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Background: Juvenile paradental cysts typically occur on the buccal aspect of mandibular first and second molars in children aged 6 to 11 years. The cysts may be treated by enucleation, with or without extraction of the involved teeth, or by marsupialization. This report demonstrates the success of a conservative surgical technique (marsupialization) and good outcomes in five juvenile paradental cyst cases. Methods: Five patients (two males, three females) with a mean age of 8.4 years, complaining of mandibular buccal swelling around the molars, underwent marsupialization of radiolucent lesions involving partially or fully erupted permanent first molars. Clinical, radiographic and histological characteristics led to diagnoses of juvenile paradental cysts. Results: The surgical procedures were simple to perform and resulted in complete remission of the lesions with no complications. The mean follow-up time was 2.8 years. No recurrences were observed, the related teeth developed normally, and complete periodontal healing was achieved. Conclusions: The surgical marsupialization of juvenile paradental cysts achieved good outcomes without compromising the development of related teeth, and thus may be considered an appropriate treatment for paediatric patients.

Ricostruzione mandibolare con lembo di fibula supportato da nuova tipologia di placca personalizzata al fine di evitare la tecnica della doppia barra.La ricostruzione mandibolare è particolarmente rilevante per il chirurgo cervico-cefalico, in quanto influenza significativamente i successi in termini di risultati estetici e funzionali per il paziente. Il gold standard per tale ricostruzione è l’utilizzo di lembi ossei rivascolarizzati, stabilizzati mediante una placca ricostruttiva in titanio. Il lembo di fibula rappresenta la prima scelta ricostruttiva laddove necessitino molteplici segmenti ossei. Tuttavia questo lembo, allestito secondo la tecnica della singola barra, non permette di ripristinare l’altezza mandibolare nativa, adeguata per una corretta riabilitazione masticatoria implanto-supportata. Lo scopo di questo studio è quindi presentare un nuovo design di placca ricostruttiva custom-made, atta a posizionare il segmento osseo di fibula in una posizione più coronale, evitando pertanto la necessità di allestire il lembo secondo la tecnica della doppia barra. La placca custom-made contribuisce inoltre al mantenimento del profilo mandibolare, garantendo il ripristino morfologico della ricostruzione. Questo protocollo è stato eseguito su quattro pazienti sottoposti a resezione mandibolare per tumori benigni. I risultati clinici e di accuratezza della procedura sono presentati. Il protocollo presentato sembra una valida alternativa alla tecnica della doppia barra al fine di ripristinare l’altezza mandibolare nativa.Mandibular reconstruction is a primary concern for head and neck reconstructive surgeons because of the aesthetic restoration needs after ablative surgery, as well as for functional reasons: the mandible has a central functional role in speaking, swallowing and mastication. It is generally agreed that the gold standard for mandibular reconstruction is a bone free flap supported by a reconstructive titanium plate. The fibular flap represents the first choice for multi-segment mandibular reconstruction. The fibula, harvested as a single barrel graft, does not exhibit sufficient thickness to reach the original height of the native mandible; therefore, the positioning of dental implants is often deeper than that of the native alveolar crest. The aim of this study was to evaluate the positioning of the fibular free flap as it pertains to the restoration of vertical mandible height, by modifying the design of a 3D-printed titanium patient-specific implant (PSI). In this novel reconstructive workflow, the customised plate was projected to support the fibular flap at an alveolar bone position above the typical inferior mandibular border, and carried out on four patients. All patients were treated for benign neoplasms involving mandibular bone. Clinical outcomes and accuracy of the procedure are described. Our reconstructive proposal appears to be a valid alternative to the double-barrel technique in order to restore the vertical height of the reconstructed mandible.

Background Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation. Purpose This retrospective study evaluated the long-term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant-supported prostheses. Materials and methods In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow-up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow-up after implant insertion was 90.2 (range, 20-204) months. Results The overall implant survival rate was 97.2% at the 12-month follow-up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12-month follow-up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy. Peri-implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5- and 10-year follow-up. The risk of developing peri-implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%). Conclusions Long-term implant-related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium-term follow-up. Moreover, a relevant peri-implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri-implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem.

Introduction Extremely atrophic maxillae can be considered the most important indication for three-dimensional maxillary reconstruction. Different bone-augmentation techniques have been suggested to accomplish this. This article illustrates a minimally invasive approach to rehabilitation of the extremely atrophic maxilla. Material and methods A 63-year-old male patient was referred for restoration of his totally edentulous maxilla with a fixed full-arch implant-prosthetic rehabilitation. Four short implants in the premaxillary region and 2 longer implants in the pterygomaxillary regions were inserted with piezoelectric implant site preparation. Discussion At the 1-year follow-up appointment, no clinical or radiographic changes in the soft-tissue contours or crestal bone levels were observed. Conclusion This surgical approach, based on the combination of short implants in the premaxillary regions and pterygoid implants in the pterygomaxillary regions, represents a way to shorten treatment timing, minimize the risk of surgical complications, and reduce patient discomfort and costs.

After guided bone regeneration (GBR) with different devices, a layer of connective tissue called pseudo-periosteum can be observed above the newly formed bone. The aim of this study is to evaluate the clinical and histologic features and to suggest a classification of this connective tissue after GBR with nonresorbable membranes or titanium (Ti)-mesh plus resorbable membranes. Forty patients with partial edentulism in the posterior mandible were randomized into two groups: 20 patients were treated by means of Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membrane (group A), while the other 20 patients were treated with Ti-mesh and a cross-linked collagen membrane (group B). After 9 months and during re-opening surgery, bone density and pseudo-periosteum type were recorded. Pseudo-periosteum was classified into Type 1 (no tissue or tissue1 mm); Type 2 (regular tissue between 1 and 2 mm); and Type 3 (irregular tissue or tissue2 mm). Histologic analyses were performed to identify the features of pseudo-periosteum. Out of 40 patients, 36 (n = 19 in Group A; n = 17 in Group B) with 99 implants were analyzed after GBR and according to the study protocol. The vertical bone gain was 4.2 ± 1.0 mm in Group A and 4.1 ± 1.0 mm in Group B. Group A had a higher bone density and greater amounts of type 1 periosteum than Group B (P = .01 for both). The preliminary results of this study show that both d-PTFE membranes and Ti-mesh plus collagen membranes are two valid options for bone augmentation in the mandible. However, nonresorbable membranes achieve higher bone density and a thinner pseudo-periosteum layer above the newly formed bone.

Purpose Coronectomy of mandibular third molars is a procedure that still raises a number of questions. The aim of the present study was to answer one unsolved question: the periodontal healing distal to the mandibular second molar after third molar coronectomy. Materials and Methods A prospective cohort study was performed of 30 patients treated at the Unit of Oral and Maxillofacial Surgery of the Department of Biomedical and Neuromotor Science of the University of Bologna. The predictor variables were the probing pocket depth (PPD), the distance between the marginal crest (MC) and the bottom of the osseous defect (BOD), and the distance between the cementum enamel junction (CEJ) and the BOD. These clinical indexes were recorded on 3 points of the distal surface of second molar: the distobuccal (DB), distomedial (DM), and distolingual (DL) sites. The other variables evaluated included root migration and postoperative complications. The Wilcoxon test for paired data and Kendall's tau-b correlation coefficient was used to evaluate all variables. The significance level was set at P = .05. Results The cohort was composed of 30 patients with 34 high-risk mandibular third molars (9 men and 21 women), with a mean age of 28 ± 7 years. At 9 months, a statistically significant reduction in the PPD of 2 ± 3, 1 ± 2, and 2 ± 2 mm and a statistically significant reduction in the MC-BOD distance of 4 ± 4, 4 ± 4, and 4 ± 5 mm for the DB, DM, and DL sites, respectively, was observed ( P = .001). Also, the intraoperative CEJ-BOD distance showed a statistically significant reduction for the DB, DM, and DL sites. Conclusions After coronectomy, restoration of a clinical healthy periodontium distal to the second molar was observed. However, further studies are necessary to confirm these preliminary clinical results and to compare periodontal healing between coronectomy and complete extraction.

A sample of 24 patients with varied morphologic defects were treated with 34 titanium meshes and particulate bone and rehabilitated at least 8 to 9 months thereafter with the placement of 88 implants. Of the 34 meshes, 4 had to be removed before implant placement (11.76% total failure) and 20 were exposed due to soft tissue dehiscence (58.82% of complications): 4 (11.77%) prematurely (within 4 to 6 weeks) and 16 (47.05%) delayed (after 4 to 6 weeks), with no compromise in implant placement. None of the 88 implants was lost (100% implant survival), and 15 demonstrated increased bone loss, yielding a cumulative implant success rate of 82.9%. This technique appears useful in treating extended and morphologically varied alveolar defects.

This study evaluated the outcomes of computer-aided design–computer-aided machining (CAD-CAM)–customized titanium mesh used for prosthetically guided bone augmentation related to the occlusion-driven implant position, to the vertical bone volume gain of the mandible and maxilla, and to complications, such as mesh exposure. Nine patients scheduled for bone augmentation of atrophic sites were treated with custom titanium mesh and particulate bone grafts with autologous bone and anorganic bovine bone in a 1:1 ratio prior to implant surgery. The bone volume needed to augment was virtually projected based on implant position, width, and length, and the mesh design was programmed for the necessary retaining screws. After 6 to 8 months, bone augmentations of 1.72 to 4.1 mm (mean: 3.83 mm) for the mandibular arch and 2.14 to 6.88 mm (mean: 3.95 mm) for the maxilla were registered on cone-beam computerized tomography. Mesh premature (within 4 to 6 weeks) exposure was observed in 3 cases and delayed (after 4 to 6 weeks) in 3 other cases. One titanium mesh was removed before the programmed time but in all augmented sites was possible implant insertion. No complication occurred during prosthetic follow-up. Using CAD-CAM technology for prosthetically guided bone augmentation showed important postoperative morbidity of mesh exposure (66%). Because of this high prevalence of mesh exposure and the potential infection that could affect the expected bone augmentation, this study suggests a cautious approach to this procedure when designing the titanium mesh, to avoid flap tension that may cause mucosal rupture.

Background: This study evaluates implant-borne prosthetic rehabilitation of 10 totally edentulous atrophic maxillae after bone reconstruction with a titanium-mesh technique and particulate bone graft. Methods: Ten atrophic maxillae were reconstructed with 19 titanium meshes and particulate autologous-heterologous bone. Maxillae were rehabilitated at least 5 months, with placement of 67 implants connected to the prostheses after an additional 4 months of rehabilitation. Cases were evaluated retrospectively in terms of complication rates, particularly on the amount of mesh exposure, implant survival, and success rates at the end of follow-up. Results: In seven cases, two meshes were prematurely exposed (within 4 to 6 weeks), and five were exposed later (after 4 to 6 weeks). Only two of the later exposures extended >1 cm2. Nevertheless, reconstructions allowed implant placement and prosthetic rehabilitation in all cases. Two implants were lost before loading. After mean follow-up at 39.3 (20 to 56) months since prosthetic loading, all 65 implants were functional (100% implant survival), but 15 implants demonstrated a peri-implant mean bone resorption of 2.96 mm increased bone loss, yielding a cumulative implant success rate of 76.9%. No prosthetic problem was observed. Conclusions: Use of titanium mesh with particulate bone can be considered a valid option in reconstructing atrophic maxillae to allow for implant-borne prosthetic rehabilitation. A high level of dehiscence did not compromise final outcome.

Purpose: To evaluate the clinical, radiographic and patient-related outcomes of a novel technique for digitalisation and customisation of reinforced polytetrafluoroethylene meshes in vertical ridge augmentation surgery. Materials and methods: A total of 10 patients (five men and five women, mean age 54 years) with vertical defects were included in the study. Prior to surgery, digital planning of bone augmentation, manufacturing of 3D printed models and replicas of the meshes and modelling of a customised reinforced polytetrafluoroethylene mesh were carried out. All patients were treated using a 50:50 mixture of xenogeneic and autogenous bone, customised reinforced polytetrafluoroethylene mesh and collagen membrane. After 6 to 9 months, computer-guided surgery was planned, the reinforced polytetrafluoroethylene mesh was removed and implants were placed in augmented sites using a fully guided surgical template. Patient-related outcomes, intraoperative timing, surgical and healing complications, vertical bone gain, bone density, pseudoperiosteum type and number and stability of implants were recorded. Results: All 10 patients were treated without surgical complications. Healing was largely uneventful, with the exception of one case of abscess formation without mesh exposure (exposure rate 0%). The mean duration of digital planning was 17.0 minutes, reinforced polytetrafluoroethylene mesh customisation took 9.0 minutes, and the total intraoperative time was 91.3 minutes. The mean planned bone volume was 1.52 cc, vertical bone defect depth was 6.0 ± 1.7 mm and vertical bone gain was 5.5 ± 1.9 mm; most sites showed medium bone density and a Type 1 pseudoperiosteum. All patient-related outcomes were favourable. Conclusions: The preliminary results of this pilot study demonstrated the feasibility and reliability of a fully digital workflow for the customisation of reinforced polytetrafluoroethylene mesh in vertical ridge augmentation.