A strip free gingival graft and a xenogeneic collagen matrix to increase keratinized tissue after vertical bone augmentation.

PURPOSE: After vertical bone augmentation (VBA) surgery, loss of both keratinized tissue (KT) and vestibule depth (VD) take place. This article evaluated KT gain, patient satisfaction, and aesthetic outcomes after a modified apically repositioned flap (ARF) in combination with a strip-free gingival graft (FGG) harvested from the palate and a xenogeneic collagen matrix (XCM) to correct mucogingival distortion (MGD) after VBA. This technique minimizes patient morbidity by reducing the need for extensive masticatory mucosa grafts. MATERIALS: The study included 12 patients with ≤3 mm KT after vertical augmentation procedures. KT gain and tissue thickness were measured. Patient morbidity and aesthetic outcomes were also evaluated. RESULTS: Twenty-four months after surgery, significant VD gain was observed, obtaining a vertical KT augmentation of 5.38 ± 2.06 mm, although tissue thickness increase was only 0.42 ± 0.42mm. Regarding patient satisfaction, aesthetic results evaluating tissue color and texture were satisfactory; the pain was slight, obtaining a score of 2.10 ± 1.13 out of 10, measured using a Visual Analogue Scale (VAS). CONCLUSION: The present retrospective case series study shows that using an apically repositioned flap combined with a strip FGG and an XCM might offer a valid means of achieving KT gain.

Dentists' Awareness of Medication-Related Osteonecrosis of the Jaw (Risk Factors, Drugs, and Prevention) in the Republic of Croatia.

Introduction: Antiresorptive drugs (AR) have been used for many years in the treatment of various bone conditions such as osteoporosis, osteopenia, Paget's disease, bone metastases, multiple myeloma and the associated malignant hypercalcemia. As a side effect of AR therapy, medication-related osteonecrosis of the jaw, which affects the mandible more commonly than the maxilla, (MRONJ) has become an increased risk regarding patients' health and quality of life. The incidence of osteonecrosis has increased significantly in the last few years. One of the main methods of the disease prevention is the education of patients and doctors of dental medicine (DDMs). This is evidenced by the national program of information and prevention of antiresorptive therapy side effects, which was also the impetus for this study. Purpose: This study aims to test the knowledge of DDMSs on AR, especially on bisphosphonate (BF) therapy, MRONJ as well as on the risk factors of the disease itself. Material and methods: 458 DDMs from the Republic of Croatia participated in the survey and responded by an anonymous questionnaire to questions about the knowledge of AR/BF and the risk of MRONJ. Results: The results showed that 36.68% of DDMs do not know that MRONJ is the main complication of AR/BF therapy. The results are significantly different in terms of academic degree, specialization, workplace, and work experience. 60.26% of respondents do not know the main indications for AR/BF use, 53.26% do not know the factors affecting the onset of the disease, and 42.58% do not know which therapy is not recommended for patients on AR/BF therapy. 93.89% of respondents expressed the desire to educate on this issue. This current study was carried out to further investigate the pilot study findings which was conducted in the year 2015, but it had a significantly lower number of participants. Conclusion: This research suggests that further education of DDMS on this topic is necessary to prevent or to start early treatment of MRONJ.

Osteonecrosis of the Jaw.

Osteonecrosis of the jaw is a condition in which bone cells die due to various causes. It is classified as drug-induced jaw osteonecrosis, osteoradionecrosis, traumatic, non-traumatic, and spontaneous osteonecrosis. Antiresorptive or antiangiogenic drugs cause drug-induced osteonecrosis. The combination of medications, microbial contamination, and local trauma induces this condition. Osteoradionecrosis is a severe radiation therapy side effect that can affect people with head and neck cancer. It is described as an exposed bone area that does not heal for longer than three months after the end of radiation treatment with the absence of any indications of an original tumor, recurrence, or metastasis. Trauma (tooth extraction), tumor site, radiation dose that the patient receives, the area of the bone which is irradiated, oral hygiene, and other factors are risk factors for the development of osteonecrosis. Less frequently, osteonecrosis can also be induced by non-traumatic and traumatic causes. Non-traumatic osteonecrosis is brought on by infections, acquired and congenital disorders, as well as the impact of chemicals. Traumatic osteonecrosis is brought on by thermal, mechanical, or chemical damage. The treatment of osteonecrosis can be conservative, which aims to be beneficial for the patient's quality of life, and surgical, which involves debridement of the necrotic bone.

Implant stability comparison of immediate and delayed maxillary implant placement by use of resonance frequency analysis--a clinical study.

The purpose of this study was to objectively evaluate the stability of dental implants by use of resonance frequency analysis (RFA). In this study, 60 Nobel Replace Tapered Groovy implants were placed in the premolar region of the maxilla in 60 patients. Thirty implants were placed immediately after tooth extraction and 30 implants were placed in healed bone sites. Implant stability quotient (ISQ) was obtained by use of the Osstell Mentor device and was recorded at the time of implant placement (T1) and 20 weeks after placement, at the time of implant loading (T2). All implants were not functionally loaded during the follow up period. Data were analyzed using simple linear regression. No implant failures were reported in the 6-month follow up period. The mean ISQvalue for immediate implant placement was 61.43 at T1 and 66.23 at T2. The implants placed in healed bone showed higher ISQvalues compared to the immediately placed implants (mean ISQvalue was 64.17 at T1 and 68.83 at T2). Differences in the mean ISQ values were statistically significant (p < 0.001). After the completed period of osseointegration, the mean ISQ value was 4.8 for immediately placed implants compared to 4.67 for implants placed in delayed sites.

Use of recombinant human bone morphogenetic protein (rhBMP2) in bilateral alveolar ridge augmentation: case report.

In recent years, the delivery of osteoinductive factors such as bone morphogenic proteins (BMPs) has become an alternative approach to traditional bone grafting due to their capacity to produce bone healing and new bone formation. BMP-2 has proved to possess the highest osteoinductive potential among BMPs. The case reported the clinical use of recombinant human BMP-2 for bilateral vertical alveolar ridge augmentation. In a case of 61 year-old patient with a significant bilateral vertical bony deficiency of the mandible, rhBMP-2 administered via an absorbable collagen sponge carrier (ACS) was used for bilateral alveolar ridge bone induction. Augmented sites were covered and fixed with titanium mesh. Augmented sites were reopened 6 months after surgery. Titanium membrane and retaining screws were removed and three dental implants were placed. The tissue samples for the histologic analysis were harvested. Following 3 months healing period, the submerged implants were uncovered and restored with zirconium-ceramic crowns. Cone beam computed tomography (CBCT), panoramix and 3D radiographic evaluation were obtained prior to and after the surgical procedure. Vertical gain of the bone was 5.5 mm on the left and 5 mm on the right side, with 6 mm width of the bone. Histologic analysis revealed formation of mature trabecular bone with signs of osteoblastic proliferation. Implant stability quotient (ISQ) values were in the range between 69 and 75 for all three implants. No suppuration, gingival recession or pain were present 24 months after surgery. Vertical bone augmentation using rhBMP-2 is optional treatment modality to consider when planning dental implant placement in sites where severe vertical insufficiency exists.

Densitometric analysis of dental implant placement between flapless technique and the two-stage technique--a pilot study.

Flapless technique is a surgical approach of implant placement without raising a mucoperiosteal flap. Such approach has many advantages: shorter surgical treatment, minimal bleeding, postoperative discomfort for the patient is reduced; possibility of immediate loading of the inserted implant, faster procedure of implant placement and by that less time is needed for the complete implant-prosthetic restoration. Purpose of this pilot study was radiographic assessment of flapless technique and determination of its clinical values in comparison with two-stage dental implant technique through computerized densitometric analysis. The sample consisted of 10 patients with missing teeth in the premolar region in the upper jaw. An implant was placed in that position. In the first group of 5 patients the implants were inserted with the flapless technique, and in the other group of 5 patients implant insertion was done with a two-stage technique. All inserted implants were loaded with metal-ceramic crowns 3 months after placement. The patients were followed for 18 months through clinical follow-ups and radiovisiographical (RVG) images made after 3, 12 and 18 months. After comparing the average densities, the results showed similar decrease of density in both groups, conventional two-stage technique showed 3.24 and flapless technique 1.23. It can be concluded that flapless technique in everyday clinical usage has the same result as the two-stage dental implant technique.