafting and dental implants in posterior maxillae with very low bone heights (<4 mm) can be performed safely, although with lower success rates than found in patients with higher residual bone heights (>4 mm).

Fatores locais relacionados à instalação de implantes imediatos em alvéolos de estração: revisão de literatura / Local factors related with placement of immediate implants into extraction sockets: literature review

A previsibilidade dos implantes dentários usando o protocolo tradicional de Branemark está bem sedimentada na literatura. Desde sua criação, este protocolo vem sendo progressivamente modificado visando à diminuição do tempo de tratamento e a redução do número de etapas cirúrgicas, maximizando o resultado estético das próteses sobre implantes. A partir da década de 80, do século passado, os implantes vêm sendo instalados imediatamente nos alvéolos de extração e, em alguns casos, podem receber uma prótese provisória no momento da cirurgia, melhorando ainda mais o conforto do paciente reabilitado com implantes orais. Após a aceitação da técnica dos implantes transalveolares imediatos pela comunidade científica, grandes benefícios para o clínico e principalmente para o paciente candidato à instalação de implantes foram viabilizados. Desta maneira, este artigo tem por objetivo apresentar uma revisão de literatura sobre os fatores que podem afetar a cicatrização de implantes instalados imediatamente, abordando também algumas manobras realizadas no tecido gengival para o fechamento primário do retalho sobre o leito do implante, nos casos onde não esta indicada a provisionalização imediata

The predictability of dental implants using Branemark’s traditional protocol is well documented in the literature. Since its creation, this protocol has been progressively modify to decrease the treatment time and reduce the number of surgeries, improvement the aesthetic result of implants prosthesis. Nowadays, the implants are placed immediately into extraction sockets and could receive a provisional in the surgery moment, improvement the comfort of rehabilitated patient with dental implants. After acceptance of transalveolar immediate implants by scientific community, many benefits to clinician and mainly to patient that will receive implants were achieved. The aim of this paper was present a literature review about factors that can effect the healing of immediate implants, approaching too procedures realized with gingival tissue to primary closure of flap onto implant in the cases without immediate provisional

Estágio atual do tratamento do espaço entre a parede óssea e a superfície do implante em alvéolos de extração: revisão de literatura / Actual stage of the space's treatment between bone wall and implant surface in extraction sockets: a literature review

Os implantes transalveolares imediatos têm sido apresentados como uma estratégia previsível de tratamento que permite minimizar a redução no volume ósseo após a perda dentária, podendo prevenir a atrofia severa do rebordo alveolar. Entretanto, nesta técnica freqüentemente permanece um espaço entre a superfície do implante e a parede óssea na porção coronária do alvéolo. Uma grande variedade de técnicas regenerativas é sugerida para viabilizar a formação óssea e melhorar a qualidade da osseointegração ao redor de implantes instalados em alvéolo de extração. O objetivo deste artigo é fazer uma revisão de literatura a respeito dos materiais e técnicas que vem sendo utilizados para tratar o espaço entre o leito ósseo e os implantes imediatos, bem como identificar as situações em que este tratamento é necessário

The placement of implants immediately after tooth extraction has proven to be predictable treatment strategy with a very high rate of success. The immediate transalveolar implants technique reduces the bone loss and preserve the height and width of the alveolar bone. Despite of this, a gap, between the implant surface and the coronal part of the buccal bone wall of the extraction socket, is present. A great variety of regenerative techniques have been used to allow the bone formation in the gape and the improve the quality of the osseointegration around those implants. The purpose of this article is to evaluate, through a literature review, the biomaterials and regenerative techniques that has been used to teat the gap as well to identify the indications of this treatment