Probing single-tooth dental implants with and without prostheses: a cross-sectional study comparing healthy and peri-implant mucositis sites.

AIM: To evaluate differences in probing depth (PPD) with and without a prosthesis in implants without interproximal bone loss (IBL). Secondarily, to assess whether the difference in PPD measured with and without the crown was affected by diagnosis or implant location. MATERIALS AND METHODS: A cross-sectional study was conducted in patients with a single screw-retained implant-supported crown in the posterior area, without IBL. PPD and was assessed before and after crown removal. A subgroup analysis compared healthy vs. mucositis implants and premolar vs. molar locations. RESULTS: In the 62 implants analysed (23 healthy and 39 with mucositis), the PPD was 1.15 mm (SD = 1.24 mm) deeper without the prosthesis than with it (p < .001). This difference was independent of the implant location (p > .05) except for buccal sites (p = .048). The mean PPD difference for implants with mucositis was 0.95 mm (SD = 1.19 mm; p < .001) while healthy implants had a mean PPD variation of 1.47 mm (SD = 1.29 mm; p < .001). CONCLUSION: The presence of prosthesis in single-tooth implants in the posterior area without IBL seems to lead to an underestimation of PPD that appears to be significant in implants diagnosed with mucositis, although the difference is even greater in healthy implants. Further studies are needed to confirm these findings.

Effect of crown to implant ratio and implantoplasty on the fracture resistance of narrow dental implants with marginal bone loss: an in vitro study.

BACKGROUND: Peri-implantitis is a biological complication that affects soft and hard tissues around dental implants. Implantoplasty (IP) polishes the exposed implant surface, to decontaminate it and make it less prone to bacterial colonization. This study investigates whether a higher clinical crown-to-implant-ratio (CIR) reduces implant fracture resistance and whether implants are more fracture-prone after IP in the presence of 50% of bone loss. METHODS: Forty-eight narrow platform (3.5 mm) 15 mm long titanium dental implants with a rough surface and hexagonal external connection were placed in standardized bone-like resin casts leaving 7.5 mm exposed. Half were selected for IP. The IP and control groups were each divided into 3 subgroups with different clinical CIRs (2:1, 2.5:1 and 3:1). The implant wall width measurements were calculated using the software ImageJ v.1.51 through the analysis of plain x-ray examination of all the samples using standardized mounts. A fracture test was performed and scanning electron microscopy was used to evaluate maximum compression force (Fmax) and implant fractures. RESULTS: IP significantly reduced the implant wall width (P < 0.001) in all reference points of each subgroup. Fmax was significantly higher in the 2:1 subgroup (control = 1276.16 N ± 169.75; IP = 1211.70 N ± 281.64) compared with the 2.5:1 (control = 815.22 N ± 185.58, P < 0.001; IP = 621.68 N ± 186.28, P < 0.001) and the 3:1 subgroup (control = 606.55 N ± 111.48, P < 0.001; IP = 465.95 N ± 68.57, P < 0.001). Only the 2.5:1 subgroup showed a significant reduction (P = 0.037) of the Fmax between the controls and the IP implants. Most fractures were located in the platform area. Only 5 implants with IP of the 2:1 CIR subgroup had a different fracture location (4 fractures in the implant body and 1 in the prosthetic screw). CONCLUSIONS: IP significantly reduces the fracture resistance of implants with a 2.5:1 CIR. The results also suggest that the CIR seems to be a more relevant variable when considering the resistance to fracture of implants, since significant reductions were observed when unfavorable CIR subgroups (2.5:1 and 3:1 CIR) were compared with the 2:1 CIR samples.

Fracture resistance after implantoplasty in three implant-abutment connection designs

BACKGROUND: To assess the effect of implantoplasty and implant-abutment design on the fracture resistance and macroscopic morphology of narrow-diameter (3.5 mm) dental implants. MATERIAL AND METHODS: SCREW-shaped titanium dental implants (n = 48) were studied in vitro. Three groups (n = 16) were established, based on implant-abutment connection type: external hexagon, internal hexagon and conical. Eight implants from each group were subjected to an implantoplasty procedure; the remaining 8 implants served as controls. Implant wall thickness was recorded. All samples were subjected to a static strength test. RESULTS: The mean wall thickness reductions varied between 106.46 and 153.75 μm. The mean fracture strengths for the control and test groups were, respectively, 1211.90 ± 89.95 N and 873.11 ± 92.37 N in the external hexagon implants; 918.41 ± 97.19 N and 661.29 ± 58.03 N in the internal hexagon implants; and 1058.67 ± 114.05 N and 747.32 ± 90.05 N in the conical connection implants. Implant wall thickness and fracture resistance (P < 0.001) showed a positive correlation. Fracture strength was influenced by both implantoplasty (P < 0.001) and connection type (P < 0.001). CONCLUSIONS: Implantoplasty in diameter-reduced implants decreases implant wall thickness and fracture resistance, and varies depending on the implant-abutment connection. Internal hexagon and conical connection implants seem to be more prone to fracture after implantoplasty

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A Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 4: Accuracy of Implant Placement.

The objective of this study was to compare the accuracy of conventional and computer-assisted implant planning and template-guided placement (CAIPP) protocols. Partially edentulous patients (N = 73) were randomly assigned to either a conventional implant planning and freehand placement protocol (control group, n = 26) or one of two different CAIPP protocols (stereolithographic guide [T1, n = 24] or 3D-printed guide [T2, n = 23]). The virtually planned and final implant positions were compared. Differences between the planned and the obtained implant position were evaluated as horizontal, vertical, and angular measurements. Descriptive statistics were calculated for overall deviation values and their fragmented mesiodistal and bucco-oral vectors at each evaluation plane. To study overall accuracy differences between study groups, analysis of variance (ANOVA) was used with Bonferroni post hoc test (Scheffé method). Possible confounding variables were analyzed using multiple linear regression with respect to treatment group. The mesiodistal or bucco-oral distribution of the positioning errors was evaluated with chi-square test. A multiple linear logistic regression was used to identify confounding variables. Inaccuracy at the level of the occlusal plane of the restoration averaged 0.65 ± 0.26 mm in the control group, 0.59 ± 0.4 mm in T1, and 0.76 ± 0.5 mm in T2. At the implant shoulder level, the inaccuracy amounted to 1.25 ± 0.62 mm, 0.97 ± 0.36 mm, and 0.72 ± 0.31 mm in the control group, T1, and T2, respectively. At the implant apex, mean deviations of 2.32 ± 1.24 mm were recorded in the control group, 0.97 ± 0.57 mm in T1, and 1.08 ± 0.57 mm in T2. Mean discrepancies in vertical direction measured 0.28 ± 1.01 mm (control), 0.2 ± 0.65 mm (T1), and -0.1 mm ± 1.0 mm (T2). Angular deviations of 7.36 ± 3.36 degrees (control), 4.23 ± 2.68 degrees (T1), and 3.13 ± 2.12 degrees (T2) were measured. Statistically significant differences were observed between the conventional and the two CAIPP groups for overall deviations at implant shoulder, apex, and implant angulation. CAIPP protocols seemed to provide a higher accuracy and precision compared to conventional freehand protocols. Still, the amount of inaccuracy using guides demands a safety margin. Moreover, intrasurgical verification during drilling and the implant placement procedure should be performed, including clinical parameters that may not be available from cone beam computed tomography data during the planning phase.

Antibiotic prescription for the prevention and treatment of postoperative complications after routine dental implant placement. A cross-sectional study performed in Spain.

BACKGROUND: As there are no established guidelines for antibiotic prescription after dental implant placement a study was made to determine the current prescribing habits of several groups of practitioners regarding antibiotics to prevent and/or treat postoperative complications - early failures and infections - in relation to routine dental implant placement. MATERIAL AND METHODS: An electronic survey was sent to postgraduate students and professionals with experience in routine dental implant placement who practice in Spain. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively to prevent and/or treat postoperative complications during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. Descriptive and bivariate analyses of the data were performed. RESULTS: Two hundred and forty-seven responses were obtained. Preventively, 17 respondents (6.9%) prescribed antibiotics only preoperatively (95% confidence interval (CI): 3.7 to 10.0%), 100 (40.5%) preferred to give them exclusively during the postoperative period (95%CI 34.4 to 46.6%) and 94 practitioners (38.1%) prescribed antibiotics both pre- and post-operatively (95%CI 32.0 to 44.1%). The most common preoperative regime was amoxicillin 2 g given orally 1 hour before the procedure (21.6%, n = 24) following amoxicillin 750 mg given orally 1 day prior to surgery (21.6%, n = 24). The most common routine postoperative regime was amoxicillin 750 mg given orally for 7 days (34.0%, n = 66). To treat postoperative infections during the osseointegration period, 233 respondents (93.2%) prescribed antibiotics (95%CI 91.4 to 97.2%). The most common regime used was amoxicillin and potassium clavulanate 875/125 mg, given orally for 7 days (51.9%, n = 121). CONCLUSIONS: There is no consensus among dental clinicians regarding antibiotic use during routine dental implant placement to prevent postoperative complications and/or early failures. Moreover, the most commonly-prescribed regimes differ from that recommend in the latest published studies. Key words:Antibiotics, dental implants, oral implantology, complications, postoperative wound infection, early failure.

Influence of wound closure on the volume stability of particulate and non-particulate GBR materials: an in vitro cone-beam computed tomographic examination. Part II.

OBJECTIVES: To test whether GBR with an L-shaped soft-block bone substitute and particulate bone substitute differs from GBR with particulate bone substitute as regards the volume stability of the augmented region during flap closure. MATERIALS AND METHODS: Twenty peri-implant box-shaped bone defects were created in 10 pig mandibles. Every bone defect was augmented with each of the following two GBR procedures in turn: control group - particulate xenograft applied buccally + collagen membrane + pins; test group - particulate xenograft applied buccally + L-shaped soft-block xenograft applied buccally and occlusally + collagen membrane + pins. Cone-beam computed tomography scans were obtained before and after wound closure. The horizontal thickness (HT) of the augmented region (bone substitute + membrane) was assessed at the implant shoulder (HT0 mm ) and at 1 mm to 5 mm apical to the implant shoulder (HT1 mm -HT5 mm ). In the test group, the vertical thickness (VT) and 45° thickness (45-T) of the augmented region were measured from the implant shoulder. The changes in HT during flap suturing were calculated as absolute (mm) and relative values (%). Repeated-measures ANOVAs were used for statistical analysis. RESULTS: The reduction in HT0 mm was 20.5 ± 23.3% (SD) in the control group and 2.4 ± 9.2% (SD) in the test group (P = 0.014). There were no statistically significant differences in changes in HT1-5 mm between the groups (P > 0.05). In the test group, the reduction in VT amounted to 28.0 ± 11.9% (SD) and the reduction in 45-T amounted to 24.8 ± 10.2% (SD) (P < 0.001). CONCLUSION: The addition of an L-shaped soft-block bone substitute to a particulate xenograft, covered by a collagen membrane and fixed with pins, significantly improved the horizontal volume stability of the augmented region during wound closure.

Clinical association of Spirochaetes and Synergistetes with peri-implantitis.

OBJECTIVES: The microbial composition of peri-implantitis-associated biofilms may resemble that of periodontitis, with some distinctive differences, as identified by various conventional or molecular detection methods. Yet, the complete microbiome of peri-implantitis awaits further characterization. The present clinical study was undertaken with the aim to investigate the association of Spirochaetes, and the more recently identified phylum Synergistetes, with peri-implantitis. MATERIALS AND METHODS: Submucosal biofilms were obtained from single sites of patients with peri-implantitis (n = 43) or individuals with peri-implant health (n = 41). The samples were analysed by fluorescence in situ hybridization (FISH) and epifluorescence microscopy, using 16S rRNA-based oligonucleotide probes for Synergistetes cluster A, subclusters A1 and A2, and Treponema groups I-III and IV. RESULTS: Treponema group IV was barely detectable, whereas Treponema groups I-III were detected at low prevalence in health, but their prevalence and numbers were significantly increased in peri-implantitis by 48% and 2.4-log, respectively. Synergistetes cluster A was detected in half of the healthy sites, and its prevalence and numbers were significantly increased in peri-implantitis by 30% and 2.5-log, respectively. No quantitative differences were found between Synergistetes subclusters A1 and A2 numbers, as both increased by 2.8-log. Synergistetes cluster A displayed strong correlations with several clinical peri-implant parameters, but Treponema groups I-III only with probing pocket depth. CONCLUSION: The present clinical cross-sectional study demonstrates that Spriochaetes of the Treponema groups I-III, but not group IV, and Synergistetes of the cluster A are highly associated with peri-implantitis. Synergistetes cluster A appears to display a stronger association with peri-implantitis than Spirochaetes.

Accuracy of periapical radiography in assessing bone level in implants affected by peri-implantitis: a cross-sectional study.

AIM: The aim of this study was to assess the accuracy of periapical radiography in measuring peri-implant bone levels. MATERIALS AND METHODS: Twenty-five subjects with 46 implants in need of surgical treatment for peri-implantitis were included in this cross-sectional study. Prior to surgery, periapical radiographs were taken, a prediction of type of defect was made and radiographic peri-implant bone levels (RxBL) were determined at the mesial and distal aspects. Intra-operatively, the peri-implant bone level (SurgBL) was assessed mesially, distally, buccally and orally and the type of defect was recorded. A paired t-test was applied to detect differences between inter-proximal RxBL and SurgBL. ANOVA was used to compare SurgBL at different circumferential positions. RESULTS: The mean inter-proximal RxBL was 4.0 ± 2.2 mm and the mean inter-proximal SurgBL was 5.3 ± 2.3 mm. The difference between RxBL and SurgBL was statistically significant (p = 0.014). There were no significant differences in SurgBL at the mesial, distal, buccal and oral aspects (p > 0.05). CONCLUSIONS: The intra-operatively measured peri-implant bone levels were more apical than the radiographic bone levels. The intra-operatively assessed peri-implant bone levels (SurgBL) were similar at all the circumferential positions around the implant.

Influence of blinded wound closure on the volume stability of different GBR materials: an in vitro cone-beam computed tomographic examination.

OBJECTIVE: To test whether the use of (i) particulated bone substitute + collagen membrane used for guided bone regeneration (GBR) of peri-implant bone defects renders different results from (ii) particulated bone substitute + collagen membrane + fixation pins and from (iii) block bone substitute + collagen membrane with respect to the volume stability of the augmented region during suturing of mucosal flaps. MATERIAL AND METHODS: Twenty peri-implant box-shaped bone defects were created in 10 pig mandibles. Every bone defect was augmented once with each of the following GBR procedures: Granulate (particulated xenograft + collagen membrane), Granulate + Pins (particulated xenograft + collagen membrane + fixation pins), and Block (block xenograft + collagen membrane). Cone-beam computed tomography scans were obtained prior and after blinded wound closure. The horizontal thickness (HT) of the augmented region (bone substitute + membrane) was assessed at the implant shoulder (HT0 mm ) and at 1-5 mm apical to the implant shoulder (HT1 mm -HT5 mm ). The changes of HT during flap suturing were calculated as absolute (mm) and relative values (%). Repeated-measures ANOVA was used for statistical analysis. RESULTS: Wound closure induced a statistically significant change of HT0 mm and of HT1 mm in all the treatment groups (P ≤ 0.05). The change in HT0 mm measured -42.8 ± 17.9% (SD) for Granulate, -22.9 ± 21.2% (SD) for Granulate + Pins, and -20.2 ± 18.9% (SD) for Block. The reduction in HT0 mm, HT1 mm , HT2 mm, and HT3 mm for the Granulate procedure was significantly higher as compared to the Granulate + Pins and the Block procedures (P ≤ 0.05). There were no statistically significant differences in the change of HT between the Granulate + Pins and the Block procedures (P > 0.05). CONCLUSION: Wound closure induced displacement of the bone substitute resulting in a partial collapse of the collagen membrane in the coronal portion of the augmented site. The stability of the bone substitute and collagen membrane was enhanced by the application of fixation pins and by the use of block bone substitute instead of particulated bone substitute.

Loading protocols for single-implant crowns: a systematic review and meta-analysis.

PURPOSE: To test whether or not immediate loading of single-implant crowns renders different results from early and conventional loading with respect to implant survival, marginal bone loss, stability of peri-implant soft tissue, esthetics, and patient satisfaction. MATERIALS AND METHODS: An electronic search of Medline and Embase databases including studies published prior to August 1, 2012, was performed and complemented by a manual search. Randomized controlled trials (RCTs) comparing different loading protocols of single-implant crowns with a follow-up after restoration of at least 1 year were included. A meta-analysis yielded odds ratios (OR) and standardized mean differences (SMD) together with the corresponding 95% confidence intervals (95% CI). RESULTS: The search provided 10 RCTs comparing immediate and conventional loading and 1 RCT comparing immediate and early loading. When assessing the implant survival at 1 year of loading, the meta-analysis of 10 studies found no significant differences between immediate and conventional loading (OR = 0.75; 95% CI: 0.32 to 1.76). The total difference of marginal bone loss during the first year of function between immediate and conventional loading protocols in 7 RCTs did not reach statistical significance (SMD = -0.05 mm; 95% CI: -0.41 to 0.31 mm). There were no significant differences between immediate and conventional loading regarding implant survival and marginal bone loss at 2, 3, and 5 years of loading. Three RCTs comparing the change of papilla level between immediate and conventional loading identified no significant differences. One study investigated the recession of the buccal mucosa after implant placement and found significantly inferior soft tissue loss for immediate loading as compared to conventional loading. Two RCTs investigated the recession of the buccal mucosa after insertion of the definitive crown and found no differences between immediate and conventional loading. The esthetics and the patient satisfaction were assessed in one and two RCTs, respectively. There were no significant differences between immediate and conventional loading. CONCLUSIONS: Immediately and conventionally loaded single-implant crowns are equally successful regarding implant survival and marginal bone loss. This conclusion is primarily derived from studies evaluating implants inserted with a torque ≥ 20 to 45 Ncm or an implant stability quotient (ISQ) ≥ 60 to 65 and with no need for simultaneous bone augmentation. Immediately and conventionally loaded implants do not appear to differently affect the papilla height during the first year of loading. Due to the heterogeneity of the time point of baseline measurements and contradictory findings in the studies, it is difficult to draw clear conclusions regarding the recession of the buccal mucosa. With respect to the assessment of esthetic outcomes and patient satisfaction, the data available remain inconclusive.

Biodegradation and bone formation of various polyethylene glycol hydrogels in acute and chronic sites in mini-pigs.

OBJECTIVE: i) To test whether or not pH modifications of a PEG hydrogel matrix influence degradation time and bone regeneration in acute and unprepared (chronic) defects; and ii) to test whether or not the addition of a PEG hydrogel to hydroxyapatite/tricalciumphosphate (HA/TCP) can further enhance bone regeneration compared to HA/TCP alone in acute defects. MATERIALS AND METHODS: In 11 mini-pigs, three acute standardized defects and one chronic site were prepared in each hemi-mandible. The following treatment modalities were applied in acute defects: PEG hydrogel regular (PEG 8.7), PEG hydrogel pH-modified plus (PEG 9.0), PEG hydrogel pH-modified minus (PEG 8.4), PEG 8.7 mixed with HA/TCP granules (PEG-HA/TCP), HA/TCP granules (HA/TCP), and empty control (control). In chronic sites, PEG 8.7 and PEG 9.0 were applied. Subsequently primary wound closure was obtained and animals sacrificed at 10 (n = 6) and 21 days (n = 5). Descriptive histology and histomorphometric analyses were performed including measurements for newly formed bone, remaining hydrogel, and percent defect fill. Standard descriptive statistics were calculated, and regression analysis used to determine the difference between treatments, taking into account relevant factors and correction for multiple comparisons. RESULTS: In acute defects, the amount of newly formed bone increased statistically significantly over time for all treatments. The increase was higher for PEG 8.7 (35.9%) compared with PEG 8.4 and PEG 9.0 and was higher for PEG-HA/TCP (24.7%) than for HA/TCP (14.6%). The remaining hydrogel ranged between 7.6 ± 13.3% for PEG 8.4 and 17.7 ± 12.8% for PEG 8.7 at 10 days. At 21 days, no remaining hydrogel was found except for PEG-HA/TCP (11.5 ± 10.4%). In chronic sites, at 10 days, the remaining hydrogel covered 29.5 ± 10.3% (PEG 9.0) and 25.6 ± 21.8% (PEG 8.7) of the area. At 21 days, the amount of hydrogel (29.7 ± 31.7% for PEG 9.0; 1.4 ± 2.5% for PEG 8.7) decreased, while the amount of bone increased to 14.0 ± 16.3% for PEG 9.0 and to 37.9 ± 15.7% for PEG 8.7. CONCLUSIONS: The PEG hydrogel matrix with a mid-range pH (PEG 8.7) may serve as a matrix for localized bone regeneration with or without the addition of a bone substitute material. This was demonstrated by enhanced bone regeneration in acute and chronic defects compared with control hydrogels and HA/TCP alone.

Long-term marginal bone loss in 217 machined-surface implants placed in 68 patients with 5 to 9 years of follow-up: a retrospective study.

PURPOSE: The aim of the present study was to evaluate marginal bone loss (mBL) adjacent to dental implants with a machined surface with at least 5 years of function. MATERIALS AND METHODS: Machined-surface implants with a minimum follow-up of 5 years were included in the study. Recorded clinical parameters included plaque and gingival bleeding indices, smoking habit (nonsmoker, 0 to 10 cigarettes/day, or more than 10 cigarettes/day), presence of periodontal disease (healthy or periodontally compromised), and compliance with periodontal maintenance. Marginal bone loss (mBL) was assessed radiographically around the implants using the long-cone parallel technique. RESULTS: Sixty-eight participants who received 217 implants were included in the study. No late failures occurred. The mean duration of follow-up was 6.7 years (range, 5 to 9 years). The mean mBL after 5 to 9 years was 0.43 threads (± 1.12 threads) (0.26 mm). Thirteen implants (6.0%) showed a mBL of at least three threads. Multiple linear regression (R2 = 0.229) showed that implants in patients with poor periodontal maintenance and implants placed in periodontally compromised patients were significantly associated with greater mBL (P < .005). Female gender and follow-up time were also associated with greater mBL. CONCLUSIONS: Limited long-term mBL was associated with machined-surface implants. Regular periodontal maintenance visits every 3 to 6 months, especially in periodontally compromised patients, have to be considered paramount to maintain peri-implant bone levels over the long term.

Prevalence of peri-implant diseases. A cross-sectional study based on a private practice environment.

AIM: To determine the prevalence of peri-implant diseases in private practice patients enrolled in a periodontal maintenance programme. MATERIAL AND METHODS: A cross-sectional study was carried out in patients with dental implants attending the dental clinic to comply with a periodontal maintenance programme between January and June 2010. Implants with at least 1 year of loading time (range: 1-18 years) were included. A patient-based prevalence analysis of peri-implant diseases was carried out. Additionally, implants were classified into the following categories: healthy, clinically stable, mucositis and peri-implantitis. RESULTS: A total of 245 patients (964 dental implants) were analysed. Implant and patient-based peri-implantitis prevalences were 9.1% [95% confidence interval (95%CI): 7.5-11.1%] and 16.3% [95%CI: 12.2-21.5%] respectively. Mucositis affected 21.6% [95%CI: 19.1-24.5%] of the studied implants and 38.8% [95%CI: 33.3-45.4%] of the patients. CONCLUSIONS: The prevalence of peri-implantitis in private practice patients enrolled in a periodontal maintenance programme was estimated to be between 12% and 22%. Almost 40% of the patients had mucositis. These prevalences are similar to those published in University environment samples.

Giant desmoplastic fibroma in the anterior zone of the maxilla.

Desmoplastic fibroma (DF) is a rare intraosseous benign neoplasm that represents less than 1% of the osseous tumors. This lesion can be locally aggressive, and the rate of recurrence is frequently high.A 34-year-old male patient was referred to our clinic presenting a tumor in the anterior zone of the maxilla. The oral examination revealed a hard and lobulated tumor, affecting teeth 13 to 26. The radiographic examination, orthopantomography, and computed tomography revealed a radiolucent, multilocular, well-defined image, which extended from tooth 13 to the mesial root of tooth 26, provoking marked expansion, thinning, and perforation of the buccal and palatal cortical plates. A provisional diagnosis of aggressive odontogenic tumor was made, and block resection of the tumor was carried out. Intraoperatively, the tumor was lobulated, composed of a homogenous fibrous tissue, hard, and white-yellowish. The histologic analysis leads to a diagnosis of DF.Desmoplastic fibroma of the oral cavity is a rare benign intraosseous tumor, especially when it involves the upper maxilla and the anterior region. The main clinical and pathologic differential diagnosis in our case was central odontogenic fibroma. The most suitable treatment option for DF of the oral cavity is a controversial issue, but block resection is the therapy reporting a lower recurrence. Finally, an interesting feature of this intraosseous neoplasm, if located in the oral cavity, refers to the different clinical pattern that might present depending on location.