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Plastic and Reconstructive Surgery.... Jun 2024The maxilla comprises horizontal and vertical buttresses, each with specific functions, supporting various organs, such as the eyes, nose, and oral cavity. Notably, they...
BACKGROUND
The maxilla comprises horizontal and vertical buttresses, each with specific functions, supporting various organs, such as the eyes, nose, and oral cavity. Notably, they combine to form a three-dimensional structure, which enables the buttresses to provide their inherent support strength. However, reconstructing the maxilla after maxillectomy by assembling new buttresses is challenging. We successfully reconstructed all the buttresses crucial for facial appearance and dental rehabilitation using a vascularized fibular flap.
METHODS
Four patients underwent maxillary buttress reconstruction with a fibular flap after total or subtotal maxillectomy. We used computer-aided design/computer-aided manufacturing digital technology to osteotomize the fibula into multiple segments and assemble them to reconstruct the maxillary buttresses. Each buttress was assembled based on a preoperative simulation.
RESULTS
All patients underwent immediate one-stage maxillary reconstruction. They had good maxillary buttress alignment and acquired good facial appearance, eye position, nasal airway, and prosthetically suitable maxillary alveolus ridge.
CONCLUSIONS
The combination of computer-aided design/computer-aided manufacturing digital technology and surgical techniques has enabled novel maxillary reconstruction, providing great hope to patients experiencing facial disfigurement and loss of function after maxillectomy.
PubMed: 38911572
DOI: 10.1097/GOX.0000000000005914 -
Journal of Maxillofacial and Oral... Jun 2024Blum defined dry socket as the presence of postoperative pain in and around the extraction site that worsens 1-3 days after the extraction.
The Effect of Intra-socket Vitamin E Application on the Reduction in Postoperative Pain and Reduction in Incidence of Dry Socket in Female Patients: A Randomized Controlled Trial.
INTRODUCTION
Blum defined dry socket as the presence of postoperative pain in and around the extraction site that worsens 1-3 days after the extraction.
METHODS
90 female patients seeking extraction of a single tooth in the lower posterior region were divided randomly into 45 patients who received vitamin E inside the socket after extraction (study group) and 45 patients who did not receive vitamin E after extraction (control group).
RESULTS
After 3 days, there was a decrease in pain levels in the study group compared to the control group. Only 7 patients out of 45 (16%) suffered from pain compared to 17 patients out of 45 (38%) in the control group. So, the improvement in pain was statistically significant = 0.02. After 7 days, there was a decrease in wound healing levels in the study group compared to the control group. Only 8 patients out of 45 (17%) had poor wound healing compared to 7 patients out of 45 (16%) in the control group. However, the improvement in wound healing was not statistically significant = 0.8.
CONCLUSION
Based on the current results, we recommend the use of vitamin E as topical intra-socket medication in reducing the early postoperative pain.
PubMed: 38911421
DOI: 10.1007/s12663-023-02076-2 -
Journal of Maxillofacial and Oral... Jun 2024To evaluate the variation in the position of the mandibular foramen and mandibular canal in patients with and without temporomandibular joint ankylosis.
AIM
To evaluate the variation in the position of the mandibular foramen and mandibular canal in patients with and without temporomandibular joint ankylosis.
MATERIALS AND METHODS
100 temporomandibular joints were evaluated of which 50 joints were ankylosed joints (Group A) and the rest 50 were normal joints (Group B) without ankylosis. These groups were further divided into those with growing potential (less than 18 years) and those without growing potential (above 18 years). The position of the mandibular foramen was measured from its center to the glenoid fossa, sigmoid notch, coronoid notch, gonion and posterior border on CBCT scans. The position of the mandibular canal was measured from the outer aspect of the canal to the lower border of the mandible, buccal and lingual cortical plates and the alveolus in the region of the 1st, 2nd and 3rd molars.
RESULTS
The mean distance of the foramen from the base of the skull in Group A was 19.01 mm while the same for Group B was 31.26 mm. The mandibular foramen was found to be closer to the occlusal plane (5.43 mm) in Group A as compared to the mean distance of 6.21 mm reported in Group B. There was no significant difference in the position of the foramen from the posterior border, gonion and sigmoid notch between the groups. The mental foramen was seen more commonly posterior to the 2nd premolar and closer to the first molar region in Group A while in Group B it was seen anterior or near the 2nd premolar. In Group A, the mean distance of the canal to the buccal cortical plate in the 1st and 2nd molar regions was 3.65 mm and 5.76 mm, respectively, while in Group B it was 6.09 mm and 6.59 mm. The canal was further away from the lower border in ankylosis cases (8.79 mm) than the control group (7.41 mm). On comparing the unaffected side in unilateral cases with the normal mandible, the canal and the foramen location were similar to that of a normal mandible with the values in the lower range that is usually seen in normal mandibles.
CONCLUSION
Ankylosis of the mandible is a debilitating condition especially when it develops in an individual prior completion of growth as it can affect the mandibular anatomy. Understanding the variations that accompany a deranged mandible can assist the surgeon in planning of surgical procedures in a manner that limits the possible complications resulting from surgery.
PubMed: 38911403
DOI: 10.1007/s12663-023-02072-6 -
BMC Oral Health Jun 2024Post-tooth extraction, dry socket is a frequently encountered complication, causing substantial pain and hindering the healing process. Conventional approaches to manage... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-tooth extraction, dry socket is a frequently encountered complication, causing substantial pain and hindering the healing process. Conventional approaches to manage this condition have traditionally involved the use of antiseptic dressings to diminish bacterial presence and facilitate healing. This study aims to assess the efficacy of laser therapy in the symptomatic treatment of alveolitis.
METHODS
A literature search was conducted on PubMed, Embase, Scopus, Google Scholar, Web of Science, focusing on publications from 1998 to 31/01/2024 using relevant keywords. The combination of "laser" and "dry socket" was executed through the boolean connection AND.
RESULTS
At the conclusion of the study, a total of 50 studies were identified across the three search engines, with only three selected for the current systematic study and meta-analysis. The meta-analysis indicated that laser treatment proves effective in addressing alveolitis compared to Alvogyl. However, the correlation between the two was not highly significant.
CONCLUSION
These findings suggest that laser therapy may serve as a viable alternative to traditional treatments for dry socket. This minimally invasive procedure has the potential to alleviate pain and promote healing with fewer associated side effects."
Topics: Humans; Dry Socket; Laser Therapy; Treatment Outcome; Tooth Extraction; Low-Level Light Therapy; Wound Healing
PubMed: 38886713
DOI: 10.1186/s12903-024-04461-w -
Clinical Oral Investigations Jun 2024To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. (Clinical Trial)
Clinical Trial
OBJECTIVE
To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up.
MATERIALS AND METHODS
Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites.
RESULTS
The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14).
CONCLUSION
The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up.
CLINICAL RELEVANCE
These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.
Topics: Humans; Prospective Studies; Male; Female; Middle Aged; Dental Prosthesis Design; Ceramics; Treatment Outcome; Adult; Patient Satisfaction; Aged; Esthetics, Dental; Alveolar Bone Loss; Tooth Socket; Dental Restoration Failure; Dental Implants
PubMed: 38886209
DOI: 10.1007/s00784-024-05783-3 -
Cureus May 2024Following the loss of a tooth, the new edentulous area of the ridge will undergo several adaptive modifications due to changes in function within and surrounding the...
BACKGROUND
Following the loss of a tooth, the new edentulous area of the ridge will undergo several adaptive modifications due to changes in function within and surrounding the socket. This bone resorption explains the need for socket preservation techniques in areas of esthetic concerns and functional demands. Demineralized freeze-dried bone allograft (DFDBA) possesses greater osteoinductive potential due to the exposure of bone morphogenetic protein (BMP-3)and collagen fibrils and can be used efficiently in socket preservation techniques. DFDBA yields better results when combined with an autologous platelet concentrate, such as platelet-rich fibrin. Therefore, we formulated this randomized controlled clinical trial to assess the clinical and radiovisiographical outcomes of platelet-rich fibrin (PRF) and DFDBAs for extraction socket preservation in humans at different time intervals.
MATERIALS AND METHODS
This was a randomized controlled trial with 100 people as study subjects, and they were randomly divided into two groups: the test group (DFDBA and PRF placed in the extraction socket) and the control group (natural healing of the extraction socket). Clinical and radiographic evaluation using radiovisiography (RVG) was done at baseline, three-month, and six-month intervals. Cone-beam computed tomography (CBCT) was used at six months to determine the bone density in the test and control groups.
RESULTS
When compared from baseline to six months, the percentage change in clinical and RVG measurements for the test group was 15.96% (11.9064 mm) and 16.77% (12.1840 mm), respectively, whereas for the control group, it was 46.09% (14.0396 mm) and 47.61% (14.5716 mm), thus indicating lesser bone resorption in the test group as opposed to the control group. CBCT values also showed greater bone density for the test group (682.3120 HU) than the control group (503.8336 HU).
CONCLUSION
This study demonstrates the advantages of DFDBA bone graft with PRF compared to natural healing in achieving socket preservation by maintaining the marginal and buccolingual bone levels.
PubMed: 38883015
DOI: 10.7759/cureus.60388 -
RSC Advances Jun 2024Post-extraction wound infections are a common complication of dental extractions. More specifically, infection in the alveolar socket after tooth extraction accelerates...
Post-extraction wound infections are a common complication of dental extractions. More specifically, infection in the alveolar socket after tooth extraction accelerates the resorption and destruction of the alveolar bone, and ultimately affects the final restoration results. Currently, the main clinical treatment approaches applied to the socket after tooth extraction include mechanical wound debridement, chemical rinses (, chlorhexidine), filling of the extraction socket with absorbent gelatin sponges, and the systemic application of antibiotics. However, these traditional treatment modalities have some limitations and their therapeutic effects are unsatisfactory. In this study, a phototherapeutic temperature-sensitive hydrogel material was constructed for injection using a tea polyphenol (TP)-modified poly--isopropylacrylamide (PNIPAM) hydrogel skeleton loaded with the photosensitiser indocyanine green (ICG). The resulting PNIPAM-TP/ICG system exhibited an excellent injectability and temperature-sensitive properties. In addition, it stopped haemorrhaging and acted as a wound astringent. The hydrogel steadily released ICG into the oral environment to exert photothermal/photodynamic effects along with synergistic antibacterial and anti-inflammatory properties when combined with tea polyphenols. experiments demonstrated that the application of PNIPAM-TP/ICG to infected dental extraction wounds in rats rapidly stopped the bleeding and accelerated wound healing. Overall, this study describes a drug-loaded, temperature-sensitive hydrogel for the treatment of open wound infections, and shows promise as a reference for the treatment of tooth extraction wounds.
PubMed: 38882475
DOI: 10.1039/d4ra03211j -
Clinical Oral Investigations Jun 2024This study evaluated the impact of the partial exposition of the nonabsorbable membrane (dPTFE) on microbial colonization during bone healing. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
This study evaluated the impact of the partial exposition of the nonabsorbable membrane (dPTFE) on microbial colonization during bone healing.
MATERIALS AND METHODS
Patients indicated for tooth extraction were randomized to dPTFE group (n = 22) - tooth extraction and alveolar ridge preservation (ARP) using an intentionally exposed dPTFE membrane and USH group (n = 22) - tooth extraction and unassisted socket healing. Biofilm samples were collected at the barrier in the dPTFE and on the natural healing site in the USH after 3 and 28 days. Samples from the inner surface of the dPTFE barrier were also collected (n = 13). The microbiome was evaluated using the Illumina MiSeq system.
RESULTS
Beta diversity was different from 3 to 28 days in both groups, and at 28 days, different microbial communities were identified between therapies. The dPTFE was characterized by a higher prevalence and abundance of gram-negative and anaerobic species than USH. Furthermore, the inner surface of the dPTFE membrane was colonized by a different community than the one observed on the outer surface.
CONCLUSION
Intentionally exposed dPTFE membrane modulates microbial colonization in the ARP site, creating a more homogeneous and anaerobic community on the inner and outer surfaces of the membrane.
CLINICAL RELEVANCE
DPTFE promoted faster biofilm colonization and enrichment of gram-negative and anaerobes close to the regenerated site in the membrane's inner and outer surfaces. dPTFE membrane can be used exposed to the oral site, but approaches for biofilm control should still be considered. The study was retrospectively registered at Clinicaltrials.gov (NCT04329351).
Topics: Humans; Male; Female; Tooth Extraction; Middle Aged; Biofilms; Membranes, Artificial; Wound Healing; Adult; Microbiota; Polytetrafluoroethylene; Aged; Tooth Socket
PubMed: 38874776
DOI: 10.1007/s00784-024-05763-7 -
The Cleft Palate-craniofacial Journal :... Jun 2024To investigate the association between the sidedness of orofacial clefts and additional congenital malformations.
OBJECTIVE
To investigate the association between the sidedness of orofacial clefts and additional congenital malformations.
DESIGN
Linkage of a national registry of cleft births to national administrative data of hospital admissions.
SETTING
National Health Service, England.
PARTICIPANTS
2007 children born with cleft lip ± alveolus (CL ± A) and 2724 with cleft lip and palate (CLP) born between 2000 and 2012.
MAIN OUTCOME MEASURE
The proportion of children with ICD-10 codes for additional congenital malformations by the sidedness (left, right or bilateral) of orofacial clefts.
RESULTS
For CL ± A phenotypes, there was no evidence for a difference in the prevalence of additional anomalies between left (22%, reference), right (22%, aOR 1.02, 95% CI 0.80 to 1.28; = .90) and bilateral clefts (23%, aOR 1.09, 95% CI 0.75 to 1.57; = .66). For CLP phenotypes, there was evidence of a lower prevalence of additional malformations in left (23%, reference) compared to right (32%, aOR 1.54, 95% CI 1.25 to 1.91; < .001) and bilateral clefts (33%, aOR 1.64, 95% CI 1.35 to 1.99; < .001).
CONCLUSIONS
The prevalence of additional congenital malformations was similar across sidedness subtypes with CL ± A phenotypes but was different for sidedness subtypes within CLP cases. These data support the hypothesis that CL ± A has a different underlying aetiology from CLP and that within the CLP phenotype, right sided CLP may lie closer in aetiology to bilateral CLP than it does to left sided CLP.
PubMed: 38870388
DOI: 10.1177/10556656241261918 -
Clinical Advances in Periodontics Jun 2024As the need for using dental implants to replace single missing teeth grows, so does the demand for greater esthetic results. However, achieving complete interproximal...
BACKGROUND
As the need for using dental implants to replace single missing teeth grows, so does the demand for greater esthetic results. However, achieving complete interproximal papillae fill in single-tooth implant restorations remains a challenge. The distally anchored connective tissue platform is a novel soft tissue augmentation technique that consists of harvesting an autogenous connective tissue graft from the palate, folding it, and positioning it at the level of the distal occlusal and buccal surfaces with the help of a distal sling suture to the adjacent distal tooth.
METHODS
This case report describes how a maxillary central incisor with compromised hard and soft tissues were replaced using a comprehensive treatment plan.
RESULTS
The clinical outcomes showed stable mucosal margin levels and complete papillae fill. The patient expressed satisfaction with the achieved results.
CONCLUSIONS
The distally anchored connective tissue graft platform performed at the time of implant placement emerges as a viable and effective soft tissue augmentation technique that yields highly esthetic results.
KEY POINTS
Why is this case new information? To the best of our knowledge, this is the first case report in the literature using the distally anchored connective tissue platform. What are the keys to successful management of this case? Adequate diagnosis and decision-making, resulting in a treatment plan focused on reconstructing both soft and hard tissues in a single-tooth implant within the esthetic area, yield favorable clinical, radiological, and patient-reported outcomes. What are the primary limitations to success in this case? The primary limitation of this study is its reliance on a single case report.
PubMed: 38853678
DOI: 10.1002/cap.10299