Mandibular and dental manifestations of Gaucher disease

Gaucher disease is a systemic lysosomal storage disorder with a high prevalence among Ashkenazi Jews. It is caused by an inherited deficiency of the lysosomal enzyme glucocerebrosidase. Common signs and symptoms include hepatosplenomegaly, anemia, thrombocytopenia, and skeletal involvement. Oral and dental manifestations are less commonly seen. These manifestations are often asymptomatic, although they may be detected by routine dental x-rays. There are several case reports and a few larger series published describing patients with Gaucher disease who have mandibulo-maxillofacial involvement. This review aims to examine the oral manifestations observed in Gaucher disease and to suggest practical guidelines for dealing with these often worrisome signs. Among the critical issues are the benign nature of Gaucher cell infiltration of the mandible and the critical importance of being prepared for postprocedure bleeding and/or infections. Therefore, it is essential that dental practitioners be aware of the possible oral and dental complications of Gaucher disease, as well as the available treatment modalities.     

Randomized Controlled Trial to Compare Two Bone Substitutes in the Treatment of Bony Dehiscences

Aim: This in vivo split‐mouth randomized controlled trial compared a synthetic bone substitute with a bovine bone mineral to cover bone dehiscences after implant insertion. Materials and Methods: Fourteen patients received four to six implants to support an overdenture. Two comparable dehiscences within the same patient were first covered with a layer of autogenous bone, followed by a layer of either Bio‐Oss® (group 1; Geistlich Pharma AG, Wolhusen, Switzerland) or Straumann BoneCeramic® (group 2; Institut Straumann AG, Basel, Switzerland) and sealed by a resorbable membrane. The change in vertical dimension of the defect was measured at implant placement and at abutment connection (6.5 months). Clinical and radiological parameters were evaluated up to 1 year of loading. Results: The vertical size of the defect at surgery was 6.4 ± 1.6 mm for group 1 and 6.4 ± 2.2 mm for group 2 sites, measured from the implant shoulder. After 6.5 months, the depth of the defect was reduced to 1.5 ± 1.2 mm and 1.9 ± 1.2 mm for group 1 and group 2 sites, respectively (p > 0.05). No implants failed during follow‐up. Mean marginal bone loss over the SLActive surface was 0.94 mm (group 1), 0.81 mm (group 2), and 0.93 mm (group 3, no dehiscence) after 1 year of loading. Conclusion: Both bone substitutes behaved equally effectively.     

Long‐Term Clinical,Microbiological, and Radiographic Outcomes of Brånemark™ Implants Installed in Augmented Maxillary Bone for Fixed Full‐Arch Rehabilitation

Purpose: The purpose of this study was to document the long‐term outcome of Brånemark implants installed in augmented maxillary bone and to identify parameters that are associated with peri‐implant bone level. Material and Methods: Patients of a periodontal practice who had been referred to a maxillofacial surgeon for iliac crest bone grafting in the atrophic maxilla were retrospectively recruited. Five months following grafting, they received 7–8 turned Brånemark implants. Following submerged healing of another 5 months, implants were uncovered and restorative procedures for fixed rehabilitation were initiated 2–3 months thereafter. The primary outcome variable was bone level defined as the distance from the implant‐abutment interface to the first visible bone‐to‐implant contact. Secondary outcome variables included plaque index, bleeding index, probing depth, and levels of 40 species in subgingival plaque samples as identified by means of checkerboard DNA–DNA hybridization. Results: Nine out of 16 patients (eight females, one male; mean age 59) with 71 implants agreed to come in for evaluation after on average 9 years (SD 4; range 3–13) of function. One implant was deemed mobile at the time of inspection. Clinical conditions were acceptable with 11% of the implants showing pockets ≥ 5 mm. Periodontopathogens were encountered frequently and in high numbers. Clinical parameters and bacterial levels were highly patient dependent. The mean bone level was 2.30 mm (SD 1.53; range 0.00–6.95), with 23% of the implants demonstrating advanced resorption (bone level > 3 mm). Regression analysis showed a significant association of the patient (p < .001) and plaque index (p = .007) with bone level. Conclusions: The long‐term outcome of Brånemark implants installed in iliac crest‐augmented maxillary bone is acceptable; however, advanced peri‐implant bone loss is rather common and indicative of graft resorption. This phenomenon is patient dependent and seems also associated with oral hygiene.     

Bone Graft Healing in Reconstruction of Maxillary Atrophy

Purpose: Evaluate correlations between volume change for iliac crest bone grafts in maxillary reconstruction (graft volume change [GVC]) and bone mineral density (BMD), bone volume fraction (BVF), hematologic bone metabolic factors (I), and identify indicators of implant failure (II). Material and Methods: Forty‐six consecutive patients had their edentulous atrophic maxilla reconstructed with free autogenous bone grafts from anterior iliac crest. Endosteal implants were placed 6 months after graft healing. Computer tomography was performed after 3 weeks and 6 months after grafting. Bone biopsies were taken from the internal table of donor site for calculation (BVF), and blood samples were collected. Implant stability was measured at placement with resonance frequency analysis and expressed as implant stability quotient (ISQ). Implant failure was registered. Results: GVC in onlay bone graft was 37%. The BVF in iliac crest biopsies was 32%. Serum‐IGFBP3 differed with 79% of the samples over normal range. Fifteen patients had one or more implant failures prior to loading (early failures). Forty‐two patients were followed for a minimum of 3 years after implant loading and, in addition, 6/42 patients had one or more implants removed during the follow‐up (late failures). GVC correlated to decreased BMD of lumbar vertebrae L2‐L4 (Kruskal–Wallis test, p = .017). No correlation was found between GVC and hematologic factors (Pearson correlation test) or between GVC and BVF (Kruskal–Wallis test). No correlation was found between ISQ and GVC (Pearson correlation test, p = .865). The association between implant failures and the described factors were evaluated, and no significant correlations were found (unconditional logistic regression). Conclusion: Onlay bone grafts decrease 37% during initial healing period, which correlate to BMD of lumbar vertebrae L2‐L4. No other evaluated parameters could explain GVC. The evaluated factors could not explain implant failure.     

不同桩核系统修复上颌中切牙残根的临床观察

目的 对不同桩核系统修复上颌中切牙的临床效果进行比较与评价.方法 选择2005-2006年运用RelyXTM fibre post-复合树脂核(A组)、铸造纯钛桩核(B组)、铸造镍铬合金桩核(C组)联合钴铬合金烤瓷冠修复上颌中切牙的病例各30例,对患者的112件修复体的边缘适合性进行评价,记录失败的例数及方式,并统计生...     

Retreatment of multiple failing maxillary implants after full arch rehabilitation: a retrospective,observational cohort study

The aim of this study was to assess implant retreatment in a group of patients whose maxillary implants were all failing after full arch rehabilitation. Treatment involved implant removal, augmentation, and placement of an overdenture supported by four to six implants. All consecutive patients referred between 2008 and 2018, following multiple late implant failures in the rehabilitated maxilla, were included in the study. Seventy implants in 15 patients were evaluated at 3.3 ± 2.5 years (range 1.1–8.6 years) after loading. Implant survival, complications, clinical parameters, marginal bone loss, and patient-related outcome measures were recorded at the time of evaluation. Overall implant survival was 95.7%. Three implant failures occurred within the first year of function. Marginal bone loss was 0.32 ± 0.46 mm; pocket probing depth was 4.55 ± 1.59 mm. Plaque, calculus, inflammation, and bleeding were hardly seen (median index score 0). Patients scored their satisfaction with their overdentures as high (mean overall score 8.7 ± 1.2, maximum 10). Chewing soft and tough food was scored as ‘good’ and hard food as ‘moderate’. The mean Oral Health Impact Profile score was 29.5 ± 33.3. It can be concluded that the replacement of multiple failing implants in an edentulous maxilla after bone augmentation is a safe and predictable treatment procedure when applied as an implant-supported overdenture.