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1.

Objective

To evaluate the quality of life in patients with moderate or large cranial bone defects before and after late cranioplasty.

Methods

Authors performed a prospective clinical trial including all consecutive patients that filled inclusion criteria during a period of 1 year. All patients answered the quality of life SF-36 questionnaire in 5 different times. Besides authors gathered information about the primary trauma and demographic characteristics.

Results

A total of 70 consecutive patients were admitted to the hospital during the study period, and 62 were included in the project. Cranioplasty statistically improved patients' quality of life in all 8 domains after a 24 months follow-up.

Conclusion

Cranioplasty has a significant impact over the quality of life in brain trauma victims who survived the primary trauma and harbor a large cranial bone defect.  相似文献   

2.

Introduction

In edentulous patients the form and size of the maxillary sinus vary greatly. Therefore sinus floor augmentation is a standard procedure for implantological purposes. As the sinus membrane cannot be characterized as periosteum, various augmentation materials are used.

Hypothesis

an artificially generated space underneath the sinus membrane in the floor of the sinus will lead to spontaneous callus forming and a stable bony consolidation without augmentation material.

Methods

Ten edentulous patients with highly atrophic maxillae were selected. Augmentation of the sinus floor was carried out in a split-mouth study design: On one side a combination of autogenous and xenogenous bone was used, and on the contralateral side a sinus membrane elevation was performed without using any substitutes. After a 6-month interval bone specimens from the test regions were harvested during implant placement.

Results

Clear histological evidence of new bone formation was found in all human bone specimens. An active de-novo bone formation process could be proven by the presence of Haversian systems (osteons) displaying osteoblastic and osteoclastic activity.

Conclusion

In the maxillary sinus of edentulous patients a spontaneous callus-derived de-novo bone formation is possible by elevating the sinus membrane without using augmentation materials.  相似文献   

3.

Statement of problem

The design of porous tantalum trabecular metal–enhanced titanium (TM) dental implants promises improved osseointegration, especially when grafting materials such as demineralized bone matrix are used; however, studies are lacking.

Purpose

The purpose of this retrospective study was to compare TM implants with conventional titanium alloy (Ti) implants with and without demineralized bone matrix in terms of peri-implant bone remodeling in the first year after implant loading.

Material and methods

A chart review was used for all patients receiving Tapered Screw-Vent Ti and TM implants. Implants were placed and restored by a single provider between 2011 and 2015. Peri-implant bone remodeling was compared by using a paired t test (α=.05).

Results

A total of 82 patients received 205 implants, 44 TM and 161 Ti implants (control). No implants failed in the TM group (survival rate of 100%), and 3 implants in total, 1 immediate, failed in the Ti groups (survival rate of 98.1%). TM implants exhibited a 0.28-mm bone gain on average, whereas the control group demonstrated 0.20 mm of marginal bone loss after the first year of implant loading. Multivariate logistic regression analysis demonstrated that the odds of having bone loss was 64% less (odds ratio: 0.36; 95% confidence interval: 0.14-0.94) in the TM group than in the Ti group after controlling for bone grafting, implant location, immediate placement, bone type, and pretreatment bone level.

Conclusions

TM implants exhibited less peri-implant bone loss than the control Ti implants.  相似文献   

4.

Aim

The current study was based on the hypothesis that the use of PRF with bone graft materials might increase bone regeneration and focus on the histopathological and immunohistochemical aspects following application of PRF with autogenous graft, xenograft and B-TCP in a rabbit model.

Material and methods

This study was performed on the twenty-eight male New Zealand divided into four group. Two defects with a diameter 10 mm were opened in calvarium. After PRF preparation, right defects were evaluated as empty defect or graft group, and left defects were evaluated as PRF test group. All animals were sacrificed at the end of 8 weeks and specimens were examined histopathologically and immunohistochemically.

Results

The most superior histopathological results were obtained in the autograft group. The combination of β-TCP-PRF could not provide superiority over the β-TCP group. The immunohistochemical results showed that, in the PRF/BTCP group, the expression of osteopontin and osteonectin was relatively higher compared to the only-BTCP group.

Conclusion

In terms of new bone formation, autograft combined with PRF yielded superior results but the combination of β-TCP-PRF had no effect compared to the only-BTCP group. However, further experimental and clinical studies might be beneficial to clarify the exact mechanism and results of combining PRF with bone grafts on bone healing process.  相似文献   

5.

Purpose

Successful implant therapy is based on fast, safe, and predictable osseointegration. Several surface modifications have been introduced to improve the bone-to-implant interaction. This in vivo study evaluates the impact of plasma surface conditioning on early wound healing and osseointegration.

Materials and methods

A total of 16 dental implants with a sand-blasted and acid-etched surface were conditioned with cold atmospheric plasma prior to insertion in the frontal bone of four miniature pigs. Sequential fluorescence labeling was administered to label bone metabolism, and after 8 weeks, bone blocks were harvested for radiological, histological, and histomorphometrical evaluation.

Results

The plasma conditioning had no impact on the morphology of the implant surface. The bone-to-implant contact ratio was 90.4% and 86.5%, the interthread bone density 72.5% and 63.4%, and the periimplant bone density 60.5% and 61.1%, in the plasma conditioned group and control group, respectively. Concentric bands of fluorescence enrichment indicated a chronological and homogenous mineralization of newly formed bone. No unwanted periimplant side effects were detected.

Conclusion

The increased parameters for osseointegration in this in vivo study merit further investigation in prospective clinical trials.  相似文献   

6.

Purpose

Microvascular fibula flap surgery is a reliable and effective procedure for reconstructing the jaws after tumour surgery. This procedure allows the placement of dental implants after bone consolidation. This study was designed to evaluate the oral, functional, and aesthetic rehabilitation of tumour patients with immediate fibula transfer and dental implants and included assessment of diet, speech, and aesthetics.

Materials and methods

The study included 34 patients who underwent ablative tumour surgery and immediate jaw reconstruction using a fibula free flap with consecutive rehabilitation by dental implants. In total, 134 implants were inserted into the transferred fibula. The functional and aesthetic results were assessed using a questionnaire. Implant loss and oral excursion were compared with diet type, speech ability, functionality, and patient satisfaction.

Results

Of the 34 patients included in this study, 33 completed the questionnaire. Twenty-six patients (76%) could eat normally without the limitation of a hard or soft diet, 73% could speak intelligibly, and 31 rated the aesthetic result from good to excellent.

Conclusion

The fibula flap with the early application of endosseous implants allowed primary immediate reconstruction of the jaw, significantly leading to functional and aesthetic satisfaction in patients who underwent ablative tumour surgery.  相似文献   

7.
8.

Purpose

Patients with cleft lip, alveolus and palate (CLAP) may suffer from marked asymmetry with an impact on attractiveness and psychosocial aspects. The aim of this study was to assess symmetry in CLAP patients compared to non-cleft controls of similar age with regard to cleft type and treatment concept.

Materials and methods

In CLAP patients with different cleft forms and in healthy non-cleft subjects (control group) a three-dimensional stereophotogrammetric face scan was performed and an objective 3D asymmetry index (AI) was calculated for the whole face, the midface, the upper lip and the nose.

Results

In total, 305 patients were included: 140 CLAP patients (90 male, 50 female, mean age 9.9 ± 3.6 years) and 165 controls (87 male, 78 female, mean age 8.7 ± 2.1 years). In general, CLAP patients showed significantly higher asymmetry than controls, with the most severe asymmetry found in unilateral complete CLAP. Patients treated according to an actual concept considering reconstruction of all affected muscular systems had a significant lower and more favourable AI than patients not treated according to this concept (p < 0.05).

Conclusion

An adequate treatment concept is essential to achieve better results concerning symmetry in CLAP, but symmetry values of healthy non-cleft controls are not reached.  相似文献   

9.

Introduction

The aim of this study was to investigate the influence of various apical preparation designs for surgical endodontics on stress concentrations in the mesial root of the mandibular molar under different experimental conditions using finite element analysis.

Methods

We designed 2 apical preparation groups according to whether an isthmus was present or not. Each group contained 4 subgroups according to the size of the apical preparation. We constrained the displacement of all nodes at the base of the supporting bone and applied a force of 150 N to the vertical axis. We analyzed stress generation and concentrations numerically for the groups and subgroups.

Results

In the subgroups, the von Mises and maximum principal stresses reduced gradually according to the enlargement of the prepared cavity. However, when the preparation extended excessively in the isthmus preparation groups, the situation reversed (ie, both von Mises and maximum principal stresses increased).

Conclusions

Within the limitations of this study, the apical preparation design influenced the distribution of stress concentration. Unlike the overall pattern in which stress decreased as the amount of apical preparation increased, stress increased when the amount of residual dentin was extremely thin.  相似文献   

10.

Background

Promoting the directional attachment of gingiva to the dental implant leads to the formation of tight connective tissue which acts as a seal against the penetration of oral bacteria. Such a directional growth is mostly governed by the surface texture.

Material and methods

In this study, three different methods, mechanical structuring, chemical etching and laser treatment, have been explored for their applicability in promoting cellular attachment and alignment of human primary gingival fibroblasts (HGFIBs).

Results

The effectiveness of mechanical structuring was shown as a simple and a cost-effective method to create patterns to align HGIFIBs.

Conclusion

Combining mechanical structuring with chemical etching enhanced both cellular attachment and the cellular alignment.  相似文献   

11.

Purpose

This systematic review aimed at assessing the effects of PRGF in new bone formation, soft tissue healing and post-operative pain and swelling in sites that underwent ridge preservation, ridge augmentation and maxillary sinus augmentation procedures.

Materials and methods

A comprehensive literature search employing seven databases was conducted by two independent reviewers. Only randomized and non-randomized controlled clinical trials using PRGF alone or in combination with bone grafting materials were selected.

Results

Overall, 919 studies were identified, of which a total of 8 articles were included in the qualitative analysis. Two of the selected studies reported on ridge preservation, one on ridge augmentation and five on maxillary sinus augmentation. Positive results were recorded for soft tissue healing and post-operative pain and swelling following these procedures. However, outcomes of PRGF on new bone formation post extraction and on maxillary sinus augmentation when combined with other biomaterials were conflicting. Meta-analysis could not be conducted for any variables due to the heterogeneity of selected studies.

Conclusion

Limited evidence exists on the effects of PRGF in different intraoral bone grafting procedures, with some benefit reported on soft tissue healing and post-operative symptomatology. As this platelet concentrate is commonly used in clinical practice, further research is needed to fully assess its clinical indications and effectiveness.  相似文献   

12.

Statement of problem

Variation in the baseline mechanical properties of polyamide thermoplastic polymers used in the fabrication of prosthetic dental appliances and the effects of nonaldehyde disinfectants on the mechanical properties of these polymers are unclear.

Purpose

The purpose of this in vitro study was to compare the flexural and impact strengths of 2 flexible denture materials (Valplast and Sunflex) and evaluate the effect of 24-hour immersion in nonaldehyde disinfectant (Perform) on their flexural and impact strengths.

Material and methods

Of 48 specimens of Valplast and Sunflex, half were immersed in nonaldehyde disinfectant solution containing the active ingredient 2% peroxymonosulfate for 24 hours. Flexural and impact strengths were measured using a universal testing machine. The Student t test with Bonferroni correction was used (α=.008).

Results

For the Valplast group, the mean ±standard deviation flexural strength was 27.8 ±0.57 MPa, and the impact strength was 3.5 ±0.98 kJ/m2. For the Sunflex group, the mean flexural strength was 57.4 ±4.09 MPa, and the impact strength was 6.0 ±3.11 kJ/m2. Sunflex showed greater flexural strength (P≤.001) and impact strength (P=.001) than Valplast. A significant increase in the impact strength (P≤.001) but not in the flexural strength of Valplast was observed after exposure to the disinfectant solution. Immersion disinfection had no significant effect on the strength of Sunflex.

Conclusions

The flexural and impact strengths of Sunflex were significantly greater than those of Valplast. Immersion disinfection with peroxymonosulfate had no significant effect on Sunflex but increased the impact strength of Valplast.  相似文献   

13.

Statement of problem

Excess cement around dental implants is a significant cause of peri-implant inflammation. Research has focused on approaches to cement removal, the type of cement used, and the different instruments used for cement removal with titanium abutments. However, data comparing zirconia with titanium abutments are lacking.

Purpose

The purpose of this in vitro study was to compare the effectiveness of excess cement removal from zirconia and titanium custom abutments using an explorer and to compare the effects of cement removal on the abutment surfaces.

Material and methods

Implant analogs were placed in a cast in the position of the 2 maxillary central incisors. After creating similar emergence profiles for both the implant abutments, 18 zirconia and titanium custom abutments were fabricated with 1-mm subgingival finish lines on the facial and interproximal areas and an equigingival finish line on the palatal side. The crowns were cemented with zinc oxide-eugenol cement, and a steel explorer was used to remove the excess cement. All abutments were analyzed under a scanning electron microscope for cement remnants and scratches.

Results

The mean surface area of cement remnants on the zirconia abutments was 778 ±113 μm2, and for titanium abutments, it was 1123 ±252 μm2, which in terms of the mean percentage area was 3.27% of the total surface area of zirconia and 4.71% of titanium abutments. Only a few abutments from each group showed scratches, and no deep scratches or gouges were observed.

Conclusions

Zirconia and titanium abutments had statistically similar cement remnants. Scratches were observed on only a few specimens.  相似文献   

14.

Background

Several significant issues on clinical trials reporting the effect of arginine-containing dental products have been addressed in systematic reviews and meta-analyses identifying the need for high-quality randomized clinical trials. A further methodological analysis of the given systematic reviews with meta-analysis on arginine products might provide information for future high-quality randomized clinical trials and current clinical practice.

Objective(s)

The objective was to perform a meta-epidemiological assessment of meta-analyses reporting the anticaries effect of arginine-containing formulations.

Methods

The data on risk-of-bias assessment, effect size measure, dispersion of estimated precision, and follow-up period were summarized for the meta-epidemiological review analysis.

Results

Studies with larger magnitude of effect sizes might present with unclear random sequence generation and unclear allocation concealment representing the selection bias. There was a significant strong negative correlation between the follow-up time and dispersion of precision estimates (rs = ?0.79, P = .034).

Conclusion

Results show that clinical trials on arginine dental products have methodological shortcomings. Both the selection bias and follow-up period influence the effect size magnitude and subsequent precision dispersion during evidence synthesis in clinical trials on arginine-containing dental products.  相似文献   

15.

Statement of problem

Identifying factors that affect the clinical outcomes of implant therapy is important.

Purpose

The purpose of this retrospective study was to determine whether implant location was a factor affecting the complication and failure rates of single-tooth implant-supported restorations in a predoctoral setting.

Material and methods

The charts of 431 patients treated with a surgically placed dental implant and restored with a single crown in the predoctoral clinic were analyzed. Data on implant location, type of complication (surgical or prosthetic), and type of failure were collected and analyzed according to implant location using the Fisher Exact Test and Mantel-Haenszel Exact Chi Square Test analysis (α=.05).

Results

The charts revealed 158 complications (68 surgical and 90 prosthetic) in 110 patients, and 3.9% of the implants failed. No statistically significant difference was found between the number of surgical complications or prosthetic complications in the maxilla and the mandible (P=.469).

Conclusions

Jaw location (maxilla compared with mandible) of the implant had no statistically significant impact on the incidence of surgically or prosthetically related complications. No statistically significant difference was found in overall implant failures, surgical failures, and prosthetic failures between maxillary and mandibular implants.  相似文献   

16.

Background

Specialty-based practice is a fundamental component of US medicine and dentistry, yet the recognition of new dental specialties has markedly diminished in the past 50 years while medical specialization has flourished.

Methods

This article reviews the history of specialty development while focusing on the underlying scientific, educational, and cultural changes in both professions. The process of dental specialty recognition is also examined.

Results

The current dental specialty recognition process provides a set of criteria aspiring specialties need to fulfill at the time of application, yet the relationship between the criteria and the sequence for attaining them is undefined. Scientific development and evidence-based practice have grown to become the cornerstone of contemporary health care specialization.

Conclusions

A new paradigm for specialty and subspecialty development in dentistry is needed. A model is presented herein that recognizes scientific development as the basis for specialization and describes a formal, sequenced process for the development of emerging specialties and subspecialties.

Practical Implications

This new paradigm for dental specialty recognition builds on the current criteria for specialization while encouraging cross-disciplinary interaction and nurturing the development of emerging specialties and subspecialties in dentistry. Doing so will allow dentistry to maintain its lead role in the maintenance of oral health and oral disease treatment in the US population.  相似文献   

17.

Introduction

Fractures of the mandibular condyle are reported to account for 9 %–45 % of all mandibular fractures. There has been a long lasting controversy on the superiority of different treatment options with endoscopic-assisted transoral approaches gaining increasing attention in recent years. In this article, we report the application of a newly developed osteosynthesis plate for an auto reposition, reconstruction and rigid fixation of condylar process fractures.

Material and methods

We present 6 cases of uni- or bilateral fractures of the condylar process treated with a transoral open reduction and rigid fixation using an auto reposition plate. Via a transoral endoscopic assisted approach the proximal condyle fragment is captured using an anatomical defined clinch of the cranial part of the plate. The reposition of the condyle is facilitated with the distal bridge of the plate ranging around the posterior part of the ascending ramus.

Results

The results show a sufficient reposition, rigid fixation and no facial nerve palsy or postoperative long-term occlusal disturbances. The mean operating time was 86 min.

Conclusion

Transoral endoscopic-assisted surgery with application of an auto reposition, reconstruction and fixation plate offers a quick and convenient way for open reconstruction and rigid fixation of condylar process fractures.  相似文献   

18.

Objective

To explore the application of modified resection compared with traditional segmental resection of the mandible for patients with anterior floor of the mouth and tongue squamous cell carcinoma (SCC) without infiltration of the mandible.

Subjects and Methods

This is a retrospective study including 36 eligible patients with anterior floor of the mouth SCC(9 patients received modified mandibulectomy, and 27 patients received segmental mandibulectomy).

Results

No patients in the modified mandibulectomy group developed recurrence in the floor of the mouth, and all of the patients survived. Only one patient developed osteoradionecrosis. When the modified mandibulectomy group was compared with the segmental mandibulectomy group, the former exhibited a lower recurrence rate in the floor of the mouth (0.0% vs. 14.8%), less blood loss (516.7 ± 70.7 ml vs. 533.3 ± 93.0 ml), shorter durations of gastric tube placement (11.4 ± 4.5 days vs. 20.7 ± 11.9 days) and tracheostomy (6.9 ± 0.6 days vs. 8.5 ± 1.6 days), a lower postoperative infection rate (11.1% vs. 18.5%), and a shorter postoperative hospital stay (13.7 ± 3.8 days vs. 15.9 ± 5.1 days).

Conclusion

This modified mandibulectomy method is safe and feasible and is recommended for further prospective study in a clinical setting.  相似文献   

19.

Purpose

This study investigates the effects of semaphorin 3A on new bone formation in an experimental rat model.

Materials and methods

Cortical bone defects, 5 mm, were created in the calvaria of 40 Wistar rats, which were then separated into three groups: empty defect (control) group, collagen group, collagen + semaphorin 3A group. The bone blocks were harvested after 4 and 8 weeks. New bone formation was assessed by micro-computed tomography (micro-CT), histology, histomorphometry, transmission electron microscope (TEM) and immunohistochemistry.

Results

Increased bone formation was observed in collagen + semaphorin 3A groups both histologically and with micro-CT. In the histomorphometic analysis, the control group had significantly less bone formation compared to both the collagen and collagen + semaphorin 3A group at 4 weeks (p = 0.0001) and 8 weeks (p = 0.0001). The collagen group had significantly less bone formation compared to collagen + semaphorin 3A group both at 4 weeks (p = 0.002) and 8 weeks (p = 0.005). Immunohistochemical analysis revealed that semaphorin 3A inhibited receptor activator of nuclear factor-kB ligand (RANKL) expression and increased the expressions of osteoblastic bone markers at 4 weeks. In TEM analysis, the collagen + semaphorin 3A group had an increased proliferation and bone formation rate at 4 weeks, whereas bone quantity and maturation were enhanced at 8 weeks.

Conclusion

Locally applied semaphorin 3A increases callus formation at 4 weeks and bone formation at 8 weeks. Semaphorin 3A prevents bone resorption by inhibiting osteoclasts and increases bone formation by inducing osteoblasts.  相似文献   

20.

Purpose

To evaluate the long-term outcome of dental implants placed with a staged procedure in resorbed alveolar ridges reconstructed with iliac crest autogenous onlay grafts.

Materials and methods

All consecutive patients treated with iliac crest onlay bone grafts and dental implants were retrospectively evaluated. During the appointment, clinical and radiological examinations were conducted to assess implant survival. A survived implant was defined as an implant still stable and in function at the follow-up visit. Implant survival was estimated at the implant level using Kaplan-Meier analyses. The cumulative survival rate was estimated using a life-table analysis. Subgroup analyses were performed for age, position, and type of retention using the log-rank test. A p-value of <0.05 was considered statistically significant.

Results

The cohort consisted of 21 female subjects receiving a total of 140 rough-surface titanium implants. Of them, 128 survived and 12 failed, yielding a cumulative survival rate of 91.1% over a median survival time of 312 months. Implants supporting cement-retained prostheses exhibithed lower survival rate compared to screw-retained restorations (p = 0.001).

Conclusion

Implants placed in bone augmented with iliac crest onlay grafts showed high long-term survival rates. Cement-retained restorations were more prone to develop implant failures.  相似文献   

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