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The International Journal of Oral &... May 2024The use of ceramic-coated patient-specific CAD/CAM titanium abutments represents a therapeutic option for the rehabilitation of single tooth. The utilization of highly...
BACKGROUND
The use of ceramic-coated patient-specific CAD/CAM titanium abutments represents a therapeutic option for the rehabilitation of single tooth. The utilization of highly customized abutments enables the accurate three-dimensional positioning of the prosthetic emergence. This study evaluates the clinical performance of implant-prosthetic rehabilitations carried out using ceramic-coated CAD/CAM titanium abutments.
MATERIALS AND METHODS
Thirty implants were placed in thirty patients and rehabilitated with thirty single crowns attached to CAD/CAM titanium abutments. A conventional procedure was applied, with implant placement after post-extraction socket healing and prosthetic restoration after implant healing. Implants of lengths ranging from 6-15 mm and widths of 3.6, 4.2, and 4.8 mm were used in this study. At the time of prosthesis delivery (T0), after two years (T1), and after five years (T2), plaque (PI) and bleeding (BoP) indices, probing depths (PPD), marginal bone levels (MBL), and PES/WES were evaluated for each implant.
RESULTS
No patient dropped out of the study during the follow-up period. All thirty implants were clinically successful at five years post-prosthesis delivery (survival rate: 100%) and showed no signs of peri-implant infection. Peri-implant soft tissues were in good health (BoP at T2: 0% in 73% of patients; 25% in 13% of patients; 50% in 10% of patients; and 75% in 3% of patients). The mean PPD was 2.05±0.56 mm at T0, 1.992±0.6 mm at T1, and 1.867±0.439 mm at T2. The mean MBL at T0 was 0.413±0.440 mm, at T1 was 0.306±0.388 mm, and at T2 was 0.263±0.368 mm. The mean PES, WES, and PES/WES indices, 7.43±1.04, 7.57±0.82, and 15.00±1.17, respectively, indicate good integration of soft tissues, satisfactory aesthetics, and an overall positive outcome.
CONCLUSIONS
The success rates, maintenance of marginal bone levels, and periodontal and aesthetic indices suggest the validity of implant-prosthetic rehabilitations with CAD/CAM abutments in cases of single crowns.
PubMed: 38717350
DOI: 10.11607/jomi.10843 -
The Cleft Palate-craniofacial Journal :... May 2024To evaluate the safety of same-day discharge for patients undergoing primary cleft palate repair.
OBJECTIVE
To evaluate the safety of same-day discharge for patients undergoing primary cleft palate repair.
DESIGN
Single-surgeon retrospective review.
SETTING
Tertiary care institution.
PATIENTS/PARTICIPANTS
40 consecutive patients that underwent primary cleft palate repair by a single surgeon from September 2018 to June 2023.
INTERVENTIONS
Same-day discharge versus overnight admission after primary palatoplasty.
MAIN OUTCOME MEASURES
30-day readmission, reoperation, wound and all-cause complication rate and 1-year fistula incidence.
RESULTS
Of 40 total cases, 20 patients were discharged on the same calendar day and 20 patients were admitted for overnight stay following primary cleft palate repair. In the same-day discharge group, readmission incidence was 10%(n = 2), wound complication incidence was 5%(n = 1), and postoperative complication incidence was 15%(n = 3). In comparison, patients admitted overnight had a readmission incidence of 5%(n = 1, = 1.00), wound complication incidence of 10%(n = 2, = 1.00), and postoperative complications of 20%(n = 4, = 1.00) No patients had 30-day reoperations or fistulas at 1 year. A higher proportion of admitted patients held a preoperative diagnosis of unilateral cleft palate and alveolus (Veau 3) as compared to patients discharged on the same day ( = .019). During the postoperative hospital course, admitted patients received significantly more oxycodone at median of 2 doses (IQR 1.00-3.75) and acetaminophen at a median of 4 doses (IQR 3.00-5.00) than patients with same-day discharge with a median of 1 dose (IQR 0.00 -1.00, < .001).
CONCLUSIONS
In a low-risk patient population, same-day discharge following primary cleft palate repair may be safely undertaken and result in similar short-term outcomes and 1-year fistula incidence as patients admitted for overnight stay.
PubMed: 38715425
DOI: 10.1177/10556656241251932 -
Journal of Dental Research Jun 2024() targets multiple signaling pathways that are involved in osteogenic differentiation and bone development. However, its therapeutic function in osteogenesis and bone...
() targets multiple signaling pathways that are involved in osteogenic differentiation and bone development. However, its therapeutic function in osteogenesis and bone regeneration remains unknown. In this study, we use in vitro and in vivo models to investigate the molecular function of overexpression and inhibition using a plasmid-based miR inhibitor system (PMIS) on osteogenic differentiation and bone regeneration. Inhibition of using significantly increased osteogenic biomarkers of human embryonic palatal mesenchyme cells and promoted bone regeneration in rat tooth socket defects. In rat maxillary M1 molar extractions, the supporting tooth structures were removed with an implant drill to yield a 3-mm defect in the alveolar bone. A collagen sponge was inserted into the open alveolar defect and plasmid DNA was added to the sponge and the wound sutured to protect the sponge and close the defect. It was important to remove the existing tooth supporting structure, which can influence alveolar bone regeneration. The alveolar bone was regenerated in 4 wk. The collagen sponge acts to stabilize and deliver the DNA to cells entering the sponge in the bone defect. We show that mesenchymal stem cells expressing CD90 and Stro-1 enter the sponges, take up the DNA, and express initiates a bone regeneration program in transformed cells in vivo. In vitro inhibition of was found to upregulate Wnt and BMP signaling activity as well as , and associated with osteogenesis. Liver and blood toxicity testing of -treated rats showed no increase in several biomarkers of liver disease. These results demonstrate the therapeutic function of for rapid bone regeneration. Furthermore, the studies were designed to demonstrate the ease of use of in solution and applied using a syringe in the clinic through a simple one-time application.
Topics: Animals; Bone Regeneration; Rats; MicroRNAs; Humans; Osteogenesis; Tooth Socket; Mesenchymal Stem Cells; Cell Differentiation; Rats, Sprague-Dawley; Male; Tooth Extraction; Alveolar Process; Plasmids; Alveolar Bone Loss; Collagen
PubMed: 38715225
DOI: 10.1177/00220345241242047 -
Head and Neck Pathology May 2024As per AJCC 8th edition TNM staging system, bone invasion is a poor prognostic marker that upstages oral cavity squamous carcinoma (OSCC) to pT4a. Cortical erosion alone...
BACKGROUND
As per AJCC 8th edition TNM staging system, bone invasion is a poor prognostic marker that upstages oral cavity squamous carcinoma (OSCC) to pT4a. Cortical erosion alone of bone or tooth socket by a gingival primary is not sufficient to upstage a tumour. The differentiation of cortical erosion from invasion through the cortical bone into the medulla is often challenging, limiting accurate staging. This review aims to assess the difficulties in differentiating cortical erosion from medullary invasion and evaluate the prognostic significance of different patterns of bone involvement.
METHODS
A retrospective review of OSCC with primary curative surgery and bone resection treated at a single-center over 10 years, was performed to assess the prognostic significance of bone invasion. Hematoxylin-eosin stained slides of a subset of cases were re-reviewed in a planned manner to assess difficulties in precise categorization (no invasion/erosion/cortical invasion and medullary invasion), evaluate interobserver agreement, and correlate with clinical outcome.
RESULTS
Five hundred and ninety patients were included, with a median follow-up of 28 months. On univariate analysis, the 3-year local, nodal and distant metastasis control were not significantly different in the 3 groups of no invasion, erosion, and invasion (p = 0.43, 0.47, and 0.47, respectively). Overall survival (OS) at 3 years was 78.1% and disease-free-survival(DFS) was 63.7% in the entire cohort. On univariate analysis, there was significant difference in OS and DFS based on these groups. This did not translate into independent prognostic benefit on multivariable analysis (p = 0.75 and 0.19, respectively). The independent prognostic factors were margin positivity, tumor differentiation, perineural invasion and pathological nodal involvement. Planned re-review of a subset of 202 cases resulted in a change in bone involvement category in 26/202 cases, which was mainly due to difficulty in assessing cortico-medullary junction near the tooth socket and bone fragmentation. The assessment showed moderate to near complete agreement (kappa 0.59-0.82) between 2 observers.
CONCLUSION
Our study shows that bone involvement is not an independent prognostic marker and there is no specific correlation of medullary invasion with outcome over those that showed cortical erosion. Several factors contribute to difficulties and interobserver variability in assessing bone involvement.
Topics: Humans; Retrospective Studies; Male; Female; Middle Aged; Prognosis; Mouth Neoplasms; Aged; Neoplasm Invasiveness; Adult; Aged, 80 and over; Bone Neoplasms; Squamous Cell Carcinoma of Head and Neck; Carcinoma, Squamous Cell
PubMed: 38710882
DOI: 10.1007/s12105-024-01642-5 -
The Journal of Craniofacial Surgery May 2024The presence of foreign bodies in the mandible is not listed as a risk factor or absolute contraindication for implant rehabilitation. However, possible complications...
The presence of foreign bodies in the mandible is not listed as a risk factor or absolute contraindication for implant rehabilitation. However, possible complications caused by foreign bodies, such as infection and cyst formation, could lead to implant failure. The authors report a case of dental implant placed 4 months after the surgical removal of embedded amalgam in the mandibular alveolus using a trephine bur and bone grafting with mineralized freeze-dried bone allograft. Clinical and radiographic evaluations were performed at each appointment to assess factors such as pain, implant mobility, probing depth, and marginal bone loss around the implant. Within 3 years of implant placement, there were no clinical signs and symptoms and no obvious radiographic marginal bone loss. Dental implant installation appears to be safe following the elimination of foreign materials, so long as anatomic and biological factors and appropriate implant choice, are taken into consideration.
PubMed: 38709071
DOI: 10.1097/SCS.0000000000010229 -
Journal of Clinical Periodontology Jul 2024To qualitatively and quantitatively evaluate the formation and maturation of peri-implant soft tissues around 'immediate' and 'delayed' implants. (Comparative Study)
Comparative Study
AIM
To qualitatively and quantitatively evaluate the formation and maturation of peri-implant soft tissues around 'immediate' and 'delayed' implants.
MATERIALS AND METHODS
Miniaturized titanium implants were placed in either maxillary first molar (mxM1) fresh extraction sockets or healed mxM1 sites in mice. Peri-implant soft tissues were evaluated at multiple timepoints to assess the molecular mechanisms of attachment and the efficacy of the soft tissue as a barrier. A healthy junctional epithelium (JE) served as positive control.
RESULTS
No differences were observed in the rate of soft-tissue integration of immediate versus delayed implants; however, overall, mucosal integration took at least twice as long as osseointegration in this model. Qualitative assessment of Vimentin expression over the time course of soft-tissue integration indicated an initially disorganized peri-implant connective tissue envelope that gradually matured with time. Quantitative analyses showed significantly less total collagen in peri-implant connective tissues compared to connective tissue around teeth around implants. Quantitative analyses also showed a gradual increase in expression of hemidesmosomal attachment proteins in the peri-implant epithelium (PIE), which was accompanied by a significant inflammatory marker reduction.
CONCLUSIONS
Within the timeframe examined, quantitative analyses showed that connective tissue maturation never reached that observed around teeth. Hemidesmosomal attachment protein expression levels were also significantly reduced compared to those in an intact JE, although quantitative analyses indicated that macrophage density in the peri-implant environment was reduced over time, suggesting an improvement in PIE barrier functions. Perhaps most unexpectedly, maturation of the peri-implant soft tissues was a significantly slower process than osseointegration.
Topics: Animals; Mice; Dental Implants; Osseointegration; Tooth Socket; Epithelial Attachment; Dental Implantation, Endosseous; Immediate Dental Implant Loading; Titanium; Connective Tissue; Vimentin; Collagen; Gingiva; Time Factors
PubMed: 38708491
DOI: 10.1111/jcpe.13980 -
Contemporary Clinical Dentistry 2024This case report describes a case of intention replantation in a 15-year-old patient with a mandibular permanent right second molar that had undergone root canal...
This case report describes a case of intention replantation in a 15-year-old patient with a mandibular permanent right second molar that had undergone root canal treatment previously. The tooth was tender on percussion. Radiographic evaluation showed the presence of a separated instrument and periapical radiolucency. The surgical procedure was performed under local anesthesia, and the tooth was extracted. After cleaning and disinfecting the root canal system, the tooth was reimplanted, and the socket was filled with a mixture of bone graft material and a growth factor. A stainless steel crown was then placed to protect the tooth. A follow-up examination was performed after 12 months. The clinical and radiographic examinations revealed a well-healing periapical lesion with no signs of infection. The patient was asymptomatic, and the tooth was functional. The results of this case indicate that intentional replantation can lead to a favorable outcome.
PubMed: 38707664
DOI: 10.4103/ccd.ccd_134_23 -
Journal of Medical Case Reports May 2024Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical... (Review)
Review
BACKGROUND
Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical irritation. Peripheral ossifying fibroma develops more commonly in young females as a solitary, slow-growing, exophytic nodular mass of the gingiva, no more than 2 cm in diameter. While various synonyms have been used to refer to peripheral ossifying fibroma, very similar names have also been applied to neoplastic diseases that are pathologically distinct from peripheral ossifying fibroma, causing considerable nomenclatural confusion. Herein, we report our experience with an unusual giant peripheral ossifying fibroma with a differential diagnostic challenge in distinguishing it from a malignancy.
CASE PRESENTATION
A 68-year-old Japanese male was referred to our department with a suspected gingival malignancy presenting with an elastic hard, pedunculated, exophytic mass 60 mm in diameter in the right maxillary gingiva. In addition to computed tomography showing extensive bone destruction in the right maxillary alveolus, positron emission tomography with computed tomography revealed fluorodeoxyglucose hyperaccumulation in the gingival lesion. Although these clinical findings were highly suggestive of malignancy, repeated preoperative biopsies showed no evidence of malignancy. Since even intraoperative frozen histological examination revealed no malignancy, surgical resection was performed in the form of partial maxillectomy for benign disease, followed by thorough curettage of the surrounding granulation tissue and alveolar bone. Histologically, the excised mass consisted primarily of a fibrous component with sparse proliferation of atypical fibroblast-like cells, partly comprising ossification, leading to a final diagnosis of peripheral ossifying fibroma. No relapse was observed at the 10-month follow-up.
CONCLUSIONS
The clinical presentation of giant peripheral ossifying fibromas can make the differential diagnosis from malignancy difficult. Proper diagnosis relies on recognition of the characteristic histopathology and identification of the underlying chronic mechanical stimuli, while successful treatment mandates complete excision of the lesion and optimization of oral hygiene. Complicated terminological issues associated with peripheral ossifying fibroma require appropriate interpretation and sufficient awareness of the disease names to avoid diagnostic confusion and provide optimal management.
Topics: Humans; Fibroma, Ossifying; Male; Aged; Diagnosis, Differential; Gingival Neoplasms; Maxillary Neoplasms; Tomography, X-Ray Computed; Maxilla
PubMed: 38702820
DOI: 10.1186/s13256-024-04529-9 -
Photobiomodulation, Photomedicine, and... May 2024Intentional replantation (IR) is an emerging and cost-effective last-resort treatment for persistent apical periodontitis. Adjunctive phototherapy for IR aims to...
Intentional replantation (IR) is an emerging and cost-effective last-resort treatment for persistent apical periodontitis. Adjunctive phototherapy for IR aims to improve the management of challenging cases by enhancing disinfection, stimulating healing and promoting regeneration. We report a novel phototherapy-assisted IR protocol conducted on a compromised lateral incisor with an extensive periapical infection (Ø > 10 mm) in a 68-year-old diabetic male. The IR protocol involved pre- and postoperative photobiomodulation (660 nm, 0.2 J/cm, 60 sec/site), antimicrobial photodynamic therapy of the root surface (660 nm, 0.6 J/cm, 30 sec, methylene blue photosensitizer), and Er:YAG root and socket debridement (2940 nm, 21 J/cm, 30 sec). The total time from extraction to replantation was 14 min 35 sec. The tooth at 3.5-year follow-up remained clinically functional with radiographic resolution of the infection indicating a successful reimplantation. This case report demonstrated that an adjunctive phototherapy IR protocol can effectively treat a compromised tooth with extensive periapical infection.
PubMed: 38700573
DOI: 10.1089/photob.2023.0197 -
British Dental Journal May 2024Introduction In June 2020, the United Kingdom (UK) published guidance on electric scooter (e-scooter) use to ease transport congestion and reduce pollution. This study...
Introduction In June 2020, the United Kingdom (UK) published guidance on electric scooter (e-scooter) use to ease transport congestion and reduce pollution. This study aims to examine dental injuries sustained during the two years following initiation of the trial.Methods The research was conducted at a UK, Level 1, supra-regional major trauma centre. All eligible patient records were analysed to identify e-scooter-related dental injuries to the following regions: teeth, periodontium, alveolus, palate, tongue, floor of mouth, frenum, buccal mucosa and lips. To assess significant associations between recorded variables, a Pearson's chi-square test was utilised.Results Of the 32 patients who experienced a total of 71 dental injuries, 46.5% (n = 33) affected teeth, predominantly upper central incisors (n = 17). 'Lacerations' (n = 32) and 'lips' (n = 30) were the most common type and site of soft tissue injuries, respectively. Unprovoked falls by riders accounted for 53.1% (n = 17) of the injuries. There was an overall increase in e-scooter-related dental injuries throughout the two-year period.Conclusion E-scooters have introduced an additional source of dental trauma. It is imperative health care professionals can also identify signs of head and non-dental injuries when managing such patients. Further studies are warranted allowing for better informed and optimised dental public health interventions.
PubMed: 38693336
DOI: 10.1038/s41415-024-7345-4