Immediate functional loading of implants in single tooth replacement: a prospective clinical multicenter study

Objectives: The aim of the present study was to evaluate the outcome of immediate functional loading of implants in single-tooth replacement using two different installation procedures.
Material and Methods: One hundred and fifty-one subjects, who required single-tooth rehabilitation in the area of 15–25 and 35–45, were enrolled in eight private clinics in Italy. The implant sites were randomly allocated to one of the following treatment groups. In the control group, in which a standard preparation procedure for implant placement and submerged healing of the implant was used, abutment connection and loading of the implants were performed 3 months after installation. In the test group 1, a standard preparation procedure for the implant placement and immediate functional loading of implant was carried out. In the test 2 group, however, a modified implant installation procedure (osteotome technique) was used followed by immediate functional loading of the implant. Clinical and radiographic examinations were performed at 3 and 12 months of follow-up at all sites.
Results: Three implants (5.5%) from the test 2 group (osteotome preparation) and one (2%) from the test 1 group (conventional drill preparation) failed to integrate and were removed one and three months after implant installation. The mean marginal bone loss assessed at 12 months was 0.31 mm (test 1), 0.25 mm (test 2) and 0.38 mm (control) (no statistically significant differences were found between the three treatment groups.)
Conclusion: It is suggested that immediate functional loading of implants that are placed with a conventional installation technique and with sufficient primary stability may be considered as a valid treatment alternative in a single-tooth replacement.     

Temporomandibular disorders and orthognathic surgery

The relations between temporomandibular dysfunctions (TMDs) and maxillomandibular malformations requiring orthognathic surgery for correction have been the object of different studies in medical literature. The authors have performed a bibliographic revision on this issue to show the state of the art. This study, an analysis of the literature of the last 20 years, is chronologically presented. It analyzes the prevalence of TMD in patients with different types of maxillomandibular deformities undergoing orthognathic surgery and the TMD changes that occurred after an orthognathic surgical treatment. Medical studies reported in literature show a high variation of results related both to the prevalence of TMD in patients with maxillomandibular deformities and to the changes ensuing from an orthognathic surgical treatment. It has been difficult to compare the different studies because of the different methods used to individuate TMD signs and symptoms in the groups of patients analyzed, as well as the different types of orthognathic surgery performed and the specific TMD treatments used when required. It is concluded that despite the different results provided by the various studies, a certain prevalence of TMD is always present in patients with maxillomandibular deformity. This can be assumed to be within a correlation between dysgnathia and TMDs, and it asserts the necessity to treat patients who have maxillomandibular deformities and TMD by performing a specific treatment of TMD.     

Prosthetic rehabilitation of a child affected from anhydrotic ectodermal dysplasia: a case report

The aim of this clinical report is to describe the management of a young patient, affected by ectodermal dysplasia, during a nine-year period. Dental treatment can vary depending on the severity of the disease (tooth size, morphology, and amount of available alveolar bone). New technologies, such as adhesive dentistry, and new materials, such as composite resin, represent current options in the management of the dental rehabilitation of patients affected by ectodermal dysplasia. Removable partial dentures were used to replace congenitally missing teeth, and composite resin materials were used to restore conical-shaped maxillary teeth to achieve a favorable esthetic result. This option minimized the sacrifice of healthy dental tissue. Prosthodontic and restorative treatment was provided for the psychological and social comfort of the young patient.     

Maxillary advancement and transpalatal expansion using internal distraction in a patient with cleft lip and palate

Correction of sagittal and transverse maxillary discrepancies in patients with cleft lip or palate remains a challenge for craniofacial surgeons. Distraction osteogenesis has revolutionized the conceptualization and approach to the craniofacial malformations and has become a reliable and irreplaceable part of the surgical armamentarium. We are reporting a case of sequential maxillary advancement and transpalatal expansion using internal distraction in a patient with unilateral cleft lip and palate presenting with severe maxillary sagittal and transverse deficiencies.     

Dry mouth as an initial sign of food-borne botulism: a case report and review of the literature

Botulism is a rare neuroparalytic disease caused by a potent neurotoxin produced by Clostridium botulinum. There are different clinical types of botulism. Early diagnosis of the condition is essential for effective treatment. We report a case of food-borne botulism in identical twins characterized by severe initial oral involvement and a review of the literature about the condition.     

Alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a multicenter prospective study on humans

PURPOSE: The purposes of this prospective multicenter study were to evaluate the use of vertical distraction osteogenesis in the correction of vertically deficient alveolar ridges and to evaluate whether the vertical bone gained by distraction osteogenesis was maintained over time when dental implants were placed in the distracted areas. MATERIALS AND METHODS: Thirty-seven patients presenting vertically deficient edentulous ridges were treated in 4 different centers by means of distraction osteogenesis with an intraoral alveolar distractor. Two to 3 months after consolidation of the distracted segments, 138 dental implants were placed in the distracted areas. Four to 6 months later, abutments were connected and prosthetic loading of the implants began. RESULTS: The mean follow-up after initial prosthetic loading was 34 months (range 15 to 55 months). The mean bone gain obtained by distraction was 9.9 mm (range 4 to 15 mm). The cumulative success rate of the implants 4 years after the onset of prosthetic loading was 94.2%, while the implants' cumulative survival rate was 100%. No statistically significant differences were found between the different centers as far as survival and success rates of implants were concerned. DISCUSSION AND CONCLUSION: The results of this study appear to demonstrate that distraction osteogenesis is a reliable technique for the correction of vertically deficient edentulous ridges. The regenerated bone appeared to withstand the functional demands of implant loading. The survival and success rates of the implants placed in the distracted areas were consistent with those reported in the literature regarding implants placed in native bone in this patient population.     

Effects of Er:YAG laser compared to ultrasonic scaler in periodontal treatment: a 2-year follow-up split-mouth clinical study

BACKGROUND: The aim of this clinical study was to compare the results of non-surgical treatment of periodontal disease with an erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser to root debridement with an ultrasonic scaler. METHODS: Twenty-five patients furnished two quadrants containing four teeth with probing depths (PD) >4 mm; the quadrants were divided equally between the right and left sides. On one side, teeth were treated by Er:YAG laser using 160 mJ/pulse at 10 Hz (test group); on the contralateral side, teeth were treated by ultrasonic scaler (control group). Clinical baseline data, including plaque index, gingival index, probing depth (PD), and clinical attachment level (CAL), were recorded before treatment and at 3 months and 1 and 2 years. RESULTS: There were statistically significant differences in PD between the test and control groups for pockets of 1 to 4 mm (P <0.05), 5 to 6 mm (P <0.01), and > or =7 mm (P <0.001). However, there were no significant differences between the test and control groups for CAL gain in pockets of 1 to 4 mm; statistically significant differences were found between the test and control groups in pockets of 5 to 6 mm (P <0.01) and > or =7 mm (P <0.001). CONCLUSION: Er:YAG laser periodontal treatment resulted in statistically significant improvements in PD and CAL gain compared to ultrasonic scaler treatment at 2-year follow-up, especially in moderate and deep pockets.     

Bone-implant contact and bone quality: evaluation of expected and actual bone contact on machined and osseotite implant surfaces

This article introduces a new technique using histomorphometrics to estimate the extent of bone-to-implant contact that might be expected on an implant surface in relation to the quality of the surrounding bone. Two implant surfaces, one machined and one Osseotite, were compared on the same implant in the same patient Eleven of these custom-made 2-mm-diameter implants were placed in the posterior maxilla and allowed to integrate. After 6 months of nonloaded healing, implants were trephined with surrounding bone tissue and prepared into histologic sections. Digitized images were analyzed at 50x magnification with image-analysis software. Bone surface area was calculated over the entire microscopic field, and the actual bone-to-implant contact for each implant surface was measured. The expected bone-to-implant contact was calculated by superimposing the profile of the implant threads on the bone image a small increment (0.15, 0.5, or 1.0 mm) from the actual implant site and counting the linear amount of bone that would be in contact with the implant surface. The actual bone-to-implant contact for Osseotite was greater than its expected bone-to-implant contact, whereas the actual bone-to-implant contact for the machined surface was mostly lower than the expected values. Thus, the Osseotite surface appears to exert a positive effect on the amount of bone approaching the implant surface and can be described as conductive, while the machined surface is nonconductive. This technique may serve to predict the clinical success that the Osseotite surface will demonstrate in poor-quality bone.