Ex vivo assessment of the buccal and oral bone by CBCT.

PURPOSE: Identifying buccal and oral bone as an important supporting periodontal structure for teeth provides important information for treatment planning in periodontics and orthodontics. This study aims to add evidence to the knowledge of preciseness of cone beam computed tomography (CBCT) measurements of the vertical dimension of buccal and oral bone. The hypothesis is that CBCT is an accurate and reliable method to measure vertical vestibular and oral bone loss. METHODS: The amount of vertical buccal and oral bone loss (bl) of 260 sites of 10 human cadavers was investigated clinically and radiographically by CBCT. Radiographic measurements were rated by two blinded raters. Measurements and the corresponding differences between clinical and radiological findings are described by medians and quartiles (Q1-Q3). For statistical analysis, Lin's concordance correlation coefficient (CCC) and Bland-Altman plots were calculated. RESULTS: The CCC between the raters was 0.994 (95% confidence interval 0.992-0.995). The median bone loss (bl) distance from the cementoenamel junction (CEJ) to the bony defect (BD) was 3.5 mm (range 3-5 mm). The median bl measured in the CBCT was 3.8 mm (range 3.1-4.8 mm). The median difference of the 2 measurements for all sites included in the study (N = 260) was -0.2 mm (-0.7 to 0.3 mm). CONCLUSIONS: CBCT seems to be an accurate and highly reliable method to detect and describe vertical buccal and oral bone loss. It could improve planning and prediction for successful combined periodontal and orthodontic therapies.

Nuevas técnicas de planificación y tratamiento para la rehabilitación maxilar con implantes cigomáticos. A propósito de un caso / New techniques in planning and restoring for zygomatic implant maxillary rehabilitation approach. A case report

Se expone el caso de una paciente de 76 años con antecedente de carcinoma epidermoide intraoral (2003) que tras la cirugía y radioterapia posterior presenta e dentulismo y atrofia maxilar severa.Tras la exploración clínica y radiológica con una tomografía axial computarizada (TAC) se decide rehabilitar el maxilar superior con implantes cigomáticos y una prótesis completa atornillada de carga inmediata. Mediante exportación DICOM del TAC maxilar al software Mimics (Materialise, Belgium) se realiza una planificación quirúrgica virtual tomando como referencia una propuesta digital protésica (DentalCAD, Exocad, USA). En el entorno 3-Matic (Materialise, Belgium) se diseñandos guías quirúrgicas óseos portadas para la colocación óptima de cuatro implantes cigomáticos combinando la técnica ZAGA (siglas en inglés de Zigoma Anatomy-Guided Approach o lo que es lo mismo, Abordaje Cigomático Guiado Anatómicamente) y Quad approach. Protésicamente, se diseña un prototipado que sirve como la tradicional prueba de dientes en cera y como férula radiológica prequirúrgica. El objetivo es simplificar la sistemática de trabajo con un nuevo método digital combinado gracias a la digitalización de los pilares de cicatrización de tipo Multi-Unit® (denominados healing caps). Con el presente caso clínico se desarrolla un protocolo de trabajo que simplifica toma de registros, abarata los costes y acorta el tiempo quirúrgico y de gabinete para la confección de una prótesis de carga inmediata de polimetil metacrilato acrílico (PMMA). Además, gracias al TAC postquirúrgico se compara y analiza la precisión aportada por las guías empleadas en el proceso de colocación de los implantes en relación con el software de planificación quirúrgica virtual (VSP –Virtual Surgical Planning-), confirmándose así la sencillez, exactitud y seguridad en todo el procedimiento quirúrgico. Se tomó como referencia para la comparación el extremo coronal y apical de cada implante cigomático junto con el ángulo resultante de la discrepancia entre el implante real y el digital. Los resultados obtenidos comparados con la bibliografía, demuestran una desviación sin repercusión en el proceso rehabilitador (AU)

Type 1 diabetes and periodontitis: prevalence and periodontal destruction-a systematic review.

AIMS: Data about the association between periodontal disease or periodontitis (PD), diabetes and hyperglycemia have been reported mostly in patients with type 2 diabetes. Conversely, information about PD in type 1 diabetes (T1DM) is relatively scarce. The aim of this meta-analysis is therefore: (1) to assess the prevalence and severity of PD in patients affected by T1DM in comparison with the general population and (2) to verify the association between severity of PD and glycemic control in type 1 diabetics. METHODS: An electronic search was performed on MEDLINE, Cochrane Central Register of Trials and EMBASE, up to October 31, 2019. Estimates of prevalence of PD in T1DM were calculated together with Mantel-Haenszel odds ratios (MH-OR) of the risk of PD associated with T1DM; weighed mean difference in CAL between T1DM and control and weighed mean difference in CAL in patients with T1DM and unsatisfactory glycemic control as compared with those in good glycemic control were also evaluated.. RESULTS: The prevalence of PD in type 1 diabetes was 18.5 [8.0; 37.1] %; the MH-OR for PD is 2.51 (1.32;4.76) in T1DM patients versus general population (p = 0.005). The weighed mean difference in CAL depth between T1DM patients and controls is 0.506 [0.181; 0.832] mm (p < 0.005), and in T1DM patients with good glycemic control CAL depth is - 0.71 [- 1.00; - 0.42] mm less deep than in subjects with HbA1c > 7%. CONCLUSIONS: The present data confirm that T1DM is a relevant risk factor for the development of PD. The proportion of patients affected by PD is more than doubled in subjects with T1DM in comparison with non-diabetic individual, and among patients with T1DM, PD seems to be more severe and the differences appear very wide between subjects in optimal and suboptimal glycemic control.

Short implants (< 8 mm) versus longer implants (≥ 8 mm) with lateral sinus floor augmentation in posterior atrophic maxilla: A meta-analysis of RCT`s in humans

BACKGROUND: One of the greatest challenges that dentists face today is to rehabilitate severe atrophied alveolar ridges in partially and completely edentulous patients with implants. Despite the high survival rate of implants placed next to sinus elevation, this technique presents complications that can be avoided by placing short implants, an option that also presents high survival rates. For this reason, the aim of this study is to compare the survival rate, marginal bone loss and complications associated with short implants (< 8 mm) versus longer implants (≥ 8 mm) placed with lateral sinus floor elevation in posterior atrophic maxillae. MATERIAL AND METHODS: A literature search was conducted by two independent reviewers in the PubMed/Medline (National Library of Medicine, Washington, DC) electronic database for articles published from January 2007 to July 2018. Seven qualified articles were selected for the meta-analysis. RESULTS: The test for overall effect did not find statistical significance in the survival rates, overall complications, intra-operative complications, post-operative complications and prosthetic complications. However, the test showed statistically significant differences in biological complications in favor of standard implants, and marginal bone loss between control and test groups in favor of short implants (< 8 mm) was found. CONCLUSIONS: Within the limitations of the present study, prosthetic rehabilitations with short implants (< 8 mm) in posterior maxilla is a reliable treatment option as an alternative to lateral wall sinus floor augmentation

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Loss of Discoidin Domain Receptor 1 Predisposes Mice to Periodontal Breakdown.

The discoidin domain receptors, DDR1 and DDR2, are nonintegrin collagen receptors and tyrosine kinases. DDRs regulate cell functions, and their extracellular domains affect collagen fibrillogenesis and mineralization. Based on the collagenous nature of dentoalveolar tissues, we hypothesized that DDR1 plays an important role in dentoalveolar development and function. Radiography, micro-computed tomography (micro-CT), histology, histomorphometry, in situ hybridization (ISH), immunohistochemistry (IHC), and transmission electron microscopy (TEM) were used to analyze Ddr1 knockout (Ddr1-/-) mice and wild-type (WT) controls at 1, 2, and 9 mo, and ISH and quantitative polymerase chain reaction (qPCR) were employed to assess Ddr1/DDR1 messenger RNA expression in mouse and human tissues. Radiographic images showed normal molars but abnormal mandibular condyles, as well as alveolar bone loss in Ddr1-/- mice versus WT controls at 9 mo. Histological, histomorphometric, micro-CT, and TEM analyses indicated no differences in enamel or dentin Ddr1-/- versus WT molars. Total volumes (TVs) and bone volumes (BVs) of subchondral and ramus bone of Ddr1-/- versus WT condyles were increased and bone volume fraction (BV/TV) was reduced at 1 and 9 mo. There were no differences in alveolar bone volume at 1 mo, but at 9 mo, severe periodontal defects and significant alveolar bone loss (14%; P < 0.0001) were evident in Ddr1-/- versus WT mandibles. Histology, ISH, and IHC revealed disrupted junctional epithelium, connective tissue destruction, bacterial invasion, increased neutrophil infiltration, upregulation of cytokines including macrophage colony-stimulating factor, and 3-fold increased osteoclast numbers (P < 0.05) in Ddr1-/- versus WT periodontia at 9 mo. In normal mouse tissues, ISH and qPCR revealed Ddr1 expression in basal cell layers of the oral epithelia and in immune cells. We confirmed a similar expression pattern in human oral epithelium by ISH and qPCR. We propose that DDR1 plays an important role in periodontal homeostasis and that absence of DDR1 predisposes mice to periodontal breakdown.

Digital and Orthodontically Driven Implant Planning: A Multidisciplinary Case History Report.

Patients presenting both severe maxillary atrophy and dental malposition require a multidisciplinary treatment approach to achieve optimal esthetic and functional results. This case history report demonstrates how digital treatment planning and teeth set-up can serve as a reference for surgical, orthodontic, and prosthodontic procedures, leading to an all-ceramic full-arch implant-supported fixed prosthesis.

Low-intensity pulsed ultrasound reduces periodontal atrophy in occlusal hypofunctional teeth.

OBJECTIVE: To clarify whether low-intensity pulsed ultrasound (LIPUS) exposure has recovery effects on the hypofunctional periodontal ligament (PDL) and interradicular alveolar bone (IRAB). MATERIALS AND METHODS: Twelve-week-old male Sprague-Dawley rats were divided into three groups (n = 5 each): a normal occlusion (C) group, an occlusal hypofunction (H) group, and an occlusal hypofunction group subjected to LIPUS (HL) treatment. Hypofunctional occlusion of the maxillary first molar (M1) of the H and HL groups was induced by the bite-raising technique. Only the HL group was irradiated with LIPUS for 5 days. The IRAB and PDL of M1 were examined by microcomputed tomography (micro-CT) analysis. To quantify mRNA expression of cytokines involved in PDL proliferation and development, real-time reverse transcription quantitative PCR (qRT-PCR) was performed for twist family bHLH transcription factor 1 (Twist1), periostin, and connective tissue growth factor (CTGF) in the PDL samples. RESULTS: Micro-CT analysis showed that the PDL volume was decreased in the H group compared with that of the C and HL groups. Both bone volume per tissue volume (BV/TV) of IRAB was decreased in the H group compared with that in the C group. LIPUS exposure restored BV/TV in the IRAB of the HL group. qRT-PCR analysis showed that Twist1, periostin, and CTGF mRNA levels were decreased in the H group and increased in the HL group. CONCLUSION: LIPUS exposure reduced the atrophic changes of alveolar bone by inducing the upregulation of periostin and CTGF expression to promote PDL healing after induction of occlusal hypofunction.

Técnica quirúrgica de Edland Mejchar para corrección de recesión gingival / Edland Mejchar surgical technique for correction of recession gingival

Las técnicas quirúrgicas periodontales correctivas se diversifican ampliamente en la actualidad por la necesidad de restablecer un periodonto sano y lograr una estética aceptable, en los últimos tiempos la casuística de las alteraciones gingivales va en aumento quizás por el advenimiento de la búsqueda de ideales de perfección por parte de los pacientes, o por la instauración de tratamientos odontológicos como la ortodoncia que se relacionan etiológicamente con estos defectos. La retracción gingival y la atrofia gingival son dos de las anomalías de la encía más prevalentes dentro de la población y, aunque la inducción más común de su aparición es una mala higiene oral, se presentan casos fenotípicos relacionados con la deficiencia de lámina ósea, grosor de encía deficiente, frenillos en inserción penetrante o vestíbulos poco profundos que ejercen fuerzas traccionales patológicas; el tratamiento de estas patologías se decide de acuerdo con las necesidades correctivas y consideraciones de cada caso. A continuación se describe la técnica mucogingival de Edland Mejchar, la cual se realizó concomitantemente con tratamiento ortodóncico, en ella hay profundización de vestíbulo, como solución a defectos de recesión gingival vestibular en sector anteroinferior causada por fuerzas traccionales ofreciendo una solución al defecto al aliviar la tensión generada en la zona por las fibras musculares y por la creación de una banda de encía fibrosa que detiene la migración apical del margen gingival

The periodontal corrective surgical techniques now widely diversified by the need to restore a healthy periodontium and achieve acceptable aesthetic, the last time the casuistry of gingival changes is increasing perhaps the advent of the search for ideals of perfection by patients or the establishment of dental and orthodontic treatments that are related etiologically to these defects. Gingival recession and gingival atrophy are some of the most common gingival abnormalities in the population, and although the most common induction of onset ranges from the management of poor oral hygiene are phenotypic cases related to the deficiency of bone plates, thickness poor gums, you braces or lobbies push-penetrating shallow tractional forces exerted pathological, treatment of these pathologies is decided according to the remedial needs and considerations of each case. The following describes the technical mucogingival Edland Mejchar, which took place concomitantly with orthodontic treatment, there is deepening of lobby, as a solution to defects of gingival recession vestibular in antero-inferior sector caused by forces tractional offering a solution to defect to relieve the tension generated in the area by the muscle fibers and the creation of a band of fibrous gum which stops the apical migration of the gingival margin

Success rate of zygomatic implants forrehabilitation of severely atrophied maxillae: a review of the literature / Tasa de éxito de los implantes cigomáticos para la rehabilitacióndel maxilar severamente atrofiado: una revisión de la literatura

Severe resorption in the posterior maxilla sectors as a result of tooth loss along with the process of pneumatization of the maxillary sinus, difficult the prosthetic rehabilitation supported by conventional implants due to the shortage of vertical bone availability. So that over the years they have designed therapeutic alternatives to help overcome these drawbacks. The zygomatic implant was introduced in 1988 by Branemark. This implant has a design which allows it to be positioned over the ridge to the height of the first molar, reducing vestibular cantilever up to 20 percent and reducing complications of peri-implant inflammation, infection and gingival hyperplasia, which may lead to perforation horizontal process of the palatine bone. The purpose of this review is to determine the success rate of zygomatic implants for rehabilitation of severely atrophied maxillae. A total of 1410 zygomatic implants and 1673 Traditional implants were included in selected articles. Of these 1410 zygomatic Implants, 365 were conventional loading and 1045 were immediately and early loading, these had a success rate of 98.3 percent and 98.7 percent, respectively. Of these 1673 Traditional Implants, 463 were conventional loading and 1210 were immediately and early loading, they had a success rate of 93.9 percent and 97.8 percent, respectively. The overall success rate of zygomatic implants and Conventional implants was 98.6 percent and 96.8 percent, respectively. The rehabilitation of severely atrophied maxilla with fixed prosthesis immediately and conventional loaded by zygomatic implants gives excellent results in the medium term. When comparing traditional treatment modalities, proposals for prosthetic reconstruction of severely atrophied maxilla, the zygomatico implant has the highest success rate over conventional treatments...

La reabsorción severa en sectores posteriores del maxilar, como resultado de la pérdida de dientes junto con el proceso de neumatización del seno maxilar, resulta en una difícil rehabilitación protésica conel apoyo de los implantes convencionales, debido a la escasez de hueso vertical disponible. A lo largo de los años se han diseñado alternativas terapéuticas para ayudar a superar estos inconvenientes. El implante cigomático fue introducido en 1988 por Branemark. Este implante tiene un diseño que permite colocarse sobre la cresta hasta la altura del primer molar, reduciendo el voladizo bucal hasta en un 20 %, con la consecuente reducción de las complicaciones del peri-implantarias, como inflamación, infección y la hiperplasia gingival, que pueden conducir al desarrollo del proceso de perforación horizontal del hueso palatino. El propósito de esta revisión fue determinar la tasa de éxito de los implantes cigomáticos para la rehabilitación del maxilar gravemente atrófico. Un total de 1410 implantes cigomáticos y 1673 implantes tradicionales fueron descritos en los artículos seleccionados. De estos 1410 implantes cigomáticos, 365 eran de carga convencional y 1045 fueron de carga inmediata y temprana, teniendo una tasa de éxito del 98,3 % y 98,7 %, respectivamente. De los 1673 implantes tradicionales, 463 fueron de carga convencional y 1210 fueron de carga inmediata y temprana, presentando una tasa de éxito del 93,9 % y 97,8 %, respectivamente. La tasa de éxito de los implantes cigomáticos y los implantes convencionales fue del 98,6 % y 96,8 %, respectivamente. La rehabilitación del maxilar severamente atrofiado con prótesis fija convencional cargado inmediatamente y por los implantes cigomáticos otorgó excelentes resultados en el mediano plazo. Al comparar las modalidades de tratamiento tradicionales, propuestas para la re-construcción protésica del maxilar severamente atrofiado, el implante cigomático tiene la mayor tasa de éxito respecto a los tratamientos convencionales.

Implantes pterigoideos, una opción de tratamiento / Pterygoid implants: a treatment option

El edentulismo parcial en el sector posterior del hueso maxilar, es producido principalmente por la pérdida de molares debido a caries, enfermedad periodontal y al exceso de fuerza soportado por losdientes de este sector. Implantes dentales mayores a 10 mm, raramente son colocados en estas zona debido auna mayor probabilidad de fracasos por el escaso volumen óseo y deficiente calidad del hueso. En el cráneo, en relación posterior a la maxila encontramos un arbotante pterigomaxilar. Este permite, en algunas situaciones, la rehabilitación de maxilares atróficos mediante la colocación de implantes con una angulación parasinusal, evitando técnicas quirúrgicas o procedimiento más complejos. El implante pterigoideo es un posible tratamiento para rehabilitar el sector posterior del maxilar atrófico, anclado en hueso cortical del proceso pterigoides. Se reporta un caso de utilización de implantes pterigoídeos en una mujer de 58 años de edad con gran neumatización en ambos senos maxilares, con un remanente de hueso alveolar de 1-2 mm.

The partially edentulous in the posterior maxilla bone is produced mainly by the loss of molars due to caries, periodontal disease and excessive force supported by the teeth of this sector. Dental implants greater than 10 mm, are rarely placed in this area due to a higher probability of failure for the low bone volume and bone quality poor. In the skull, in the post jawbone relationship, we find a pterygomaxillary buttress. This allows, in some situations, the rehabilitation of atrophic jaws by placing implants with a parasinusal angulation, avoiding surgical techniques or more complex procedure. The pterygoid implant is a possible treatment to rehabilitate the atrophic posterior maxilla, anchored in cortical bone of the pterygoid process. A case of placement of pterygoid implants in a woman 58 years old with a large pneumatization in both maxillary sinuses, with a remaining alveolar bone 1-2 mm is reported.

Alveolar ridge splitting for implant installation in atrophic sites: analysis of a case series / División de reborde alveolar para instalación de implantes en sitios atróficos: análisis de una serie de casos

The alveolar ridge splitting technique (ARST) has been developed for close to 20 years, demonstrating effectiveness and efficiency in some cases. The aim of this study was to evaluate the behavior of the technique in a series of surgical cases using a piezoelectric system. Eleven patients (ASA I and ASA II) were included in this study. Subjects who smoked or who presented previous implant treatments or reconstructive surgeries in the treatment area were excluded. The surgeries took place under local anesthesia without sedation and consisted of a straight crestal incision and subsequent bone management with 4 different types of inserts mounted on a piezoelectric system, which were used gradually on the alveolar crest, moving down approximately 10 mm. Once the approximately 3 mm expansion had been achieved, the implants were installed under controlled torque and the implant sites and defects present were filled with lyophilized bovine bone. In the splitting technique, there was a fracture of the bone plate in 4 cases, although in each case the implants were installed. A total of 34 implants were installed, of which 27 reached 35 N in installation and the rest between 20 N and 35 N. In the second surgery 2 implants were lost. It can be concluded that the technique is predictable, of low morbidity and with rapid treatment completion, presenting limited intraoperative complications.

La técnica de división de reborde alveolar (DRA) tiene cerca de 20 años de evolución demostrando efectividad y eficiencia en algunos casos. El objetivo de este estudio es evaluar el comportamiento de la técnica en una serie de casos operados con sistema piezoeléctrico. Once pacientes (ASA I y ASA II) fueron incluidos en este estudio; se excluyeron sujetos fumadores o que presentaran tratamientos implantológicos o quirúrgicos reconstructivos previos en el área a tratar; las intervenciones se desarrollaron bajo anestesia local, sin sedación y consistió en una incisión crestal recta y posteriormente el manejo óseo con 4 tipos diferentes de insertos montados en sistema piezoeléctrico los que fueron utilizados gradualmente sobre la cresta alveolar profundizando hasta los 10 mm aproximadamente; una vez obtenida la expansión de 3 mm aproximadamente se procedió a la instalación de implantes bajo torque controlado y relleno con hueso liofilizado bovino de los sitios implantados y defectos presentes. En la técnica de división, en 4 casos existió fractura de la tabla ósea, aunque en todos ellos fueron instalados los implantes. Se instalaron un total de 34 implantes de los cuales 27 consiguieron los 35 N en instalación y el resto presento de entre 20 N y 35 N; en la segunda cirugía se observo una perdida de 2 implantes. Se puede concluir que la técnica es predecible, de baja morbilidad y de rápida finalización de tratamiento, presentando limitadas complicaciones intraoperatorias.

Clinical features of gingival lesions in patients with dystrophic epidermolysis bullosa: a cross-sectional study.

BACKGROUND: Gingival lesions in patients with dystrophic epidermolysis bullosa (DEB) are a common manifestation. However, their clinical features, frequency and severity are currently unknown. METHODS: Forty-five DEB patients were assessed by an oral medicine specialist, who analysed the presence/absence of four clinical signs (erythema, erosion/ulcer, atrophy, blister) on free and attached gingiva, using the Epidermolysis Bullosa Oropharyngeal Severity score. RESULTS: Twenty-eight (62.2%) out of 45 DEB patients showed different types of gingival lesions, whose presence/absence and total frequency/distribution were not significantly different between males and females (p=0.087 and p=0.091, respectively). Erythema was the most prevalent lesion (66.2%) and the recessive DEB severe generalized (RDEB-sev gen) reached the highest median disease activity score. A significant correlation was observed between the DEB subtypes and the disease activity median score (p<0.001), but not between age and total disease activity score in each group of DEB (p>0.05). Lastly, logistic regression showed that only gender (p=0.031) and RDEB-sev gen (p=0.001) were risks factors for the presence of gingival lesions. CONCLUSIONS: Gingival lesions in DEB patients are a relatively common entity and may have multiple clinical aspects, emphasizing the need for thorough attention and awareness among dentists.

Osteoplastic reconstruction of severely resorbed maxilla by stack plasty: combining sinus augmentation with lateral and vertical onlay bone grafting.

Progressive loss of the alveolus with aging leads to defects in the buccolingual and vertical dimensions. Maxillomandibular spatial discrepancies and deficits in sagittal facial projection develop at the same time as deficiencies of the periodontal unit, alveolar bone, and attached gingiva increase, depending on the extent of the atrophy. To restore the anatomy, a sinus lift should be combined with lateral and vertical bony augmentation in an osteoplastic procedure. To achieve this, "block over block" replacement with bone from the iliac crest allows precise functional and aesthetic restoration of the alveolus and the nasomaxillary region by combining inlay, interpositional, and onlay grafting. To our knowledge, preprosthetic osteoplastic reconstruction with stacked bone grafts has not previously been documented with a large number of patients. We report the results of this procedure in 62 patients with severe maxillary atrophy.

Complication rate in 200 consecutive sinus lift procedures: guidelines for prevention and treatment.

PURPOSE: Maxillary sinus grafting is a predictable and reliable procedure that has been routinely performed for more than 30 years. The complication rate is low, but some cases may require additional surgery, and the outcome of oral rehabilitation may be affected. The purpose of the present study was to evaluate the early and late complications after sinus lift procedures performed in the authors' center, with special attention to risk factors and their connection to the principles of prevention and treatment. MATERIALS AND METHODS: A retrospective analysis of 127 patients was performed. During an 8-year period, patients underwent preprosthetic surgery with implants and a maxillary sinus lift procedure because of maxillary atrophy. In total, 202 sinus lift procedures were performed and 364 implants were placed (117 simultaneously and 247 delayed). Clinical data, local or systemic disease, risk factors, type of surgery, intraoperative and postoperative complications, and the evolution of the implant zone were recorded. RESULTS: The most common intraoperative complication was damage to the Schneiderian membrane (25.7%), which did not show any connection to postoperative complications. Thirty patients (14.9%) developed postoperative complications, including wound infection, abscess, or dehiscence with drainage (9 cases), maxillary sinusitis of the operated area (6 cases), partial exposure of the simultaneous onlay graft (6 cases), and loss of the graft (2 cases). CONCLUSION: Sinus lift surgery is a proven and reliable technique because of the low observed rate of postoperative complications and the success rate of implants placed into the grafted area. To minimize risk, care must be taken with all technical details and risk factors that can lead to fatality.

Human palatal and tuberosity mucosa as donor sites for ridge augmentation.

Since different clinical outcomes of periodontal bilaminar surgeries using the palate or the maxillary tuberosity as connective tissue (CT) donor sites have been observed, tissues grafted with CT from the palate or the tuberosity 1 year after surgical procedures for ridge augmentation were compared with nongrafted tissues by using morphologic and molecular methods. Collagen content and matrix metalloproteinases 1 and 2 expression were similar in tissues and cultured fibroblasts from the palate and tuberosity, although with interindividual differences. In contrast, differences in collagen cross-linking and maturation in the tuberosity fibroblasts were observed, suggesting a possible role in determining hyperplastic responses in some patients.

Enxertos ósseo e gengival para instalação de implantes dentários em áreas estéticas / Hard and soft tissue augmentation for dental implant restoration in the aesthetic area

A reconstrução do rebordo alveolar para instalação de implantes dentários é muito comum, e uma alternativa favorável para pacientes com problemas estéticos devido à falta de dentes anteriores. O sucesso depende do tipo de enxerto, o qual deve gerar o volume necessário para corrigir o defeito. É preferível escolher um material com excelentes características biomorfológicas. Os enxertos autógenos são o padrão-ouro de regeneração óssea guiada (ROG), por suas propriedades únicas. A combinação de enxertos ósseos e técnicas mucogengivais visa alcançar excelentes resultados estéticos e sucesso clínico em Implantodontia. Este relato de caso mostra a aplicação de um enxerto autólogo em bloco do ramo da mandíbula antes da colocação de implantes dentários em um paciente com um defeito ósseo horizontal em área estética. Também foi feito um enxerto gengival e condicionamento gengival através de provisório imediato.

Alveolar ridge augmentation prior to dental implant placement is a favourable alternative for patients with single-tooth loss in the aesthetic region. However, optimal results depend heavily on the type of graft used to generate the appropriate volume to correct the defect. It is preferable to choose a material with great biomorphologic characteristics. Autologous grafts are the gold standard of guided bone regeneration (ROG) because of it unique properties. Excellent aesthetics and clinical success are achievable with the combination of autografts and mucogingival techniques. This case report shows the application of a ramus autologous block graft previous to dental implant treatment and connective tissue graft in a patient with horizontal ridge deficiency in the aesthetic region. Also, gingival graft an soft tissue conditioning were performed using an immediate provisional restoration.

Occlusal hypofunction causes periodontal atrophy and VEGF/VEGFR inhibition in tooth movement.

OBJECTIVE: To examine changes in microvasculature and the expression of vascular endothelial growth factor A (VEGF-A) and VEGF receptor 2 (VEGFR-2) in rat hypofunctional periodontal ligament (PDL) during experimental tooth movement. MATERIALS AND METHODS: Twelve-week-old male Sprague-Dawley rats were divided into normal occlusion and occlusal hypofunction groups. After a 2-week bite-raising period, rat first molar was moved mesially using a 10-gf titanium-nickel alloy closed coil spring in both groups. On days 0, 1, 2, 3, and 7 after tooth movement, histologic changes were examined by micro-computed tomography and immunohistochemistry using CD31, VEGF-A, VEGFR-2, and the terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) method. RESULTS: Hypofunctional molars inclined more than normal molars and did not move notably after day 1 of tooth movement. Blood vessels increased on the tension side of the PDL in normal teeth. Immunoreactivities for VEGF-A and VEGFR-2 in normal teeth were greater than those in hypofunctional teeth during tooth movement. Compressive force rapidly caused apoptosis of the PDL and vascular endothelial cells in hypofunctional teeth, but not in normal teeth. CONCLUSIONS: Occlusal hypofunction induces vascular constriction through a decrease in the expression of VEGF-A and VEGFR-2, and apoptosis of the PDL and vascular cells occurs during tooth movement.

Clinical evaluation of intrabony defects in localized aggressive periodontitis patients with and without bioglass- an in-vivo study.

BACKGROUND: Aggressive periodontitis is a specific type of periodontitis with clearly identifiable clinical characteristics such as rapid attachment loss, bone destruction and familial aggregation. Regeneration of mineralized tissues affected by aggressive periodontitis comprises a major scientific and clinical challenge. In recent years some evidence has been provided that bioactive glass is also capable of supporting the regenerative healing of periodontal lesions. OBJECTIVE: The aim of this clinical and radiological prospective study was to evaluate the efficacy of bioactive glass in the treatment of intra-bony defects in patients with localized aggressive periodontitis. METHODS: Twelve localized aggressive periodontitis patients with bilaterally located three-walled intra-bony defect depth = 2 mm, preoperative probing depths = 5 mm were randomly treated either with the bioactive glass or without the bioactive glass. The clinical parameters plaque index, gingival index, probing depth, gingival recession, clinical attachment level, and mobility were recorded prior to surgery as well as 12 months after surgery. Intraoral radiographs were digitized to evaluate the bone defect depth at baseline and 12 months after the surgery. RESULTS: After 12 months, a reduction in probing depth of 3.92 + 0.313 mm (P < 0.001) and a gain in clinical attachment level of 4.42+0358mm (P < 0.001) were registered in the test group. In the control group, a reduction in probing depth of 2.5 +0.230mm (P <0.001) and a gain in clinical attachment level of 2.58 + 0.149 mm (P <0.001) was recorded. Radiographically, the defects were found to be filled by 2.587 + 0.218 mm (P < 0.001) in the test group and by 0.1792 + 0.031mm (P < 0.001) in the control group. Changes in gingival recession showed no significant differences. . CONCLUSION: Highly significant improvements in the parameters Probing depth, Clinical attachment level, and Bone defect depth were recorded after 12 months, with regenerative material.

[Dental implantation planning in the cases of bone deficiency and prevention of perioperative complications. Part 1. Radiological diagnostics].

The primary goal of reconstructive procedures before dental implantation is restoration of bone volume to prevent the damage of anatomic structures during implantation. Radiological methods are the important component of complex follow-up. Application of radiological methods in planning of the given kind of treatment allows choosing optimum tactics of surgical treatment and their dynamic application in the postoperative period gives the chance to reveal and address in time the developing complications thus improving the success rate.