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1.
Renzo G. Bassetti Alexandra Stähli Mario A. Bassetti Anton Sculean 《Clinical oral investigations》2016,20(7):1369-1387
Objectives
The aim of this systematic review was to evaluate the efficacy of different soft tissue augmentation/correction methods in terms of increasing the peri-implant width of keratinized mucosa (KM) and/or gain of soft tissue volume during second-stage surgery.Materials and methods
Screening of two databases, MEDLINE (PubMed) and EMBASE (OVID), and hand search of related articles, were performed. Human studies reporting on soft tissue augmentation/correction methods around submucosally osseointegrated implants during second-stage surgery up to July 31, 2015 were considered. Quality assessment of the selected full-text articles was performed according to the Cochrane collaboration’s tool to assess the risk of bias.Results
Overall, eight prospective studies (risk of bias: high) and two case series (risk of bias: high) were included. Depending on the surgical technique and graft material used, the enlargement of keratinized tissue (KT) ranged between ?0.20 and 9.35 mm. An apically positioned partial-thickness flap/vestibuloplasty (APPTF/VP) in combination with a free gingival graft (FGG) or a xenogeneic graft material (XCM) was most effective. Applying a roll envelope flap (REF) or an APPTF in combination with a subepithelial connective tissue graft (SCTG), mean increases in soft tissue volumes of 2.41 and 3.10 mm, respectively, were achieved. Due to the heterogeneity of study designs, no meta-analysis could be performed.Conclusions
Within the limitations of this review, regarding the enlargement of peri-implant KT, the APPTF in the maxilla and the APPTF/VP in combination with FGG or XCM in the lower and upper jaw seem to provide acceptable outcomes. To augment peri-implant soft tissue volume REF in the maxilla or APPTF + SCTG in the lower and upper jaw appear to be reliable treatment options.Clinical relevance
The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.2.
Objectives
The rapidly increasing numbers of inserted dental implants and the growing incidence of peri-implant mucositis and peri-implantitis with the current absence of reliable disease risk prediction highlight the importance of early and sensitive diagnosis of possible disease progression. The aim of this study is to assess quantitative and qualitative analysis of peri-implant sulcular fluid (PISF) during implant maintenance control and to identify whether there is a positive correlation and statistical significance between peri-implant sulcular fluid volume results and collagenase2 level obtained from both superficial and fundus area of peri-implant sulcus.Material and method
Twenty-seven implants from patients under recall provided peri-implant sulcular fluid volume samples, which were collected with the Periotron 8000 micro-moisture meter, and collagenase2 levels, which were assessed using dentoTest aMMP8. Statistical analysis was obtained using Spearman’s correlation.Results
Positive correlation was found between collagenase2 collected from sulcular and fundus areas on both mesial and distal sides. There was correlation between peri-implant sulcular fluid volume and collagenase2 level from fundus and distal area, but not from the mesial and superficial area.Conclusions
Examination of collagenase2 is a sensitive method when examining early inflammatory changes but depends from the depth of the sample collection in the gingival pocket.Clinical relevance
The examination of MMP8 seems to be a more sensitive method than the analysis of peri-implant sulcular fluid to detect peri-implant mucositis and peri-implantitis.3.
Vinay V. Kumar P. C. Jacob Vikram Kekatpure Naveen Hedne Felix P. Koch Moni A. Kuriakose 《Journal of maxillofacial and oral surgery》2016,15(3):346-348
Aim
The aim of this clinical paper is to introduce a technique to plan for functional maxillofacial reconstructions.Materials and Methods
Preoperative dental casts were made of the patient and mock surgery performed on the casts. A fibula analogue was then placed in an ideal functional reconstruction position. New dentures were fabricated on the fibula analogue and drill holes for the placement of implants were placed through the denture. This denture formed as a guide to position the fibula transplant during surgery.Results
This technique was useful in producing functional and rehabilitative outcomes in cases of both maxillary and mandibular reconstructive surgeries.Conclusion
The Jugaad technique—denture based inverse planning—is a cost effective method for planning and executing maxillofacial reconstructions using mock surgery on casts and interim dentures.4.
Alfonso Baruffaldi Pier Paolo Poli Andrea Baruffaldi Lorenzo Giberti Maurizio Pigozzo Carlo Maiorana 《Oral and maxillofacial surgery》2016,20(3):313-319
Purpose
The aim of the present technical note was to describe a prosthetic technique developed to increase the predictability of immediately loaded implants supporting a fixed prosthesis after computer-aided template-guided flapless implant placement.Methods
During a 2-year period, eight patients presenting partial edentulism underwent computer-aided template-guided implant placement. The presented technique was used during the prosthetic procedures to directly transfer the data obtained with the facebow to the surgical environment, allowing for accurate repositioning of the temporary prosthesis on the implants as previously planned with the digital software.Results
A total of 78 dental implants were immediately loaded with an implant-supported fixed prosthesis after flapless template-guided implant placement. A survival and success rate of 100 % was reported after a mean follow-up of 1 year from the prosthetic loading. Neither major complications nor dropouts were observed during the healing time. From both clinical and radiological evaluations, implants appeared stable with no signs of soft tissue inflammation or infection and no evidence of pathological peri-implant bone resorption.Conclusions
The proposed technique associated with computer-aided implant placement and immediate loading protocol provided a high implant and prosthetic survival and success rate. No complications were reported during the recalls, suggesting predictability and reliability of the present technique over a short-term period.5.
Simone?Schaumann Ingmar?Staufenbiel Ralph?Scherer Markus?Schilhabel Andreas?Winkel Sascha?Nico?Stumpp J?rg?Eberhard
Background
To investigate the microbial composition of biofilms at inflamed peri-implant and periodontal tissues in the same subject, using 16S rRNA sequencing.Methods
Supra- and submucosal, and supra- and subgingival plaque samples were collected from 7 subjects suffering from diseased peri-implant and periodontal tissues. Bacterial DNA was isolated and 16S rRNA genes were amplified, sequenced and aligned for the identification of bacterial genera.Results
43734 chimera-depleted, denoised sequences were identified, corresponding to 1 phylum, 8 classes, 10 orders, 44 families and 150 genera. The most abundant families or genera found in supramucosal or supragingival plaque were Streptoccocaceae, Rothia and Porphyromonas. In submucosal plaque, the most abundant family or genera found were Rothia, Streptococcaceae and Porphyromonas on implants. The most abundant subgingival bacteria on teeth were Prevotella, Streptococcaceae, and TG5. The number of sequences found for the genera Tannerella and Aggregatibacter on implants differed significantly between supra- and submucosal locations before multiple testing. The analyses demonstrated no significant differences between microbiomes on implants and teeth in supra- or submucosal and supra- or subgingival biofilms.Conclusion
Diseased peri-implant and periodontal tissues in the same subject share similiar bacterial genera and based on the analysis of taxa on a genus level biofilm compositions may not account for the potentially distinct pathologies at implants or teeth.6.
Jannice de Queiroz Fernandes Valthierre Nunes de Lima João Paulo Bonardi Osvaldo Magro Filho Sormani Bento Fernandes Queiroz 《Journal of maxillofacial and oral surgery》2018,17(1):13-18
Aim
The aim of this work was to perform a systematic literature review on the clinical application of rhBMP-2 in bone reconstruction prior to placing implants.Materials and Methods
A PUBMED search was made about the subject and nine clinical trials were selected according to strict inclusion criteria.Results
Overall success rates of bone regeneration with rhBMP-2 was 81.4% and success of implants placed was 87.4%. Most frequent adverse events were pain, edema and erythema.Conclusion
It was concluded that the treatment with rhBMP-2 foi satisfactory in most cases and the placement of dental implants in the bone regenerated with rhBMP-2 is feasible.7.
Olindo Massarelli Luigi Angelo Vaira Andrea Biglio Roberta Gobbi Pasquale Piombino Giacomo De Riu 《Oral and maxillofacial surgery》2017,21(4):453-459
Background
Reconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide “ideal reconstruction” of oral/oropharyngeal defects because they carry a thin, mobile, well-vascularized, and sensitive tissue, like that excised or lost. Nevertheless, these flaps are not immediately popular because of confusion surrounding the complex terminology used to name them.Methods
After a retrospective study on our experience and a literature review, the authors propose a new rational and simplified nomenclature for the classification of buccinator myomucosal flaps, which clarifies the source vessel, the composition of the flap, and the type of transfer.Results
According to this nomenclature, six types of buccinator myomucosal flaps are described.Conclusions
This proposed nomenclature may bring a consensus on the classification of buccinator myomucosal flaps and can help their spread.8.
Sunil S Shroff Sanjiv C Nair Anjan Shah Balasubramanya Kumar 《Journal of maxillofacial and oral surgery》2017,16(1):101-107
Purpose
To study a series of cases where vascularised fibula flap was used in various combinations of bone with muscle and skin along with its modifications for reconstruction of simple and composite defects of the facial region.Patients and Methods
The investigators designed a retrospective study composed of patients with any pathology or defect who underwent reconstruction of maxilla or mandible with vascularised fibula free flap from 2009 to 2013. All patients were evaluated for age, gender, location and type of defect, incorporation of adjoining skin paddle and muscle, number of fibula osteotomies, ischaemia time, anticoagulant regimen, length of hospital stay, flap failure rate, dental implant rehabilitation. All patients with a minimum follow-up of 3 months post-operatively, were included in this study.Results
The study sample composed of 30 patients with average age of 39.5 years. Immediate reconstruction was done in 86.66 % of patients. 93.1 % were mandibular reconstructions. In 40 % of patients, the fibula was double barrelled. Skin island was included with the fibula in 20 % of patients. 10 % patients underwent dental rehabilitation using implants with 6.66 % requiring distraction osteogenesis of the fibula which was not required with double barrel reconstructions. Hematoma at the recipient site was the commonest post-operative complication, although its frequency was low. A significant donor site morbidity of around 3.33 % was seen. Average stay in hospital was about 7 days. Post-operatively all patients ambulated normally and none used assisted devices. A reconstruction plate was used to achieve the ideal contour of the jaw in most cases. Aesthetic results were usually good, especially in young patients. The overall success rate was 93.33 %.Conclusion
The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.9.
Context
Cranioplasty is a frequently performed procedure that uses a variety of reconstruction materials and techniques. In this technical note, we present refinements of computer-aided design–computer-aided manufacturing inlay cranioplasty.Objective, design, and setting
In an attempt to decrease complications related to polyether-ether-ketone (PEEK) cranioplasty, we gradually made changes to implant design and cranioplasty techniques. These changes include under-contouring of the implant and the use of segmented plates for large defects, microplate fixation for small temporal defects, temporal shell implants to reconstruct the temporalis muscle, and perforations to facilitate the drainage of blood and cerebrospinal fluid and serve as fixation points.Results
From June 2016 to June 2017, 18 patients underwent cranioplasty, and a total of 31 PEEK and titanium implants were inserted. All implants were successful.Conclusions
These changes to implant design and cranioplasty techniques facilitate the insertion and fixation of patient-specific cranial implants and improve esthetic outcomes.10.
Purpose
Osseointegrated skin-penetrating implants enhance the retention and stability of the craniofacial prostheses and provide the long-term comfort. However, to determine the implant locations is a great challenge facing the surgeon. Implants may either be located in conventional manner or by STL generated surgical guides.Materials and Methods
Present study reports the CT based 3D virtual modeling, preoperative virtual planning and the implant placement by using a STL surgical guide, in an anotia case.Results
Employed materials and the methods facilitated the implant surgery while improving the operational security.Conclusions
CT based 3D virtual modeling of the surgical site, determining the implant locations virtually and the STL guided placement of the craniofacial implants, were found useful applications in order to facilitating the surgical intervention and providing prevention from complications.11.
Ikuya Miyamoto Tetsu Takahashi Tatsurou Tanaka Bunichi Hirayama Kenko Tanaka Toru Yamazaki Yasuhiro Morimoto Izumi Yoshioka 《Oral Radiology》2018,34(3):199-207
Objectives
The mechanism of late implant failure is unclear. This study examined the association between sclerosing cancellous bone images and the risk of late implant failures using multi-detector row computed tomography (CT) imaging data.Methods
We performed a case–control study. The study group consisted of consecutive patients with implant failures treated at Kyushu Dental University between 2001 and 2016. CT data for late failure of 36 implants in 16 patients were available. The study cohort consisted of 16 patients with 36 late failed implants and 28 patients with 113 successful implants.Results
The mean survival rate was 6.9 months for early implant failure, 76.6 months for late failure with marginal bone resorption, inflammation symptoms, and so-called peri-implantitis, and 95.0 months for late failure caused by implant fracture. The mean HU value for cases in the control group was 507 compared with 1231 for cases with late failure implants. Logistic regression was used for analysis. There were signs of high radiodensity of peri-implant cancellous bone when comparing adjusted radiodensity per 100 HU using CT data (OR 2.35; 95% CI 1.73–3.20; p < 0.001).Conclusions
Within the limits of our study, the presence of high radiodensity and cancellous bone consolidation on imaging may be related to risk factors for late implant failure. Therefore, CT images of the host cancellous bone status for observation of visible sclerosis could be a useful diagnostic indicator for late implant failure.12.
Yulan Wang Yufeng Zhang Dai Jing Yang Shuang Richard J. Miron 《Clinical oral investigations》2016,20(4):685-695
Objective
Although an extensive amount of research has demonstrated the positive effects of an enamel matrix derivative (EMD) on soft tissue wound healing around intrabony defects, little information is available describing its effect on peri-implant soft tissues, an area that has recently gained tremendous awareness due to the increasing prevalence of peri-implantitis. The aim of the present study was to assess the role of EMD when gingival fibroblasts were cultured on titanium surface with different surface topographies.Methods
Human primary gingival fibroblasts were cultured on pickled (PT) and sand-blasted with large grit followed by acid etching (SLA) surfaces and assessed for cell adhesion at 2, 4, and 8 h, cell morphology at 2, 4, 8, and 24 h as well as cell proliferation at 1, 3, and 5 days post-seeding. Furthermore, genes encoding collagen 1a1, vascular endothelial growth factor-A (VEGF-A), and fibronectin were assessed by real-time PCR. Human gingival fibroblasts were also quantified for their ability to synthesize a collagen matrix on the various titanium surfaces with and without EMD by immunofluorescence staining.Results
The results from the present study demonstrate that EMD significantly increased cell spreading at 2, 4, 8, and 24 h on PT surfaces and 4, 8, and 24 h on SLA surfaces. Furthermore, proliferation at 5 days on PT surfaces and 3 and 5 days on SLA surfaces was also increased for groups containing EMD. Real-time PCR results demonstrated that the culture of gingival fibroblasts with EMD significantly increased extracellular matrix synthesis of collagen 1 as well as improved mRNA levels of VEGF-A and fibronectin. Collagen1 immuno-fluorescent staining revealed a significantly higher area of staining for cells seeded on PT + EMD at 7 and 14 days and 14 days for SLA + EMD when compared to control samples.Conclusion
The results from the present study favor the use of EMD for colonization of gingival fibroblasts on titanium surfaces by increasing cell growth, spreading, and synthesis of an extracellular matrix. The improvements were primarily irrespective of surface topography. Future animal and human studies are necessary to fully characterize the beneficial effects of incorporating EMD during soft tissue regeneration of implant protocols.Clinical relevance
The use of EMD may speed up the quality of soft tissue integration around dental implants by facilitating gingival cell attachment, proliferation, and matrix synthesis of collagen 1.13.
Santhosh Rao Sameer Pandey Yogesh Kumar Sruthi Rao 《Oral and maxillofacial surgery》2018,22(4):475-476
Background
The pattern of venous drainage of head and neck involves single external jugular vein bilaterally.Methods and results
We report a case of bifurcation of the external jugular vein observed during a neck dissection procedure.Conclusions
Anatomical variations in drainage pattern of superficial veins of the head and neck are important for head and neck surgeries including for anastomosis during free tissue transfer for head and neck reconstruction.14.
Purpose
The main aim of our study was to assess and evaluate the efficacy, long standing outcome and infection of porous polyethylene implants in treatment of orbital floor fractures.Patient and methods
Twelve patients with fractures of orbital floor were included in the study. The cause of fracture was road traffic accident, self fall and cow hit respectively. They also complained of enophthalmos (n = 9), diplopia (n = 3), restricted eye movement (n = 2), impairment of infraorbital nerve (n = 3) and dystopia (n = 6). All the fractures were reconstructed with thin porous polyethylene sheets.Results
No implants were extruded and there were no signs of inflammatory reactions against porous polyethylene implant. In all nine patients with pre-op enophthalmos it was corrected post-operatively with p value = 0.000 and was statistically significant; diplopia in one patient was corrected; persistence of double vision was noted in two patients. Restricted eye movement was corrected in all patients, dystopia was corrected in four patients and in two patients have persisting dystopia. Paresthesia persisted in all three patients.Conclusion
Our experience was that reconstruction of orbital floor fracture using porous polyethylene implant is reliable, safe and effective and may be used for reconstruction of the orbital floor fracture with no donor site morbidity.15.
André Tonetto Pablo Walker Lago Márcia Borba Vinícius Rosa 《Clinical oral investigations》2016,20(2):267-274
Objectives
The objective of this study was to evaluate the use of a chondroitin sulfate and glycosaminoglycan-based chrondro-osseous regenerative compound (CORC) with different local treatments for bone regeneration in dehiscence defects. The hypothesis is that CORC can enhance bone regeneration with or without local treatment.Materials and methods
Twelve mongrel dogs received four implants each in the right femur. Bony defects (4-mm height?×?4-mm width) were created and locally treated as follows: reabsorbable membrane (Mem), hidroxyapatite (HA), hydroxyapatite covered with membrane (HA+Mem), or left untreated (Con). Six dogs received one pill of the CORC daily. After 90 days, the implants were retrieved, and histological sections were obtained. The height of bone formation, new bone area (NBA), and bone to implant contact (BIC) within the threads were evaluated to assess the effects of the use of CORC to promote bone regeneration in the defects. Results were statistically analyzed using ANOVA and Tukey’s test with 5 % significance level.Results
CORC was not capable to increase the height of bone formation, NBA, and BIC. When the local treatments were analyzed regardless of the use of CORC, HA+Mem and Ha presented higher BIC and height of bone formation. There was no difference for NBA among the local treatments.Conclusions
The hypothesis was rejected since the use of CORC has not increased any of the parameters evaluated.Clinical relevance
Dehiscence-like defects can compromise soft tissue support and result in loss of periodontal health and implants. Hydroxyapatite can induce bone regeneration in the defects created. CORC in the formulation used in this study did not promote further bone regeneration in dehiscence-like defects.16.
Robrecht J. H. Logjes Ronald L. A. W. Bleys Corstiaan C. Breugem 《Clinical oral investigations》2016,20(5):895-901
Objective
Surgical techniques to obtain adequate soft palate repair in cleft palate patients elaborate on the muscle repair; however, there is little available information regarding the innervation of muscles. Improved insights into the innervation of the musculature will likely allow improvements in the repair of the cleft palate and subsequently decrease the incidence of velopharyngeal insufficiency. We performed a literature review focusing on recent advances in the understanding of soft palate muscle innervation.Material and methods
The Medline and Embase databases were searched for anatomical studies concerning the innervation of the soft palate.Results
Our literature review highlights the lack of accurate information about the innervation of the levator veli palatini and palatopharyngeus muscles. It is probable that the lesser palatine nerve and the pharyngeal plexus dually innervate the levator veli palatini and palatopharyngeus muscles. Nerves of the superior-extravelar part of the levator veli palatini and palatopharyngeus muscles enter the muscle form the lateral side. Subsequently, the lesser palatine nerve enters from the lateral side of the inferior-velar part of the levator veli palatini muscle. This knowledge could aid surgeons during reconstruction of the cleft musculature. The innervation of the tensor veli palatini muscle by a small branch of the mandibular nerve was confirmed in all studies.Conclusion
Both the levator veli palatini and palatopharyngeus muscles receive motor fibres from the accessory nerve (through the vagus nerve and the glossopharyngeal nerve) and also the lesser palatine nerve. A small branch of the mandibular nerve innervates the tensor veli palatini muscle.Clinical relevance
Knowledge about these nerves could aid the cleft surgeon to perform a more careful dissection of the lateral side of the musculature.17.
Luigi Angelo Vaira Olindo Massarelli Roberta Gobbi Andrea Biglio Giacomo De Riu 《Oral and maxillofacial surgery》2018,22(2):151-156
Background
The sensitive restoration is a primary aim of oral reconstructive surgery. The Semmes-Weinstein monofilament test is the “Gold Standard” to assess the threshold of tactile sensitivity on the skin but its use in the oral cavity is limited due to the size of the tools. We adopted half-cut Semmes-Weinstein monofilaments to evaluate the threshold of tactile sensitivity in oral reconstructions with buccinator myomucosal flaps.Materials and methods
Monofilaments were half-cut and recalibrated. Fifty-seven oral reconstructions were considered at 4-year minimum follow-up. Test was conducted both on the reconstructive flap and on the non-operated contralateral side.Results
All of the considered flaps (100%) showed a recovery of tactile sensitivity. The overall average tactile threshold value assessed on this sample was 0.76?±?1.58 g/mm2 overall.Conclusions
Shortened monofilaments allow easily assessment of tactile sensitivity in all the oral cavity areas, even in operated patients which often present lockjaw or microstomia.18.
Staged Ridge Split Procedure in the Management of Horizontal Ridge Deficiency Utilizing Piezosurgery
A. B. Tarun Kumar M. G. Triveni V. Priyadharshini D. S. Mehta 《Journal of maxillofacial and oral surgery》2016,15(4):542-546
Aim and Objectives
Edentulism is an incapacitating and irretrievable condition which can lead unswervingly to functional limitation, physical, psychological and social handicap. Maintenance of bone after tooth loss to improve retention, function, and performance of the restoration is a challenging task. The existence of a thin edentulous ridge signifies a clinical situation that is more complex for the placement of endosseous implants. Dental rehabilitation of the edentulous ridges with oral implants has become a routine treatment modality in the last few decades with consistent long term results.Methods
A staged ridge spilt procedure was performed in the maxillary posterior edentulous region employing piezosurgery for the augmentation of horizontal ridge deficiency which was followed by the successful placement of implant supported prosthesis.Results
At the 20 months follow-up, stable results were appreciated with minimal bone loss around the implants.Conclusion
This proficient technique precludes the need for a second surgical site for the procurement of graft which in turn decreases patient discomfort. Hence this procedure can be used as an alternative to other strenuous procedures.19.
Raj Nagarkar Gauri Kokane Ashvin Wagh Sirshendu Roy 《Oral and maxillofacial surgery》2018,22(3):341-343
Introduction
Neck dissection is a part of the standard surgical procedure in the management of head and neck malignancy. Diplopia following neck dissection is a rare entity; hence, its diagnosis and management strategies needed to be discussed for prevention of its grave consequences.Case report
A 30-year-old male patient presented with binocular horizontal diplopia following total thyroidectomy and neck dissection. On evaluation, there was internal jugular vein (IJV) thrombosis followed by cerebral venous sinus thrombosis (CVST). After meticulous medical management with diuretics and antiplatelet drugs, diplopia resolved completely and normal vision was restored.Conclusion
Therapeutic ligation of internal jugular vein during neck dissection may result in IJV thrombosis followed by CVST leading to raised intracranial tension (ICT). It has to be anticipated and addressed as early as possible to prevent its grave consequences like blindness and death.20.
Ruben Muñoz Golaszewski Gajos Jose Bladimir Diaz Carvajal Alvaro Luis Grace Del Valle Speranza 《Oral and maxillofacial surgery》2018,22(1):39-44